EBME Forums Forums Maintenance Technical Assistance resmed cpap machines ppm schedules

Hi all,
Can anyone enlighten me as to how often (if at all they do) test s8/s9 and s10 cpap machines. We are finding that once they go out into the community that they are rarely seen again. This of course results in open jobs on our system that we have no way of completing. The service data from resmed suggests that these devices have a life of 5 years after which they should be replaced? Any comments here greatly welcomed

I would suggest that, as Resmed say there is no service requirement and that the service life is 5 years, you may want to consider putting them on a 5 year service interval.
The 5 year interval gives the Trust the opportunity to check they are still in service at they 5 years and someone can inspect them to check their condition. There is no requirement to replace them at 5 years (it's entirely up to the Trust), but it might be beneficial to have a point at which you can audit them to ensure they are still working OK. At they point you can make a decision as to whether they are OK to continue in use, or whether they require replacement. Placing them back into use for what could be another 5 years would depend upon your approach to dealing with failures - some trusts simply swap them out on failure and then assess them for repair at that point. From experience, once out of warranty, replacement is usually preferred over repair.

We are just beginning to hold "CPAP clinics" where the patient brings their CPAP device into the hospital on an annual basis for a check.

The check entails a visual, EST and performance check. An engineer is situated within the clinical department to carry these out.

Leaving it 5 years from an EST point of view was deemed to be too long so it was one of the main factors in checking annually.

Hi Carl,

This is always a tricky topic and different trusts have different approach to it. I have worked in a few so I perhaps I can suggest something.

My first trust had an approach similar to GylnEd’s suggestion above. We had a clinic set up where one of us engineers were expected to be there all afternoon regardless of how many CPAP’s we PPM. The patients would come in for their appointment with the nurse and if their CPAP was due PPM it would be done when they arrived.

A second trust I worked for operated similarly only that we did not have a clinic setup. The sleep nurse would usually bring a trolley full of CPAPs around for us for PPM. Obviously the service agreement was to have a same day turnaround so one of us would be at hand for it.

In both the above approach, we never had CPAPs on any PPM schedule and were done as an adhoc PPM job. This meant we did not have as many open CPAP jobs. CPAPs are equipment that go away with the patient so it is very difficult to have them available when they were due as manufacturer’s specification. So the service agreement was such that when a patient arrived for their check up the nurse would know by the ‘Next Test Due’ label that the CPAP needs PPM or not. If the patient reports a machine faulty, the nurses would just replace and CPAP and bring the faulty one over to us. If the CPAP was in warranty, we would send it back for repair and if not we would decommission it. Most new ones do not need any kind of checks to be carried out as per the manufacturers’ specifications so there was no real need for a PPM schedule. And since it is a Class 2 BF for electrical safety it was deemed as low risk. Also there was no way of knowing if the patient always used the supplied lead.

The drawback with this approach is that we would not have a record of attempted PPM and obviously if audited questions would have to be answered. But I assume a service level agreement was defined for this reason at management level.

In another trust, they do have two yearly PPM schedule for all CPAPs. An email is sent to the nurse with a list of due CPAPs and we rely on the nurse to inform us. Most of the time there is no answer and there are usually 100s of CPAP PPM jobs open. Although, we do try to close these jobs when we haven’t had a response after 3 attempts it doesn’t always happen. There is a lot of chasing up involved and it does end being more of an admin job. It doesn’t seem like a productive or efficient approach. You will have a record of attempt but not sure if it is cost effective even for a lower band role. It is most likely that many of these CPAP will never be seen but will remain ‘in service’ on the database.

In either case, a bit of proactiveness is needed from the end user (i.e. checking the next test due label) but as EBME engineers we all know how hard that is!

Hope this helps!

Dipan

thank you all so much for your replies

It seems I'm a bit late in replying, Carl. I had been planiing to lay out an (yet another) essay on "Technical Support of Medical Equipment Used in the Community". Maybe we need a new breed of technician ... the Community Biomed (mobile, roaming and no doubt "understanding").

So instead I shall refer folk to (what I believe) is the current "official guidance":- MHRA (Jan 2021).

It talks about "lines of accountability", "systems for managing medical devices", "device identification and traceability" ... and stuff like that. All "old hat", really.


Meanwhile, whilst I'm broadly in agreement with Dipan's fourth paragraph, I would point out:-

1) Ignore manufacturer's recommendations ... they are based on "ideal conditions".
2) "Ideal conditions" will not be the norm in many patient's circumstances.
3) "Next Test Due" labels can (and do) go missing.
4) Mains power cables (and sometimes the equipment themselves) can become dog's favourite toys!
5) Community equipment is sometimes minging ... who cleans them?
6) No need to have the kit on a PM schedule that cannot be met.
7) The biomed should simply deal with whatever is presented.

Lastly, I can remember the days (before PM became the raison d'etre for biomed technicians) when users were required (expected, and indeed encouraged) to Report Faults. I believe that is the nub of what is being discussed here (that is, a return to that philosophy and mind-set).

Renal technicians do this i'd imagine (for dialysis machines of course)

but would this be economical for a 'Sleep apnoea machine'? Sure they are the best part of £500 but when you add costs it's amazing how quickly it adds up, might be half the cost of a new one just going to a patients house to tell them they need a new one. >.<

In an ideal world this is how I see it:

There is a missing link here and this is the clinical staff that provide these to the patient and the respiratory specialist that 'prescribes' (yes a CPAP treatment setting is prescribed ) to the patient. Surely in such a case there has to be a responsibility with on going treatment that the clinician must ensure they are receiving this effectively?

therefore... I wouldn't think it would be remiss of us as ebme technicians to ask that the clinnical team do more on this issue, surely when they book appointments they can note down machine will need service around so and so appointment. Machine Number is.... etc etc

and if they resist such request, for better traceability you have a list of essentially lost medical equipment because of jobs can't be closed and could calculate the approx loss in cost to your trust.

Yes; place the onus on the clinical staff. That is, the user ... as opposed to the end-user (aka the patient).

I believe that is where the "legal" (or at least "moral") responsibility belongs anyway.

As I may have mentioned on here a few times before:- put the monkey on their back.

Biomeds can't do everything ... and there are a lot of "them" but very few of "us".