EBME Forums Forums Management Medical Equipment Management PPM Schedule

My personal experience...

until recently our hospital had 25 beds dedicated to long term bed ridden patients(ALS etc), all requiring assisted breathing for at least 12hours a day.
The ONLY time that the bed was made available to us was when the unfortunate soul passed away and should this happen during the week end I can guarantee that Monday morning a new patient was occupying the bed.
As the beds were new we had almost no repairs in this two year period and even in those two cases having access to beds was anything but simple.

So needless to say our PM schedules were not met, but fortunately (for us) we had our work orders signed off by the dept. head, with onus on them to call us asap when the bed was eventually available.

In all honesty (hand on heart) the majority of the PM's were carried out when the department was transferred to another hospital in our group and the beds repurposed in other departments.

Yes; which highlights a point I held back on mentioning earlier ... who gets to declare whether PM is completed or not?

Would it be some sort of independent inspection team? The BME Manager, or just the tech concerned?

Or perhaps a friendly Head of (user) Department, nurse or whomever. Lots of scope there for tins of biscuits!

Back in my day, the basic premise was, unless there was evidence to the contrary, something along the lines of "trust the technician".

Quis custodiet ipsos custodes?

This is indeed a good subject and question. I can give a good example of device being commissioned and then requiring attention very soon after. It appears a fleet of devices we purchased and commissioned use a consumable part that lasts 2 years. that said it was apparent that this part (O2 sensor) required replacing. This is because the part is "smart". With the advent of RFID built into components and consumables we are on borrowed time and as soon as we write a risk score/policy, chances are we'll need to rewrite it the next year.
Knowledge is power and in an ideal world we would get the correct information before purchasing or at least at the time of unboxing but its only as good as what the company you buying from want you to know.....
In this case it was fine and covered by warranty and no complaints, but it did raise a few questions similar to what we are all writing.

Yes; but where is the rule that PM must be completed within thirty days of it being scheduled?

Bottom line there is no 30 day rule!

Some good points here.

I don't think there is a general rule. This being said, it can be written into policy, the QMS and used to determine performance, as a KPI embedded into the CAFM (Computer Aided Facilities Management) software.

An expected completion window should really be set and understood and it can be varied, for instance P1 (priority 1 or high risk) modalities should be completed within i month of release, P2 medium & P3 low risk completion deadlines may be extended.

As long as activity is managed, monitored, performance and risk assessed.

KPIs can be good ... especially meaningful ones agreed within the organisation (that is, rather that imposed arbitrarily by outside bodies).

In the context of this discussion, I believe that "% PM on track" is a good metric. That is:- the percentage of PM completed within the current schedule. This figure could (should) be available at any time. The aim should be 100%, but this is unlikely to be achieved very often, as PM completion will be a moving target as time marches on.

There can be some locally agreed leeway on individual PM target dates; plus or minus so many days. It would make sense for High/Medium/Low risk items to be granted different allowances.

For instance, High risk items could be plus/minus a week (you were being a bit generous there, Alf), whilst Low risk could be plus/minus a month (or even longer).

Notice that I have mentioned "minus" ... when correctly set up and administered, PM should not be carried out too early (as well as not being too late).

One final point:- what about "slippage"? That is, say for example that PM with 180 day interval is carried out late (at 200 days). Should the next PM come after 160 days (to keep the schedule neat) or should it should wait another 180 days?

By the way, I am aware that the answer to the above question may well depend upon the CMMS being used.

I'm just going to throw a cat amongst the pigeons here.

The 30 day grace period is a thought provoking one, down to local policy I believe in most cases? However I do believe this grace period should not be employed and we should adhere to dates strictly, unless demonstrated risk is minimal.

Comparatively what would we say to service users of said device? We normally say don't use a device that is out of date, in the same way a pharmacist might say do not administer out of date suppositories. The pharmacist might be aware in any case that the use by date of a specific medication is down to the manufacturers guarantee of the integrity of the package being finite, compared to another brand being longer, however they are as strict with dates, I advocate that we should be to.

I once did some work where the biomeds had no PM schedule worthy of the name (in fact, thinking back, many were like that) ... but simply relied upon user departments to check the dated stickers and alert the techs when maintenance was due. There may be arguments to support that idea (eg:- making the users take responsibility for their equipment).

Trouble was that when a keen Head Nurse finally got around to checking her department's kit ... we would be suddenly overwhelmed with a load of (over-due) PMs. One time they even brought a whole department's worth of infusion pumps into the workshop for "immediate action".

The moral of the story? Unless the PM schedule is crafted with care, there may be days on the schedule that indicate hours of PM work way beyond the daily man-hours available in the biomed shop. Also, what if the actual due date falls on a weekend, holiday or whatever? PM cannot always be completed per schedule ("on the day"); so, there has to be some degree of flexibility.

As I keep banging on about, properly conducted Risk-Based PM takes care of all this. In short, the work should be carried out in consideration of priority. For instance, it may not really matter if some low-risk items never gets PM'd at all (but simply left at a "repair when failed" status). "Leeway" beyond the due PM date for more important items could (should) depend upon the priority assigned to each.

But even with a well balanced schedule (that is, with planned workload evenly spread across the calendar) there is bound to be slippage from time to time. This could be due to problems such as loss of available man-power or some other "unforeseen circumstance" that screws up the schedule.

Anyway ... who makes the rules?

ah, the 30 day window

I've always allowed (and implemented) a 30 day window, literally forever, I've never seen any national guidance giving me authority however. But this is still what I practice and preach, its down to local policy.

There's a few reasons, both of which are entirely justifiable and logical. My view is that your backlog measurement trigger interval should match your tolerance for PPM slip.

[BACKLOG]
I have always classed backlog as being 'Those devices more than 1 month outside of their planned date'. We have regular reviews of the backlog list to ensure we are keeping it minimal and safe.

This gives staff and the teams up to a month to physically locate the equipment and send it to Clinical Engineering before we start to worry too much.

[Location Based Fixed PPM]
Location Based PPM: When undertaking location based PPM on large departments and completing the whole area, it could take anywhere from 1-3 weeks depending on the size of the department. the tolerance of 1 month helps to ensure that the department your visiting daily with the extended team during PPM doesnt trigger unnecessarily onto the backlog list.

[Rolling PPM]
When undertaking rolling planned maintenance on equipment types such as incubators, anaesthetic machines and the like, these often are notoriously difficult to release due to shift patterns, usage and the fact that they are high in demand, difficult to transport etc. Its a reasonable measure to allow some tolerance for the clinical staff to 'Plan' or schedule the release of the equipment.
We have equipment leads for these types of equipment (rolling) who communicate with the clinical staff/housekeepers to ensure the equipment comes back to us in an appropriate manner.

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Across the whole of the system, both rolling and location based, we have automated reports sending reminders etc.

We monitor carefully the 'Backlog' and 'High Acuity Rolling PPM' for any which are hitting the end point which forms a very reasonable response system given the fairly tight tolerance of 1 month. Were talking low numbers but with high intervention for the size of the trust we are!

If we had to shift this downwards to 3,2,1,0 weeks etc. We would be crying wolf all the time to ourselves and may end up with an 11 month schedule rather than a 12 in order to make it work without compromise.

An 11 month schedule would generate a never ending spiral of resourcing issues and re-adjustment of a steady fixed programme.

We dont have the resource to undertake an 11 month schedule, its hard enough for us all to to keep things moving on a 12 month one.

My advice is to include a definition of backlog in your medical devices policy, not just for KPI purposes but for risk appetite as this may be not only reasonably practicable, but sensibly implementable.

I've known/heard of some trusts not classifying backlog until it hits the 2,3,4 month stage, or allocating maintenance in 2,3 month windows. well if this is the case your tolerances/appetites for risk should be adjusted accordingly.

Its an interesting subject, everyones got their take in some way, in terms of practical application on a large scale, I've made my bed and have to live by it.