BIOMEDICAL ENGINEERING


Ongoing improvement requires good relations with clinical staff. Biomeds are typically siloed from clinical staff. One of my previous roles involved paying regular visits to a local, but somewhat unloved, hospital, just for a routine walk-around. During my visits, it was not uncommon to hear the old ‘Oh, wait Michael, while you are here…’ Likewise, if I see a nurse struggling with a piece of equipment, it’s an opportunity to help. One of the most crucial relationships that exists in a hospital is that which exists between the nursing staff, who work on the frontlines, and Clinical Engineering, who are responsible for the reliability and safety of the equipment upon which they rely. When that relationship is strong and the needs of nursing, and, by extension, the needs of patients, are quickly addressed, everyone benefits.


Vital information for nurses Almost everything nurses do depends on the information they get from medical devices, and Clinical Engineering staff are responsible for these devices. A colleague once told me that a misreading tympanic thermometer, a very common issue due to dirt build-up on the ear probe, could result in a patient having an unnecessary overnight stay in a hospital. I discussed this with some clinicians, who assured me that while a temperature reading on its own was not enough to admit a patient, it was something to think about.


Managing device incidents There are many reasons why a device may fail, potentially resulting in patient harm; for example, a defibrillator could fail to deliver a shock, or an infusion pump could overdeliver or underdeliver a drug to a patient. Fully understanding a root cause for a device-related incident requires full knowledge of the device, the patient, the building, infrastructure, clinical procedures, and numerous other factors. Good communication with clinical staff is vital to getting to the cause of an incident. There are several steps involved in understanding a device incident, and without going too deeply into it, here are the basic steps: n Clinical staff should ensure that the patient is safe.


n Clinical staff should notify Clinical Engineering of a device incident.


n The device should be removed from service, and clearly marked as being faulty.


n The one thing that clinical staff most often forget – that all accessories, disposables, and packaging, should be preserved.


Clinical Engineering staff then work with the clinical staff, and whoever else is required, to establish the cause of the fault, and how to prevent it from happening again.


Christchurch Public Hospital’s newest automated external defibrillator, the Lifepak CR2, is a Wi-Fi-connected device.


Threat to patient safety


Personnel and training


Policies and procedures


Medical equipment


Patient harm


Equipment management


‘Reason’s Swiss Cheese Model’ infers that in a complex system such as healthcare, hazards are prevented by a series of barriers.


Swiss Cheese model A commonly used metaphor for understanding safety incidents is ‘Reason’s Swiss Cheese Model’. To summarise, in a complex system such as healthcare, hazards are prevented by a series of barriers. Each barrier has unintended weakness or holes, hence the Swiss Cheese analogy. However, in reality, unlike Swiss cheese, the holes are ever changing size and moving. This adaptation of Reason’s model specifically for the management of medical equipment encourages a focus on three main factors that we should pay attention to: n Identifying and eliminating or minimising potential threats.


n Improving the effectiveness of processes, procedures, people, or equipment – represented by the slices of cheese. Effectively making the holes smaller.


n Proactively seeking and plugging holes or weaknesses in barriers.


Clinical Engineering literature is full of examples, case histories, and horror stories, involving device-related injuries and deaths. Many devices apply energy to the patient, be it pneumatic, mechanical, or electrical. While continuing


improvements in device design can and have reduced the incidence of such injuries, these devices, by their very nature, remain intrinsically dangerous. As such, users need to rely on the development and use of appropriate and pragmatic barriers to ensure patient safety.


Recalls


During the life of a product, the manufacturer may issue device upgrade notifications, advising of changes that may be necessary to keep a medical device running optimally. ECRI Institute regularly sends out notifications of recalls and upgrades to equipment, as do equipment manufacturers and vendors. It is absolutely vital that the recommendations are carried out, as failure to do so can result in patient harm. I was once involved in an incident in a remote hospital where I was required to test an automated external defibrillator. The AED had two battery bars showing, so I felt confident that I could test it and leave it with sufficient battery capacity after I had completed my tests, should it be required for therapeutic use. However, one 360 Joule shock was sufficient to flatten the battery. To compound the issue, I did not have a spare battery on me. In some ways it was fortunate that the unit stopped working while I was testing it, and not while on a patient. However, I had left the hospital’s only AED useless while we sourced a replacement battery. A few months later, the agent for the defibrillator announced a software upgrade, as I was not the first person to encounter this issue. So, this has just been a bit of an insight into how biomeds like me help make hospitals safer places for patients and staff alike. I love what I do, and the fact that I am able to use my technical and engineering skills to assist in patient care.


hej August 2020 Health Estate Journal 27


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