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HOSPITAL SERVICES


Challenger that exploded in 1986 resulting in the loss of seven lives and a billion dollar space shuttle, was caused by a faulty $2 O-ring. It reminded me of a piece of advice that an old colleague and NZIHE board member, Nigel Cross, gave to me. He told me that whenever I worked on a piece of equipment, I should remember that the next person to be attached to that equipment could be me, my wife, or one of my children. After the 2011 Christchurch earthquake,


I can recall sitting at my bench testing intravenous fluid pumps, which is the bread and butter of what we do, and thinking that there must be something better that I could be doing to help out at the hospital during the time of crisis. In hindsight, this is probably how things should work in clinical engineering – it is an indication that our equipment held up well during a period of extraordinarily high use. As the clinical engineer in my hospital


responsible for the maintenance of the equipment located in our ED, it is a source of honour to me that my work supports and enables the clinicians who are doing the real lifesaving work. That is particularly fitting, given the


mass casualty incidents that we have experienced over the last ten years, such as the previously mentioned earthquakes, or more recently, the mosque shooting that occurred in Christchurch in March 2019, resulting in 49 gunshot victims arriving at our ED with the space of an hour. In today’s throwaway society, biomeds


work to keep equipment working like new in hospitals, clinics and laboratories, saving our organisations millions of dollars every year. biomeds have an extremely important role to play regarding not only the repair and testing medical equipment, but other important aspects detailed below.


Pre-purchase planning I suspect that every biomed has had a crate turn up in their workshop that they were not expecting, and that have known nothing about it. Upon excitedly unpacking it, they have found a piece of equipment that they have never seen before, minus manuals and statutory paperwork, and in the odd case, with power cables fitted with the wrong country plug. As a consequence, the biomed has


had to go back to the supplier, requesting such standard information as WAND, which is New Zealand’s medical equipment database operated by the New Zealand government, and ARTG inclusion documentation, service manuals and the like. To this, the response from the supplier is sometimes ‘no-one has ever asked for that before’, despite the requirements being statutory. According to AS/NZ3551, the


38 Plugs!


equipment must also have the correct markings, such as the manufacturer’s name, supply voltage and ratings, and other markings. Biomeds are responsible for ensuring that equipment complies with these basic standards. Pre-purchase planning is not just about ensuring that the equipment to be purchased is of high quality and fulfils statutory requirements. It also requires ensuring that there is adequate service backup and that the cost of ownership has been considered. I once had to tell a client that their $2000 defibrillator required a $700 battery. Needless to say, my client now wishes they had purchased a different brand of defibrillator. If they had asked a biomed like me what I thought prior to purchase, I would have been happy to point them in the right direction. That is just one small example where a


customer was not aware of the true cost of ownership. I have been involved in far more expensive and serious issues where our advice was ignored and consequently our healthcare system has suffered. Involving biomeds in equipment


purchasing also leads to hospitals standardising on equipment. Multiple monitoring systems result in the need for additional training to be given to clinicians, and of course, a greater range of consumables must be stocked to suit each brand. Ultimately, clinical engineering


involvement can prevent the hospital from purchasing junk. The costs involved with servicing healthcare equipment is massive, and biomeds have the potential to make or break a hospital’s budget.


Interconnectivity with information services In most hospitals, computer networking services are separated from clinical engineering, however the demarcation lines are starting to get fuzzier. We are now in a situation where we have increased software support verses hardware support. Consequently, my hospital has been upskilling biomeds in the area of computing networking. Biomeds are more frequently required


to work with a hospital’s IT staff as an increasing amount of equipment is


Welch Allyn Connex vital signs monitor. IFHE DIGEST 2021


becoming interconnected to the hospital’s data network. This is huge growth in this area, and we are seeing more and more equipment that requires networking or that can enhance patient care by being connected to the hospitals network. Here are just three examples of biomeds working closely with Information Services, as they are known in our hospital: l We have intravenous fluid pumps at our hospital that have wifi built in or wifi tags attached to them, and thus, we can use software to track the pumps whereabouts within the hospital. In my hospital, pumps that are used in our ED travel all over our main campus, and sometimes even to other hospitals. Using wifi, we can find these pumps


wherever they are within our hospital wifi system, and this has resulted in huge savings in man-hours looking for pumps when our ED has run out of them. This has been a huge help to those involved in running ED. The same system also enables us to remotely monitor drug fridge temperatures using the same tags. If a remote temperature gauge located inside a fridge goes out of range, an alert is raised in our telephone office, and the telephone operators will call the department involved to inform them. This has resulted in the prevention of thousands of dollars worth of drugs being damaged.


l Our newest AEDs (automated external defibrillator), the Lifepak CR2, is a wifi- connected device that is capable of not only sending email alerts when it is not in a ready state, it is capable of providing first responders with real-time ECG data remotely. For example, our ED staff can be observing a patient’s arrhythmia tracing while the patient is receiving CPR at a remote location, such as a rural hospital or medical centre. And as a biomed, I regularly receive notifications when a defibrillator has been used, and not immediately returned to a state of readiness.


l ECGs taken on mobile ECG carts are now being automatically uploaded to the patient’s electronic medical records. Our newest monitors, such as the Welch Allyn CSM and CVSM, are


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