Clinical engineering
Smarter decision making for HealthTech maintenance
Dr. John Sandham has been involved in healthcare technology management for over 30 years and has been consulted by hundreds of healthcare organisations in the UK and abroad. During this time, he has observed a common problem within many organisations – the ability to keep up to date with the latest maintenance practices for their healthcare technology.
I recently spoke to a senior clinical engineering colleague at a large university Trust who told me that they have a policy which has been in place for many years, of testing all their medical equipment assets every six months. Unsurprisingly, his department only manages to hit around 45% of their planned maintenance targets, but some simple maths will show that if the maintenance was extended to once a year, then his current resources should enable that target to be increased to 90%. I would argue that trying to achieve a
maintenance inspection of every asset once a year is also unnecessary, since many manufacturers are now designing equipment that does not require maintenance or calibration. There are potentially four things healthcare organisations can do with medical equipment when considering maintenance: 1. Do no planned maintenance at all (breakdown only)
2. Physical inspection only 3. Inspection and calibration tests 4. Inspection, calibration and replacing parts
Each one of these four categories means different levels of resources will be required. This article considers each of these categories:
Doing no planned maintenance at all. This would happen on equipment that is classified by the manufacturer as maintenance free, but could also be on other items designated as low risk by the clinical engineering team. You might think that this point is obvious, but many healthcare organisations will keep inspecting and checking the calibration of medical equipment according to their local policies and practices, unless the management team decide to change those. Every healthcare organisation I have been in contact with has assets inspected/calibration checked,that do not actually require any checks because the organisation has bought new
technology that is designated as ‘maintenance free’, but their engineering processes or work instructions are not updated. Due to these ‘habitual practices’ thousands of hours are wasted carrying out unnecessary testing. This also means equipment is avoidably unavailable for clinical use during the time it is being tested.
Physical inspection only. Some equipment should be physically inspected to ensure it is where it is meant to be, and it is in good physical condition – for example, maintenance free automated external defibrillators (AEDs). These types of devices need to be in the right location, and available for immediate use. It is good practice to ensure they are there and in good physical condition, but the majority of AEDs require no actual maintenance. Owners or managers of an AED are not
expected to carry out any maintenance tasks other than replacing the battery when necessary (as indicated by the service light on the AED, or at routine maintenance), and replacing used or out-of-date disposable items such as adhesive pads (electrodes), razors and plastic gloves.
The shelf life of these (unused) is usually 3-5 years, so such maintenance tasks are infrequent (unless the AED is used frequently). In all cases, the manufacturer’s instructions should be followed. If used, the electrode pads may be replaced without charge by the ambulance service, but you will need to confirm with them from the outset whether they can offer to do this. All AEDs currently on sale perform regular self-checks and, if a problem is detected, it will be indicated. In most cases this is shown by a warning sign or light visible on the front of the machine (Resuscitation Council, 2019).1 A pre-use check and annual inspection to
check the battery and operational status is recommended, but some organisations are testing these AED devices using defibrillator testers, which reduces the battery life and therefore increase numbers of batteries being purchased.
Inspection and calibration tests (where devices are delivering high risk drugs, ventilation, cardiac monitoring, etc). The clinical user will want to be assured that the device is working within a specified calibration window and
January 2024 I
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