PEER REVIEW
Risk management when deploying respiratory support l In the cases discussed – which were anonymised – the risks were identified proactively and in time at the hospital concerned.
l Take note of concurrent use of equipment and ensure sufficient pipeline capacity for medical gases.
l Avoid connecting too many oxygen units to the same oxygen supply line at the same time, as this reduces the pressure and may cause a malfunction.
l Ensure fire hazard levelling in case of excessively high oxygen concentrations in the patient room. If a patient cannot absorb the amount of oxygen administered, the oxygen is released into the patient room and additional measures must be taken with regard to ventilation. In this case, higher ventilation rates are required (e.g. six- fold instead of three-fold per hour).
l An oxygen supply of 60 litres/minute is usually too much too handle for a patient. As a result, measures are needed to prevent the oxygen concentration in the patient room from rising too high.
l Please note that if respiratory support fails in a patient, the oxygen supply from the medical gas pipeline does not always stop automatically, instead entering the patient room and resulting in increasing oxygen concentrations, which may cause a fire and explosion hazard.
l Be aware that oxygen is heavier than ordinary air. It is then advisable to install air extraction grilles at floor level instead of the usual location in the ceiling. It is also useful to provide an O2
sensor with alarm to medical staff,
plus a work protocol on what to do about extra ventilation measures after an alarm has been sounded for excessive oxygen concentrations.
l Record how to deal procedurally with the risk of an Air Handling Unit (AHU) outage and unscheduled malfunction. Due to the corona pandemic, regular maintenance is sometimes postponed in order to preserve healthcare capacity, but in the case of treatments with oxygen administration, mechanical ventilation also has an important fire- prevention function that must be resolved in an organisational way in the event of outage.
Risk management in Air Handling Unit (AHU) applications l In the cases discussed – which were anonymised – the risks were identified proactively and in time at the hospital concerned.
l Regarding maintenance of the main switchboard, measures were taken to prevent ventilation outages in the cohort department.
40
Legislation and regulations (procedures)
Process Risk assessment
Risk analysis (PRI)
Control measures
Periodic checks
Deviations? Figure 1.
l The AHUs were not connected to an Emergency Power Unit or UPS.
l Medical staff awareness of ventilation requirements was reviewed.
l After maintenance, the procedures were tightened up for the healthcare staff.
Process optimisation and interfaces management The initial phase of the corona crisis was characterised by major and abrupt changes for employees and work processes. It is a ‘combined disaster’: the imbalance was caused by a changing demand for healthcare and a changing supply of healthcare. The healthcare institutions were not only confronted with many new disease variants of seriously ill patients, but also some of the staff themselves became ill. At many hospitals, a plan of action was developed by the Crisis Policy Team (CPT) for the administrative/strategic level and the Operational Crisis Team (OCT). Within the OCT, there was a need to respond quickly to an expansion of healthcare in a very exceptional situation. Where can we improve when it comes to preventing technical risks? The NVTG institution members who
participated in the peer review meetings unanimously called for greater attention – at the start of a crisis – for the impact of a changing, and perhaps temporary, strategy on building management and technology, both medical and otherwise. The impact of technical risks should not be forgotten in the considerations. By reserving two seats at the crisis team table for technical specialists, you ensure attention is given to this aspect: have we given enough thought to the technical aspects and risks? Have the medical staff and nurses been properly included in the changed healthcare environment?
The CPT and OCT are thus forced to
think even more carefully about the interfaces between: l Technical facilities in spaces outside the treatment environment designed originally, such as an Intensive Care Unit.
l Medical equipment and the protocols for its technical connections.
l Medical treatments and their technical procedures.
l Training and manuals.
The method for a comprehensive screening of treatment method versus building & technology might look like Figure 1.
Risk management is crucial, says the
working group. Make sure that certain risks from your risk analysis are reduced as much as possible. Analyse whether the approach to the risks is working and whether new risks are emerging. Preferably, a design plan is devised around the primary care process in which the treatment of the patient is central. This results in a well-described treatment environment that also includes the peripheral equipment, preferably in diagrammatic form so that the work floor can be properly and broadly informed. In preparing the design plan, the
following questions are asked as a minimum: l What medical equipment is used around the patient?
l What degree of galvanic contact is generated during treatment?
l What installation facilities are considered necessary for this?
l Does this equipment require galvanic isolation by means of isolation transformers?
l What power supply does the equipment require? (emergency power 230V wall outlet/uninterruptible power 230V wall outlet)
IFHE DIGEST 2023
Plan of action
Improve control measures
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