By Arleen Thukral, M.S., CCE, CHTM
Preventative maintenance is a proactive approach that involves regular inspections, testing and servicing of equipment to prevent potential failures before they occur. In the field of healthcare technology management (HTM), preventative maintenance is a core responsibility in ensuring the safety of patients and healthcare providers. For example, sensors that monitor flow rates and pressure can degrade over time in an infusion pump. If not replaced, they might fail to detect anomalies, causing the pump to malfunction and potentially harm the patient. Healthcare delivery organizations (HDO) must comply with stringent regulations and standards to ensure patient safety. Regular maintenance service records are required to demonstrate that medical devices are maintained according to manufacturer guidelines.
HDO are required to measure preventative maintenance (PM) completion but how can an HDO measure the quality of its preventative maintenance? VISN 2 New York and New Jersey Healthcare Network started our journey towards high reliability in seeking to measure PM quality. The objective for PM quality is that PMs are conducted according to manufacturer requirements or AEM requirements.
The PM quality life cycle in VISN 2 starts with HTM staff reviewing the service manual and identifying the OEM PM frequency, which is then manually input in the CMMS model table instead of just setting up the PM schedule according to this frequency. Because the data of OEM PM frequency is catalogued in CMMS by model, reports can easily identify any deviations from OEM requirement. “None” frequency is also documented to identify an accurate count for missing PMs. A PM checklist workgroup meets to create PM checklist questions based on the service manual. CMMS admin then implements checklist using checklist rules so that PM generates with PM checklist. If an external technician is completing the PM, the checklist can be skipped, and service report attached instead. Before each PM, the assigned technician reviews the service manual for revisions. Some PMs generate a quality assurance (QA) work order, with closing code of Pass or Fail. During the QA, the manager reviews the latest service manual to identify if PM frequency revisions are incorporated in the process. The manager inspects the medical device to review the service logs and PM sticker on the device. A fail closing code are utilized on the QA work order if PM documentation, procedure or frequency does not meet OEM requirements.
There are a few CMMS limitations that currently mitigate complete PM quality tracking. Currently, there is no CMMS PM suppression capability so if there are multiple maintenance definitions, multiple PM work orders generate when frequencies align such as semi-annual and annual. This makes it difficult for the front-line staff to streamline their work to complete both PM tasks for different work orders on the same device.
To measure the effectiveness of the quality life cycle process, a few metrics may be utilized. First, QA fail percentage, which can be monitored to find areas of improvement with processes or training. QA fail percent is proportion of QA fail divided by QAs generated times 100. Some examples include vendor service report missing, missing procedure step, mismatch of vendor PM month to CMMS PM month, missing part for PM kit, etc.
The second quality metric is OEM PM conformance. OEM PM conformance provides a quantitative composite measure of whether OEM PM frequency is met for models where OEM PM frequency is noted. OEM PM conformance is the proportion of devices without missing PM or wrong PM schedules divided by number of medical equipment times 100. As the percentage of inventory impacted by OEM PM decisions increases over time, OEM PM conformance increases in reliability. Data hygiene is important to note for this metric. To accurately measure the OEM PM conformance, the assets in the inventory must have accurate naming by model.
Another metric is percentage of vendor PM wos without service reports. This is the proportion of vendor PM wos without service reports divided by the number of vendor PM wos. Since checklists are bypassed for vendor PM work, service reports are utilized to ensure PM quality.
The PM checklist is another way to ensure that a PM is conducted according to manufacturer requirements. To err is human, so checklists act as a cognitive net that helps BMETs remember essential steps, especially in complex tasks. Checklists also establish a baseline for performance, ensuring individuals do not overlook critical details. The standard documentation ensures an entry-level BMET reviewing the PM history will understand what steps were performed. In addition, checklists can be designed to fail automatically based on out-of-range value and generate a corrective maintenance (CM) work order. While checklists provide structure, they should complement professional judgement rather than replace it.
In conclusion, implementing a PM quality program is crucial for healthcare organizations to ensure patient safety, regulatory compliance and optimal equipment performance. By adopting a systematic approach to PM quality measurement, as demonstrated by VISN 2 New York and New Jersey Healthcare network, HTM departments can significantly improve their maintenance practices. This includes careful documentation of OEM requirements, creation of comprehensive PM checklists, regular quality assurance checks, and continuous monitoring of key metrics such as QA fail percentage, OEM PM conformance and vendor PM work order documentation. While challenges remain such as CMMS limitations and the need for quality data hygiene, the benefits of a well-executed PM quality program are clear.
As medical technology continues to advance, the importance of high-quality preventative maintenance will only grow, making it an essential focus for healthcare organizations striving for operational excellence and high reliability.
