Q: Before we jump though too many flaming hoops on this power strip ban announcement, has anyone actually seen a document from CMS that supports the claim that they have completely banned all power strips in patient care areas? So far, we have been unable to locate any such documentation, but I have no doubt that George Mills knew what he was talking about.
We wanted to show something in writing to our OR leadership that supports us removing all their power strips, but basing the decision on a statement made by one individual without seeing it directly from the purported source does not seem advisable or reasonable. If anyone has a written copy of a statement from CMS or a URL where I can see this information online, I would really appreciate you sharing it.
A: CMS has not made a statement. Their comments (made through George Mills) were that they are merely enforcing the existing code requirements in the 2005 NFPA-99. If they would update their reference to the 2012 edition, RTPs are allowed, with proper planning and ongoing surveillance.
One HTM director in California asked their local CMS inspector how he planned to enforce RTPs. His reply was that unless they are obviously unkempt, hanging in mid-air, or daisy chained together, he was not going to pay attention to them. While this is not a definitive or nationwide guidance, it does indicate that it is not going to be as big a deal as everyone expects. Also, even if they do note it, are they going to jeopardize your accreditation because of a few RTPs? I think not.
By the way, you can eliminate 90 percent of your extension cords, RTPs, Octopuses (Octopi?), and outlet strips if you just replace your detachable power cords with custom-made ones that are 15 to 20 feet long. Several companies will make power cords any length, wire gauge, and connector type you wish. Replacing all detachable power cords allows the necessary length for every machine to reach any available outlet. I did this, and it is cheap, and has no negative implications, either from regulatory, safety, tripping or leakage aspects.
Follow Up: Thank you for that clarification. We recently received a statement from DHEC that seemed to allow RTPs if handled correctly, but they too are using an outdated version of the NFPA codes so what is a person to do? I think our approach is going to be, inventory them and document annual inspection and testing of them. If that is not good enough, we can go to the next step.
A: We made the difference years ago. After replacing power cords damaged by beds, carts, etc. rolling over them. We bought 8-foot power strips and had facilities mount them above headwalls.
A: The power cords for Steris surgery tables are 20 feet long, with a 90-degree plug.
A: I know that InterPower will make any quantity power cord that you need, to any specification.
A: Here is an important breaking news story. It is of vital interest to all Biomeds and HTM professionals. We are all familiar with the recent CMS and Joint Commission statements outlawing multi-outlet strips in patient care areas of hospitals. All hospitals are having difficulty complying in a cost-effective manner. A recent waiver retracts their original position. Everyone needs to read the entire waiver because there are some stipulations required for the use of outlet strips. You may download it from the HTMA-SC website. (www.htma-sc.org )
Q: There is a flowmeter attached to an air/oxygen blender. The question is: What color should the flowmeter be? This is green (oxygen), but the output is not pure oxygen. Should it be yellow (air)? The flowmeter calibration is not an issue, just the color of the flowmeter.
A: I’d say that there are a couple of factors involved with this decision. First, does this facility ever use any air-only (yellow) regulators? Second, what percent O2 would the blender be routinely set at?
If the answer to the first questions is “no” and if the answer to the second question is a low percentage, then I would be tempted to say go with the air, yellow, body of the regulator.
If the answer to the first question is “yes,” and the answer to the second question is “all over the place,” I would say go with the O2, green, body of the regulator.
It’s the nursing/technician recognition of something that might be different, and what is being delivered.
A: I would say that since you are able to give 100 percent oxygen, the flowmeters must be green. What is the need for the Y connector on the output? Are they trying to use the same blender for two different patients or do they just want a backup flowmeter?
A: NFPA 99 doesn’t specifically give anything on this, and CGA C7 only specifies cylinders and containers, not delivery systems. According to that standard, if you were going to be completely within the “sense” of what’s out there, you would use flowmeters that were green and yellow. That would be the technical standard if you were putting a blend of oxygen and air in a cylinder; use both colors.
Both standards also caution not to trust by color alone at any time. They both state, “Color coding shall not be utilized as a primary method of determining cylinder or container content.”
You would think that having the oxygen flowmeters connected directly to a blender would key the administering staff that it is not necessarily pure oxygen, but that would be making an assumption. We all know how those go!
Follow Up: Thanks for the replies. I assume the dual flowmeter is to serve two patients simultaneously. The consensus seems to be that green is best.
A: Flowmeters that are attached to blenders should be green as they can deliver 100 percent O2. Yellow should only be used where 21 percent air is the only possible output delivered. Safety-wise the yellow flowmeter should have a different DISS/quick connect connector on it that can’t be connected to a blender. In my opinion, yellow flowmeters should only be used on air tanks and wall air output connectors.
It is not unusual for some ICUs to use a Y-connector on a blender that can only provide a blended output from one side of it.
A: Based on the American Academy of Pediatrics (AAP) and the Neonatal Resuscitation Program (NRP), this is a typical setup for neonates. One blender is 15 lpm and the other is 3 lpm. You would not use two different patients on the same blender because the physician prescribes the output. And you would not be able to change each percentage independently. As far as color, the therapy that you are delivering is oxygen. Whether it is at 100 percent, 21 percent or somewhere in between, it is still oxygen. Therefore the color must be green.
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