One major aspect of managing a biomed program today is deciding on OEM or AEM preventative maintenance. By now we are all well aware of the CMS requirement that identifies what we must do; 100 percent PM completion on all medical equipment. I know many programs are defaulting to the OEM, however, given the technological advances of modern day medical equipment and the varied environments the equipment must operate in, are we sure the OEM knows best?
I feel like I need to first establish that for the purpose of this discussion I am referring to scheduled performance inspections (SPI). These checks differ from preventative maintenance (PM) because SPI does not require replacing parts that wear out.
As managers, one of our tasks is to manage the expenses of our departments. We do this in many ways including managing our human resources. If you work for a prospering and growing organization, you are adding new equipment to your inventory almost daily. The inventory growth seems to outpace the removal of equipment from the inventory which ultimately increases work load for the technician. Since it is very difficult to add new staff, we have to find ways to optimize our human resources to maintain equipment that benefits from our intervention.
For the past two decades, up until the CMS changes, we used a risk ranking model to decide what equipment would be included in a SPI/PM program. I remember when we first started implementing these programs many people were skeptical. They claimed we were jeopardizing patients and that equipment would become unreliable. To my knowledge, that did not happen. We removed many small items from our inspection list and traded that time for rounding with nursing to help them understand how to operate their equipment.
One example of a pitfall of selecting OEM recommendations for SPI or PMs is that you must strictly follow those recommendations. This means you cannot add steps to the PM. For example, ultrasound machines, which are mandated to be on an OEM program, may be operated in an environment that requires a filter change more frequently than what the OEM recommends. Even though it is the right thing to do for the machine, technically you are not adhering to the manufacturer recommendations.
A very common piece of equipment in hospitals is thermometers. When I polled a group of biomeds, about half of them had thermometers on a SPI. In my opinion, they are the perfect candidate for the AEM program. There are many of them in a hospital and they are hard to find. That makes achieving 100 percent completion almost impossible. Walking through a risk analysis reveals thermometers should be on an AEM program.
The thermometers we use do a self-diagnosis every time they are turned on and also when the probe is removed. The self-test checks all the major systems and the probe to ensure everything is working correctly. If it is not, the thermometer gives an error code that will not permit the unit to be used until the error is corrected. When a thermometer gives a “questionable reading “the user will recheck the patient and try another thermometer to ensure the reading is correct. The user manual states that the only maintenance needed is to check the batteries, check the physical condition and to keep the unit clean. These tasks certainly do not need to be conducted by a biomedical technician. The service manual recommends cleaning and a visual inspection (which should be done by the user) and a calibration “check” annually. So if you are following OEM for thermometers you need to purchase the calibration well needed to check the thermometer, find every thermometer and do a calibration verification. None of these steps extend the life of the unit. So why are we still chasing down thermometers?
I know some of my colleagues worry about litigation but a common excuse when a patient incident occurs close to the time of the last “performance check” the tech usually explains that the check is only accurate the minute the equipment is checked. After that anything can happen to affect the safety and performance of the equipment. If all we are doing is a performance verification and not performing steps that actually prevent failure, like replacing seals, cables, and filters, then we aren’t preventing anything.
What should we be doing? If we want to be effective at improving patient safety and equipment availability, we should be focusing on outcomes not tasks. Looking at a list of recommended PM or SPI tasks is only half of the equation. What are the outcomes from the steps we are performing? Are we making equipment more reliable or less reliable? Is equipment available for our nurses when they need it? What environmental factors should be considered when performing a PM or SPI on the equipment? Deciding on a strictly OEM only program may be the easiest to manage, but I do not feel it is the right thing to do for your customers or for your departments efficiency and efficacy.
Jim Fedele, CBET, is the director of clinical engineering for Susquehanna Health Systems in Williamsport, Pa. He can be reached for questions and/or comments via email at firstname.lastname@example.org.
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