By Jim Fedele
Lately, I have read many posts about documentation, specifically, what information should be required and what is required. The opinions vary and it is hard to know with any certainty what should be documented. Personally, I have always wondered about all the documentation we are required to do and if it is necessary.
If you ask 10 biomeds what needs to be documented on work orders you will get at least five different answers. Where the biomed was trained, their age and experience, will all influence the answer. For instance, biomeds trained by the military are very good at documenting every measurement and step they took to fix a problem, while some of the younger techs see less value in writing everything down. It is hard to say who is right. The military-trained tech is taught this is exactly how you do the task and this is how you record what you did, no room for interpretation. A traditional school trained tech may not see any value in writing everything down therefore it is not done.
When I first started as biomed tech, I found it very helpful to look up old work orders on equipment to see if the problem occurred before and how it was solved. Frequently, I could cut my repair time down because I found the answers in the equipment’s history file written down in the work request documentation. Lately, these opportunities are not so frequent. One would think that advances in computerized maintenance programs would make it faster and easier to check for previous problems. It is easier; however, equipment is not failing as it used to in the past. No longer do we “replace Q2 on the processor board.” Now, we just swap out a black box that only takes you a minute to figure out. With all that being said, is it really necessary to document everything you do to solve a problem? Is your time better spent doing something else?
Documenting preventive maintenance (PM) results is also subject to many opinions. However, the differences that seem to guide opinions is usually driven by the biomed’s personal experience. For example, if one has testified in court about a piece of equipment or an accreditation/licensing agency has asked for the recorded output of some piece of equipment, it will influence the tech’s opinion on what needs to be recorded during a PM. To me, these situations reveal how little people know about biomeds and equipment service. If an entity is going to require that an output be recorded, I wonder what purpose it serves. Does it really make sense to document that the output measured 10 on setting 10? Would anyone ever document that the output was six? I would hope they would fix it first. The purpose for mandating that outputs be documented is an attempt to ensure that the outputs get measured. My thought on this is that if a person is going to “paper whip” a PM, writing down an output that must match the spec isn’t going motivate them to do the right thing anyway.
But what about from a legal perspective? Being told that your records are being subpoenaed by the defense in a lawsuit give many biomed techs chills. Think about it, what would happen if you made a simple mistake like transposed a number when writing it down, or you forgot a decimal point? Now a lawyer is questioning your competency and placing doubt in the jury’s minds. Just the thought of it makes me feel uncomfortable. So, what should be documented? I personally like pass/fail, put the equipment specifications on a label affixed to the unit or have your CMMS print them with the work order, so every tech can easily know and find them. Test the equipment and then document pass or fail, if fail fix it and recheck and document passed. To me it is clean and simple, there is little room for mistakes and it keeps you from answering any potentially embarrassing question.
So, at the end of the day, what is the best solution? I think it depends. If you have an aggressive accreditation surveyor or DOH surveyor you need to do what they say. However, if you don’t, I think less is more. Remember that all work requests are legal documents. I personally have read work request repair descriptions that have had a little too much information. A frustrated technician decides to editorialize a repair description and made comments like “the staff refuses to learn how to use the unit,” “staff is too lazy” and etcetera. I think that as an industry, we should be united and willing to explain to those mandating documented outputs that there is questionable value to that exercise.
Jim Fedele, CBET, is the senior director of clinical engineering for UPMC. He magazines six Susquehanna Health hospitals. He has 30 years of HTM experience and has worked for multiple service organizations. Send questions or comments to Editor@MDPublishing.com.
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