“For want of a nail…a kingdom was lost.” That proverb could certainly apply in the healthcare field: “For want of a working piece of equipment, a patient was lost.” Evidence-based studies indicate that in the United States, premature death related to preventable harm to patients may be as high as 400,000 per year. Tens of thousands of these deaths may result from equipment-related issues.
Imagine a defibrillator that doesn’t power up, an operating room laser that fails, a patient monitor that doesn’t alarm, a radiation device that shifts out of calibration, or a digital control system that just shuts down. When any of these situations occurs, it can lead to a bad outcome for a patient, even death. Hospital professionals rely on having working equipment to do their jobs well. Equipment maintenance is critical to make sure this happens.
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What types of maintenance apply in a healthcare facility?
Maintaining medical equipment is very similar to maintaining our cars or home appliances. We want our equipment to be working at peak conditions for safety, performance, cost, and usable life, so we follow recommended schedules of maintenance and pay attention to performance indicators. We do maintenance ourselves or get it done by a professional.
Preventive maintenance (PM) is completed based on elapsed time or usage since installation or previous maintenance event. For example, a large piece of equipment such as an MRI might have a service contract with a checklist of quarterly maintenance items to be completed by the manufacturer’s technician or an outside service provider.
On the other hand, distributed equipment such as a mobile defibrillator (AED) may require inspection after every use, monthly inspection regardless of use, and battery replacement every three to five years. Most equipment, when purchased, will have a recommended PM schedule from the manufacturer to include inspection, calibration, parts replacement, repair, or other necessary work.
Corrective maintenance (CM) is completed after an equipment failure while in use or a signal of the need to restore the equipment to a position of readiness. When a piece of equipment in a patient’s room goes “on the fritz,” it is removed and replaced and the non-working equipment is sent for maintenance.
Predictive maintenance prevents failures. The goal of predictive maintenance is to monitor equipment process signals to catch developing problems before the equipment fails during use and causes catastrophic results. Using data analysis and pattern recognition, devices can be flagged for necessary maintenance even though the PM period has not elapsed. For example, a monitor on a medical gas stream showing a flow or pressure decrease may indicate that filters are plugging, allowing the team to remove the system from operation at the next convenient opportunity. Using “big data” from equipment failures, predictive maintenance can forecast anticipated issues on specific equipment types and remove a machine before failure. (Similarly, predictive analytics of medical conditions can help prevent patient failure.)
Total productive maintenance (TPM) is a cross-functional maintenance program focused on avoiding all equipment failures so that overall organization objectives can be met. One element involves having machine operators, in this case, nurses and other hospital machine users, trained in basic machine maintenance and troubleshooting. Just like a car driver knows when her car is purring and when it’s sputtering, hospital staff may sense when a piece of equipment is acting differently from normal. Having basic knowledge of machine maintenance can help staff avoid unsafe conditions, recognize incorrect hookups or other common operator errors, run diagnostics, or remove equipment from usage for more extensive maintenance attention.
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Steps of a healthcare equipment maintenance program
Everything starts with a cross-functional team. With equipment maintenance, in particular, it’s valuable to have a partnering approach rather than a dysfunctional practice, such as: “stick it in the hallway and hope someone fixes it.” The maintenance process must be a closed loop. These are some of the critical steps in the partnering process:
- Form the cross-functional team for initial program creation and long-term monitoring.
- Identify the equipment to be maintained, including manufacturers’ maintenance recommendations. Along with verifying inventory, create an equipment maintenance prioritization based on risk.
- Establish roles and responsibilities for identifying and communicating maintenance needs, completing maintenance work (in-house, off-site, contract outsourcing), and managing removal and restoration to service of machines receiving maintenance work.
- Put in place all necessary management tools, such as equipment tagging supplies, standard operating procedures, work request forms, and real-time monitoring.
- Establish a process for PM for the classes of devices, with specific timelines for individual machines. This process becomes much easier when an effective electronic asset management system is used.
- Track where equipment is being used or stored (using the asset management system) and identify specific locations where equipment needing maintenance will be placed.
- Establish service level agreements for responsibilities and metrics, including agreed turnaround time for return of equipment.
- Communicate to all parties among healthcare and maintenance staff and establish a feedback process for issues and improvement suggestions.
- Implement management metrics including maintenance hours, maintenance costs, service repair time, downtime (equipment not available for use when needed).
Effective equipment maintenance provides dependable machines across the facility. This means healthcare professionals spend less time and frustration dealing with equipment problems and have more time and energy to focus on patients. Contact EON to start an assessment of equipment maintenance performance in your healthcare organization.
