Over the years, many troubleshooting methods have been discussed in various articles, but most come down to the same few points to remember. Over the next few articles in this series, examples and discussions of troubleshooting steps will be presented.
On a typical Monday morning as you approach your shop, you see an infusion pump sitting there with the very informative sign on it—“broken”—with no other details of where, when, and under what circumstances. So you take it into the lab, planning to get to it that morning, if all goes well. What many of you may not realize is that you have taken the first step in the troubleshooting process: You have looked at the device and have possibly detected the problem.
Before you can work on the pump, a call comes in from the intensive care unit saying that bed 11, which is rarely used, is not coming up on the central display. Thinking about what the problem could be, you grab the simulator and head for the unit. Upon arrival, you notice that the screen is dark with no trace and no alphanumerics. Again, your first diagnostic tool was to look at the unit and determine that there is not a display. Now where do you go first? Using your experience, you think then check: A) is the power cord plugged into an AC outlet? B) Is it turned on? C) Is there another on/off switch on the back? (Note—whoever came up with the second switch must have never worked in a hospital.) Your experience has been that 70% of the time it is either a or b, and c less than 5% of the time. You checked the most common problems, and the unit is still not working. What did you miss, and what do you do next? Thinking back a little, you remember that the room is rarely used, so that gives you some clues as to what to do next. The following answers have all bitten me over the years, and they have probably bitten you too.
First, is the outlet live? Sometimes, the circuit breakers in the wall box will be “flipped” when a room is not commonly used. Once you determine that the outlet is live, what is your next step? Is the power cord plugged into the unit? Is the power cord good? My favorite is, did someone take the fuse out of the unit in the spare room instead of going to get a new one in the shop and forget to replace the one they removed? This one got me about 2 am on a Sunday, after a little too many the night before, which may have contributed to my brain cramp that morning. Have you forgotten anything? Check the fuse to be sure it is good. Is there an interlock on the monitor, or was this unit a problem in the past that you forgot to fix after the last patient was in the room?
All of these should have been part of the process. You have done what generally cures this type of problem 95% of the time, but now you have to open up the case and have a look inside. What do you see? Any loose or missing boards? What is the level of dust in the unit? Is the fan frozen either from overheating or dust? Can you see a problem with the capacitors in the power supply? You clean the dust from the fan, spin it with your finger to free it up, and the unit powers up. After you put the covers back on, you head back to the shop feeling pretty good about your troubleshooting skills. But if your preventive maintenance program does not include cleaning dust from fans, you will have a lot more opportunities to do what you just did.
Back in the shop, you put the intravenous (IV) pump on your test fixture and let it run, probably before checking its error log. It works fine, so why was it sent down as not working? This should be a question that you ask. Be sure that you check the error log on the unit and correct any problems noted. Since you have no indication where the unit came from, you cannot ask users about the problem that caused them to send it to the shop, so you are at a dead end with the troubleshooting. How do you record the cause of the trouble call? Was it operator error? Was it no problem found? Was it something else? Be careful if you use operator error or no problem found, because they both indicate that there is a training problem on the pump and that follow-up with the training staff is needed. Also, the safety committee will need to know the number of these events in your next report to them.
Basically, troubleshooting comes easily to most of us when a device or problem is in front of us, but we often have problems with questions on exams. You should read the question fully and not anticipate what the question is. You should read each answer fully and think, is this possible but not probable? Is this probable? Is it not possible or probable? Finally, which of the answers is most probable? You have to use the same thought process with the questions on the exam that you used on the monitor or the IV pump. Do not overcomplicate the problem. Think “simple,” and look for the obvious.
David Harrington, PhD, is director of staff development and training at Technology in Medicine (TiM), Holliston, Mass, and is a member of 24×7’s editorial advisory board.
1) An IV pump is reported to be overinfusing, but when it is checked on your test setup the infused volume is underinfusing, according to the manufacturer’s tolerance. What is your next step?
a) Change the IV set and retest to be sure that it is not a set problem.
b) Check the error log on the unit.
c) Calibrate the pump and retest the unit.
d) Adjust the flow rate upward.
2) A patient monitor in the ambulatory care area is not detecting a patient’s heart rate, and the trace is very small. What are the most likely causes of the problem?
a) Dried out electrodes and poor skin prep.
b) The amplifier gain is too low, so the monitor is not detecting the R waves.
c) The patient has a low cardiac output.
d) The monitor is defective.