The More Technical You Are, the Better
Every once in a while, what I find when evaluating an on-site biomedical service surprises me. For instance, every now and then I run across an in-house department or an outside vendor service that is still performing needless safety checks that consume time and serve no useful function. I found one biomed shop still safety checking all the leads on an electrocardiogram (ECG) machine, so I asked, Why?
Weve always done it, I was told.
Have you ever found a bad one?
Did you know that for a little over 10 years now all manufactured ECG/EKG devices have been optically isolated, and the chance of any current and/or voltage traveling back to the patient is next to impossible? I asked.
Well, someone needs to check them!
All ECG/EKG devices have built-in software that checks and/or performs a complete diagnostic of all leads during startup and/or during the patient recording process, per Food and Drug Administration requirements.
Under todays demanding, do-more-with-less edict, why would you perform needless tasks?
Another problem Ill occasionally find in my biomedical service evaluations is a biomed or service organization employee who cannot operate a ventilator or, say, an anesthesia machine. How can you run the diagnostics on your equipment if you dont know how it is used?
Biomeds/clinical engineers today have to be more machine technical than the users/operators. How else are you going to perform one of the major job responsibilities of a biomed technicianassisting clinical personnel? How are you going to determine whether the medical device has a problem or whether there has been an operator error, which, according to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is reportable to the safety committee of the institution for which you are providing service?
The only admonition I would offer regarding knowing how to operate your equipment is to keep in mind that as a biomed/clinical engineer, you are not a clinician, so never reference a patient when explaining or demonstrating the operation of a medical device with end-users. You can tell them the way it should operate, how to react to alarms, or even how to set up the device for use. Make sure you have the user/operator manual in hand, and continue to reference it at all times during any dissertations you might provide. But remember, the only person who can give an acceptable/accrediting in-service is a factory representative or clinician.
At the end of my evaluation process, I usually give the chief biomed some of the following advice:
1. Examine precedents for equipment preventive maintenance (PM) checks to establish a more valuable and productive biomedical department. When a new piece of equipment comes in, a biomed shop, to be safe, may set the PM interval at 4 times per year. After 2 or 3 years and no reportable incidents, a precedent is set, so the manager can drop the PM interval to the manufacturer-recommended PM intervalsometimes only once per year.
2. Go through the factory-recommended PM list for each piece of major medical equipment. Make sure that each PM task is valuable. If theres a questionthe only stupid question is the one thats never askedcall the manufacturer and ask if that particular procedure can be dropped off of the PM interval list. If the answer is yes, have the manufacturer fax over the amended PM task list and file it with the service manual. Following the above two examples, a biomed department or service organization can turn wasted time into time used to update and train in-house personnel, providing better qualified, more knowledgeable employees. Remember, a lot of independent service organizations will come in and perform nothing but safety checks on all the equipment, making their proposal sound very reasonable by saying they are going to save the hospital a lot of money if they get rid of in-house clinical engineering staff.
What the hospital may not realize is that with safety checks only, the facility becomes fully liable for all equipment not receiving manufacturer-recommended PM. This is where you and yours can shine. Make yourselves indispensable. Attend JCAHO Environment of Care and department director/manager meetings, help equipment operators with proper equipment usage, be on time when your assistance is needed in the operating room, and by all means, know how to use every type of medical device that falls under your auspices!
Scottie R. DeWolfe, CE, BMET, is the sole proprietor of B-METS Corp in Dothan, Ala.