Summer Training At Fortis Memorial Research Institute

Summer Training
At
Fortis Memorial Research Institute,Gurgaon,Haryana
April 2, 2018 to June 2,2018A Report
By
Laxmi Koranga
Under the guidance of Dr. Anoop Khanna
MBA Hospital and Health Management 2018-2019

3810050165
ACKNOWLEDGEMENT
I would like to extend our heartfelt gratitude to the Head of Quality Department Dr.Saavita Sharma of Fortis Memorial Research Institute for providing me the opportunity to undergo our Summer Training in the esteemed organization.
I sincerely thank my mentor, Ms. Samira Parhar, Assitant Manager, for guiding us at each step and for providing us opportunities of judicious learning by allotting us projects and always being open for constructive discussions.
I am grateful to Lekeshmi Geerish , clinical pharmacist, quality department for being a constant source of knowledge, support and guidance throughout the span of time.
The completion of this undertaking would not have been possible without the wholehearted support of all the Head of the Departments at FMRI , Gurgaon.

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I would also like to extend a note of thanks to my mentor at The IIHMR University, Dr. Anoop Khana for being my constant guide and for always being available whenever we needed their guidance.

Table of Contents
Table Of Figures………………………………………………………………………………..

FORTIS HOSPITALS…………………………………………………………………………..

FORTIS MEMORIAL RESEARCH INSTITUTE,GURGAON……………………….

OBSERVATIONAL LEARNING AT FMRI,GURGAON………………………………
A STUDY ON “TO STUDY CRITICAL EQUIPMENT DOWNTIME & MAINTENANCE OF CALL LOG REGISTER AS PER NABH GUIDELINES,FINDING GAPS AND GIVING RECOMMENDATIONS”………………….…………………………………………………
References

Table of Figures
Figure SEQ Figure * ARABIC 1: Frequency Of Downtime Per Month………………………………………….19
Figure SEQ Figure * ARABIC 2: Number Of Downtime Department Wise……………………………………..20
Figure SEQ Figure * ARABIC 3: Number Of Downtime Equipment Wise In The Month Of January…………..22
Figure 4: Number Of Downtime Equipment Wise In The Month Of February…………23
Figure 5: Number Of Downtime Equipment Wise In The Month Of March……………..24
Figure 6: Graph Showing Maintenance Of Complain Log Register In Departments…….25
Figure 7:Protocol Followed On Critical Call Alert For Equipment Downtime…………31
Figure 8: Hospital equipment management system……………………………………..33
Figure 9: Co-authoring…………………………………………………………………..34
Figure 10: CMMS……………………………………………………………………….35
ABBREVIATIONS:
NABH- National Accreditation Board for Hospitals & Healthcare Providers
JCI- Joint Commission International
CPR- Cardiopulmonary resuscitation
BVM- Bag-valve-mask
SWOT -Strengths, Weaknesses, Opportunities and Threats
CME- Critical Medical Equipment
BiPAP- Bilevel Positive Airway Pressure
CT- Computed Tomography
AMBU BAG- Artificial Manual Breathing Unit
CMMS- Computerized Maintenance Management System
FORTIS HOSPITALS
Fortis Healthcare Limited is a leading integrated healthcare delivery service provider in India. The healthcare verticals of the company primarily comprise hospitals, diagnostics and day care specialty facilities. Currently, the company operates its healthcare delivery services in India, Dubai, Mauritius and Sri Lanka with 45 healthcare facilities (including projects under development), approximately 10,000 potential beds and 314 diagnostic centres.

Brand Fortis was established in 1996, by Founder Chairman Late Dr. Parvinder Singh, who instituted it with the vision ‘to create a world class integrated healthcare delivery system in India, entailing the finest medical skills combined with compassionate patient care.’
Fortis Healthcare is the country’s ‘fastest’ growing healthcare group. It has grown from first hospital at Mohali (Chandigarh) which opened in 2001.From North to South, East to West, Fortis truly has India covered – the frontier city of Amritsar, to Ludhiana, Mohali, the National Capital region, Mumbai, Bangalore, Mysore, Chennai, Kolkata and many more destinations are all home to Fortis facilities.

Brand and the Logo
The Fortis brand with its distinctive logo is a synthesis of human values of trust, ethics and service and quality healthcare.
The integration of the hands (in a distinctive ‘green’ with a ‘red dot’) and the human figure is completely seamless and is representative of ‘Fortis’ responsive approach to healthcare. The green colour of hands is representative of health, wellbeing, compassion, nurturing and generosity while the red dot gives an immediate association to our Indian roots, while it is also represents energy, spirituality, courage and symbol of good luck.

OBSERVATIONAL LEARNINGS AT FORTIS MEMORIAL RESEARCH INSTITUTE
VISION-“Saving & Enriching Lives”
MISSION-“To be a globally respected healthcare organisation known for Clinical Excellence and Distinctive Patient Care”
VALUES
Patient Centricity
Commit to ‘best outcomes and experience’ for patients.

Treat patients and their caregivers with compassion, care and understanding.

Patients’ needs come first.

Integrity
Be principled, open and honest.

Model and live ‘Values’.

Demonstrate moral courage to speak up and do the right things.

Teamwork
Proactively support each other and operate as one team.

Respect and value people at all levels with different opinions, experiences and backgrounds.

Put organization needs’ before department / self interest.

Ownership
Be responsible and take pride in actions.

Take initiative and go beyond the call of duty.

Deliver commitment and agreement made.

Innovation
Continuously improve and innovate to exceed expectations.

Adopt a ‘can-do’ attitude.

Challenge ourselves to do things differently.

CARDIOPULMONARY RESUSCITATION:
CPR should be performed immediately on any person who has become unconscious and is found to be pulse less. Cardiopulmonary resuscitation (CPR) consists of the use of chest compressions and artificial ventilation to maintain circulatory flow and oxygenation during cardiac arrest
Chest compression:
The heel of one hand is placed on the patient’s sternum, and the other hand is placed on top of the first, fingers interlaced. The elbows are extended and the provider leans directly over the patient. The provider presses down, compressing the chest at least 2 in. The chest is released and allowed to recoil completely.
The compressions are repeated 30 times at a rate of 100/min. After 30 compressions, 2 breaths are given
Ventilation:
If the patient is not breathing, 2 ventilations are given via the provider’s or a bag-valve-mask (BVM).

SWOT ANALYSIS OF FMRI GURGAON:
A SWOT (Strengths, Weaknesses, Opportunities and Threats)
analysis is a helpful tool for comparing and strategy planning for any business initiative.

STRENGTH:-
World class facilities.Multispecialty Hospital.India is very well placed to tap the growing potential of the healthcare sector.

Location of the Hospital. WEAKNESS:-
Increasing cost of curative medical services.Recent Negative Image in the market.

Suspended blood bank.High Attrition rate of Employees.OPPORTUNITIES:-
Healthcare industry is the world’s largest industry.

Medical Tourism in India will be one of the major sources for
foreign exchange.

THREATS:-
Poor public infrastructure. Inflation. Medico legal jurisdictions. Country specific restrictions
Increasing Competition.HAND HYGIENE:
Thousands of people die every day around the world from infections acquired while receiving health care.

• Hands are the main pathways of germ transmission during health care.

• Hand hygiene is therefore the most important measure to avoid the transmission of harmful germs and prevent health care-associated infections.

HOW TO HANDWASH?
Wash hands when visibly soiled! otherwise, use hand rub.

Duration of the entire procedure: 40-60 seconds.

STEPS:
Apply enough soap to cover all hand surfaces;
Rub hands palm to palm;
Right palm over left dorsum with interlaced fingers and vice versa;
Palm to palm with fingers interlaced;
Backs of fingers to opposing palms with fingers interlocked;
Rotational rubbing of left thumb clasped in right palm and vice versa;
Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa;
Rinse hands with water;
Dry hands thoroughly. Use towel to turn off faucet; Your hands are now safe.

FIVE MOMENTS FOR HAND HYGIENE:

FORTIS MEMORIAL RESEARCH INSTITUTE,GURGAONFortis Memorial Research Institute (FMRI) is a multi-super-speciality, quaternary care hospital with an enviable international faculty, reputed clinicians, including super-sub-specialists and speciality nurses, supported by cutting–edge technology.

A premium referral hospital, it endeavours to be the ‘Mecca of Healthcare’ for Asia Pacific and beyond. Set on a spacious 11-acre campus with 1000 beds, this ‘Next Generation Hospital’ is built on the foundation of ‘Trust’ and rests on four strong pillars: Talent, Technology, Service and Infrastructure.

Management
Dr. Ritu Garg-Zonal Director Fortis Memorial Research Institute
Mr. Deepak Sanan-Head, Finance
Ritu Verma-Head, Human Resources
Affiliations & Accreditations
National- NABH
International- JCI
QUALITY POLICY OF FMRI GURGAON:
FMRI is committed to treat all patients and caregivers with compassion, integrity, teamwork and honesty. Hospital endeavour to achieve high standards of medical care through a quality improvement system. Strives to improve and sustain patient satisfaction, patient safety and clinical outcomes.

Patient Safety and Quality Measures:
FMRI has been by accreditated NABH. They measure, monitor and analyze 64 indicators (Clinical and Non-Clinical Indicators). They have defined Process Audits for Service and Clinical Parameters under Fortis operating System and Medical Operating System respectively. Regular monthly audits are also done and data presented in the Validation meetings. Compliance to high risk medicines and maintain a Medication safety Scorecard, Compliance Scorecard for consents is being checked regularly. Safe surgery checklist and mortality are also maintained.

They have18 committees to ensure protocols are adhered and action taken whenever there is deviation:
Infection Control, Pharmacy and Therapeutic, Safety Committee, HR Committee, Quality and Patient safety Committee etc
Quality policy
Committed to treat patients and their caregivers with compassion ,integrity,teamwork and honesty.

Endeavour to achieve high standards of medical care through ethical and effective quality improvement system.

Strive to continuously improve and sustain clinical outcomes,patient safety and patient satisfaction.

Quality objective
To practice patient centric approach
To ensure safety of patient,employees and other service providers.

To monitor ,measure ,assess and improve our performance to achieve service,clinical excellance and patient satisfaction.

To provide a platform for continuous learning at all levels of the organization.

To empower and involve all employees in continuous quality improvement.

“TO STUDY CRITICAL EQUIPMENT DOWNTIME & MAINTENANCE OF CALL LOG REGISTER AS PER NABH GUIDELINES,FINDING GAPS AND GIVING RECOMMENDATIONS”
INTRODUCTION
Critical Equipment
Critical equipment is essential for patient care under normal operating conditions and whose failure could cause imminent serious injury or death to patients or users.

Critical downtime
Downtime is broadly defined as the time during which a critical equipment is unavailable for use as a result of a malfunction (unplanned) or regular preventive maintenance (planned).

It is the summation of problem realization time by the technician, diagnosis time by the engineer, logistic time, and alignment time of spare parts.

Planned Downtime
Planned downtime occurs in a controlled fashion. It ensure all users are aware of any upcoming downtimes and expected duration of downtimes. Planned downtime for regular maintenance may be required from time to time, but is kept to a minimum.

Unplanned Downtime
Unplanned downtime occurs as a result of unforeseen circumstances such as power failures, hardware failures or software failures.

REVIEW OF LITERARTURE
Downtime Reduction on Medical Equipment Maintenance at The Directorate of Biomedical Engineering in the Jordanian MOH(A. Al-Bashir ,A. Al-Tawarah, A. Abdul Jawwad)
-In this analysis sixteen fault classes were identified; depending on the specific (or main) corrective action carried out by CMMS. These included: electrical, mechanical, electronic, software, calibration, installation, transportation, accessories, cleaning, environment, user fault, misuse, false alarm, scrap, training, and other (unclassifiable).

Downtime in Digital Hospitals: An Analysis of Patterns and Causes Over 33 Months (Jessica CHENa, Ying WANGb and Farah MAGRABI )
-Of the 128 events analysed, all but one were unplanned (n=127). The total downtime associated with these 41 events was 147 hours and 22 minutes over the 33-month period . Analysis of temporal patterns showed that 51% of total downtime was between 9 am and 5 pm; 90% in 2010, 24% in 2011, and 11% in 2012 .Downtime was unevenly distributed over the week with 68% of downtime occurring on weekdays. In 2010, 85% of downtime occurred on weekdays, 94% in 2011, and 31% in 2012. In 2012, 69% of downtime was on a Saturday.

-On average, the hospital experienced 49 hours of disruption per year which is almost double the 25 hours of annual downtime typically experienced by organisations in other industries
A Study of Current Maintenance Strategies and the Reliability of Critical Medical Equipment in Hospitals in Relation to Patient Outcomes-Khelood A. Mkalaf, Peter Gibson, John Flanagan
This study examined 14 CME ,total of 5769 devices.8% were new,57.6% had one to four year of use and 39.6% had over 5 years of use.

The reasons for the failure of this equipment were classified in the survey into three types from this survey ; technical cause 43.67%,human error 52.73%, and over use 3.6%.

Failure mode and effects analysis applied to the maintenance and repair of anesthetic equipment inanaustere medical environment
Michael A. Rosen, Benjamin H. Lee, John B. Sampson, Rahul Koka, Adaora M. Chima, Onyebuchi U. Ogbuagu, Megan K. Marx, Thaim B. Kamara, Michael Koroma And Eric V. Jackson
-The participating biomedical engineers identi?ed a number of critical barriers to effective maintenance and repair . The highest perceived barrier was access to spare parts, including air ?lters and oxygen sensors, as well as lack of availability of proper repair tools. Each department had access to only one set of repair tools for multiple technicians. Communication between biomedical engineers and clinical staff was also identi?ed as a frequent and critical failure mode. This failure manifested in two primary ways. First, as the biomedical engineering department was a relatively new entity, a formal, written reporting system was not in place, and breakdowns in verbal communication caused delays in repairs and missing reports. Second, biomedical engineering reported a hesitancy of clinical staff to report malfunctioning equipment. They reported multiple instances of staff failure to report malfunctioning equipment even when asked directly about its status. The engineers’ interpretation was that clinicians feared that they would be blamed for the failure or malfunction of the machine/device or held personally accountable for the cost of repairs or replacement. Two additional themes emerged. First, engineering accessto the UAM (Universal Anaesthesia Machine) was limited because of its high rate of use in surgical cases. Biomedical technicians did not have ready access to the attire required (scrubs) to enter the operating theater. Second,
biomedical engineers perceived that a high frequency of use errors caused equipment damage (e.g. improper handling of different types of sensor leads, including pulse oximetry) and compounded theirchallenge of scarce replacement parts
Failures of Medical Equipment
NMCHC (1999) Sample, n= 85
Islamabad Children’s Hospital (1993) Sample, n= 63
In case of NMCHC, equipment failure had remarkably decreased after implementation of maintenance system, and the EUR has been maintaining at 85-90%.Failures due to inappropriate operation in NMCHC account for 19% of all the failure cases, which was high compared to 8% of those at Islamabad Children’s Hospital.The failures due to inadequate maintenance in NMCHC account for 59% of all the failure cases. The same failures in Islamabad Children’s Hospital accounted for 64%.In both hospitals, failure caused by inadequate maintenance, inappropriate handling, environmental stress and wear-out failure totals 80% and above.
Critical Equipment List
Life-support equipment such as Ventilators,
Resuscitation equipment such as Defibrillators
Mission-critical equipment such as a CT scanner
Dialysis systems,
Steam sterilizer, high speed
Drill, Neuro
infusion pump/syringe pump
Heart Lung machine
Cardiac saw
Electrosurgical unit
Multiple gas monitors
Operating microscopes
Linear accelerators
Physiological monitoring system
BiPAPAnesthesia machine
Crash carts
Incubators
Suction machines/aspirators
Medical gases
AMBU emergency case
Objective:
To track the Critical equipment downtime
To find gaps in handling complain call register
To study and validate the response time for critical equipment
To study the frequency of breakdown and reduce the equipment downtime
To find the root causes of equipment downtime
Recommend ways to bridge the gaps.
Research Question
Primary Research Question –
-What is the total number of equipment downtime in last 3 months?
Secondary Research Question-
-What are the root causes of major equipment downtime?
-How to minimize the critical equipment frequency of breakdown and reduce the magnitude of equipment downtime?
Research Methods — Quantitaive Analysis.Study time: 3 months
Study type: Observational Study.
Data collection : Respective Departments and Biomedical engineering Department.
Total number of downtime during study period:
MONTH January February March
NO.OF DOWNTIME 127 126 139
Total number of downtime during study period:

Figure SEQ Figure * ARABIC 1: FREQUENCY OF DOWNTIME PER MONTH
Total number of hours in downtime:
January – 57 hrs:40 min Average- 27 min
February – 126 hrs Average- 1hr
March -139 hrs Average -1hr
Department wise complaint
DEPARTMENT JANUARY FEBRUARY MARCH
OT 6 12 11
ICU 79 57 76
3RD FLOOR 1 2 3
4TH FLOOR 2 2 3
5TH FLOOR 6 3 4
BME 0 1 0
BRONCHOSCOPY 0 1 1
CATHLAB 2 4 2
CHEMO 4 4 0
CSSD 2 3 6
DSA LAB 1 2 0
EMERGENCY 8 4 5
ENDOSCOPY 0 1 1
H4U 1 2 2
LDR 2 2 0
NM 4 10 6
NGW 0 1 1
NIC 0 1 2
OPD LG 0 0 2
RADIOLOGY 9 14 13
No.Of Downtime

Figure SEQ Figure * ARABIC 2: Number Of Downtime Department Wise
Equipment wise complaint :EQUIPMENTS JANUARY FEBRUARY MARCH
Anaesthesia Machine 4 8 6
BIPAP 0 0 1
ABG Machine 28 26 28
Ventilator 25 25 25
Infusion Pump 6 5 10
DSA Lab 0 2 0
EEG LAPTOP 0 0 1
EBUS SYSTEM 0 0 1
MRI Machine 3 1 2
PET CT 2 4 2
ECG Machine 10 11 11
Autoclave Machine 2 3 7
OPERATION MICROSCOPE 0 0 2
CR SYSTEM 0 0 1
Digital x-ray 2 3 1
Mammography 0 2 0
CTG Machine 0 2 0
Plasma Sterilizer 0 2 0
Syringe Pump 7 7 0
Defibrilator5 1 6
Multipara Monitor 25 3 15
Gamma Camera 2 7 4
Ultrasound Machine 5 6 9
Broncoscopy0 1 0
Washer Disinfecter0 1 0
Flouroscopy0 1 0
ECHO Machine 0 2 1
Endoscopy 0 1 0
MRI Workstation 0 1 0
CATHLAB 1 0 0
PRINTER 0 0 3
C ARM 0 0 1
HUMIDIFIER 0 0 1
January Equipment Downtime:
No.Of Downtime
EQUIPMENTS

Figure SEQ Figure * ARABIC 3: Number Of Downtime Equipment Wise In The Month Of January
February Equipment Downtime:
No.Of Downtime

Figure SEQ Figure * ARABIC 4: Number Of Downtime Equipment Wise In The Month Of February
March Equipment Downtime:

Figure SEQ Figure * ARABIC 5: Number Of Downtime Equipment Wise In The Month Of March
Maintenance of complain log register:
DEPARTMENTS REGISTER MAINTAINED
ICU 4 Maintained
ICU 5 Maintained
ICU 6 Maintained
ICU 7 No register
ICU 8 Maintained
ICU 9 Register not updated
BMT ICU Maintained
PICU Maintained
OT Register not updated
NICU Maintained
5TH FLOOR Maintained
4TH FLOOR Maintained
3RD FLOOR Maintained
EMERGENCY Maintained
CSSD No Register
RADIOLOGY Maintained
LDR Maintained
NM No Register
CHEMO Maintained
CATH LAB Maintained
ENDOSCOPY Maintained
H4U Register not updated
DSA LAB Register not updated
NGW Maintained
BME Maintained
BRONCHOSCOPY Register not updated
NIC No Register
OPD LG Register not updated
Nightangle ward Maintained
Physio Department Outsource
Ophthalmology Maintained

Figure 6: Graph Showing Maintainance Of Complain Log Register In Departments
GAPS/ROOT CAUSES
Improper maintenance of critical equipment downtime system records by respective departments.

No proper checklist provided to users/maintainers.

Mismatch between uptime of equipment’s by biomedical department and respective department.
Mishandling of equipment’s by users.

Frequent repairs of obsolete & unreliable equipment’s.
CQI forms incomplete.
Complaint log registers not updated or maintained by respective departments
There was no operating Checklist provided to users
Gap found in CQI forms:
CQI forms incomplete:
Factors which contributed to that event not documented
Analysis summary not documented
Actions required to prevent such incidents occurring in future not documented
Category: A to I is not filled in every forms
Category: D to I: RCA form should be attached
Components of a maintenance program

Critical factors in planning a maintenance programmeMethodology
Identi? cation of the method by which maintenance will be provided to the items included in the programme.

Resources
The ?nancial, physical, and human resources available to the programme.Inventory
The types and numbers of medical devices to be tracked by the hospital and those that are speci? cally included in the maintenance programme.

Involve Managers and users:
Involve the people in charge of purchasing and storing equipment and also with those in overall charge of the institution. It is important to explain that day to day maintenance tasks cannot solve all of the problems.Even a small amount of water or other liquid falling on critical equipment can result in total shutdown until it has been cleaned, tested and recertified.
If a major problem occurs, trained technical help will be needed. Plan for the whole life cycle of equipment. People need to know WHAT to do, WHEN to do it and WHO is going to do it. Users must be allowed time in their regular schedule to carry out these tasks they will not take long, but the benefits will be enormous. In each department, it will be helpful to assign responsibility for each item of equipment.

Maintenance
Plan the tasks
-The maintenance tasks are placed in daily and weekly checklists.

Display the lists
-The maintenance checklists are designed to fit on a single page per section. This makes it easy to print or copy them and display them near the equipment. The lists will only be useful if they are easy to see, so placing them on the equipment or on a wall nearby will be best.

Record the work/inspection
– Some way of recording when maintenance should be done.

Tags and labels
A label indicates the date the device was serviced or inspected and may indicate when the next service is due and the procedure that is to be performed. These tags are sometimes printed in different colours, one for each year or inspection cycle so that it is easier to identify devices that are due for inspection. This tag may be covered with plastic adhesive/cover to protect it from being defaced during the cleaning process.

This helps readily identify which equipment is next due for inspection.

Mean time between failures. The average time elapsed between failures.

Repeated failures. The number of failures within a speci? ed period of time.

Response time. The time between a request for service and the start of repair.

Repair time. The time between the start and ? nish of repair.

Downtime. The percentage of time that a device was out of service.

Effective Maintenance Strategy
User as well as service manuals
Training to technicians and operators.
Providing user / operating manuals.
Providing service / maintenance manuals
Receipt and incoming inspection
Inventory and documentation
Installation and final acceptance
Equipment history
Maintenance
Condemnation of old and obsolete equipment
Types and approaches to Maintenance of Medical Equipment:
There are two types of maintenance:
Corrective Maintenance (or Repair) -This is done to take corrective action in the event of a breakdown of the equipment. The equipment is returned repaired and calibrated.
Planned (or Scheduled) Preventive Maintenance -This work is done in a planned way before repair is required and the scheduled time for the work circulated well in advance. It involves cleaning, regular function / safety tests and makes sure that any problems are picked up while they are still small.
Planned Maintenance of Medical Equipment
Planned preventive maintenance is regular, repetitive work done at scheduled intervals to keep equipment in good working condition. The activities under preventive maintenance involve routine cleaning, calibrating and adjusting, checking for wear and tear and lubricating to optimize working efficiency and to avoid breakdown. Also consumables replacement like the fitting of new of filters etc. is done as part of this work.

An equipment inventory
Definition of maintenance tasks
Establishing intervals of maintenance
Personnel
Reminder system
Special test equipment
Surveillance
Planning User Maintenance Tasks
The tasks are separated into Daily and Weekly tables in order to help users plan a routine of inspections.
User Maintenance Checklist
Daily
Cleaning
Remove any dust / dirt with dry cloth
Remove water and waste matter from inside
Audio-Visual checks
If any leak is audible, check with soapy solution
Check all seals, connectors, adapters and parts are tight
Check all moving parts move freely, all holes are unblocked
Check that battery charge indicator, power indicator and patient cable connector indicators are working
Function checks
Report any faults to technician immediately
Check the calibration of machine before use using 1mV pulse
After use, depressurize system and replace all caps / covers
Weekly
Cleaning
Clean the printing head
Clean inside and outside with damp cloth and dry off
Audio-Visual checks
Check connections for leakage with soap solution and dry off
Inspect filters, clean or replace if needed.
Check all fittings for proper assembly
Replace soda lime if it has turned blue
Replace any deteriorated hoses and tubing
If seal, plug, cable or socket are damaged, replace
Function checks When next used, check pressure gauges rise
When next used, check there are no leaks
Every six months Biomedical Technician check
Spare Procurement Time
The biggest challenge is in reducing the spare procurement time.The downtime can be checked and controlled at the time of negotiation of medical equipment procurement with the vendor by incorporating uptime guarantee (usually from 95-99 per cent) and having downtime penalty clearly specified in the purchase order.

Disposal of Equipment
Equipment should be declared obsolete or unserviceable if it is:
Unserviceable or unreliable – If equipment cannot be repaired (either no parts available or not economical to repair) or it cannot be maintained properly it should be scrapped and replaced.
Obsolete -When equipment is not usable because parts are out of date or the clinical technique is no longer recommended it should be scrapped.
Damaged through negligence or abuse -Where abuse of equipment is suspected, this should be reported to management and the equipment taken out of use.
Beyond its prescribed life period – Examine the condition of the equipment to see whether the item could be put to further use and if not they will declaring the item obsolete/surplus or unserviceable as appropriate.

Report of surplus, Obsolete and Unserviceable Stores for Disposal
Item No. Particulars of Stores Quantity Purchase price Condition ; year of purchase Mode of disposal
(auction,sale,tender) Remarks
Guidelines Followed In Critical Call Alert System As Per SOP:
S.O.P:CRITICAL=10 minSEMICRITICAL=10-15 min
Figure 7:Protocol Followed On Critical Call Alert For Equipment Downtime
What should be done:Maintain schedule preventive maintenance report.

Equipment transfer slip should be maintained
Equipment under repairing should be maintained, it can increase traceability.

Disposal forms register should be updated
Do’s and Don’t typical regarding equipment should be displayed in every department.

Operating checklist to be provided in different departments to users/maintainers.

Implementation of IT in the hospital.

Suggestions:

Decrease frequency of downtime Decrease magnitude of downtime
Regular maintenance Effective training programmes.
Provide checklist to users ; maintainers Fast spare procurements.
Pre-screening of equipment Up gradation of inventory.
Discard/dispose equipment with frequent downtime Scheduled ; unscheduled maintenance
Regular update of downtime register records. Hospital equipment management system:
It is a management cycle that starts from planning, procurement, acquisition, installation, commission, decommissioning and final disposal of hospital equipment
ChallengeSolutionOutcomesLonger downtime of equipmentData privacyDelayed fault reportingAbsence of evidence-based information system Implementing planned preventive maintenance (PPM) policiesHospital equipment management systemImprove performance in productivity, quality, ; morale lead to increased profitabilityImproved safety and equipment availabilityTo provide a solid foundation to build continuous improvement
Figure 8: Hospital equipment management system
Co-authoring:
This allows multiple users to edit a spreadsheet at the same time.

ChallengeSolutionOutcomesIts allows multiple users to edit spreadsheet at the same time, so, can cause data mishandlingAnyone can make changes in the data spreadsheetA shared storage areaCan increase the efficiency of nurses and the biomedical engineer as it does not require to update manuallyImprove efficiency of the nurses as the complain data should not be maintained in registerReduce the manual workEasy to access for all the department
Figure 9: Co-authoring
CMMS:
Computerized Maintenance Management system: CMMS is a software package that maintains a computer database of information about maintenance operations
CMMS is used by clinical engineers to collect, store and analyze data on the inventory, corrective and preventive maintenance in addition to other activities related to medical devices
ChallengeSolutionOutcomesActively manage medical equipment to reduce failures, downtime, support, use errors ; improve patient care quality ; safetyCMMS should be able to collate, analyse for emergent situations.Maintain operations with increased transparencyPrevent and predict equipment failureImprove labor productivityScheduled ; unscheduled maintenanceTechnicians /nurses who comprise work crews possess varying degrees of experience, computer literacy, and capabilitySolid wi-fi connection
Figure 10: CMMS
REFERENCES:
www.fortishealthcare.comwww.online-journals.org
www.pubmed.comwww.researchgate.net
www.wikipedia.comwww.who.int
[email protected]