Equipment Management County Durham

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Equipment ManagementCounty Durham
Darlington Foundation Trust(C.D.D.F.T.)
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C.D.D.F.T.

• Organisational Statistics
• Serves a population of 500,000
• Number of in-patients treated per year 83,314
• Employs 6000 staff
• Annual Income 330 million

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C.D.D.F.T.
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Background

• Medical Devices Policy - HSJ Award 2005
• also related policies Infusion Device
  Policy and
• Training Competency Policy for Medical
  Devices.
• Established Network of Equipment Controllers
• Medical Devices Group review of MHRA alerts
  with Risk Management, review of Trust incident
  reports with Patient Safety Managers.
• Clinical Engineering Team Leaders monthly
  review of medical devices related incidents.

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Background

• 2003/2004 early stages of amalgamation of other
  sites into what is now County Durham Darlington
  Foundation Trust (C.D.D.F.T.)
• Various types of equipment were in use across the
  developing Trust prompting the introduction of a
  standardisation programme.

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Background

• Decision made to centralise some equipment,
  initially on one Trust site - Darlington
• Prior to this, infusion devices and pressure
  relief systems were with users, stored on wards.
• An audit of infusion device usage was carried out
• Results mirrored the NPSA audit Pilot Study
  (2004) - that at any one time there was 65
  non-utilisation
• Pressure relief systems were purchased based on
  utilisation of rental equipment.

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Central Equipment Loan Library(C.E.L.L.)

• In October 2004 the Central Equipment Loan
  Library (C.E.L.L.) was opened at Darlington
• Pressure relief systems and infusion devices
  chosen
• The service included visual checks of the
  equipment, cleaning/decontamination and tracking
  of individual patient use via an electronic
  database, providing audit trails.
• C.E.L.L. based in Clinical Engineering Dept
  making it easy for equipment to be located for
  Planned preventative maintenance (P.P.M.) and
  relevant repairs/service to be carried out

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Equipment Tracking
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C.E.L.L.
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C.E.L.L.
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Pressure Relief Mattress Systems (P.R.S.)

• PRS are requested from C.E.L.L. by ward staff
  following patient evaluation and delivered by
  C.E.L.L. staff
• Patient details and ward location are recorded
  against the PRS asset reference. The individual
  base cover and top cover numbers are also
  recorded providing audit trail.

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Pressure Relief Mattress Systems(P.R.S.)

• In 2008 the provision of P.R.S was expanded to
  another Trust site twelve miles away by operating
  a satellite service from the Darlington site.
• Deliveries and collections are made at least
  three times per week.
• P.R.S. are distributed via the Linen Bank,
  patient details sent to Darlington to be added to
  the data base.

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Pressure Relief Mattress Systems(P.R.S.)

• 2009 another C.E.L.L. opened at the University
  Hospital of North Durham (UHND), providing the
  same service.
• 2010 further satellite service for P.R.S. from
  UHND opened providing equipment to Chester le
  Street Hospital and Shotley Bridge Hospital.
• Training is provided by both the Medical Devices
  Nurses and the Tissue Viability Team in
  conjunction with the manufacturer.
• Mandatory Training changed with the addition of a
  Medical Devices workshop.

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P.R.S. Inventory

• January 2005 ninety five pressure relief
  mattresses across seven different products
• June 2011 three hundred and forty mattresses
  across four different products plus seat cushions

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Utilisation

• P.R.S. utilisation for first full financial year
  2005 -2006 18,796 bed days
• P.R.S. utilisation for 2010 2011 financial
  year 67,211 bed days

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Pressure Ulcer Prevalence
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High Risk WLSgt20
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Tissue Viability

• Development of Tissue Viability team in 2004
  2006
• Replacement of all Kings fund bed frames for
  electronic profiling bed frames
• Replacement of standard hospital mattress for
  pressure reducing foams as standard for all
  patients
• Annual audit of all surfaces ie. Mattresses,
  chairs, trolleys etc
• From 2011 monthly auditing of all mattresses

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Falls
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Harm Rates/Morbidity

• Global Trigger Tool and Mortality 3 x 2 used
  every month,
• Minimum of 50 case note reviews 3.2 for
  2010/2011
• Any equipment issues identified from audits are
  actioned.

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Infusion Devices

• The infusion device standardisation programme was
  completed October 2010
• The general areas all use the same model of
  infusion devices that are configured the same
  Trust wide.
• Specialist areas also use the same models which
  are also configured the same Trust wide.
• Competency based training is provided monthly on
  a rotational site basis

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Infusion Devices

• At DMH and UHND, infusion devices for the general
  areas are accessed by requesting them from CELL.
• Patient details and ward location are recorded on
  the electronic database against the device asset
  number, providing an audit trail.
• Devices are easily made available for P.P.M due
  to proximity of Clinical Engineering Dept.
• Although no metrics gathered, anecdotally harm
  incidents have reduced

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The Way Ahead

• Since August 2010 Clinical Engineering services
  have been working in the PCT with Medical Devices
  Nurse (Community) to review and develop an up to
  date inventory of equipment for P.P.M
• April 2011 PCT integrated into C.D.D.F.T.
• Medical Devices Nurse (Acute) and Medical Devices
  Nurse (Community) now working together in the
  same Trust.

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The Way Ahead

• Several work streams have been identified and are
  being developed including
• Using the Community equipment inventory to
  develop a Training Needs Analysis (T.N.A.) for
  Community Division and incorporating it into the
  already established T.N.A. for the Acute
  Divisions
• Identifying and including Equipment Controllers
  (Link staff) for medical devices from the
  Community sector and including them in the
  already established Equipment Controller list
  facilities and training.
• Identifying Community sector representatives to
  established Medical Devices Group
• Standardisation of equipment to ensure smooth
  transition of patients between the Community
  Acute settings. There is ongoing work with
  Palliative Care Team to reduce readmissions
  through availability of equipment and the care
  pathways.
• Operating satellite services for P.R.S to
  Community Hospitals

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The Way Ahead

• Introduction of Guardrails a patient safety
  dosing system, to infusion devices
• Introduction of the McKinley T34 ambulatory pump
  into the Acute Divisions already established in
  the Community Divisions

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Other Teams Working to Reduce Harm

• Clinical Procurement Standardisation Group 150
  commonly used consumables
• Latex Reduction Group
• Tracheostomy Care In response to an alert from
  a coroner about patients with tracheotomy a
  multi-disciplinary group was established to
  review the key learning points. Any gaps were
  then actioned.
• An insulin device guide has been produced UHND
  after gaps were identified in clinical staffs
  awareness and knowledge of the multiple devices
  currently available.
• The development of the PYJown making it easier
  for patients to dress, but also maintaining
  dignity and allowing access for I.V extension
  lines.

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Clinical Engineering Team
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