Raising the Profile of Clinical Engineering 17th May 2002

From Trust to Region: A Clinical Engineering Perspective Dr George Dempsey, Head of Clinical Engineering & Physiological Sciences, N.I
Regional Medical Physics Agency, East Wing, Royal Victoria Hospital, Belfast BT12 6BA Tel: +44 (0)28 9026 3240 Fax: +44 (0)28 9032 2290 Email: george.Dempsey@royalhospitals.n-i.nhs.uk For many the role of the clinical engineer is seen as one who provides direct support in patient care and advancing technology and services through the exploitation of engineering skills. However, the engineer’s management and advisory skills can indirectly contribute to improving the overall quality of patient care and cost effectiveness within the health service. In N.Ireland clinical engineering has remained underdeveloped with the majority of 18 HSS Trusts dependent on external commercial service maintenance providers and Trust Estate departments having responsibility for medical device management. In 1994, the Medical Physics Agency was formed to provide regional support in a number of specialist areas including clinical engineering and physiological sciences. Todate, the engineering service provides limited equipment maintenance. However, the professional management has significantly contributed to the development of policies and practices in two of the Trusts and more recently is supporting and developing the environment and system tools for more effective medical device management within the largest Trust in the province. A recent regional survey highlighted the need for improvement in more effective equipment management across the Trusts and the Medical Physics Agency in collaboration with the Health Estates Agency have now managed to develop a regional forum group, within which a clinical engineer will play a key role. Rather than adopting to change there are opportunities as described where the clinical engineer can effect change and in doing so raises the profile of the profession and the benefits it can bring to the healthcare service.

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A New Breed? Dr Stephen Young, Clinical Scientist, Clinical Engineering Charing Cross Hospital
Fulham Palace Road London W6 8R Tel: +44 (0)20 8846 1924 Fax: + 44 (0)20 8846 1220 bleep (int. 5790) 07693 007085 E-mail syoung@hhnt.org One way of raising your profile is professionalisation - eg ODP's, with recognised national bodies and mandatory training. But we would have to agree what sort of training. The problem is that traditional tasks for EBME departments included: • Rigorous acceptance testing - new products rejected if they do not meet standards • In-house workshop-based planned maintenance - equipment withdrawn from service for checks • Component level repairs in workshop, fixing unreliable devices while in service, eg in theatres and ICU's • Equipment modification to suit user needs - eg design and build of mains supplies for battery-powered devices, fabrication of brackets and stands in metal workshop • Electronic and software research and development - novel devices and locally written databases programs are eg's. Staffing: bosses = graduate engineers, workers = electronics technicians with apprenticeship/HNC. Workers happiest trouble-shooting and doing long complex repairs. But in an updated Clinical Engineering Dept (like ours) we have: • Close involvement in tendering and purchasing - user issues, diversity addressed. New equipment commissioned and licensed. • User issues - training and assisting in meeting trust guidelines • Planned maintenance for critical equipment out-sourced. General standards maintained by ward care visits under ISO quality system. • Repairs triaged - complex repairs out-sourced. Old or unreliable equipment decommissioned and replaced. • Risk management and regulatory compliance (eg Controls Assurance) are major activities. • Performance bench-marked against similar trusts - research efforts in training and performance monitoring areas. Staffing: bosses must be able to get their hands on and control big budgets for equipment updating, and have a wide role in guiding trust senior management. A boss with no engineering background at all will find himself at a frequent disadvantage with his colleagues, and will never be able to command the respect of the workers in the same way that an equivalent engineer might. Workers: need to be comfortable out on wards relating to clinical staff, delivering training. Need background in science physics medical engineering and physiology, but not detailed knowledge of electronics.

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To raise our profile we need to agree what the core functions of an in-house Clinical Engineering Department are, and to put in place NOS career and training structures for the new breed of Clinical Engineer.

Planning a New Hospital - An Executive Board Presentation Dr Andy Nevill MIPEM MIEE SRCS Ceng, Head of Clinical Technology North
Staffordshire Hospital (NHS) Trust, City General, Newcastle Road, Stoke on Trent, Staffordshire ST4 6QG Tel: +44 (0)1782 553480 Fax: +44 (0)1782 552182 Email: AndyNevill@compuserve.com For the foreseeable future, the only way to finance a new hospital or major capital development is through a Private Finance Initiative. It is becoming increasingly important to consider medical equipment as part of these initiatives, and the clinical engineering community needs to embrace these opportunities. This means getting involved, understanding what it all means, being part of the solution and influencing Trust boards. It can also mean tough decisions for Trusts. This is a presentation which was given to the executive board at North Staffordshire Hospitals (NHS) Trust in January 2002 in order to encourage decisions around future equipping and service provision strategies for the new hospital which is being planned for 2008. By May 2002, the Trust will have received feedback on the success, or otherwise, of its Outline Business Case (OBC) submission.

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Taking Control of Medical Equipment Purchasing Ms Emer Brangan*, Lindsay Grant*, David Hyde*, Andrew Taylor†
* Department of Medical Physics, Royal United Hospital, Combe Park, Bath BA1 3NG Tel: +44 (0)1225 824 091 Fax: +44 (0)1225 447 535 Email: emer.brangan@ruh-bath.swest.nhs.uk † Department of Clinical Biochemistry, Royal United Hospital, Bath The Medical Equipment Committee at the Royal United Hospital, Bath, has over the last 2 years taken firmer control of the purchase of medical equipment in the Trust. This development has been greatly assisted by the clinical engineering department, and the systems we have put in place. Using information technology, loop holes have been closed and greater access to the committee has been given to staff at all levels in all areas. Prioritisation of the allocation of funds across the Trust has been improved, and the use of tracking systems has prevented funds being lost because of delays. The easy availability of data has highlighted the disparity between funding available and the equipment required in the Trust, and has put the committee in a stronger position when budgets are being allocated. The implementation of a risk analysis process for all equipment bids will strengthen this position further. The clinical engineering section have noted an increase in the number of pre-purchase enquiries regarding medical equipment from staff. Increased use of the expertise in the section is leading to better equipment choices, and greater standardisation. The supplies department have also become aware of the need to ensure clinical engineering advice has been sought, thus helping to enforce the system. The contact the committee has with staff at all levels within the organisation has led to greater management support for the strategies of the clinical engineering section relating to equipment management within the Trust.

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Training, A Vehicle for Raising the Profile of Clinical Engineering Mr Justin McCarthy, Bryan Hicks, Roger Jones, Stephen Keay.
Clinical Engineering, University Hospital of Wales, Cardiff & Vale NHS Trust, Cardiff CF14 5QQ Tel: +44 (0)292 074 8502 Fax: +44 (0)292 074 8550 Email: Justin.mccarthy@uhw-tr.wales.nhs.uk Training in the safe use of medical equipment, especially infusion pumps has become a high profile issue within the UK NHS. A number of Trusts have had Improvement Notices served on them by HSE either following incidents (some fatal) or following HSE inspections. Training in the proper use of equipment is part of equipment management. The role of Clinical Engineering is to provide equipment management not just equipment maintenance. It follows, therefore, that the task of organising and delivering medical equipment training should fall to Clinical Engineering departments. This presentation aims to show why Clinical Engineering departments should embrace this task and the benefits, including raising the profile, that can be realised by ensuring a close integration of training with other aspects of equipment management.

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Equipment Training - Quantification Through Risk Based Models Mr Paul Robbins, Electro Medical Services Manager, Papworth Hospital, Papworth,
Cambridgeshire CB3 8RE Tel: +44 (0)1480 830 541 ext 4419 Fax: +44(0)1480 364 731 Email: paul.robbins@papworth-tr.anglox.nhs.uk Peter Chatfield Risk Manager – Papworth Hospital Anne Carter Directorate Manager – Portsmouth Hospitals NHS Trust (Formally CNST Manager – Papworth Hospital) Evidence based activities in modern healthcare are becoming prevalent. Long gone are the days when “Trust me I am a doctor” or “We’ve always done it this way” could act as a suitable defence when challenged about organisational activity). The requirements of CNST and Controls Assurance coupled with recent legal actions and organisational requirements under Consumer Protection Act and Health & Safety legislation are forcing organisations to elevate the questions and concepts of equipment training even higher up on the scale of organisational priorities. But the question is what is the right approach, are schemes covering every aspect of every device really the most effective way forward? This paper will explain how one organisation has invented and adopted a multidisciplinary approach using sound risk based methodologies which has been recognised as an exemplar approach by the CNST assessment bodies to quantifying its training requirements. Further indications will be given showing how with little modification the same model can be used to provide a risk-based assessment of the equipment to ensure maximum uptime and maximum equipment value for money.

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Don’t Cry Wolf, Cinderella - Will the NPSA Help Turn Risk Assessments into Opportunity Knocks? Dr Daniel Clark, Medical Physics Department, Nottingham City Hospital NHS Trust,
Derby Road, Nottingham NG7 2UH Email: dclark1@ncht.trent.nhs.uk With the National Patients Safety Authority about to make a significant impact on incident reporting in trusts, now might be a good time to place risk-managed processes back on everyone’s agenda. The modern NHS is a minefield of risks and litigations, of inspections and selfassessments, of audits and standards. The potential for doing serious harm to one’s self, one’s trust or one’s chief executive officer (not to mention the patient) would appear to be ever increasing. Why is it then that all things health and safety are still so often perceived as necessary evils? Why are the vast majority of healthcare professionals still reluctant to engage in a risk-managed approach to the provision of services? And how can Clinical Engineering – the unnoticed, unloved Cinderella service - make a difference? Working within quality systems, assessing hazards and managing risks as a natural part of our working life, Clinical Engineering and Equipment Management teams have the skills, experience and aptitude to educate staff and help implement trust-wide riskmanaged schemes. Moreover, Clinical Engineering and Equipment Management already engage with every ward and department within the hospital. Who then is better placed to effect this cultural change? So, if the NPSA is going to make trusts look again at reporting and learning from incidents and risks, then Clinical Engineers need to be ready to play a central role in this process.

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Profile Control = Salesmanship; Why we should Sell our Profession and How Dr Bruce Bartup, Clinical Engineering Section, Medical Physics Department, Guy’s
Hospital, Cunliffe Labs, Thomas’ Street, London SE1 9RT Tel: +44 (0)207 955 5000 ext. 5375 Fax: +44 (0)207 955 4213 Email: bruce.bartup@gstt.sthames.nhs.uk This paper will present a general motive and some possible general means for the promotion of Clinical Engineering. RAISING TH PROFILE = PROMOTION = SALES, MARKETING, PUBLIC RELATIONS E WHY PROMOTE CLINICAL ENGINEERING? Premises Opportunities to improve lives and save money can only be fully exploited if key staff know, trust and admire Clinical Engineers. Clinical Engineers act in the interests of patients and employer (for example to improve lives and save money). Promotion, or salesmanship, is a skill. Competition will tend to remove Clinical Engineering sections with low promotional skills Conclusion Clinical Engineers can do a better job by proficient salesmanship. WHY US? No one else to do it We need to be in control Clinical Engineers are ready HOW TO PROMOTE CLINICAL ENGINEERING CAVEAT VENDITOR GOALS - PLANS - COMMITMENT POSITIONING Define the Product. Identify the M arket. Identify sales Prospects. Make use of opportunities. Take the initiative THE ‘SALE’ Questions and listening Timing Dealing with objections and building confidence THE LONG TERM: PUBLIC RELATIONS, SPIN, KNOWING WHEN TO DUCK? CAN I SIGN YOU UP TODAY?

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Cross Institutional Initiatives in Raising the Visibility of Clinical Engineering Professor Robert Allen, Chairman of AIME, Institute of Sound and Vibration
Research, University of Southampton, Highfield, Southampton SO17 1BJ Tel: +44 (0) 23 8059 3746 Fax: +44 (0) 23 8059 3190 Email: ra@soton.ac.uk Why do we need to increase the profile of Clinical Engineers in particular ? Are they a special case ? Surely Medical Engineering in general would benefit from an increased profile – or would it ? Perhaps the problem is the word ‘Engineering’ ? Most observers would not consider ‘Clinical’ or ‘Medical’ to have a low profile. Engineer can, as we know, mean quite different things to different people and this is no doubt at the root of the problem – if one exists. Surely the Clinical Engineer must just turn up and fix things ? Certainly the Professional Engineering Institutions have been discussing the status of Engineers for many years, due to the fact that the title ‘Engineer’ has dropped considerably down the status hierarchy since the days of Stephenson or Brunel. Maybe high quality work will do most to improve the profile of Clinical Engineers in the long term, but this will clearly this will take time. This presentation will describe initiatives aimed at increasing, at least, the visibility of Medical Engineers. This is particularly important since Medical Engineering is a multidisciplinary, priority growth area which needs coordination. Whether increased visibility will enhance the profile of Clinical Engineers remains to be seen, but coordinated activities and a combined voice may lead to a greater recognition of the role and contribution of Clinical Engineers.

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The Requirement for Statutory Registration of Health and Social Professionals in Ireland - the Impact on Clinical Engineering Ms Meabh Smith *, McGivney J**, Grainger P†
*Capital Equipment Replacement Project, Beaumont Hospital, Dublin 9, Ireland Tel: +353 1 809 3372 Fax: +353 1 809 3967 Email: meabh.smith@beaumont.ie ** Physics Department, St Luke's Hospital, Dublin 6 † Medical Physics and Bioengineering Department, Adelaide, Meath incorporating National Childrens Hospital, Dublin 22 The Clinical Engineering Profession in Ireland has been blurred at the edges, both in terms of its relationship with other professions and even between the grades within the profession. Statutory Instrument 1, 1999 sets out the legal requirements for the professional registration of all Health and Social Professionals in Ireland. In 2000 the Department of Health and Children published a detailed document setting down the principles and guidelines for the implementation of Statutory Registration. This document has acted as a catalyst for a review of the profession of Clinical Engineering which has resulted in a series of significant developments in the profession of Clinical Engineering. Including the development of a well-defined structure for the professional formation and development of the Clinical Engineer incorporating training, education, registration and CPD. The impact in terms of raising the profile of Clinical Engineering is beginning to show and the benefits of "sharpening the edges" have already been felt. This paper expands on the impact of imminent Statutory Registration on the profession of Clinical Engineering.

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Raising the Profile: A Developing Role for IPEM Dr.C.Callicott and Mr.D.A.CookeΡ Medical Physics and Clinical Engineering,
Addenbrooke’s NHS Trust, Hills Road Cambridge CB2 2QQ Tel: +44 (0)1223 216 471 Fax: +44 (0)1223 217 029 Email: chris.callicott@msexc.addenbrookes.anglox Ρ The Royal Berkshire and Battle Hospitals NHS Trust, Reading, NHS Clinical Engineering departments are facing unprecedented demands for increases in the efficiency, effectiveness, quality and safety of the services which they provide. At the same time, alternative means of delivering our clinical engineering services are also being explored. If we, the profession, are to help ensure the continued improvements in our services which are crucial to the delivery of the NHS Plan, few would argue that we need to raise the profile of Clinical Engineering. But who, how and where? Whilst individual members must influence decision-makers at a local level, IPEM has a complementary national role. In this presentation, the authors will set outline the ways in which IPEM’s Engineering Group Board and CESIG are currently helping to raise the profile and how we plan to develop these activities. Discussion, debate and new ideas which will help achieve this aim will be most welcome!

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IT Geeks Bearing Gifts – An EBME Intranet Web Site Mr Steven P Lake , B Jolly*, CJ Newnham*
Clinical Engineering Dept, Royal Liverpool University Hospitals, Prescott Street, Liverpool L7 8XP Tel: +44 (0)151 716 4220 Fax: +44 (0)151 7164220 Email: splake@liv.ac.uk *Medical Engineering Dept, Royal Liverpool Children’s Hospital, Alder Hey Many hospitals are setting up internal intranet web sites in an attempt to promote better communications and collaboration between departments and wards within the hospital. These web sites are relatively easy to produce and can be integrated into a site that represents the whole hospital. An EBME intranet web site can bring many benefits by raising the awareness of what the department does and does not do. It can even help meet some of the Controls Assurance criteria and provide access to the department’s records. EBME staff would find the technical aspects of producing a web site undemanding but the effort required to collect all the details together for inclusion in the site can be daunting. Further considerations include setting aside time to keep the site up to date and the quality of the hospital’s IT provisions. Significant benefit can be realised by setting up an EBME intranet web site but the investment required should not be underestimated and careful consideration should be given to what the site contains. This presentation will introduce some of these benefits, including how it can help with Controls Assurance and provide access to the department’s records. A demonstration of the web site run by the medical engineering department at the Royal Liverpool Children’s Hospital will be provided with a discussion of what was, and what was included and why.


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Role of a Dept. of Medical Physics and Bioengineering in the development and introduction of Clinical Information Systems in a University based Teaching Hospital Mr Brendan Touhy, F.Kirrane, W.J.M. van der Putten
Department of Medical Physics and Bioengineering, University College Hospital, Newcastle Rd. Galway Tel: +353 091 544311 Fax: +353 091 583017 Email: Brendan.tuohy@bsi.ie University College Hospital Galway is presently engaged in a large capital building development programme, which will equip the hospital with leading edge technology. These developments are taking place against a background of increased requirements for Clinical Information on demand. Well known examples of this are Picture Archive and Communication System (PACS) in Radiology and Record and Verify Systems in Radiotherapy but nowadays almost all current medical technology, such as physiological monitoring, cardiac ultrasound and Physiological measurement, process and store clinical data in a digital format. This has allowed the development of a variety of systems to support clinical processes, for example the use of sophisticated ECG arrhythmia analysis software at each bedside physiological monitor. Clinical information management systems (CIMS) are designed to incorporate these functions; the management of primary data (clinical data collected at the point-of-care), clinical data from other sources (pathology data, radiology data, pharmacy etc.) and administrative and management support information (patient demographics etc.). It is now recognised internationally by both Clinical Staff and Hospital Management that Medical Physics/Engineering Departments have an increasingly important role in the development and introduction of these systems . Physical Scientists have evolved into this role because these systems are increasingly viewed as clinical decision support tools and not simply information management and data archival tools, such as Hospital Information Systems (HIS), Radiology Information Systems (RIS) etc. In addition, a new approach to the management of this technology must be investigated within the hospital structure, as existing IT infrastructures which are based on industry standard protocols will not support primary data based systems. Therefore interesting “turf battles” are created. In addition the project has questioned the appropriate “skill mix” within a Physics/Engineering dept. to properly manage such a project. It has also imposed on those that fund such projects in Ireland a new and challenging set of issues. All of these questions will be addressed in this paper where we will summarise our experiences to date in introducing several projects of this nature to our hospital.

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Raising the Profile of Clinical Engineering – can the internet help? Mr John Sandham, Electronic and Biomedical Engineering, Princess Alexandra
Hospital, Hamstel Road, Harlow CM20 1QX Tel: +44 (0)1279 827 533 Fax: +44(0)1279 626 944 Email: john@embe.co.uk We all need to look at new ways of forming networks to work on continually improving services and staying abreast of best Clinical Enginnering practice. This will enable better communication and use of resources to deliver high quality services within our Healthcare Institutions. We also need to consider staff needs, system flexibility, and board level involvement in the development of these services. Patients expect high quality care and the most effective use of medical devices and resources to deal with their needs. To enable this Clinical Engineering professionals need to look at their continuing professional development, and bring national standards of professionalism to Clinical Engineering. We all need to find ways to develop supportive regional ,national and International networks where engineers can discuss their objectives and seek assistance from the group. Websites are excellent resources to facilitate the tranfer of information. Websites can provide interactive databases and web based systems enabling both weband electronic newsletter-based neutral services giving us the ability to take part in surveys of common interest topics, and extract valuable information. Websites provide forums, promote pathways for education, professional development and standards among persons interested in biomedical and clinical engineering, and to represent the profession in a positive light. They help to promote the generation and exchange of knowledge relevant to this diverse field. Websites can also help with the development and maintenance of standards for best practice in biomedical and clinical engineering, and related technological services in healthcare. We need to encourage the use of websites for the growth of our profession and to create an awareness of the field amongst other related professional groups and the public at large. To have a voice and be heard on matters, which relate to medical devices management we should be involved in group development projects in Clinical Engineering for the benefit of the profession. There is not always a need to travel to a venue to improve services and raise awareness. I am fortunate to work for an NHS Trust which is open to development of Clinical Engineering services. We have a Clinical engineer who spends approximately 40% of his time developing and managing the EBME website, which not only benefits our department, but all the departments who have open access to our site. Many of the the new initiatiatives to our Trust came about with the assistance of many fellow professionals who actively take part in ebme forums to share their experiences and knowledge.

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The website www.ebme.co.uk was set up as a portal of experience enabling clinical and biomedical engineers to gather information for the benefit of their departments, and submit information for the benefit of others. The registered members of this site are developing strategic plans and measurable short-term (1-3year) operational objectives by which we can measure our progress as a community. This will give us tangible means to measure our continual improvement. In deriving this operational plan, we are progressively developing strategic goals to promote medical engineering. Some of these strategic goals involve: 1. Benchmarking 2. Education and training 3. Voluntary registration 4. Recruitment and 5. Management Benchmarking can be defined as follows: "Benchmarking is the continuous process of measuring products, services and practices against competitors or other organisations recognised as leader, with the goal of achieving superiority in all areas: quality, reliability, asset use, cost and customer satisfaction" [NPAG for the NHS] The objective of benchmarking is to help an organisation to be the best in comparison with others. Key elements include: • Learning from others • Understanding who are the best role models • Understanding best performance • Using knowledge to set goals and drive improvement • This is a continuous process and should be part of a performance improvement strategy Benchmarking compares performance in specific measurable terms. This seems like an impossible task considering the resourses that a department receives can vary wildly. But maybe that is one part should be considered. In an ideal world we would all have the tools, facilities, staff and money to do the job. This is where I believe benchmarking will prove useful. It will show the NHS Executive and government what is needed to reduce risk and manage medical devices properly and safely in a cost effective manner. A Benchmarking club for clinical engineering has been set up by the members of www.ebme.co.uk seeking to act for and on behalf of the community. This will help to promote a single culture but with multi-faceted delivery mechanisms. We are researching and responding to the realities of the marketplace for Clinical Engineering services which means giving the best service we can provide by using the resources at our disposal in a cost effective and sensible way. This will gain us Professional Recognition, providing clinical and biomedical engineers with the status that we lack at present. We are seeking to: Page - 16 -

• Market ourselves as competent and ethical professionals • transfer our skills throughout our community • support our community to attract resources for developing expertise • be recognised as respected professionals in the wider professional community We should all be responsible for advancing our profession by assisting those who are less knowledgeable to improve their skills. Since launching www.ebme.co.uk we have developed the site by listening to those members who are willing to share their information and knowledge. There are many experienced Clinical Engineers who have well resourced departments, running quality systems, with internet access and are willing to share their experience and knowledge. This enables less experienced engineers to gain the information they need to develop their services more easily, including setting and implementing standards, encouraging a code of ethics, and thus promoting our community. Using the internet wisely will enable us to increase the recognition from those who are outside engineering practice or its management. We should be responsible for sustaining engineering practice in tune with aspirations of the wider biomedical community. The internet can help us in identifying and preserving those significant bodies of knowledge that already exist, and sharing it openly. Sharing this knowledge will Contribute to the Wider Community such as Nurses, Doctors and other medical professionals. We should be leading initiatives through which the collective wisdom of our community will provide real long-term benefits to this wider community. Information available for the efficient management of medical devices on the internet includes: • EU/UK regulations, relating to medical equipment. • Safety • Procurement • Acceptance • Asset management • Contract management • Clinical effectiveness • And Disposal. (and probably a few more I have’nt mentioned) When it comes down to proper medical devices management - we are considered as the experts. As a profession, we are nearly invisible, and we do not do enough to promote understanding of medical engineers, who we are, and what we can do for healthcare. I am a firm believer that we are only scratching the surface and unless we get together and promote our ability to improve medical devices management, we will never be properly recognised, and will be inviting others to make decisions relating to medical devices without our input. We could carry out projects in the general community supporting education, developing technological literacy, and encourage bright young people towards careers in biomedical and clinical engineering.

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If we use the internet to keep in contact, and form networks of proactive engineers willing to take part in forum discussions and debate best practice, we will progress and raise the profile of Clinical Engineering.

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Raising the Profile of Clinical Engineering 17th May 2002

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Where are all the Medical Equipment Maintenance Organisations ? Or “I’ve not got them on my list” (with apologies to Gilbert and Sullivan) Ms Frances M Armes, Medical Physics Department, Bradford Hospitals NHS Trust,
Bradford BD9 6RJ Tel: +44 (0)1274 364 144 Fax: +44 (0)1274 364 134 Email work 1 frances.armes@bradfordhospitals.nhs.uk (does not take large attachments) Email work 2 frances@dhirst.demon.co.uk (takes large attachments) In these days of controls assurance, audit and benchmarking you would expect that the Department of Health would have a complete list of medical equipment maintenance organisations within the NHS in England if not the rest of the UK. Well you would be wrong - as we found to our cost last year. We had wanted to know how many such organisations there were. This was to enable us to calculate some statistics during a benchmarking exercise we were undertaking. Enquiries made to the Department of Health, MDA, ECRI, IPEM, NHS Estates and one or two equipment suppliers all failed to come up with a definitive list. The problem was equipment maintainers come under the guise of EBME or Medical Physics Departments; Maintenance Organisations, Renal Technical Services or Estates Departments to name but a few. This prompted us to set about producing our own list. The path taken to compile the list and the trials and tribulations encountered along the way are recounted here.

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Disseminating Equipment Related Information via a Web Intranet. Mr Roger Jones, Richard Truran., Clinical Engineering, University Hospital of Wales,
Cardiff & Vale NHS Trust, Quadrant Centre, Cardiff Business Park, Llanishen, Cardiff CF14 5QQ Tel: +44 (0)29 2074 5678 Fax: +44 (0)29 2074 8550 Email: roger.jones@clineng.uhw-tr.wales.nhs.uk The last few years have seen the arrival of PC’s on wards and clinical areas, browsers included in the basic windows package and the installation of trust wide networks. These tools present an opportunity to deliver large quantities of equipment related information to anyone on the network at little additional cost. Clinical Engineering in Cardiff use a computerised equipment management system that holds comprehensive records on over twenty thousand items of electromedical equipment. In order to raise the department’s profile and “add value” to the work we do, this data is made available within the trust’s firewall, in a view only format. Clinical Engineering restricts the level of access and the areas of access. Equipment status, equipment histories and inventory information can be accessed directly by the users twenty-four hours a day. The maintenance costs of equipment can be accessed directly by the Business / Directorate Managers. Proposed future developments include on-line user manuals for general equipment, a drug - infusion device advice screen and an integrated equipment loan service. This presentation will demonstrate the system capabilities, real time from a demo version of our system.

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Electrical safety and performance assessment of medical electrical equipment used in the practice of anesthesia
Isaura Cristina Soares de Miranda1, Joao Carlos Langanke Pedroso2, Jose Luiz Gomes do Amaral 3, Lucio Costa de Brito4, Saide Jorge Calil5 Disciplina de Anestesiologia, Dor e Terapia Intensiva Escola Paulista de Medicina (EPM) Universidade Federal de Sao Paulo (UNIFESP) Rua Napoleao de Barros, 715, 4 o andar – Anestesiologia, Sao Paulo-SP, Brazil, Zip Code 04024-900 Phone: 55-11-5576-4092, Fax: 55-11-5576-4069 crisaura@uol.com.br, isaura@einstein.br Departamento de Engenharia Biomedica (DEB) Universidade Estadual de Campinas (UNICAMP) P. O. Box 6040, Campinas-SP, Brazil, Zip Code 13083-970 Phone: 55-19-3788-9287, Fax: 55-19-3289-3346 jpedroso@hcor.com.br, jclpedroso@yahoo.com Disciplina de Anestesiologia, Dor e Terapia Intensiva Escola Paulista de Medicina (EPM) Universidade Federal de Sao Paulo (UNIFESP) Rua Napoleao de Barros, 715, 4 º andar – Anestesiologia, Sao Paulo-SP, Brazil, Zip Code 04024-900 Phone: 55-11-5576-4092, Fax: 55-11-5576-4069 jlgamaral@uol.com.br Departamento de Engenharia Biomedica (DEB) Universidade Estadual de Campinas (UNICAMP) P. O. Box 6040, Campinas-SP, Brazil, Zip Code 13083-970 Phone: 55-19-3788-9287, Fax: 55-19-3289-3346 lucio@ceb.unicamp.br Departamento de Engenharia Biomedica (DEB) Universidade Estadual de Campinas (UNICAMP) P. O. Box 6040, Campinas-SP, Brazil, Zip Code 13083-970 Phone: 55-19-3788-9287, Fax: 55-19-3289-3346 calil@ceb.unicamp.br Justification and Objectives – Modern practice of anesthesia requires the simultaneous utilization of various medical electrical equipment, in a situation where the patient is usually deprived of the human body’s first line of defense against the hazard of electrical shock: the skin impedance. In addition to this, parameters related to equipment performance degrade along the lifetime of those devices. The main objective of this paper is to assess the condition of equipment used in the practice of anesthesia, verifying conformity to the prescriptions of international electrical safety and performance standards. Scope of the tests: anesthesia units, carbon dioxide monitors, cardiac defibrillators, cardiac defibrillator-monitors, electrocardiographic monitoring equipment, non-invasive blood pressure monitors, pulse oximeters, respired/anesthetic gas monitors and sphygmomanometers. Methodology – A total of 510 equipment was evaluated in 96 operating rooms of 7 major health care institutions (2 private, 1 public and 4 Page - 22 5 4 3 2 1

public/university hospitals) in the city of Sao Paulo – SP – Brazil. The evaluation comprised qualitative and quantitative electrical safety and performance tests. The NBRIEC60601 standards, of the Brazilian Technical Standards Association (ABNT), were adopted as the main reference for electrical safety. Performance assessment was carried out based on test protocols elaborated from the Inspection and Preventive Maintenance System (IPM System) of The Emergency Care Research Institute (ECRI). The following test equipment were utilized: 601 Pro Series – International Safety Analyzer, QED 6 – Defibrillator/pacer Analyzer, MAX O2 – Oxygen Monitor, Lionheart 3 – Multiparameter Simulator, VT 2 – Adult/infant Ventilator Tester, DPM 2 – Universal Pressure Meter , BP Pump – Non-invasive Blood Pressure Monitor (NIBPM) Analyzer, all by Bio-Tek Instruments. Results – In relation to electrical safety, 55.5% of the evaluated equipment were in satisfactory operating conditions; 30.3% were in unsatisfactory conditions, presenting either marginal or severe non-conformities, demanding immediate corrective action; 14.2% of them were not tested because of either incompatibility or inaccessibility. In relation to performance, 38.5% of the evaluated equipment were in satisfactory operating conditions; 30.8% were in unsatisfactory conditions, presenting either marginal or severe non-conformities, demanding immediate corrective action; 30.7% of them were not tested because of either incompatibility or inaccessibility. Conclusions – The amount and quality of the irregularities found is relevant. The findings emphasize the need for continuous monitoring of electrical safety and performance of equipment used in anesthesia practice. Key-words: Anesthesia, Anesthesiology, Clinical Engineering, Electrical Safety, Medical Electrical Equipment, Performance, Standards.

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Clinical Engineering and Radiology – With a little help from our friends! Mr Patrick Pentony, Clinical Engineering, St Vincent’s University Hospital, Elm Park,
Dublin 4 Ireland Tel: +353 269 4533 Email: p.pentony@st-vincents.ie Historically, Clinical Engineering has always been involved with Radiology in St. Vincent’s University Hospital, since the opening of the current Hospital in 1971. The progress throughout the decades within Radiology has mirrored the development in Clinical engineering. The technological advances can be seen at many levels, from changes in healthcare structures and procurement procedures to the rapid development of digital imaging systems and PACS. Clinical engineering has also changed significantly to meet these current and future demands. There is a greater emphasis within the role of Clinical Engineering, as a critical team member, compared with the previous role of providing an essential service. The contribution of Clinical Engineering to Radiology begins before any equipment is purchased with their involvement in the tender process and continues until final decommissioning. Throughout the life of all radiology equipm ent Clinical Engineering cooperates in conjunction with Medical Physics, Clinicians, Radiographers and hospital management, to ensure Patient safety and the many standards associated with Radiology are maintained and applied.

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Mandatory Infusion Device Training. Miss Andrea Wilson, North Western Medical Physics, Clinical Engineering,
Withington Hospital, Manchester M20 2LR andrea_w@fs1.with.man.ac.uk There has been a dramatic increase in the use of infusion devices in recent years, and a corresponding increase in exposure to the potential risks their use brings. The MDA receives many reports of adverse incidents involving this type of equipment, often the reports are of over infusions, the majority of which are due to user error. Following consultation with the hospital risk managers a Steering group of clinically based nurses and senior support staff was established to identify relevant problems and find appropriate solutions. The structure of this group will be presented. After a successful bid to the local Education Consortium a nurse was appointed as ‘Infusion Device Trainer’. The first task undertaken by the trainer was that of a training needs analysis, this took the form of a baseline audit. The results of the audit were alarming but not totally unexpected. As a result, the process of standardisation of infusion devices has begun, together with the implementation of mandatory, competency based infusion device training for all users, the content of which will be presented. After twelve months the same audit was repeated. The results of which have been very encouraging, demonstrating an increase in user knowledge and ability. Examples of comparative figures for pre and post training will be presented. Despite this positive step, the issues surrounding the safe and effective use of infusion devices, from maintenance to drug administration and from medical engineering staff to nursing staff, still continue. To reduce the risk of error and provide a safe and effective service both technical and medical staff must continue to work in partnership.

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Implantation of a Program for Quality Control as part of Quality Assurance in Mode B Diagnostic Ultrasound 1. Mr Glaucia Ribeiro Zucatti1, Button, Vera L. S. Nantes 1, Dantas, Ricardo G.1

Ultrasound Laboratory, Biomedical Engineering Department (DEB), Faculty of Electrical and Computing Engineering (FEEC) and Biomedical Engineering Centre (CEB), state University of Campinas (UNICAMP), CP 6040 – Campinas - SP – 13083-970- Brazil Tel: +55 19 3788 9283 Fax: +55 19 3289 3346 A program of quality assurance involves many activities, including: quality control tests, preventive maintenance, calibration, training of user, acceptance and evaluation tests of new products .The implantation of a program of quality control in ultrasound equipments provides greater quality of diagnosis and magnifies the availability of the equipment. This paper aims at the development of a program of quality control as part of the quality assurance, involving the application of protocols that describe: physical and mechanics inspection of the equipment, performance tests and tolerance recommendations for the result of performance tests, as well as the a calendar indicating the correct period to carry through each one of the tests. The mechanic and physics inspection includes a checklist with the verification of the integrity of the cables of energy, air filters, brakes, printer, etc. Moreover, a description of the main problems that can occur with the transducers. Performance tests as part of the quality control of image are tests carried through with a mimic tissue object (Phantom), through which it can be gotten evaluations on uniformity of image, maximum depth calibration (sensitivity), lateral and axial resolution measurements, geometric tests (vertical and horizontal distances accuracy measurement) dead zone measurement and detail contrast. We also carried out tests to verify the influence of the controls setting over the periodic tests to establish which would be the acceptable variation in these settings from a test to another one and also included in the target of this work a field research, that showed the minimum percentage of the health institutions has an equivalent program.

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