Manage Medical Equipment Inventory

Standard Operating Procedures
for
Medical Equipment Management
Version 5, September 2019
‘How to Manage’
Medical Equipment in Zambia
as a
hospital BME Technologist
Author:
Chris R. Mol, PhD
Lusaka, 2019
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Table of Contents
1. Introduction 3
2. Medical Equipment (ME) Inventory and analysis 4
3. Activity reporting and analysis 7
4. Preventive maintenance 9
5. User training 11
6. Service and User manuals 13
7. Service History Files 13
8. ME Acceptance procedures 14
9. Decommissioning 16
10. Management Reporting 17
11. ‘Reason-not-repaired’ analysis 20
12. Procurement of consumables and spare parts 21
13. New Equipment procurement priorities 22
14. Tools, workshop and test equipment 23
Appendix 1: Tools, Consumables and Test Equipment 25
Version 5 ME Management Zambia September, 2019

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1. Introduction
This document is for use by BioMedical Engineering Technologists (BMETs) working in hospitals in
Zambia. It explains what is expected from them in terms of Management of Medical Equipment
(ME). It deals with procedures such as maintaining an equipment inventory, setting up a preventive
maintenance schedule, commissioning new medical equipment, etc. It builds on the learnings of the
BMET diploma course (Teveta Curriculum Syllabus for Diploma in Biomedical Engineering
Technology, Chart No. 279). It is targeted at the situation in Zambia in 2019/2020.
The current document is created by THET as part of a ‘HTM Improvement Project’ that is contracted
by SIDA to take place in Luapula, Muchinga, Eastern and Southern Provinces between 2018 and
2021. It is biased towards Level 1 (‘District’) and Level 2 (‘General’) hospitals since this is where most
BMETs will be employed. Further detailing of required BMET actions in Level 3 Hospitals may be
added in a future version.
Use is made here of the MoH ‘Medical Equipment Management guidelines 2012’ as produced in
cooperation with JICA. However, paper forms are now replaced by computer-based files and
associated methods for data analysis. Also, these SOPs are targeted at hospital-based BMETs in MoH
employment. It does not include activities which - in Zambia - are mostly executed at (MoH) national
level, such as ME Procurement, Service Contract Management and Donations management. For
more information on these last topics, the BMET is referred back to the BMET Diploma Program.
Currently, BMETs and their work do not have adequate management visibility and status in the
hospitals. Medical Equipment condition is poor. As suggested elsewhere, setting up ME
Management Committees in hospitals would improve this; but this is not happening yet. A BMET
can improve this situation by carrying out professional equipment maintenance and by making this
visible for management. That is why detailed management reporting is included in this document.
It is targeted that this document will be reviewed and formally adopted by both MoH BME
management and the BioMedical Engineering Association of Zambia (BEAZ). It can then serve as the
national ‘Standard Operating Procedures’ for BME management work.
Notes:
 In order to do professional Medical Equipment (ME) maintenance work, a BMET needs to have
access to a computer (desktop or laptop) and the internet. Information Technology (IT) is an
essential tool for a BMET, no less so than a multi-meter or screwdriver. It may be so that many
of today’s ME maintainers in the country do not have such IT tools. In that case, such persons
can be useful for the hospital, but their ME work cannot be ‘professional’.
 In addition to BME equipment management activities, the associated BMET SOP course also
gives attention to presentation skills (PowerPoint), spreadsheet analysis (Excel) skills and written
communication skills. These skills are crucial for professional BMET functioning.

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2. Medical Equipment (ME) Inventory and analysis

The ME Inventory is an important document that needs to be updated by a BMET every month. From
the analysis of this inventory, one can immediately appreciate the status of the Medical Equipment
in the hospital. Updating an ME Inventory monthly will not take much time. It will require the BMET
to check at all departments of the hospital regularly and it will keep him/her focused on the ME
Uptime results (see further on).
The inventory format (Excel) used in this document was adapted from the MoH ME Management
Guidelines, September 2012. The following columns were added:
1. The estimated initial price of the equipment: ‘estimated value when new (USD)’. This is
important for making business cases and financial projections. The values used for pricing of
each type of equipment are maintained and available in a separate file.
2. Under the ‘Frequency of usage’ a distinction is made between the devices that are ‘not used
but functional’ and the devices that are ‘not used, not functional’. The first category
indicates devices that clinical workers do not choose to use, even though that would be
possible from a technical point of view. This is e.g. the case when there are too many of such
devices in the hospital. Such devices are candidates to be transferred to other hospitals in
the District or the Province. The second category are those devices that are ‘down’ and thus
cannot be used in clinical work.
3. The number of ‘Down days’ of each unit in the past month. This is a number between 0 and
30 that indicates how many days in the past month the equipment has not been functional.
From this parameter, the overall ME Uptime is calculated (see further on).
o All medical equipment that is not technically fit to be used clinically will be classified
as ‘down’. Equipment that is technically ok, but is not used clinically for other
reasons, is not classified as ‘down’.
o Equipment that has been decommissioned or equipment that hospital management
has agreed to decommission is removed from the Inventory.
4. 3rd Party maintenance contract or (first year) warranty in place.
5. Next
2018-08-30 PM date
2018 35 (week number). ] 9
number of
6. of Consumables
Date
Year needs
Week number
BMET and
Name: required consumables budget per year.
devices in
Inventory
Inventory
Item (Equipment name)
Date of Inventory Hospital Hospital

Manufacturer Model Serial No.
last check number Name: Department fill in item name
pick from list (choose 'not on list' if
only if 'not on
item is not mentioned)
list'

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3rd party maintenance contract (none = 0;
0=
Manuals
consumables budget required per year

Estimated Value when new (USD)
(1=available, 0 = Frequency of usage
warranty = 1; contract = 2)
not available)
Next date of PM (week number)

Year of Commissioning
to be decommissioned
Consumables needed
Year of Manufacture
Down-
User / Operation Manual
Not used, not functional

Not used but functional
Few times per month
Few times per week
Country of Region of days in
Service Manual
Origin Origin this
Every day
month
The ME inventory format, displayed here in two halves.
Notes:
 Only ‘medical’ equipment must be included in the inventory, no other hospital equipment.
Mortuary fridges are counted as medical equipment, but laundry machines, air conditioners
and electrical generators are not.
 An X-ray system counts as one device, even though it consists of different parts (e.g.
generator, X-ray tube, table, etc.). The same goes for a ‘dental chair’, i.e. including lights,
drills, etc.
 Inventory codes must be created when making the equipment inventory for the first time
and when new equipment is being commissioned. These will have the following format:
THDH0001 where TH indicates the name of the hospital (e.g. TH for Thomson), DH indicates
District Hospital, and will be GH for General Hospital, UH for University Hospital, HC for
Health Center or HP for Health Post. 0001 indicates a simple serial number, starting at 0001
and running until maximum 9999.
 In order to do an combined analysis for Inventories from multiple hospitals, it is necessary
that name giving (‘nomen clature’) of equipment is standardized. An autoclave and a
sterilizer should not be analyzed as different systems. For this purpose, a list is created of
‘standard’ equipment names from which the proper name must be picked for each
equipment unit (drop down menu). The same is done for hospital department names.
 If a BMET is responsible for more than one health facility in a District, e.g. a District Hospital
plus the associated Health Centers and Health Posts, all equipment in these facilities can be
added in a single inventory. From the ME Inventory numbers it can be seen in which facility
each unit of equipment is located. Different Districts get different Inventory files.
 The name of the inventory file has the following format: YYYY MM DD THDH ME Inventory.
Where YYYY MM DD indicates the date and THDH is an example for the name of the hospital
(as in the inventory code).
Analysis of ME Inventory: Equipment Status

One or the reasons that hospitals currently do not actively maintain a paper-based equipment
inventory is that it is not easy to derive information from such a document. It therefore has limited
use. This changes as soon as a spreadsheet program (Excel) is used for the inventory. In this case a
simple calculation can be added to the ME Inventory to come up with the following ‘Equipment
Status’ overview. It gives a one table overview of the status of the ME in a hospital. It will be used for

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reporting both to hospital management – to re-inforce their focus on medical equipment – and to
the provincial and national ME management in the country.
ME Inventory status
Thomson DH November 2019
Number of units in Est.value when new

Average age (years)
Inventory (USD) The Medical Equipment
Inventory status is derived
9 10.1 $43,450
from the ME Inventory. It
Number under warranty
% with user manual % with service manual
gives an overview of the
or contract equipment situation which is
3 56% 11% tailored to Hospital
management.
Number that is functional Number that is long term % that is functional (ME
but not used not functional Uptime)
1 1 84.1%
An important number in this overview is at the bottom-right: the Medical Equipment (ME) Uptime.
This number indicates what percentage of all medical equipment in the hospital is functional in the
month that is covered by the overview. Since it is a main task of a BMET in a hospital to keep all
medical equipment functional, ME Uptime is an important measurement of success. Various
measurements have indicated that the current ME Uptime in most Zambian hospitals without a
BMET is around 70%. This means that 30% of the equipment is ‘down’: not functional. It must be
targeted that the ME Uptime is at least 95% in each hospital.
The ME Uptime is measured here over the period of one month. This is done by counting the
number of down days over the past month (between 0 and 30). The advantage of measuring over a
month rather than on a single day is that the result will be less dependent on the precise moment of
updating the inventory.
Medical Equipment prices

Initial procurement prices of similar medical devices in the market show great variation. This reflects
the differences in quality of the equipment, but also the differences in workers wage costs between
different manufacturing locations. Prices are also impacted by the degree of competition in the
market of certain devices. The more simple a device, the easier it is to produce and the more
companies can produce it. This situation usually leads to high competition and lower prices.
Looking up prices on the internet gives results that reflect this variation and is biased towards low
cost (and low quality) equipment. Only companies that feature low prices will publish their prices on
the internet. In order to get representative prices for the equipment in our hospitals, a price list has
been collected. It is proposed to use the prices of high quality equipment in ME inventories. Using
these, the actual ‘new value’ of the equipment is then estimated to be between 50% and 100% of
the resulting price, depending on the type of equipment in the particular hospital.

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3. Activity reporting and analysis
Traditional administrative procedures around equipment maintenance require that a job card (paper form) is
filled in for each Corrective and for each Preventive maintenance action. The format of such a job card has
been defined in the MoH (/JICA) guidelines. These forms are paper based since the different sections have to
be filled out by different persons: clinical users, administrators, BMETs, …
A disadvantage of the use of paper job cards is that physical copies have to be made to communicate and
archive. Also, it is not easy to make an analysis of all work that has been performed over a period of time.
For these reasons, BMETs will from now on note their CM, PM and User Training activities in a spreadsheet.
The following forms are available in digital format for this:
The Activity Report format for Corrective Maintenance, separated into two halves.
Preventive Maintenance Activity Report
District Name: Thomson DH BMET name:
how many how many

nr. Date of PM Inventory nr. Equipment type minutes spent months since successfully completed? Cost of used materials Further Information
on this PM previous PM
The Activity Report format for Preventive Maintenance
User Training
District name: Thomson DH BMET name:
Date of User How many how many minutes

nr. Equipment type Further Information
Training session users trained? spent on this training
The Activity Report format for User Training sessions
For each CM, PM and User Training activity, one row in the appropriate Activity report sheet must be
completed, describing the duration of the different activities as well as customer complaints, root causes,
main fixes, materials needed, success achieved, etc.. Selections for some of these parameters (columns) are
structured via pull down menus. This makes it possible to do an analysis of the frequency of the different
activities and circumstances.

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The Activity report contains two sheets for Corrective Maintenance. One sheet for CM of the Medical
Equipment, one sheet for the ‘Other’ equipment, such as air conditioners, electrical generators, laundry
equipment, etc.
For each new activity a new row at the bottom of the sheet is filled in. Therefore, this is a ‘growing’ sheet.
Old jobs (rows) are not removed. When you hold a long term position in a hospital, it is proposed that you
start each calendar year by creating a new (empty) Activity Report file.
Each row in the Corrective sheet is considered to be a job card. Each row musts be updated as further
progress on the same CM action is made over the following weeks. Don't make copies of a row, relating to
the same job. Don't leave rows in the status 'still working on it' (column R) if the job has been completed.
If you find this convenient, you can re-position (cut & paste) a row with an activity that you 'are still working
on' to lower down in the sheet, so that you keep the 'open jobs' at the bottom of the sheet. In this case, the
date of the row / job card / in column F remains the day that the CM action 'came into the workshop'.
The activity file needs to be updated once per week. If you wait longer, you may have forgotten some
details.
Unlike on the paper-based job card, in the computer-based approach the involvement of the users and
administrators is not recorded in these activity reports. This may be a problem in bigger (Level 3?) hospitals
where more equipment is involved and more administrative control is required. In those cases, it may be
decided to keep the traditional paper-based job card administration side by side with the computer-based
recordings.
Analysis of CM, PM and User training activities

An overview of the ME Activities can now be constructed from the resulting spreadsheet. See below:
Activity overview
Thomson DH January 2020
Spare part Spare part

Number of CM
procurement procurement spent
Corrective actions in month
actions needed in month
Maintenance (CM)
10 4 ZMK 2,000
Consumables
Number of PM Average minutes
procurement spent
Preventive actions in month spent per PM
in month
Maintenance (PM)
12 55 ZMK 500
Number of UT Average minutes Average number of

actions in month spent per UT Users per UT
User Training (UT)
4 30 6
It gives a good insight in the number of actions undertaken, the procurement required and used, etc. This
information can help to define the actions to be taken to improve effectivity.
Unlike in the Equipment Inventory status, the calculations behind this Activity overview are not automated,
but need to calculated 'by hand' from the previous sheets. Calculation via Excel formulas here is complicated
and easily leads to mistakes.

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4. Preventive Maintenance (PM)
Preventive Maintenance is one of the core activities of each BMET. It is well-known that the regular
execution of PM reduces the incidence of equipment breakdown and associated CM actions. Total
maintenance costs will go down and the life span of equipment will be extended.
The actions that need to be

undertaken during PM depend
on the type & make of the
specific equipment and are
described in its user manual
and service manual. This needs
to be looked up and followed.
In case manuals cannot be
found, some logical - generic -
PM actions can be performed.
PM can be separated in User-

PM and BMET-PM. If a device is
under 3rd party maintenance
contract, the service provider
Example of PM Instruction in the manufacturers service manual
will do the PM. This must be
checked by the hospital BMET.
User-PM is carried out by the clinical users of the equipment and is done on a daily and weekly basis.
The main activities here are to keep the equipment clean and perform simple activities such as
minor lubrication, checking fluid levels, etc. User-PM also serves as an early warning for more
serious equipment problems for which the BMET needs to be called. The users must be trained in
user-PM during ME User training sessions. It is a good idea to write down required user-PM actions
and post these on or near the equipment.
BMET PM takes place typically every 6 months. Main content of these actions usually include (but:
check service manual!): cleaning, lubrication, changing filters, safety checks, performance checks,
calibration, etc..
Notes on PM:
 It is a good idea to copy PM instructions from the Service Manual in a separate word doc and
store this for each device in the Service History file.
 Consumables and cleaning materials for PM need to be kept on stock: see section on
budgeting and procurement.

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 For some equipment it is necessary to have special test equipment to carry out good
performance checks and/or to perform calibration. For example, the air volume of a
ventilator, the shock energy of a defibrillator, etc. See chapter on tools and test equipment.
The MoH Guidelines (2012) include

generic PM instructions as well as daily
maintenance instructions for Users for
many types of equipment. These can be
followed when the user and service
manuals cannot be found.
PM activities need to be planned to make sure that PM is done systematically. For this, the required
frequency of PM for each equipment needs to be looked up in the Service manual. If that manual
cannot be found, assume that PM needs to be carried out 2x per year.
The PM planning needs to be noted down in the ME Inventory in the column that indicates the date
(week number) for the next PM action (column Z). When a PM action has been performed, this date
can then be increased by 6 months (26 weeks). Note that the details of each PM action that has
been completed must be recorded in the Activity file. Current experience indicates that a thorough
PM action typically takes 1.0 to 1.5 hours per device.
It is good practice to reserve a fixed day in the week for PM. On such a day, PM’s of about 4-6
devices can be completed. If a hospital owns 100-120 devices, this means that all PM can take place
in 25 days. Spending 1 day a week on PM, this means that it takes half a year to do PM of all devices,
in line with a PM frequency of 2x/year.

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Of course, some flexibility should be maintained with the PM schedule, since it can be overruled by
urgent CM action. In such cases, the PM should be rescheduled, not skipped!
5. User training
An important root cause of equipment breakdown as well as of reduced patient safety is the inability
of some clinical users to properly operate and/or clean the different types of equipment. Analysis of
previous projects shows that this is the cause of about 20% of required CM actions. Especially in
situations where clinical personnel changes often, it is important to regularly repeat such ME User
trainings.
It is a task of the BMET to make sure that all clinical users are properly trained on how to operate
each device. Note that a BMET does not train users in clinical aspects of the equipment use, e.g. on
how much air to use for ventilation of a certain patient, what temperature to select if newborns
have fever, etc.
Assessing User Training Needs

To plan user training in a professional way, an overview (spreadsheet, next page) can be set up and
maintained containing the names of all the clinical users in the hospital (e.g. via HR department).
Subsequently, in an interview of each user, the following questions are posed:
1. What medical equipment do you use (regularly) in your current function?

2. How familiar are you with each unit?
3. Would you like to have some additional training on the technical function and requirements
of this unit?
The answers to above questions are filled in in the table below.
In a hospital with a large number of clinical users, it may work better to make such an overview per
hospital department. The rows with equipment that is not present in the hospital or in that
department may be deleted to simplify the overview.
When Totals at the right side of the spreadsheet are added up, it can easily be seen what is the total
request for user training on each type medical equipment. This helps in setting priorities for which
user training to give first.
Earlier experience indicates that not all clinical users may want to answer such questions from new
BMETs. Also, clinical users may be reluctant to admit that they would require training. Such request
could indicate to management that they are not fully qualified. In such cases, it may work well to
first explain to hospital management the need for user training and request management to instruct
users to cooperate with your assessment and to participate in your User Training activities.

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Totals
fill in: User name 1 fill in: User name 2
ME Training need? (yse=1, no=0 )?
ME Training need? (yse=1, no=0)?
Average familiarity with device

Total number of users / device
user of ME (yes=1, no= 0)?
user of ME (yes=1, no=0)?
user of ME (yes=1, no=0)?

Clinical Users
Total Training need

How familiar (1-5)?
How familiar (1-5)?

Medical Equipment
'General' equipment BP Machine 1 5 0 1 5 0

'General' equipment Injection pump 0 0 0
'General' equipment Nebulizer 0 0 0
'General' equipment Oxygen Concentrator 1 3 1 1 3 1
'General' equipment Pulse Oximeter 0 0 0
'General' equipment Suction Machine 1 4 0 1 4 0
'General' equipment ECG system 0 0 0
Mother and Child CTG machine 0 0 0
Mother and Child Fetal Heart Monitor (Doppler) 0 0 0
Mother and Child (Transport) Incubator (infant) 0 0 0
Mother and Child Phototherapy Unit 0 0 0
Mother and Child Radiant Warmer 0 0 0
Mother and Child Resuscitaire 1 2 1 1 2 1
Sterilization Autoclaves 1 4 0 1 4 0
Sterilization Instrument Washer 0 0 0
Sterilization Water Distiller 1 2 1 1 2 1
Operating Theatre Anesthesia Machine 0 0 0
Operating Theatre Baby CPAP system 1 3 1 1 3 1
Operating Theatre Defibrillator 1 2 1 1 2 1
Operating Theatre Electro-Surgical Unit 0 0 0
Operating Theatre Operating Table 1 4 0 1 4 0
Operating Theatre Patient Monitor 0 0 0
Operating Theatre Ventilator 0 0 0
Operating Theatre Vital Signs Monitor 0 0 0
Medical Laboratory Analytical Balance 0 0 0
Medical Laboratory Centrifuge 0 0 0
Medical Laboratory Microscope 0 0 0
Medical Laboratory Photometer 0 0 0
Physio-therapy Electric Muscle Stimulator 0 0 0
Physio-therapy Infrared Therapy lamp 0 0 0
Physio-therapy Shortwave diathermy machine 0 0 0
Physio-therapy Therapeutic ultrasound 0 0 0
Dental Dental Chair (complete) 0 0 0
Total number of training requests: 5
Executing User Training

Depending on complexity of equipment and staff’s previous experience, the following topics need to
be dealt with during the user training:
 good practices when handling the equipment
 how to operate the equipment
 symbols and markings on the system
 care, cleaning and decontamination
 safety procedures
 daily and weekly preventive maintenance for users

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As a start, the BMET can begin giving User training on medical equipment that shows a high demand
for training. Names of participants in the training sessions need to be noted down and the training
spreadsheet must be updated after the training to reflect the new situation: i.e. the users training
requests that have been completed for a certain user must be taken out of the User Training needs
column (change 1 to 0).
In addition to the described, systematic approach, it is good practice to give user training on the
spot, e.g. when a certain problem (CM action) in a department was caused by user error and during
commissioning of a new unit. Also, opportunities to give user training during a ‘clinical meeting’ at
the hospital must always be pursued.
User Training materials

It is a good training practice to hand out a written summary of the trained information to the
trainees during the training. It is suggested to do this on a 1x A4 Word document.
It is envisaged that such training materials are shared amongst the BMETs in the country. This can
easily be done by making these materials available on a (e.g. BEAZ or MoH) website.
6. Service and user manuals
The ME inventory indicates for each of the devices whether a ‘user’ (or: ‘operator’) manual and a ‘service’
manual are available. Traditionally, this refers to a paper copy of such manuals, available at the BME
workshop or at the clinical department. Over time, more of such manuals will become available in digital
format and reside in computer memory and on USB sticks.
It is the task of each BMET to collect all service and user manuals – in digital or paper format – at his/her
hospital. The presence of these manuals is noted down in the equipment inventory.
It is proposed that in the near future a national library is made of all service and user manuals and is posted
on a website from either MoH and/or BEAZ, to be used by all BMETs in the country.
7. Service History File
Conventionally, a BMET collects all paper information that belongs to a device in a ‘Service History File’: a
‘binder’ for each device. With a good Service History File, it is easy to access e.g. the original Order
Acceptance Data, information from all CM and PM actions, etc..
In the digital era, the Service History File will be in digital format. For this, the BMET must make a separate
file structure on his/her computer collecting all information of each device.
A separate subdirectory will be made for the Service History Files of each ME Inventory item. In these
subdirectories, all (digital) information files related to the indicated device are stored.
For a BMET working at Thomson District Hospital this will look as follows:

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This PC/Documents/MEServiceHistoryFile/THDHXXXX, with XXXX between 0001 and 9999,

corresponding with the ME Inventory code of the various devices.
Thus: This PC/Documents/MEServiceHistoryFile/THD0016 subdirectory will contain all the
documents related to the ME Inventory item with code THD0016
The paper part of the Service History File will contain e.g. service manuals as well as any other
papers that will be found at the hospital such as Acceptance docs, Supplier info, etc.. and is kept in a
cupboard in/near the workshop, also organized per Inventory code number. If the paper info is
limited, the BMET could consider to make photographs of the paper info and store these digitally.
In the transition from paper to digital, it may be unavoidable that a Service History File consists of both a
paper and a digital part. The BMET is therefore required to maintain digital and paper format both, without
the need to have double data: if a digital version is available, the paper version can be discarded. The BMET
must make sure that an up to date back-up copy of all digital data is always available in case the original gets
lost, e.g. through a computer crash.
8. ME Acceptance procedure
The ME Acceptance procedure is composed of the following steps:
1. Receive and unpack the equipment on site

There are many stories around that the arrival of new medical equipment is not always
communicated beforehand and that it arrives unexpectedly at the hospital, potentially during
the weekend. In such cases, the proper acceptance of the equipment may be even more
important, because it would create the only evidence that a delivery is incomplete or damaged.
During reception, a check must be made whether the received goods correspond well with the
logistics information (i.e. is ‘complete’) as well as whether it is undamaged. Make photographs
to document your findings when this is not the case. Keep all packaging materials, etc. as you
may have to re-pack the equipment to return it for repairs. Check that User and Service manuals
are included.
2. Assemble, Install and Commission (put the system to work)

Make certain that there is enough information on how to assemble the equipment and that you
understand how the equipment is supposed to function. Assemble and test the functioning of
the equipment and its performance. Perform safety tests (earthing, leakage currents) as well as
functional tests according to the service documentation. Involve the clinical users to get
acceptance of the system.
3. Initial User Training

Ensure that all relevant users receive adequate training in operation and (user) preventive
maintenance. Document the participation in the training session. If the equipment is unfamiliar
to the BMET, training should be carried out by the supplier or their representative, or by a
BMET-colleague (e.g. PMEO) with knowledge of the equipment. For complex equipment, it is
normal that a manufacturer sends technical personnel to do the installation and commissioning,
and a different person to do the user training.

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4. Enter the new equipment into the ME Inventory

Give the new equipment a new ME Inventory number. Fill in all the data fields in the Inventory.
Enter the date for the first PM.
5. Complete and file the Acceptance Test Logsheet

All sections of the Acceptance Test Logsheet (see below) need to be completed to indicate that
the activity has been successfully completed. Of course, this should be done in a digital file.
Create a new sub-directory in the Service History File for the digital docs. Create a new binder
for the paper docs. Put your (digital) Acceptance Test log sheet in the (digital) Service History
File.
Equipment Acceptance form

from the MoH Guidelines
(2012)

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9. Decommissioning
Decommissioning of ME needs to be done when there is no prospect of the equipment ever being
repaired for a reasonable amount of money. This is especially the case if equipment is old versus its
expected lifetime, if spare parts are not any more available or prohibitively expensive, and if the
equipment is broken or unsafe.
Decommissioning starts by requesting confirmation from the Provincial Medical Equipment Officer
for his/her agreement with the decommissioning of a device. If this is the case, the BMET writes a
memo to the hospital management, explaining the reason to condemn the equipment and asking for
management agreement. If this is obtained – preferably in writing – the BMET will proceed with the
typical BMET tasks:
 potential spare parts for other equipment must be harvested from the equipment to be
decommissioned.
 Also, any computer memory with patient data must be destroyed.
 Checks must be made for dangerous materials that cannot be thrown away in a public place,
such as mercury in BP machines, asbestos or radioactive sources.
 At this point in time, the ME device must be removed from the ME Inventory.
Next, the following administrative procedures have to be carried out:
When this procedure is completed, an auction can be held to sell off the remaining equipment
components as well as the materials for which scrap value can be obtained (e.g. scrap metal).
The execution of the administrative procedures is thought to be primarily the responsibility of

hospital management. If requested, the BMET can assist in the execution of these procedures.

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10. Management reporting
One of the reasons why the ME situation in Zambia is currently poor is that there is insufficient management
attention for this topic. Without such attention, allocation of budgets and manpower will always be very
limited. In order to gain management attention, the MoH/JICA guidelines prescribe that each hospital facility
must establish a ME Management Committee. Members of the hospital management are to participate and
ME issues should be discussed on a regular basis. In spite of good efforts, such Committees have turned out
to be difficult to establish and sustain. Whereas the ultimate goal of our BMET management efforts is to
establish such a Committee in order to regularly discuss ME topics, we will start with a more modest and
achievable approach, in order to increase the awareness of management with the ME situation.
Overview of ME Activities, leading to a monthly ME Management Report
In order to attract management attention for Medical Equipment and its maintenance, the BMET will make a
monthly report, to be sent out within the first two working days after the completion of each month. This
report contains the following items:
1. the ME Inventory status (from the ME Inventory file)
2. the ME Activity overview (from the Activity report file)
3. ME Highlights on equipment and equipment maintenance over the last month (text). This
includes a list of equipment that is commissioned or de-commissioned in the month.
4. Outstanding and new ME requests to management for procurement of parts, etc.
Preferably this report fits on a single page and has a fixed format. This will make it easier for management to
pick out the information that they are interested in. See example on page 18.
It is envisaged that when hospital management will receive such professional ME reporting every month,
they will discuss this at their management meetings, possibly inviting the BMET for this discussion. In this
way, the establishment of a ME Management Committee may be taking place over time.

18
Thomson DISTRICT HOSPITAL

Medical Equipment Management Overview
January 2020
Activity report ME Inventory status

Thomson DH January 2020 Thomson DH January 2020
Spare part Spare part
Number of CM Number of units in Est.value when new
procurement procurement spent Average age (years)
Corrective actions in month Inventory (USD)
actions needed in month
Maintenance (CM)
10 4 ZMK 2,000 9 9.3 $43,450
Consumables
Number of PM Average minutes Number under
procurement spent % with user manual % with service manual
Preventive actions in month spent per PM warranty or contract
in month
Maintenance (PM)
12 55 ZMK 500 3 56% 11%
Number of UT Average minutes Average number of Number that is Number that is not % that is functional (ME
actions in month spent per UT Users per UT functional but not used functional Uptime)
User Training (UT)
4 30 6 1 1 84.1%
Highlights of the month
 ME Uptime has increased from 70% in November 2019 to 95% today

 Main CM actions concerned the autoclave for the Operating Theatre and the X-ray system.
 A dental chair was installed and commissioned.
 The old ultrasound machine that has been stored for 4 years already was de-commissioned.
 A User Training was given on resuscitaires in the Maternity department. All users of this
equipment are well trained now.
 Procurement of fuses for suction machines were completed (200 Kw).
 The incubator that was not used has been transferred to a nearby health center.
Open Procurement requests:
 Ultrasound probe: has been requested via PMEO

 Batteries for scale in Maternity ward: 4x AA batteries. To be procured in town. Waiting for
funds (80 Kwacha).
 Heating element for autoclave in Medical Lab. To be procured locally. Waiting for funds (300
Kw)
Further requests:
 Upgrade of the BME workshop is going slower than planned, due to contractor relations.
Management attention requested.
 A padlock is needed to prevent theft of tools and test equipment in the BME lab (cost: 100
Kw)
Signed: January 31, 2020, BMET Name

19
A copy of this ME Management report must be emailed to the BMET’s Manager on District and
Provincial level, within the first two days of each new month.
Provincial ME Overview
Following the receipt of the BMET status reports in his/her Province, the PMEO will compile a provincial level
status report and send this to the national CMEO. This report should also fit on a single page. This Provincial
ME Status overview is proposed to contain the following information:
• The average equipment overview and activity report of the hospitals in their province. Only
hospitals where a BMET is stationed shall be included.
• An overview of BMETs positions and reporting in the province
• A selection of the highlights of the month: selected from individual BMET hospital reports.
• A list of the ‘top-ten’ priorities of the PMEO, the status of these priorities and the actions that
the PMEO plans for these priorities in the coming month. Every time that a priority action has
been completed, a new one can be added to the list.
Unless at special (CMEO) request, there is no need for the PMEO to regularly send to the CMEO a
more detailed analysis of the provincial ME situation. This would only overload the CMEO with
information and keep the PMEO from making his/her own contribution (‘decentralization’). A
detailed standard for such Provincial report will be made in a following version of this document.

20
11. ‘Reason not repaired’ analysis
An example of a further analysis which can easily be made from the acquired data is the ‘bottleneck
analysis’. This analysis is derived from data in the ME Inventory. For this analysis, a new file/sheet is made
with a copy of the ME Inventory. In this copy, the ME units (rows) that are ‘functioning’ are removed, so that
only items are kept which are ‘down’. A new column at the right hand side is created titled ‘reason not
repaired’. This column is filled in for each item, choosing one of the reasons mentioned below:
Reason not repaired

not started I have not yet started repair (but will do this soon)
searching I am still working on this but have not yet discovered what component is wrong
I do not know how to proceed with this repair; I cannot find the root cause or the
stuck wrong component
I know what component is wrong and I am now waiting for the budget /
waiting for procurement procurement / arrival of the component
I know what needs to be done and have all materials. The repair will soon be
almost done completed
no plans to fix this device There are no actions currentlly planned to fix this device.
other Any other reason: please explain.
From this file the frequency of each ‘Reason not repaired’ can be computed. See table below. This is useful
information to support management requests for e.g. faster procurement.
18% Percentage with 'not started'

3% searching
3% stuck
33% waiting for procurement
6% almost done
19% no plans to fix this device
12% other
The ‘Reasons not repaired’ analysis is

especially useful if a good number of units is
involved (down), such as when considering
multiple hospitals per Province. The result can
be displayed as a graph and helps to identify
the main actions that need to be taken to
improve the ME Uptime.

21
12. Procurement of consumables and spare parts
Consumables are items which regularly need to be replaced and whose need can be predicted and
calculated accurately, either per patient or per hour of use.
A distinction is made between ‘technical’ consumables and ‘clinical’ consumables. Technical

consumables include: filters for autoclaves or suction machines, light bulbs for e.g. an operating
theatre lamp, batteries for scales, etc.. Clinical consumables include: ‘breathing circuits’ for
anaesthesia systems, ultrasound gel, ECG electrodes, etc.
In general, BMETs will take responsibility for the technical consumables (only). Technical
consumables are often used during Preventive Maintenance, e.g. for the replacements of filters.
Since the use of consumables is predictable, it is ‘unprofessional’ to run into shortages of these
materials. To prevent this from happening, a BMET must make a forecast of the consumables that
will be needed for each ME device per year. This is done in the Equipment Inventory, Column AA and
AB. Both types (column AA) and procurement price (column AB) of consumables must be included
here. Note that if a consumable, e.g. a battery, needs to be replaced only every two years, the price
per year is only half the procurement price of this battery. If a filter replacement needs to be done
twice per year, the yearly required funds is two times the price of the filter.
When the required consumable requirements have been calculated, a request for a budget for
consumables must be made to hospital management, usually via the Procurement Manager.
Whereas currently Zambian hospitals do not have a budget for technical consumables, it is still
important for the hospital BMET to continuously bring up the need for such a budget.
Note that without certain consumables (e.g. suction machine filters) the continued use of such
devices may lead to damage to equipment, and to use of the equipment that is unsafe for the
patient. It is the duty of a hospital BMET to make sure that such unsafe use does not take place.
Spare parts are for example electrical components, heating elements for autoclaves, temperature
probes for incubators, etc.. Spare parts usually fail in an unpredictable fashion and cannot be
procured on forecast: i.e. these are not taken on stock. Spare parts thus need to be procured when
the need arises, usually when the equipment is down. At that moment there may well be urgent to
procure such spare parts: the patients and the clinical staff are waiting. For this reason, it is highly
desirable that there is a hospital budget allocated to spare parts, so that procurement can be done
quickly. From earlier experiences it is estimated that a suitable budget for spare parts in a District
Hospital is around 2,000 US$/year.
When such a budget is not available, the BMET will have to propose each spare part procurement to
Hospital Management, as needed. Usually, spare parts procurement in a hospital has to compete
with food for patients, medicines, etc. and may well be delayed. In order to let Management not
forget about the spare parts need, such requests must be maintained on the monthly management
report, until the part is procured.
Note that apart from mentioned budgets here, the BMET will also have a need for other, work
related consumables, such as solder, glue, cleaning materials, etc. See also under tools and
consumables in an appendix to this document.

22
13. New equipment procurement priorities
The BMET can play a key role in creating and maintaining a list of the procurement priorities of the
medical equipment in the hospital. This list can be used to prioritize the direct procurements by the
hospital. It can also be passed on to District, Provincial and National levels to guide central
procurement. Currently such procurement priority lists do not exist. Without such lists, procurement
priorities will be set in ad hoc way, based on the partial insights of the persons involved.
The BMET is in a good position to maintain this list because (s)he has a good insight in what
equipment is available in the hospital, what should be available (Standard Equipment List), what
equipment will need replacement in the coming years (age of the equipment), the costs of
maintenance of each equipment unit and the approximate price of new equipment.
This priority list should be updated at least once per year, preferably around July, in time for the
national budgeting rounds for the coming year.
The first step in establishing these priorities is to take the Standard Equipment List for the level of
hospital at hand and compare this with the actual ME Inventory. This leads to a document indicating
the ‘missing equipment’ per department according to the SEL.
The second step is to discuss this list with each of the hospital department managers. In this discussion,
each ‘missing equipment’ should be given one of the following procurement priorities:
 Top priority - which means that patient’s lives could be saved by having this equipment.
 Very Important - which means that the quality of care for the patients in the department
would increase significantly by having this equipment.
 Important – which means that the efficiency of the department personnel would increase
considerably by having this equipment.
 Not so Important – all other
When this has been done for all departments, a priority list for the whole hospital can be constructed
by ordering the list per procurement priority (rather than per clinical department).
The resulting list must then be communicated with the Management Team of the hospital. The
Management Team can bring in modifications and, ultimately, approve the list. This list can then be
communicated to the District, Provincial and National MoH organization.

23
14. Tools, Workshop and Test Equipment
Tools
BME tools must have a reasonable quality, preferably from (South) Africa. Cheap, low-quality tools
must be avoided. On the other hand, high quality tools may be prohibitive in price and often need to
be ordered from abroad. This is not always suitable for the hospital environment in Zambia.
In Appendix 1, the tools as procured for the ME Uptime pilot project in 2017 are listed, including
their prices. It is a minimum tool set. Professionals can argue a long time over what is needed. This is
especially so, since the Zambian BMET will often be requested to do some work on non-medical
equipment, e.g. for plumbing , power systems, laundry machines, etc. The specialized tools that are
used for such operations are not included in the standard BMET toolbox.
Access to a desktop PC or laptop is considered necessary for a BMET.

 PC/Laptop with MS Office and a virus scanner, a carrying bag at about 600 USD.
 A dongle/MIFI, SIM card and monthly Internet bundels (3GB/month minimum).
Workshop
The minimum requirements for a workshop in a District Hospital are:
 Workbench and chair/stool
 Lockable cabinet for toolbox and consumables
 220V power supply
 Water & sink
 Lighting
 (Wall painting)
Test Equipment
Test equipment is used to test the proper functioning of Medical Equipment. For example: how can
you be sure that a good concentration of oxygen is produced by an Oxygen Concentrator if you do
not have test equipment to measure oxygen concentration? The main function of test equipment is
to ensure the safety of the use of the equipment.
Professional BMETs in ‘high income’ countries use a lot of test equipment. However, test equipment
is often very expensive. In low and middle income countries, a balance has to be found between
procuring medical equipment to diagnose and treat patients and test equipment to ensure the
safety of this. For example, a hospital does not need a defibrillator tester if the hospital does not
own a defibrillator (or if it is never used).
Most test equipment is not used in a hospital every day. Therefore, it is a good approach to procure
& manage test equipment at the Provincial level and share it with all hospitals in the Province.
When funding is limited, a priority list of test equipment needs to be made. This proposed list is as
follows:
 Oxygen concentration measurement equipment

 Water purity (conductivity) measurement equipment
 Electric safety analyzer
 Physiological signal generator (patient simulator)

24
 Ventilator tester
 Defibrillator tester

 ….
Priority is given here to equipment that is used for most patients, i.e. in District Hospitals. In the
Appendix, some brands and prices are mentioned.

25
Appendix 1: Tools, Consumables and Test Equipment as used in the ME Uptime pilot project (2017)
BMET Hospital Toolbox

Tool configuration Picture Brand Supplier/shop Price/unit (ZMW)
Mastercraft Hex Key

1 Allen Key Set 2 sets: metric, inches. Wrench Set 16 PCE, Builders Warehouse 80
metric and inches
2 sets: blades and Grip s/driver insulated set

2 Screw Driver Set Builders Warehouse 330
phillips 7PCE
Screw Driver Set: set to include blades

3 FRAGRAM PREC.? GAME 43
Precision Type and phillips
Voltage Function Screw

4 1 x long Voltic Electrical Ltd 30
Driver
5 x Fragram Spanner Set

8PC S1852 a 149 + 3 x
5 Wrench/Spanner set set of 8 Mastercraft Comb Handyman's Paradise 326
Wrench Quad Grip 7PCS a
620
ProTech waterpump
6 Plumber's Pliers City Television Hire Ltd 53
pliers
7 Long Nose Pliers GAME 20
8 Diagonal Cutter (Mini) GAME 17
ProTech 8inch
9 Combination pliers City Television Hire Ltd 80
combination plier
Adjustable Wire 6inch wire stripper King

10 City Television Hire Ltd 76
Strippers Roy VDE
Stanley trimming knife

11 Pen Knife Builders Warehouse 110
fixed
Ross prof hacksaw frame

12 Hacksaw (Big) Builders Warehouse 75
H/D BLK/RED
Grip/ProTech Builders Warehouse/City

13 Hacksaw (Mini) 75
(3x100)+(5x60) Television Hire Ltd
LED, with 2AA batteries Energizer LED 2AA Plastic

14 Torch Builders Warehouse 40
each Torch
15 Measuring Tape Ross measuring tape 5M Builders Warehouse 40
Academy Paint Brush

Blondie 8 x 50 mm à 25
16 Brush 2x: small and big Builders Warehouse 35
ZMW and 8 x 12mm à 10
ZMW
7 x Mastercraft t/box 5-
tray cantilever a 320 + 1 x
17 Steel Toolbox 7x steel, 1x plastic Builders Warehouse 303
Grip Plastic Tool Box
50cm a 180
18 Padlock Brs Plated 32 mm 4 x Cobolt Shackle 32mm a 65 and

Builders
3 x Cobolt
Warehouse
Shackle 38mm a 9070
+ 1 bras plated 32 mm a 30
Grip claw hammer fibre

19 Hammer Builders Warehouse 100
handle 450G
with a durable coated

20 Soldering iron Stanley 30 Watt City Television Hire Ltd 224
tip
5 x RT21/651B RACO MICMAR/City Television

21 Solder Sucker solder sucker/3 x Nikko Hire Ltd/Lusaka Hardware 99,375
(5x132) + (3x45) Ltd
Grip warding file set 6PCE

small set (for keys) and
23 File Set small + Grip steel file half Builders Warehouse 205
big half round
round 200mm a 75
5 x Majortech digital m/m

with temperature c/w temp EN 3 x Builders Warehouse/Voltic
24 Digital Multimeter 775
sensor included Toptronic T235H (5x880) Electrical Ltd
+ (3x600)
Total Price Tools (ZMK) 3.206

26
BMET Hospital Test Equipment

est. price
Equipment Comments Picture suggested model
(USD)
measuring cell plus cable and digital device; cell

http://www.conrad.com/ce/en/product/1231
is consumable; for checing oxygen
2 Oxygen analyser 01/Greisinger-GOX-100-T-Oxygen-Meter-with- 210
concentrators, incubators and ventilators;
Sensor
including protective cover/bag
http://www.conrad.com/ce/en/product/1008
NB. high sensitivity range required ! to test
4 water purifier analyser 55/Greisinger----GLF-100----Universal- 220
sterility of water used for autoclave, incubator
conductivity-meter-GLF-100----05-----0
Rigel Unipulse 400 (to be launched…)

http://www.seaward-
3 defib tester/analyser only in case the a defibrillator is present 2.580
groupusa.com/downloads/rigel_medical_sale
s_flyer_usa_2014_v1.2.pdf
NB: this will not test the grounding system of

6 electrical safety tester 410A910 - RIGEL SAFETEST 60 ROW 1.400
the hospital.

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Standard Operating Procedures

Appendix 1: Tools, Consumables and Test Equipment 25

Version 5 ME Management Zambia September, 2019

Version 5 ME Management Zambia September, 2019

2. Medical Equipment (ME) Inventory and analysis

Item (Equipment name)

Date of Inventory Hospital Hospital

Version 5 ME Management Zambia September, 2019

3rd party maintenance contract (none = 0;

consumables budget required per year

Next date of PM (week number)

User / Operation Manual

Not used, not functional

The ME inventory format, displayed here in two halves.

Analysis of ME Inventory: Equipment Status

Version 5 ME Management Zambia September, 2019

Number of units in Est.value when new

Medical Equipment prices

Version 5 ME Management Zambia September, 2019

3. Activity reporting and analysis

Preventive Maintenance Activity Report

District Name: Thomson DH BMET name:

how many how many

The Activity Report format for Preventive Maintenance

District name: Thomson DH BMET name:

Date of User How many how many minutes

The Activity Report format for User Training sessions

Version 5 ME Management Zambia September, 2019

Analysis of CM, PM and User training activities

Spare part Spare part

Number of UT Average minutes Average number of

Version 5 ME Management Zambia September, 2019

4. Preventive Maintenance (PM)

The actions that need to be

PM can be separated in User-

Version 5 ME Management Zambia September, 2019

The MoH Guidelines (2012) include

Version 5 ME Management Zambia September, 2019

Assessing User Training Needs

1. What medical equipment do you use (regularly) in your current function?

The answers to above questions are filled in in the table below.

Version 5 ME Management Zambia September, 2019

ME Training need? (yse=1, no=0 )?

ME Training need? (yse=1, no=0)?

Average familiarity with device

user of ME (yes=1, no=0)?

user of ME (yes=1, no=0)?

Total Training need

How familiar (1-5)?

'General' equipment BP Machine 1 5 0 1 5 0

Executing User Training

Version 5 ME Management Zambia September, 2019

User Training materials

6. Service and user manuals

7. Service History File

Version 5 ME Management Zambia September, 2019

This PC/Documents/MEServiceHistoryFile/THDHXXXX, with XXXX between 0001 and 9999,

The ME Acceptance procedure is composed of the following steps:

1. Receive and unpack the equipment on site

2. Assemble, Install and Commission (put the system to work)

3. Initial User Training

Version 5 ME Management Zambia September, 2019

4. Enter the new equipment into the ME Inventory