By Patrick Lynch, CBET, CCE, CHTM, CPHIMS, FACCE

What is the one task that you would rather not do at work? Repairs? In-service? No, it’s PMs, of course. After the first two rotations out of biomed school, PMs become routine, boring, and not the most fun part of the job. Plus, they consume up to 50% or more of your total workday.

So, would you like to figure out a way to do less PMs and free up time to do the more rewarding and fun parts of your job?

Well, do you listen to the Centers for Medicare & Medicaid Services (CMS)? Do you perform maintenance on every item according to manufacturer standards and frequencies? If so, you are doing too much work—as well as wasting valuable hospital resources.

For decades, we in HTM—or “biomed” as we were then called—wrote our own preventive maintenance procedures based on what we knew to be true for patient care equipment. In 1979, the American Hospital Association even published an entire book of PM procedures for medical equipment. This included x-ray generators, laboratory equipment, as well as all of the general types of medical equipment that existed back then. (Obviously, the list excluded lasers, personal computers, and robotic surgery systems.)

Then, several years ago, CMS, in their infinite (and governmental) wisdom, decided that we knew nothing and that only manufacturers knew anything about equipment maintenance. CMS then forbade us from deviating from the procedures that the manufacturers placed in their manuals before the equipment was even placed into service.

CMS has since eased from this stance slightly, but returning to our tried and proven methods requires following a very strict set of rules in order to develop an alternative equipment maintenance program, or AEM. Developing the justifications for the many types of equipment is the toughest part. You need “scientific evidence” for each deviation from the manufacturer’s procedures or frequency. That is why most hospitals have not yet adopted AEM as completely as they should or could.

A Novel Approach

We have a solution for you: The RCM Task Force is an AAMI-supported project to streamline PMs using a scientific approach, which we have developed. Pioneered by HTM veteran Dr. Malcolm Ridgeway, the RCM Task Force is comprised of many of the biggest names in the industry. As such, we have developed some very advanced methodologies to assist in the creation of AEM programs.

RCM stands for “reliability centered maintenance,” a maintenance approach that started in the civil aviation industry and has migrated to most other industries.

To apply RCM to HTM, we have to consider the three reasons a medical device can fail:

  1. Inherent causes—such as circuit boards failing, poor construction, poor design, etc.
  2. Process-related causes— for instance, the device being dropped, incorrect operation by the user, etc.
  3. Maintenance-related causes—such as inadequate PM tasks, inadequate PM frequency, etc.

For our purpose here—analyzing the effectiveness of PM programs —we are concerned only with PM-preventable failures, so we can choose to ignore the inherent and process-related causes (which, together, usually account for more than 90% of all medical equipment failures). Furthermore, we evaluated every PM task to see which items could lead to patient injury if not performed.

Maximizing RCM 

The RCM Task Force has a website with a scientifically generated list of every item that can be safely placed on an AEM program. You are welcome to visit the website at www.HTMcommunitydb.org and download the entire program, along with a table that shows the 20 items that must be left on the AEM program. All others are open for an alternative program of reduced PM frequency and/or procedures.

Once you’ve opened the website, take these three steps:

  1. Consult the severity rating tables on the website to identify all of your devices that are either “zero-PM risk” or “PM-critical” with adverse failure outcome severity levels.
  2. Follow the seven-step implementation plan, listed in 16.9 here.
  3. Rest easy and enjoy an immediate boost in the efficiency of your PM program.

Patrick Lynch, CBET, CCE, CHTM, CPHIMS, FACCE, is a biomedical manager with 40 years’ experience. Questions and comments can be directed to 24×7 Magazine chief editor Keri Forsythe-Stephens at kstephens@medqor.com.