No Problem Found?

 Have you ever worked on any type of medical equipment only to find nothing wrong with it? When this happens, it might be tempting just to close your work order with “no problem found.” My goal is to persuade you listen closely to the clinician and think twice before you conclude that there is no problem found.

The downside to new technology is its complexity. An intermittent problem due to a software anomaly, unintended user interaction with equipment, or electronic interference can cause equipment to function improperly. It may not be possible to duplicate the problem that a clinician reports.

For example, your day may start with a service call reporting that a defibrillator is not working. You know the first thing you should do is to obtain a work order stating the device’s problem and the person reporting the problem. You talk to the person reporting the problem and find out that the defibrillator charged normally, but would not discharge to shock the patient. The user turned the defibrillator off and then back on and was able to successfully convert the patient into a normal sinus rhythm.

Now that you know the problem the user experienced you try to duplicate the problem. You test the defibrillator several times using your defibrillator analyzer, and it discharges normally every time. The unit seems to be working, so you conclude there is nothing wrong with the defibrillator. You close your work order with “no problem found.” Do you feel comfortable that this problem is resolved?

I feel there is still more that could be done to resolve the problem. Your defibrillator may have a setup menu, error code log, and an event log. Be sure to take advantage of all the information you can get, not only from the user that experienced the problem but also from the defibrillator itself. Say you check the setup configuration of the device and it has not been changed, and the error log contained no error codes. The event archive, however, contains what caused the symptom the user reported with the defibrillator.

One ECG strip documented a patient having a fine-ventricular fibrillation cardiac rhythm. The defibrillator sync function was documented as being turned on, but was unable to detect any R-waves. In ventricular fibrillation, the ventricles of the heart are just quivering in spontaneous contraction of individual muscle fibers. Since there is no organized ventricular contraction, the defibrillator may not be able to detect the R-wave and therefore will not discharge. In this example, the clinician should have turned the sync function off to defibrillate. The event archive shows that when the clinician turned the unit off and back on, the sync function was off and the defibrillator discharged normally.

What could you do if the event archive did not provide any conclusive information about the problem? The defibrillator could be replaced with a known good spare. A call to the defibrillator manufacturer for advice could result in more information about the problem and possible solutions. The defibrillator also could be sent to the manufacturer. This would be better than telling the clinician “no problem found” and would let the clinician know you are doing everything possible to resolve the problem.

There are so many variables in how clinicians can use medical equipment for patient care. The problem could be a combination of many factors, including user error, but certainly never overlook the possibility of equipment malfunction. How equipment is used for patient care is ultimately the responsibility of the clinician, but when asked to resolve an equipment problem, I hope you will look beyond “no problem found.”

Sid R. Wilson, CBET, CET, is a BMET at Cox Health in Springfield, Mo.

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