This week Gradian is joining many others in the celebration of Healthcare Technology Management (HTM) Week — May 18-24, 2014.

This annual celebration is sponsored by the Technology Management Council (TMC) of the American Association for the Advancement of Medical Instrumentation (AAMI) (aaami.org) and is designed to promote the awareness of—and appreciation for—the critical work of biomedical equipment technicians (BMETs), clinical engineers, and other members of the healthcare technology management (HTM) field.

A recent BMET training in Ethiopia

At Gradian we recognize the invaluable support that our HTM colleagues provide to ensure that medical technology functions correctly and safely. At the core of our work is the provision of training and capacity building – not only to support the UAM but to support safe surgery in general.

EWH Training in Rwanda

The following articles, recently published by the Austere Anesthesia Health Outcomes Research Group of John Hopkins, illustrate the value added by biomedical engineers and technicians in ensuring the safe and proper operation of anesthesia equipment. The abstracts and a link to each of the full articles are below.

Failure mode and effects analysis applied to the maintenance and repair of anesthetic equipment in an austere medical environment – published in the International Journal for Quality in Health Care, May 2014 (full article here)

Objective Medical technology designed for Western settings frequently does not function adequately or as intended when placed in an austere clinical environment because of issues such as the instability of the electrical grid, environmental conditions, access to replacement parts, level of provider training and general absence of biomedical engineering support. The purpose of this study was to demonstrate the feasibility of applying failure mode and effects analysis as part of an implementation strategy for medical devices in austere medical settings.

Design Observational case-study.

Setting/Participants/Intervention We conducted failure mode and effects analysis sessions with 16 biomedical engineering technicians at two tertiary-care hospitals in Freetown, Sierra Leone. The sessions focused on maintenance and repair processes for the Universal Anaesthesia Machine. Participating biomedical engineers detailed local maintenance and repair processes and failure modes, including resource availability, communication challenges, use errors and physical access to the machine.

Main Outcome Measure(s) Qualitative descriptive themes in barriers perceived and solutions generated by biomedical engineers.

Results Solutions generated involved redesigned work processes to increase the efficiency of identifying machine malfunctions, clinician engagement strategies, a formal plan for acquiring spare parts and plans for improving access to the machine. Follow-up interviews indicated solutions generated were implemented and perceived to be effective.

Conclusions This study demonstrates the feasibility of using the failure mode and effects analysis approach to improve implementation of technology in austere medical environments.

The BMETs at Mbale during training with the UAM

The BMETs at Mbale during training with the UAM

Failure mode and effects analysis of the universal anaesthesia machine in two tertiary care hospitals in Sierra Leone – published in the British Journal of Anaesthesia, May 2014 (full article here)

Background Anaesthesia care in developed countries involves sophisticated technology and experienced providers. However, advanced machines may be inoperable or fail frequently when placed into the austere medical environment of a developing country. Failure mode and effects analysis (FMEA) is a method for engaging local staff in identifying real or potential breakdowns in processes or work systems and to develop strategies to mitigate risks.

Methods Nurse anaesthetists from the two tertiary care hospitals in Freetown, Sierra Leone, participated in three sessions moderated by a human factors specialist and an anaesthesiologist. Sessions were audio recorded, and group discussion graphically mapped by the session facilitator for analysis and commentary. These sessions sought to identify potential barriers to implementing an anaesthesia machine designed for austere medical environments—the universal anaesthesia machine (UAM)—and also engaging local nurse anaesthetists in identifying potential solutions to these barriers.

Results Participating Sierra Leonean clinicians identified five main categories of failure modes (resource availability, environmental issues, staff knowledge and attitudes, and workload and staffing issues) and four categories of mitigation strategies (resource management plans, engaging and educating stakeholders, peer support for new machine use, and collectively advocating for needed resources).

Conclusions We identified factors that may limit the impact of a UAM and devised likely effective strategies for mitigating those risks.

Thank you HTM professionals!

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