Esperanto for Engineers, Technical Talk for Medical Engineers

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Presentation given at the 2012 NPAG Conference in Rugby UK. Some suggestions as to how we can better develop our 'technical talk' and what has already been developed and available.

Presentation given at the 2012 NPAG Conference in Rugby UK. Some suggestions as to how we can better develop our 'technical talk' and what has already been developed and available.

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  • 1. Esperanto for Engineers “Tools for Technical Talk” Paul A Blackett Medical Engineering Operations Manager Lancashire Teaching Hospitals NHS Foundation Trust
  • 2. Paul A Blackett: NPAG Clinical Engineering Conference 2012
  • 3. Paul A Blackett: NPAG Clinical Engineering Conference 2012 In Windows…
  • 4. Paul A Blackett: NPAG Clinical Engineering Conference 2012 At the Polling Station
  • 5. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Overview • GMDN • UDI • GS1 coding • Technical Nomenclature • Failure Codes • Risk • KPIs • The way ahead
  • 6. Paul A Blackett: NPAG Clinical Engineering Conference 2012 GMDN • Equipment Databases held locally • Naming of devices • ECG Monitor, Cardiac monitor, vital signs monitor, multiparameter monitor? • a common naming convention – Brings together 6 previous nomenclatures [1] – GMDN [2] (Global Medical Device Nomenclature) From ISO 15225:2010 part of Global Harmonization – Used by Manufacturers and EUDAMED (European Database on Medical Devices) – Maintained by GMDN Agency – Accessible at a cost to pay for administration – Term: Centrifuge, general-purpose laboratory (Code: 36465) What What What What’’’’s in a name? s in a name? s in a name? s in a name?
  • 7. Paul A Blackett: NPAG Clinical Engineering Conference 2012 GMDN Data
  • 8. Paul A Blackett: NPAG Clinical Engineering Conference 2012 GMDN Data The device category is the broadest level of the GMDN data. It divides the entire medical device product market into highest-level groups based on device application, technology, or other common characteristics. The standard (ISO 15225) allocates codes for 20 categories. These are: Category Description 01 Active implantable devices 02 Anaesthetic and respiratory devices 03 Dental devices 04 Electro mechanical medical devices 05 Hospital hardware 06 In vitro diagnostic devices 07 Non-active implantable devices 08 Ophthalmic and optical devices 09 Reusable devices 10 Single use devices 11 Assistive products for persons with disability 12 Diagnostic and therapeutic radiation devices 13 Complementary therapy devices 14 Biological-derived devices 15 Healthcare facility products and adaptations 16 Laboratory equipment 17 Vacant 18 Vacant 19 Vacant 20 Vacant
  • 9. Paul A Blackett: NPAG Clinical Engineering Conference 2012 GMDN Data Collective terms are high-level device terms used to aggregate medical device groups that have common features within the GMDN. Collective terms may be device names (e.g., Stents, Catheters, Pacemakers) or device attributes (e.g., Electrophysiology, Absorbable, Home-use); the device name collective terms are especially used to create hierarchical constructs in the GMDN.
  • 10. Paul A Blackett: NPAG Clinical Engineering Conference 2012 GMDN Data Preferred terms with their unique 5 digit codes are the only terms available for product identification. The preferred term is the optimal name selected to represent a group of devices (a collection of device types) that have the same or similar intended use or commonality of technology allowing them to be grouped in a generic manner, typically without reflecting specialized characteristics such as brand or trade names. Other Terms exist such as Template, which is used as a root for more specific terms and Synonym which is used as a navigational toot to find the Preferred Term.
  • 11. Paul A Blackett: NPAG Clinical Engineering Conference 2012 GMDN Data Sample data Sample data Sample data Sample data…………
  • 12. Paul A Blackett: NPAG Clinical Engineering Conference 2012 GMDN Data What it looks like in real life What it looks like in real life What it looks like in real life What it looks like in real life………… •Long Term names! •Term ID added to the end of the Device Type? •Could possibly use the Term ID as part of the Equipment Code?
  • 13. Paul A Blackett: NPAG Clinical Engineering Conference 2012 GMDN Data •Integration with SNOMED CT WhatWhatWhatWhat’’’’s next?s next?s next?s next? 'Systematized Nomenclature of Medicine Clinical Terms' The Integration of GMDNS into Clinical Terminology and health records. [5]
  • 14. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Unique Device Identification • Unique Device Identification [9][10] – A global number for each model by 2013 – Traceable – Product Part – Producer Part
  • 15. Paul A Blackett: NPAG Clinical Engineering Conference 2012 UDI What the UDI includes… • Unique for each version or model • Permanently marked on device • The trade or brand name (as shown on the device) • Lot No / Serial No. (some ambiguity here) • Version or model
  • 16. Paul A Blackett: NPAG Clinical Engineering Conference 2012 UDI • Sterile or non-sterile • Contains latex or not • Size and unit of measure (if relevant) • GMDN code • Packing quantity UDI Code
  • 17. Paul A Blackett: NPAG Clinical Engineering Conference 2012 GS1 Coding • Common data structures - Coding for Success [6] – GS1 coding of labels for patient… and equipment (300+ trusts reg’d) – Recommended by the NAO [7] and Lord Hunt [8] – Choice of data carrier…
  • 18. Paul A Blackett: NPAG Clinical Engineering Conference 2012 GS1 Coding • Patient wrist band identification • Drugs • Medical Equipment • Staff
  • 19. Paul A Blackett: NPAG Clinical Engineering Conference 2012 [F1]8004505521790000023672 GIAI Global Individual Asset Identifier Site code Local number GS1 identifier
  • 20. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Technical Nomenclature Q1 A Nurse arrives at your department and says her infusion pump needs maintaining. Do you… a) Presume it needs a repair b) Presume it needs a service c) Presume nothing d) Do something different!
  • 21. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Technical Nomenclature Q2 An Engineer asks you if the ECG monitor on Ward 1 needs a service, PVP, an inspection or PPM. Do you… a) Say Yes b) Pretend not to hear c) Tell him he should know by now d) Move onto the next slide to find out…..
  • 22. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Technical Nomenclature Corrective Maintenance, repair, PM, PVP, Maintained, Serviced, inspection , Tested, PPM, checked ok! FixedFixedFixedFixed Acceptance testedAcceptance testedAcceptance testedAcceptance tested,,,, Commissioned, Received, Scrapped, Retired, Removed from service • We need to speak the same technical language • ECRI Publication: – “Clear Talk About Service” [3] ECRI publication for unifying and defining terms we use in our profession
  • 23. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Technical Nomenclature ECRI’s Universal Medical Technical Service Nomenclature (UMTSN). Definitions provided for 24 common phrases used in the management of health care technology Inspection. A procedure used to verify that the physical integrity, safety, and performance of a device meet the necessary requirements. Preventive maintenance. A routine procedure used to minimize a device’s risk of FAILURE and to ensure its continued proper operation. Examples of preventive maintenance tasks are lubricating, adjusting, and replacing parts as recommended by the manufacturer (e.g., batteries, O-rings).
  • 24. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Technical Nomenclature Calibration. A procedure used to determine a device’s accuracy using test equipment whose own accuracy is appropriate and has been verified; and then, as needed, adjusting that medical device to meet the manufacturer’s specifications. Acceptance inspection. A detailed INSPECTION performed before a device is put into use either after initial receipt (i.e., the incoming inspection of new equipment) or following other service activities (e.g., a major REPAIR, MODIFICATION, or OVERHAUL) as appropriate. Downtime. The time that a device is not available for clinical use because of the need to perform activities such as INSPECTIONS, PREVENTIVE MAINTENANCE, and REPAIRS. Downtime is specified in hours or as a percentage. Repair. A process used to restore the physical integrity, safety, and/or performance of a device after a FAILURE.
  • 25. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Failure Codes What is a Failure Code? Why are they used? • Most Databases have some ability to record events or observations against work activity. Failure codes provide a convenient method of getting statistics about equipment failures or breakdowns Failure codes are used to illustrate why an asset failed or the reason that the asset failed.
  • 26. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Failure Codes Standardising failure Codes [4] – Journal of Clinical Engineering: Measuring Maintenance Effectiveness with Failure Codes. – Range of codes suggested to make comparing failures easier between organisations.
  • 27. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Failure Codes • NPF – No Problem Found • ACC – Accessory Failure • BATT – Battery Failure • USE – User damage /abuse • PPF – Preventable or Predictable Failure • SIF – Service Induced Fault • UPF – Unpredictable Failure • (FFPM – Failure Found in PM) Repair Codes
  • 28. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Failure Codes • NPF – No Problem Found • EF – Evident Failure (Could have been reported but wasn’t) • HF - Hidden Failure (Failure not detectable by User) • PF – Potential Failure (eg frayed power cord) Close PM job with code and open Repair job (use code FFPM) Scheduled Maintenance Codes
  • 29. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Failure Codes • Annual Failure Probability • Use as evidence for maintenance • Target specific failures eg, ACC, BATT, EF • Purchase devices with a lower UPF Analysis and Action
  • 30. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Risk • Standardising Risk Models Swedish Model of Prioritising Maintenance Risk calculated between 1 and 5 (greatest) Maintenance needs between 1 and 5 (greatest) Mission Critical function between 1 and 10 (most severe) Score = 2*Risk + 2*Maintenance + Mission Critical
  • 31. Paul A Blackett: NPAG Clinical Engineering Conference 2012 KPIs Service User Internal Management Continuous Improvement Financial • Response Time - from requesting phone call to first action. • Time to Completion – from requesting phone call to completed job. • Scheduled maintenance completion – percentage attempted in a 12 month period. • Repair jobs open for more than 3 months. • Annual Customer Satisfaction survey • Time spent on Engineer training – hrs per year • Annual cost per device • Annual cost per bed
  • 32. Paul A Blackett: NPAG Clinical Engineering Conference 2012 The way ahead… • GMDN – FDA will adopt as part of UDI – Already adopted by some UK hospitals • UDI – Adopting by 2013 • GS1 – Already here. • UMTSN – Published, easy to adopt. • Failure Codes – new. • Risk Models – A lot of reticence. • KPIs – NPAG lead the pack.
  • 33. Paul A Blackett: NPAG Clinical Engineering Conference 2012 Finally… Perhaps our next Conference could be in Esperanto? NPAG Kliniko Inĝenierio Konferenco 2013
  • 34. Paul A Blackett: NPAG Clinical Engineering Conference 2012 References and suggestions for further study [1] http://www.gmdnagency.org/Downloads/GMDN_Agency_User_Guide_v120810.pdf [2] http://www.gmdnagency.com/ [3] Clear Talk about Service. 2009 ECRI Health Devices, April https://www.ecri.org/umtsn [4] Wang B. et al. 2010 Evidence Based Maintenance pt 1 Journal of Clinical Engineering Vol 35, No. 3 July/Sep [5] http://www.ihtsdo.org/news/article/article/ihtsdo-and-gmdna-signs-cooperation-agreement/ [6] DH 2007 Coding for Success. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_066082 [7] GS1-uk 2010 http://www.gs1uk.org/news/Pages/GS1UKNewsDetails.aspx?NewsID=445 [8] http://www.connectingforhealth.nhs.uk/systemsandservices/aidc/background [9] GHTF 2010 Unique Device Information for Medical Devices http://www.ghtf.org/documents/ahwg/AHWG-PD2-N2R2.pdf [10] http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm310505.htm Thank you for your attention Paul.Blackett@lthtr.nhs.uk