1. SCOPE • Volume 15 • Issue 3 • SEPTEMBER 200620
As a reader of Scope I have long considered there to be a
lack of articles covering the work of Technologists.
Recently I contacted Peter Harding the Technology Editor
of Scope to share my concerns with a view to contributing
an article. If you are a Technologist member let this be a
nudge in your direction – please consider contributing
articles, papers, meeting reports, and other relevant
information to Scope to highlight the valuable work
performed by Technologists within healthcare.
Queen’s Medical Centre Nottingham NHS Trust was the
first purpose built teaching hospital in the UK. It operates
in conjunction with the University of Nottingham’s Faculty
of Medicine and Health Sciences to provide a teaching
environment. Queen’s has an enviable international
reputation for patient care, teaching and research. It
admitted its first patient in August 1978 and replaced 5
other hospitals in the area that together had a history of
healthcare in Nottingham of more than 200 years.
Queen’s provides elective, emergency and day care
services to over 650,000 people together with specialist
and tertiary services to over 2 million people. It employs
around 6,000 staff with an income of over £200 million.
Queen’s has gained national and international recognition
in many of its specialities.
The Medical Equipment Service Unit (MESU) was
established just before the opening of Queen’s with the
remit of managing the increasing number of medical
devices. Presently MESU provides specialist medical
device management services for in excess of 20,000
assets valued at £25.5 million.
MESU employs 36 staff. Of these staff 27 are qualified Clinical
Engineering Technologists with the remaining staff being
classed as Library/Portering and Business Support staff.
The main core services of MESU are Medical Device
Management, Equipment Library, Medical Device User
Training, and Medical Device Maintenance. To provide the
maintenance services MESU technologist staff is split into 3
operational teams to allow work effort to be directed
towards core duties:
• The Response Team - respond to all customer requests
for maintenance with a remit to sort out any problems
that can be resolved speedily.
• The Repair Team - responsible for any repairs that
require more in-depth fault finding together with the
acceptance of new medical devices into service.
• The Scheduled Maintenance Team - responsible for
performing routine maintenance on medical devices.
The remaining staff in the department comprise of:
• The Business Support Team - provide administrative
and operational support services to all areas of the
department.
• The Equipment Library and Stores Team - responsible
for the provision of equipment library and logistical
services.
• Medical Devices Trainer – responsible for ensuring
devices are used competently and safely by all users.
• The Management Team - determine the strategic
direction and operational strategy of the department.
MESU Staffing and Organisation
Introduction
A Focus on MESU (Medical
Equipment Service Unit), QMC
NHS Trust, Nottingham – The Role
of Technologists
Mark L Callaghan, Assistant Manager, MESU
Queen's Medical Centre, Nottingham NHS Trust
features

2. SCOPE • Volume 15 • Issue 3 • SEPTEMBER 2006 21
The structure of these all of the teams permits MESU to
respond in a more timely fashion to operational needs. It
also means that a focus is maintained on the different
areas of work to ensure that for example, scheduled
maintenance does not fall behind. The MESU
Departmental Manager reports directly to the Operations
Director of the Trust. This ensures that he has complete
autonomy regarding making decisions on staffing,
changes of establishment, procedural changes,
equipment purchasing, and managing budget. This
flexibility permits a great deal of freedom to react speedily
to change.
The Equipment Library provides a pool of devices that are
available centrally for use wherever there is a clinical need.
In order to obtain a device, the clinical staff contacts the
Library with a request for a device for a particular patient.
This in turn will be delivered directly to the ward ready for
use. One advantage of the Equipment Library is that it saves
clinical staff searching or ringing around for devices as
would have happened in the past. Often they would not be
found or there would be a delay in locating them, thus
resulting in delays to patient treatment together with an
exacerbation of patient condition. From a budgetary
viewpoint the Library permits increased asset efficiency by
utilising a lower number of assets more effectively – fewer
assets in use more of the time.
The Medical Device Trainer provides user training to clinical
staff. Scheduled training sessions for wide usage devices
are arranged and ad-hoc sessions are provided where
necessary. Clinical staff can attend sessions to improve
their knowledge and understanding of the medical devices
that they are using, which. In turn promotes better patient
care because clinical staff use devices more effectively,
with improved confidence and most importantly improved
safety. Information is also made available via the MESU
website at http://www.qmc.nhs.uk/Divisions/Diagnostics/
MESU to promote a greater understanding and knowledge
of medical devices. This information (under the “Product
Info” section) provides users with product overview articles
and product selection information, as well as in some
cases full user manuals. It must be appreciated that people
learn in different ways, so providing a variety of sources of
information is beneficial to helping clinical staff gain better
understanding of medical devices. Self Declaration
Competence Statements are also available on the website
for users to download and print. These are designed to
check whether user knowledge on products is adequate by
asking a series of questions that a competent user is
expected to know. Some generic examples of question are
regarding settings for the device and what action to take in
the event of alarm conditions.
One important aspect of the work of the department, that
works hand-in-hand with the Library and Medical Device
Training, is standardisation of medical devices. By
following an approach to standardisation numerous
benefits can be achieved:
• The prime one focuses on training. Staffs that come
across only one product (for example the same syringe
pump) are more likely to be able to use that one
product safely.
• When purchasing devices you are in a strong negotiating
position to obtain discounts for quantity orders.
MESU Equipment Library providing device pool

3. SCOPE • Volume 15 • Issue 3 • SEPTEMBER 200622
• By following a careful selection process it is possible to
select the product that meets all of your needs.
• It is easier to reduce downtime on devices by only
having to keep a limited range of spare parts available.
Linked in with this it is possible to negotiate volume
discounts on spares.
• If a device fails in use, the same product can be
borrowed from the Library without any confusion arising
over how to use it.
Due to changing health needs, expectations regarding
healthcare are increasing rapidly. Healthcare is
increasingly reliant on the development of medical
technology to permit advancements in medical care
which reduce the patient’s length of stay. This
technology needs to be managed effectively to enable
clinicians to deliver the better quality of care that is
expected. The majority of procedures that are
commonplace today are assisted by advances in
medical technology. If you were to conduct a survey say,
down at the local pub, of healthcare professions, it
would be a long time before you came across anybody
who ventured anything approaching “looking after the
equipment”. But if on the other hand you asked what
might be used to aid a person suffering a heart attack?,
most people would name a defibrillator (even though
they may call it the “electric shock thing”). These devices
gain a high profile and most lay people would be aware
that they have the ability to restart the heart by delivering
an electric shock. However most people would be
unaware of the work performed by technologist’s behind
the scenes to ensure that the defibrillator will save lives
when called upon – if a defibrillator fails to deliver its
energy the most likely outcome is that the patient will not
survive the cardiac arrest.
Medical Device Management involves looking after
medical devices throughout the complete life cycle of the
device. This life cycle starts before the device is
purchased, when a need for a new device is identified and
involves a number of distinct stages:
• Evaluation – If new devices are to be purchased they
must be trialled and evaluated to ensure that they are fit
for purpose and meet the user’s needs. Technologists
working within the department participate in this
evaluation work together with clinical users to allow a
consensus of opinion to be reached on the most
appropriate device.
• Purchase – When new devices are purchased the
department works with users and the Supplies
Department to ensure the most suitable product is
purchased. This works in tandem with the
standardisation policy. If the purchase is large capital
replacement procurement program an advert will
have been placed in the OJEC European Journal
inviting manufacturers to tender for the business.
Approval for purchasing involves certain controls,
which include the manufacturer completing a Pre-
Purchase Questionnaire (PPQ). Smaller one-off
purchases will require advice being given to users on
suitable products.
• Acceptance checks for newly delivered devices –
Newly delivered devices require safety and functional
checks to be performed to ensure that the devices
work as intended. These checks include the verification
of any delivered energy, of general device function,
and electrical safety (especially regarding patient
connections). The device is entered onto a database
system that permits a service history to be recorded.
This enables uniquely identifiable information to be
kept over the life cycle of the device to inform any
decision process.
• Useful Life – This can be broken down into scheduled and
non-scheduled maintenance. Certain devices require
routine scheduled maintenance to be performed at
regular intervals throughout the life of the device to help
ensure continued operation. However, due to the
technological nature of modern devices it is impossible to
predict when failure will occur, hence the need for non-
scheduled maintenance when a device fails unexpectedly.
Work Undertaken by Technologists
Technologist performing electrical safety tests

4. SCOPE • Volume 15 • Issue 3 • SEPTEMBER 2006 23
• Disposal – For disposal of a device to occur it must
satisfy one of the following requirements. It must be
technically obsolete, clinically obsolete, or be beyond
economical repair. Once disposal is decided as the
course of action the technologist must render the device
inoperable to prevent the possibility of an untrained
person using a potentially dangerous medical device.
They must then decide if any component parts warrant
controlled disposal – for instance batteries must be
disposed of in an environmentally sound manner.
Evaluation of New Devices
Whenever new devices are to be selected an evaluation
process needs to be undertaken to inform the decision
process. This can involve quite a comprehensive series of
tests being performed which will vary from item to item but
include tests for compatibility and a comparison with
existing methods. These tests will permit a conclusion to be
reached regarding the suitability of the device.
Development of Technology
Technologists can contribute to the development of
technology by sharing their practical experience with
manufacturers. An example of this at Queens is the ongoing
development of continuous veno-venous haemofiltration
(CVVH) fluid balance systems. Technologists in MESU
working closely with clinical specialists were able to deliver
valuable feedback to the manufacturers that permitted
continual development of the product. These developments
have included:
• Development of the software due to issues with
disconnection of treatment
• Development of a more robust transducer design
• Addressing issues associated with self-test failures
• Addressing weigh scale drifts
• Modification of syringe pump sensing to prevent
spurious alarms, syringe siphoning, and syringe
displacement
• Blood Leak module development to prevent false
triggering due to UV sensitivity
These developments have resulted in better management of
patients suffering Acute Renal Failure in the Intensive Care
environment.
Working towards Improved Patient Safety
Nowadays (quite rightly) there is an increased focus on
learning from incidents and making improvements to
practice with the resultant improvement in patient safety.
Technologists working in Clinical Engineering departments
have long had a role to play in improvements being made to
patient safety where medical devices are concerned. Since
the inception of the departments, technologists have
performed routine electrical safety testing on devices with
the premise of preventing electrical safety hazards being
present in the patient environment. Due to the nature of
patients being hospitalised they are more vulnerable to any
kind of electrical hazard – for instance a small circulating
leakage current between patient connections could prove
fatal. In early designs of medical devices it was possible for
component failures to have an impact on patient safety.
Modern devices have improved designs that safeguard the
patient; however it is still possible for combinations of
situations to arise that may compromise patient safety.
Examples include the use of “systems” (multiple devices) of
devices around the patient – resulting in all of the devices
connected to a patient becoming a system which can result
in cumulative effects being present. Obviously technologists
with knowledge of all of the factors involved have a valuable
part to play in maintaining patient safety.
Adverse Incident Investigation
When an untoward incident occurs involving a medical
device, technologist staff within MESU undertake an
investigation of the incident. This involves a visual inspection
of the device as received together with any accessories.
From here a course of action will be decided. This will include
functional checks being performed together with the
examination of any event data that may be stored. There will
also be an attempt to replicate the incident conditions
Some examples of work undertaken by
Technologists in MESU:
Some of the medical technology required around an Intensive Care
bed space

5. SCOPE • Volume 15 • Issue 3 • SEPTEMBER 200624
described. The findings from these steps will then be
examined to help establish the causes of the incident and
draw conclusions about what happened, from which
recommendations can be made to help prevent a
reoccurrence of the incident. One aspect of this is to
determine whether human error was a contributory factor and
whether user training should be considered.
Calibration and Measurement Assurance Checks
Any medical device that delivers energy requires checks to
be performed to ensure that the energy is delivered
accurately. Some examples include defibrillators, ultrasound
therapy devices, electrosurgery, premature baby incubators,
life support ventilators, and various types of infusion device
including patient controlled analgesia (PCA).
Also, devices that perform physiological measurement
functions require the accuracy of these functions to be
verified. Some examples include ECG, invasive and non-
invasive blood pressure, temperature, fetal monitoring, and
point of care testing (POCT) blood chemistry analysers.
Technologists working in MESU perform a complete range
of checks on all of the devices listed above and many more
besides. These checks ensure that patients are not
subjected to an uncontrolled potentially harmful energy or
output, and also that when a physiological function is being
monitored it is reproduced on the monitoring device
accurately. It is worth considering this in a little more detail
by means of two examples:
• Consider a baby being nursed in a premature baby
incubator – in basic terms this delivers a controlled
energy (in this case heat) to a baby ensuring that the
baby’s temperature is maintained within a defined range.
To ensure that this defined temperature is maintained it
is necessary to monitor a physiological function (in this
case temperature). Technologists ensure that the heat is
delivered accurately by the incubator. They will also
ensure that when measuring the temperature of the baby
a true reading is obtained. Should there be a failure in
any one of these areas, then the baby may be subjected
to an unnecessary stress or hazard – for instance if not
enough heat is delivered to the baby, it will utilise too
much of it’s energy in an attempt to generate heat which
leads to further problems with the baby not growing and
developing as it should do.
• Consider a person on a life support ventilator – in basic
terms this delivers a controlled output (in this case
breathing gas is forced into the lungs) to the patient to
replace the respiration function that is necessary to
enable gas exchange to take place. The patients’
physiological functions (in this case blood chemistry in
particular) require monitoring to ensure that an ideal
blood chemistry balance is maintained. Arterial blood
samples are taken from the patient at regular intervals
and analysed in a point of care blood chemistry analyser.
These blood chemistry results determine settings that
require changing on the ventilator for optimum effect. On
a basic level this can mean increasing the oxygen setting
on the ventilator if the blood oxygen reading is low, or
increasing the ventilator breathing rate or tidal volume
settings if the blood carbon dioxide readings are
elevated. There are actually a lot of other factors
regarding blood chemistry that come into effect and a
sample analysed in a point of care blood chemistry
analyser can be very informative about the condition of
the patient. Technologists perform maintenance and
checks that ensure that the ventilator delivers all of its
parameters accurately, and that the point of care blood
chemistry analyser measures any of its multitudes of
parameters accurately.
As can be seen from these illustrations medical technology
has various interactions with patients. Technologists have
a key role to assume that helps contribute to advanced
healthcare outcomes. They are required to keep abreast of
all the latest advances in healthcare technology to
maintain their knowledge and skills base to enable them to
contribute to healthcare delivery.
It should be realised that the role of technologists working
in a Clinical Engineering department like MESU is far wider
reaching than just “repairing the equipment” – the role of
equipment management should be to take a holistic
approach to the equipment, that is, to not consider the
equipment in isolation but to consider the whole system
i.e. equipment, user, patient. Only by clinical engineering
departments doing this can they claim to be operating in
the true role of equipment management.
Conclusions
Technologist verifying calibration of infusion pump