Bci NeBe conf 2017 practical - realistic testing - would you dare to shut down the power v2 - louis de pauw - martijn does sd

1. Louis de Pauw & Martijn Does 12 September 2017
1
Emergency power test
Reinier de Graaf Hospital Delft

2. 2

3. 18-9-2014 3

4. - Size 57.500 m2
- 5 floors (no basement)
- Separate energy building for emergency power system
- 475 hospital beds
- 8 operating theatres with 2 central preparation rooms, 4 small operating
rooms
- Emergency facilities (electrical power, water, cooling, medical gas)
- Measures to increase the resistance against fire, smoke and flooding
- Prepared to stop the use of gas for boilers
- Construction time 28 months
- Total costs including medical facilities €160,000,000 ex. taxes.
4
Building features

5. 18-9-2014 5
Design of the energy building

6. 6
Energy building

7. 7
Design of the control system

8. 8
Design electrotechnical distribution system
energievoorziening

9. - A well thought through design which matches with the 24/7 business
management & risks
- In-company technical knowledge
- Good manuals & drawings
- A good test script
- Reserve extra standby help (contractors, hospital personnel etc.)
- Work on self confidence in the organisation (facilities & healthcare)
- Evaluate with colleagues involved
- Carry out weekly generator tests (without disruption)
- Make technology important
- Don’t give the impression that you know it all, keep asking others to think
about …
- Share success
9
What is important for success?

10. - How is it managed on operational level on the user site?
- Emergency facilities like UPS (central & decentral)
- Use of red, green and yellow 230Volts (emergency power) outlets
- Checklists for power failures (what needs attention, manual start ups etc.)
- One planned emergency power test per year
• Opening 28 August 2015
• 1ste test executed on 16 April 2016
• 2e test executed on 8 April 2017
10
Power failure

11. - What do we want to practice?
- Switch off the main supply and let the emergency power come in
automatically. After 30 minutes switch in manually additional non
emergency power (only if all three generators are running well).
- Test goals
- Technical goal:
• Testing switch on time (step up load / load sharing, max. load)
• Global impression in the working of the distribution panels and the
scaling/start up after the switch off.
- Detect improvements for continuity and emergency plans for departments
- Create a real Power Outage with the power supplier (Stedin), only
exception is very expensive equipment like linear accelerators, MRI’s and
CT’s. The owner decides which exceptions have to be made.
11
How do we prepare?

12. - Agreement from the medical staff and CEO
- Drafting of Prospective Risk Inventories (PRI) en actualized
emergency procedures
- Taskforce en practice staff
- Purpose; integral cooperation
- Get the organization enthusiastic by supporting, coaching, visits etc.
- Nurses who where afraid of the dark got flashlights
- The results of the PRI’s where leading in planning the test
• Which installations / equipment do we want to test?
- Setup test script
12
How do we prepare?

13. Elements/subjects
- Target groups / stakeholders > total 23
- Exercise goal
- Safety and communication for users
- Program before and after testing (Go / no go moment), briefing &
debriefing
- Delay moments (two times one hour in case of emergency)
- Contact points, like:
• Practice staff
• Taskforce
• Observers
- On duty crisis managers
- Observers observations lists
• Phase 1 and phase 2 observations
13
Making the script

14. 14
Recognition during the test

15. 18-9-2014 15
Intensive Care department

16. - Drafting risk inventories for infrastructure and every hospital department
- Making a website with Frequently Asked Questions (FAQ’s)
- Planning meetings with users and delegate tasks
- Informing all (external) stakeholders
16
Further preparations

17. 17
Risk inventory Intensive Care
Afdeling: IC
verbeteractie
Kritiekmoment?
Controleerbaarh
eid?
Detecteerbaarhe
id?
Doorgaan?
1.
Beademingstoestel
Beademingstoestel
gaat over op de accu.
(accu gaat half uur
mee) De noodstroom
neemt het niet over.
ernstig zuurstof
tekort voor patient
ca 15 seconden
valt de stroom
uit.
Ja Hoog ja ja ja Beheersen Beademingstoestel valt gedurende
15 seconden terug op de accu.
Verpleegkundige is aanwezig om
in geval van nood op de hand te
beademen of door inzet Oxylog.
Dienstlijst: voldoende personeel
inzetten
1-12-15 Betty,
Maurice
Ja
ca beademingstoe
stel staat niet
op noodstroom.
Ja Hoog ja ja ja Beheersen Alle beademingstoestellen staan
op noodstroom via groene
noodstopcontact conform nen-
norm 3010. Zuurstofflessen zijn in
de kamers aanwezig voor het geval
dat verpleegkundige direct moet
handelen. Oefening dient direct te
beeindigd te worden. (no play)
1-03-16 Betty,
Maurice
Ja
2. CVVH-machine Substitutie/ultrafiltraat
stopt gelijk. Bloedpomp
blijft 9 minuten in
bedrijf. (10-12
Renal Pratitioner heeft
alle machines getest.
Bloedpomp blijft 9
minuten in bedrijf.
Substitutie/ultrafiltraat
stopt gelijk.)
Patient krijgt geen
CVVH behandeling
ma Tijdelijk geen
stroomvoorzien
ing, omdat de
accu ontbreekt.
Ja hoog ja ja ja Beheersen Met medisch coördinator
overleggen of het acceptabel is
dat de CVVH machine 15 sec bij
de stabiel en/of de instabiele
patiënt alleen op de bloedpomp
loopt. (hierdoor zou tijdelijk
stoppen overbodig zijn)
1-03-16 IC-
verpleeg
kundige
en
intensivis
t
Ja
3. Spuit /
infusiepomp
Spuit / infusiepomp
gaat niet over op de
accu. Na 15 sec gaat de
noodstroom aan.
Medicatie loopt
tijdelijk niet door.
ca Infusiepomp of
spuit met
slecht
functionerende
accu, en/of niet
opgeladen
accu. (Bij een
goed
opgeladen accu
geeft de pomp
alleen een
alarm).
We zeer
hoog
ja ja ja Beheersen 1. Voorafgaande aan de test de
accuwerking van alle pompen
controleren.
2. IC-er is op kamer aanwezig bij
patiënt met noradrenaline e.d.
Verpleegkundige is hier alert op.
3. Bij alle patiënten met een
noradrenaline pomp wordt
voorafgaande aan de test een
spuit met adrenaline op de kamer
klaargelegd.
9-04-16 1. IC-
verpleeg
kundige
nog
toewijzen
deadline
7/4
ja
Advies van afdeling kwaliteit = geef alles de gradatie van ernst 'HOOG'. Dit omdat de apparatuur tot de groep kritische apparatuur behoord. Je wilt bij deze apparatuur uitsluiten dat er wat
mee gebeurt ongeacht hoe vaak het voorkomt.
Hoog risico apparatuur conform convenant medisch apparatuur.
Ernst(tabel1)
Kans(tabel2)
Processtap /
apparatuur
Potentiële gevolgen Potentiële
oorzaken
Elimineren,Beheersenof
accepteren?
Potentiële faalwijze
Stroom valt uit, 15
seconden valt de
stroom uit en gaat
daarna op de
preferente groepen
over.
Risicoscore(tabel3)
Deadline
Verantwoordelijkepersoon
Managementakkoord?
beslisboom (figuur
1)
Procesgeborgdin
kwaliteitsdocument

18. 18-9-2014 18
Central debriefing with CEO

19. 19
Evaluate
- Compile evaluation report
- On the basis of all observations
1ste test 2016: 175 observations
2e test 2017: 75% less (PDCA-cycle secured)
- Shared with management and users of healthcare departments
- Implement improvements
- Carry out changes / measures in emergency procedures or continuity
plan

20. - The test takes place every year (PDCA)
- Preparation
- Communication, check or actualize PRI’s, get agreement from Medici and
board, test script, execute test, evaluate and implement.
- Next cycle next year
- Normal maintenance on generators, switchboards etc. can take
place during the year.
- During the year, changes on hardware and firmware updates are
not allowed.
- Planned ICT maintenance
- Upgrade core switch
20
Securing (2e, 3e, 4e test, etc.)

21. 21
Prevent

22. - Main power connection from supplier Stedin twin 10 MVA cable
- Emergency power 3.75 MVA continuous (3 x1.25 MVA) 1 hour load 4.12 MVA,
use of the building ca. 2 MVA
- Emergency shore connections for 3 x 1 MVA (substations) en 1 x 1.25 MVA
(central). For plugging in mobile generators in case of……….
- Distribution by open 10 KV ring of 10 MVA to three substations
- Transformer power 10,000 V/400V total 7.2 MVA
- Transformer power step up 400 V/10,000 V emergency power 5 MVA
- Two diesel tanks 35,000 litre (autonomy by full load one week)
- Three day tanks of 1,000 litre
- Integral control system for electro technical distribution, communication by
double separate fiber optic net (separated from SER)
- Four 400 V main distribution panels, four 10,000 V panels
22
Installation specs electrotechnical

23. - Extensive acces control and security systems
- Electrotechnical distribution from the fifth floor down (high water level)
- Main connection supplier Stedin 10,000V n+1 configuration (double)
- Number of emergency generators = n+1 configuration
- 2 x 35,000 litre diesel tanks secured against floating in the ground
- Shore connection for consumption water to connect a truck
- 100% extra air capacity for operating rooms
- Concrete tunnels between hospital and energy building, laboratory
- 10 kVolt ringcable via separate ways and partially protected by hi-fog water mist
- Shore connections for medical gasses and cooling water
23
Measures to increase the resistance of the building

24. Thank you for your attention
Questions?
Louis de Pauw & Martijn Does

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