Equipment Management
County Durham & Darlington
Foundation Trust
(C.D.D.F.T.)
C.D.D.F.T.
Organisational Statistics
• Serves a population of: 500,000
• Number of in-patients treated per year:
83,314
• Employs 6000 staff
• Annual Income: £330 million
C.D.D.F.T.
Background
• Medical Devices Policy - HSJ Award 2005
…also related policies – Infusion Device Policy and
Training & Competency Policy for Medical Devices.
• Established Network of Equipment Controllers
• Medical Devices Group – review of MHRA alerts with
Risk Management, review of Trust incident reports with
Patient Safety Managers.
• Clinical Engineering – Team Leaders monthly review of
medical devices related incidents.
Background
• 2003/2004 early stages of amalgamation
of other sites into what is now County
Durham & Darlington Foundation Trust
(C.D.D.F.T.)
• Various types of equipment were in use
across the developing Trust prompting the
introduction of a standardisation
programme.
Background
• Decision made to centralise some equipment,
initially on one Trust site - Darlington
• Prior to this, infusion devices and pressure relief
systems were with users, stored on wards.
• An audit of infusion device usage was carried
out
• Results ‘mirrored’ the NPSA audit – Pilot Study
(2004) - that at any one time there was 65%
non-utilisation
• Pressure relief systems were purchased based
on utilisation of rental equipment.
Central Equipment Loan Library
(C.E.L.L.)
• In October 2004 the Central Equipment Loan
Library (C.E.L.L.) was opened at Darlington
• Pressure relief systems and infusion devices
chosen
• The service included visual checks of the
equipment, cleaning/decontamination and
tracking of individual patient use via an
electronic database, providing audit trails.
• C.E.L.L. based in Clinical Engineering Dept
making it easy for equipment to be located for
Planned preventative maintenance (P.P.M.) and
relevant repairs/service to be carried out
Equipment Tracking
C.E.L.L.
C.E.L.L.
Pressure Relief Mattress
Systems (P.R.S.)
• PRS are requested from C.E.L.L. by ward
staff following patient evaluation and
delivered by C.E.L.L. staff
• Patient details and ward location are
recorded against the PRS asset reference.
The individual base cover and top cover
numbers are also recorded – providing
audit trail.
Pressure Relief Mattress Systems
(P.R.S.)
• In 2008 the provision of P.R.S was
expanded to another Trust site twelve
miles away by operating a satellite service
from the Darlington site.
• Deliveries and collections are made at
least three times per week.
• P.R.S. are distributed via the Linen Bank,
patient details sent to Darlington to be
added to the data base.
Pressure Relief Mattress Systems
(P.R.S.)
• 2009 – another C.E.L.L. opened at the University
Hospital of North Durham (UHND), providing the same
service.
• 2010 – further satellite service for P.R.S. from UHND
opened providing equipment to Chester le Street
Hospital and Shotley Bridge Hospital.
• Training is provided by both the Medical Devices Nurses
and the Tissue Viability Team in conjunction with the
manufacturer.
• Mandatory Training changed with the addition of a
Medical Devices workshop.
P.R.S. Inventory
• January 2005 – ninety five pressure relief
mattresses across seven different
products
• June 2011 – three hundred and forty
mattresses across four different products
plus seat cushions
Utilisation
• P.R.S. utilisation for first full financial year
2005 -2006
18,796 bed days
• P.R.S. utilisation for 2010 – 2011 financial
year
67,211 bed days
Pressure Ulcer Prevalence
Prevalence Trend 2003 - 2010
7
6
5
Overall
4
Hospital Acquired
3
Admitted w ith
2
1
0
2003
2004
2005
2006
2007
2008
2009
2010
High Risk % WLS>20
High/Very High Risk % WLS>20
60
50
40
30
Risk %
20
10
0
2006
2007
2008
2010
Tissue Viability
• Development of Tissue Viability team in 2004 &
2006
• Replacement of all Kings fund bed frames for
electronic profiling bed frames
• Replacement of standard hospital mattress for
pressure reducing foams as standard for all
patients
• Annual audit of all surfaces ie. Mattresses,
chairs, trolleys etc
• From 2011 monthly auditing of all mattresses
Falls
Harm Rates/Morbidity
• Global Trigger Tool and Mortality 3 x 2 used every month,
• Minimum of 50 case note reviews – 3.2% for 2010/2011
• Any equipment issues identified from audits are actioned.
Infusion Devices
• The infusion device standardisation programme
was completed October 2010
• The general areas all use the same model of
infusion devices that are configured the same
Trust wide.
• Specialist areas also use the same models
which are also configured the same Trust wide.
• Competency based training is provided monthly
on a rotational site basis
Infusion Devices
• At DMH and UHND, infusion devices for the
general areas are accessed by requesting them
from CELL.
• Patient details and ward location are recorded
on the electronic database against the device
asset number, providing an audit trail.
• Devices are easily made available for P.P.M due
to proximity of Clinical Engineering Dept.
• Although no metrics gathered, anecdotally harm
& incidents have reduced
The Way Ahead
• Since August 2010 Clinical Engineering services
have been working in the PCT with Medical
Devices Nurse (Community) to review and
develop an up to date inventory of equipment for
P.P.M
• April 2011 PCT integrated into C.D.D.F.T.
• Medical Devices Nurse (Acute) and Medical
Devices Nurse (Community) now working
together in the same Trust.
The Way Ahead
Several work streams have been identified and are being developed
including;
•Using the Community equipment inventory to develop a Training
Needs Analysis (T.N.A.) for Community Division and incorporating it
into the already established T.N.A. for the Acute Divisions
•Identifying and including Equipment Controllers (Link staff) for medical
devices from the Community sector and including them in the already
established Equipment Controller list facilities and training.
•Identifying Community sector representatives to established Medical
Devices Group
•Standardisation of equipment to ensure smooth transition of patients
between the Community & Acute settings. There is ongoing work with
Palliative Care Team to reduce readmissions through availability of
equipment and the care pathways.
•Operating satellite services for P.R.S to Community Hospitals
The Way Ahead
• Introduction of ‘Guardrails’ – a patient
safety dosing system, to infusion devices
• Introduction of the McKinley T34
ambulatory pump into the Acute Divisions
– already established in the Community
Divisions
…Other Teams Working to Reduce Harm
• Clinical Procurement Standardisation Group – 150 commonly used
consumables
• Latex Reduction Group
• Tracheostomy Care – In response to an alert from a coroner about
patients with tracheotomy a multi-disciplinary group was established
to review the key learning points. Any gaps were then actioned.
• An insulin device guide has been produced UHND after gaps were
identified in clinical staff’s awareness and knowledge of the multiple
devices currently available.
• The development of the PYJown – making it easier for patients to
dress, but also maintaining dignity and allowing access for I.V
extension lines.
Clinical Engineering Team