Environmental Rounds

Addressing many ills with one pill.
Aneroids, suction regulators, oto/ophthalmoscopes, nurse call, draped power cords: one for all, and all for one.
Copyright, May, 2003.

Many forces were at play when the fast-paced discussion broke out at the Environment of Care (EOC) meeting. How were wall mounted oral suction regulators going to be maintained? Was it really necessary to inspect them periodically?

In rapid fire – the BME Director said nursing staff should be able to determine if a suction regulator was working properly; the Nursing Director said it wasn’t his staff’s responsibility to check these things; Central Supply made the same claim regarding her staff; and the Emergency Care physician commented that if regulators were not checked on a regular basis, defective ones might be overlooked, not removed, and cause confusion during a resuscitation attempt, an added extra you do not need during those instances.

The EOC chair, an administrator for Support Services, clearly was at odds as to how to handle this hot potato. He:
a) sided with the conservative approach and demanded they be inspected periodically,
b) saw the writing on the wall, and said they would no longer be inspected due to lack of resources,
c) said he was going on vacation next week, and when he returned, would expect everyone to have resolved this issue.

Aneroid manometers, suction regulators, oto/ophthalmoscopes, nurse call, floor draped power cords – are everywhere, and are problematic because some failures, in some instances, can have catastrophic results, while the time to do paperwork (or data input) can be greater than the inspection time making these devices ripe for exclusion from a maintenance program.

Electrical and physical safety checks have changed over time. Years ago, when many devices had metal cases and no double insulation, a decision was made that the way to make a shock-safe environment was to assure that all conductive surfaces were of an equal electrical potential. That’s still a good idea, but times have changed: cases are often plastic non-conductive surfaces, and internal electrical components may be double insulated. Add these changes to other technological advances such as optical isolation, low voltage/low current external power supplies, and shock-resistant materials, and you have a very different work environment to consider when determining the kinds of safety tests that are necessary to perform.

Address many ills with one pill, using environmental rounds: one pass through a given area testing many different devices, and all of the devices tested going into one work order documenting all of the work completed.

Utilizing environmental rounds to inspect a variety of devices and conditions is efficient and can be effective. But it raises other issues for the BME department administrator: assuring that technicians actually perform the necessary checks (without requiring a sign-off for each device completed), and convincing a surveyor that inspections are actually being made and that you are tracking each component without documenting each inspection.

One pass-through for all, and all inspections for one documented entry – with the advent of bar-code readers, and hand-held data collecting devices, documentation (for institutions able to afford these innovations) is becoming simplified.

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