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The Stakes Are High When Preventive Maintenance Is Low 

What’s at stake when you halt your preventive measures (PM) program because a pandemic has changed all sense of normalcy in your SPD? Maybe a lot more than you might think. Yes, tides have shifted, but preventive measures should be the increasing rather than declining in this ever-constant storm we call COVID.

Surgical caseloads at many facilities are operating at an all-time high, exceeding even last year’s volumes. Elective procedures being put on hold for a few months created a backlog of procedures that now must be performed, and the unpredictable nature of our current state has left many departments scrambling to stay afloat.

Yet we must remain vigilant inspecting, managing, and maintaining surgical instrumentation amid the challenge COVID brings, although it may seem like it should take a back burner to the immediate needs that arise from increased caseloads. However, take caution that proactively maintaining your equipment is more prevalent now than it’s ever been. Not continuing maintenance of your devices would be like ignoring the check engine light in your car before a road trip. Sure, you’re over by a few thousand miles on that oil change and you haven’t rotated your tires, but let’s load the kids in the car and head for the coast to take that 800-mile trip anyways. What could possibly go wrong? You see where this is going. So, let’s talk about proactive maintenance and why the heck it matters.

In this article we will cover what is required (the process), the impact of not proactively maintaining surgical devices and instrumentation (the purpose), and the payoff (literally) in doing so.

The process
Ensuring your instrumentation is ready for surgery requires multiple steps, from inspection points of the instrument to routine maintenance, and proper care and handling. How does one ensure that instruments are proactively maintained so we can avoid case delays and ensure patient safety? It requires having a strict system in place, and thankfully today many facilities have tracking systems like SPM, CensiTrac, or IMPRESS, in which a facility has the ability to flag trays that are due for service based on usage. This is best-case scenario, and not every facility has this luxury if it does not have a tracking system partnering with a repair vendor that can help you establish a rotation based on your specific facility needs. For example, if you are heavy on neurology cases, the highly used trays may need to be serviced more often than, say, an ENT tray. The reality is that just because a flag is set or a system is in place, that doesn’t mean the necessary tray volumes are pulled to stay up to par on maintenance intervals. It would be tempting amid COVID to cancel service days or decrease the number of trays that get serviced, but doing so simply creates a backlog, and the long-term results will be reactive in nature versus proactive.

The purpose
This is twofold in nature; the purpose of proper proactive maintenance is patient safety and regulatory compliance. Let’s break each one down a bit more. Patient safety is why any technician or healthcare provider does what they do. If the tools necessary to perform a procedure are malfunctioning, it can cause harm to the patient ranging anywhere from electrosurgical shock (ESS) to tissue being torn versus cut or punched. In the case of ESS, the result can be sepsis; in the latter, it can result in increased recovery time for a patient. Neither outcome desirable, and in most cases fully avoidable in nature.

Sterile processing technicians have so many steps and inspection points to perform it can be easy to miss minor details, hence the need for another set of eyes on each item. From a regulatory perspective, when a facility receives an audit, it can be asked for its PM history or documentation ensuring that devices are safe for patient use. Could your facility readily provide that information if you were asked today? Or if a tray was opened at random, would you feel comfortable that it would pass the test of the critical auditor’s eye? We always hope that you can feel confident in the status of trays, but without proper PMs it can be a gamble at best. Julie Williamson stated, “the responsibility will continue to fall on healthcare facilities to educate and engage their staff, and work closely with their instrumentation and equipment vendors—and, certainly, their repair partners—to keep their devices clean and well-maintained. This dedicated, ongoing education and due diligence isn’t always easy, but when effectively and consistently applied, is effective.”1 But the truth is keeping up on your proactive maintenance in not only critical for patient safety, but also to the bottom line in terms of revenue.

The payoff
Time is money, and when cases are delayed due to instrumentation or device malfunction, it’s expensive. In an article published in OR Management News, “OR costs range from $22 to $133 per minute, depending on the complexity of the procedure, with an average cost pegged at $62 a minute, according to an older study of 100 hospitals in the United States (J Cosmetic Surg 2005;22[1]:25-34).” This excludes surgeon and anesthesiologist fees.2 When a case has to be stopped, a new set retrieved, and an interruption in the surgeon’s flow happens, this is all occurring on a very expensive clock.

Proactive maintenance and instrument repair, when done correctly, can extend the life of instrumentation and prevent costs accumulated with having to buy these items outright, whether out of a desperate need for a functioning instrument, or one too far gone to repair anymore. These margins can be dramatic from a cost perspective.

When we take a look at the larger implications of canceling service, not proactively maintaining instrumentation, or decreasing service levels because we have an uptick in surgery volumes, maybe we should take a step back and view things from the lens of patient safety, regulatory compliance, and overall revenue loss from not maintaining instrumentation. The cost of not taking proactive measures may be greater than what meets the eye.

References

  1. https://cdn.hpnonline.com/inside/2012-04/1204-CS-Maintenance.html
  2. https://www.ormanagement.net/Clinical-News/Article/06-18/What-Is-a-Minute-Worth-in-the-OR-/48791

Rebecca Kinney has been working to improve patient safety in the medical arena for more than 13 years. She provides educational content on LinkedIn to help sterile processing and medical professionals gain knowledge as it relates to surgical devices, and her articles have appeared in Outpatient Surgery magazine. Her articles focus on the practical, hands-on knowledge operating room professionals can benefit from—never lacking in entertainment as she unfolds the true reality and struggles that are faced every day in the operating room setting. She is also a small business owner of a startup sales and marketing consulting agency.

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