No one, with any certainty, can tell when a device will break down. Biomedical equipment technicians (BMETs) get calls for repairs all the time. Add this to the scheduled work for preventive maintenance; the incoming inspection of equipment; special projects; and all of the unexpected, spontaneous requests that require undivided attention, and you really have a mix of work to accomplish. But how do you decide which items take precedence over others? Does your organization have a policy to cover just such occurrences? Do you drop everything when the phone rings to respond to yet another unexpected interruption? These questions seem simple, but not everyone has a similar answer to them. This article will cover some of the ways to help prioritize your work.
Where do we start? One of the first things to pay attention to is the device priority. Some organizations set priorities by placing items in tier levels such as 1, 2, or 3 or A, B, or C. Another popular ranking system is life support, urgent, routine, and deferred (though the exact names may vary). However they are stated, priorities give you a place to start from. As an example, let us stick with the life support-urgent-routine-deferred system. Everyone knows that if a device is a life support device, this unit takes top priority (though even the Joint Commission does not strictly define what life-support devices are). These devices provide functions that an organ should be doing but cannot do on its own—pacemakers to aid the heart by ensuring it pumps when necessary, ventilators to aid in breathing, and so on. Some examples of urgent equipment include, but are not limited to, defibrillators, vaporizers, and patient monitors.
Let us take a look at defibrillators for a moment to illustrate the important point that there are no definitive lines as to where certain devices belong. If a defibrillator has pacing capability, does it fall under urgent or life support? If it has a pacing function and could be used as a pacemaker, it would fall under life support. If it has no pacing capability, then it cannot perform a function of sustaining life and would be considered an urgent priority. The defibrillator's primary function is to “reset” the heart. It can save a life, but on its own it cannot support life. Each device needs to be assessed when it enters the facility for what level of response it should receive when a call comes in.
What other aspects should we be looking for when assessing a device's true priority? How about the availability of a back-up device? Is this unit a one-of-a-kind item in your inventory? Is there a suitable substitute the clinician can use in its place? Take the example of infusion pumps. These devices are usually available for use whenever they are needed, although some nursing floors would tend to disagree with this statement! When one goes down, does this get an urgent priority because lack of an infusion pump can cause death, or does it get treated as routine, to be looked at when the next tech is available? When calls come in, it is necessary to triage each call with what has occurred and whether harm has come to the patient or caregiver, which could jump a call from routine to urgent depending on the severity of the injury. Each organization sets its priorities differently. Consult your policies and service delivery plans to guide you in making these tough choices.
A biomedical equipment technician needs to know not just how to repair medical devices, but how to set priorities based on each device's use within the hospital. Asking these questions and many more when you receive a request will help you to prioritize your service calls:
✓ Is this device considered life support, as defined by your facility's guidelines?
✓ Is there a replacement device that can be used?
✓ Will a patient be harmed if this device malfunctions?
Finally, let us look at the work requests themselves. Everything is a priority, it seems. Preventive maintenance work orders are a priority because their intent is to reduce the number of corrective calls. Incoming inspections are a priority because no device can be used until it receives the necessary testing. When a machine breaks, it cannot be used to provide care for patients. As a general rule, these actions take priority over preventive maintenance or new equipment because the caregiver knows these devices and has an expectation to have them when needed. Medical equipment can cause serious harm or even death and we need to ensure that all devices are tested with care and the results recorded. Some projects are geared toward adding revenue to a facility, and administration places high priority on these. Special requests such as helping clinicians resolve equipment issues can go a long way toward increasing your credibility within your organization. With all the different reasons why something should come first, how does a reasonable person decide? As a healthcare professional, the mindset is to provide our services to those in need while maintaining the safest environments.
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Time is a vital factor in your decision-making. Sometimes tackling projects that can get the most done in the least amount of time is the way to go. Other times, the priority lies in the severity of the call. It is not easy to decide which way to go on the days you are extremely busy, but the decision is yours to make. Seeking input from your boss is one tactic. Another is to rely on the experience of those who have been in the field for a while. Whatever you decide, do not forget that your peers can help you get the work done. We are all in this together.
No matter what work you need to perform, always remember that you are a professional, and make the choice of what can be done in the time allotted. Access your resources, talk with your peers, and work with your customers. Communication is a big part of our profession. Most customers will realize that the work will get done and they can be reasoned with once you explain the situation. This is not a skill learned overnight, but it is a necessary one to learn to succeed in this field.
Which of the following calls needs to be responded to first?
a) An infusion pump with a dead battery
b) An operating room table that won't lower
c) A defibrillator that failed during a code
d) An otoscope with a lamp out
A big part of our profession is:
a) Preventive maintenance
b) Communication
c) Corrective maintenance
d) All of the above
Which device has the highest priority:
a) Defibrillator
b) Infusion pump
c) Pacemaker
d) Electrosurgical unit
Answer Key: 1) c 2) d 3) c
