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Scheduled Service is Better than Out of Service

Tuesday, January 7, 2020  
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It's Time for a Preventative Maintenance Plan
by SimGHOSTS Board member, Billie Paschal 

As healthcare simulation professionals, we are always looking for information, data and research in an effort to offer the best simulation experience for our learners. We write scenarios to meet the objectives, create moulage, make the electronic health record (EHR) and create surveys and pre-briefs. We put in hours that most likely exceed what our HR departments would approve (your secret is safe with me).  But all of this is futile if the equipment does not work!   

Outside of healthcare simulation, there are guidelines or best practices for all kinds of equipment maintenance.  For example, it is best practice to:

  • Change vehicle oil every 3,000-5,000 miles or every twelve months whichever comes first
  • Dirt bikes need chains inspected and tightened after every race
  • In aviation, the lavatory is required to be inspected every 6,000 flight hours

So then, what about our equipment? Vendors offer preventative maintenance plans that include a checklist upon completion of a scheduled preventive maintenance visit.  What about centers that are not afforded the “luxury” of purchasing preventative maintenance plans? What about equipment that no longer qualifies for vendor preventative maintenance support?  

Healthcare simulation parallels aviation in many ways, and being married to an Aviation Mechanic, I have seen the importance of tracking what has been performed mechanically, including knowing exactly what needs to be done and how often it needs to be done. I have always wanted to create a standard checklist and log to keep track of everything done to prolong the life of equipment. Guess what? I never had time to create a standardized process!  I was excited to see a process of documenting scheduled preventative maintenance already in place when joining a program with a ten year history.   

Cook Children’s Simulation Program has a long list of equipment that provided more than 26,000 hours of simulation for over 11,000 learners in fiscal year 2019.  This also means our calendar is booked sunup to sundown on most days.   Let’s be honest, with this type of schedule things MUST be addressed before they break.  “Prevention is worth an ounce of cure,” right?  Using the car analogy, with the mileage I drive annually (39,000 miles), I would be remiss to wait for a once a year oil change.  Accommodations must be made based on use.  The version of simulator we “beat up” the most is the Laerdal Mega Code Kid.  We lovingly call him Cody, all six of him. They range in purchase dates from 2011 to 2013.  Cook Children’s Simulation Program has been fortunate enough to purchase annual preventive maintenance visits and warranties, but there comes a date that the vendor no longer provides such support.  I feel confident that these investments, along with the simulation team completing scheduled check-ups, have increased the lifespan of our equipment.

If accreditation is in the vision for your program, now is the time to put a preventative maintenance schedule in place. As stated in SSH accreditation Core Standard Three – Resource Management:   

 

3. iii. Describe the process to continually assess simulation equipment and technology and how they are utilized in the Program.

Preventative maintenance will save money. Discovering a small issue such as a torn “vein” and replacing it is cheaper than buying an entire new arm due to mold! (Yes, I have seen this happen.)  Time is a limited resource, especially on simulation days!  Better to find that the EKG leads are not working and need to be replaced before the learners arrive and the entire day is off schedule. 

We call our every six-week maintenance check a “well child visit” at Cook. Sometimes the gap is bigger depending on lab usage, but we try very hard to stick to every six weeks  The checklist we use is basic, and it should be! When I attempted this at previous centers, I was putting way too much on the list. All six “Cody” manikins can be seen in about two hours, of course, barring any major issues.  BLOCK OUT THE TIME!  The check-up time causes much less stress than having a simulation event delayed.  

Another suggestion, besides the checklist, is to have as many consumable parts available as possible.  Having chest skins, extra vein tubing, IO legs, chest plates, defibrillation and EKG posts handy has helped us keep forward momentum. You have a spare tire in the trunk, right?  Same concept. If it is in the budget ALWAYS have a spare simulator. This is a major timesaver. Just make sure to put the spare in the maintenance rotation.      

Once the checklist is complete, the information is entered into an Excel spreadsheet and saved in our department drive.  This is so any team member can verify a simulators status and we can track issues.  I prefer pen and paper for completing the checklist because I am typically multitasking on “well child visit” days.  I am hopeful that this information helps at least one person.  As we end one decade and start another, take time to make certain that everything works as needed by implementing a preventative maintenance routine.