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Maybe there’s a hole in there somewhere: Keeping your critical equipment running!

An interesting line of questioning is emerging in some recent survey activity (mostly during state visits, but the accreditation organizations are moving in this direction, particularly those with a focus on ISO processes) relates to the management of “high mortality” utility systems components, particularly emergency power supply system parts. If you look at this as a function of high reliability, ensuring that you have close to immediate access to a means of repairing those things that are most likely to break (and I suspect that everyone out there in the reading audience know which of your utility systems are most likely to give you fits—from experience, elevators always seem to figure in on that count).

I think in most instances it would require some level of working with your service providers to identify the things that are most likely to go wrong and then to set up a process for ensuring ready access to parts and service. Let’s face it, there are few more angst-filled moments than when you have to tell your boss that a critical piece of equipment is going to be down because parts need to be ordered, etc. And I don’t know of too many service vendors that are maintaining a broad-range of replacement parts, etc. on their shelves (I’m sure there are some and that’s great for you if they “live” in your neighborhood); inventory can be an expensive undertaking. But maybe there’s a way to build that into your next service contract—something to think about—your incumbent is probably going to have the most specific failure data relative to your equipment, but I would think there are sufficient commonalities of systems and equipment to allow for competitive proposals if you choose to go that route.

Some other contractual considerations (and this is more on the compliance front than anything, but still)—a “hard” touch whenever folks are onsite servicing equipment—at the very least, they can let you know if they see anything that might prove troublesome, so you don’t have to hunt for it when the paperwork arrives (hopefully sooner rather than later—that’s another contractual consideration—turnaround time for service reports/records). I don’t know that we’ll ever have enough granularity of data from the regulatory folks, but I am absolutely convinced (based on what I’ve seen) that the reason that findings in and around fire safety (and other) systems documentation relates to stuff being buried in vendor reports: the “classic” smoke detector that didn’t get tested or the heat detector in an elevator shaft that someone terms “inaccessible.” We (as a collective) are on the hook for ensuring that 100% of your devices and equipment are inspected, tested, and maintained in accordance with code and regulation. Our vendors really don’t have any “skin” in the game.

I’m sure this is all rather self-evident to you folks, but where I’m sitting at the moment, there’s not a lot of “new” stuff floating around and it was a miserable rainy day, so this is what the connection of head and fingers conjured up.

Making stock, taking stock: Emergency inventory madness!

In trolling The Joint Commission’s FAQ page for interesting tidbits to share, I came across the entry regarding the thought process around the establishment of an emergency inventory. Some interesting takes on certain aspects of the emergency inventory concept—it doesn’t “have” to be centralized, in recognition of “just in time” purchasing and the importance of being able to use stock with a shelf-life (it would not be good to have your EM supplies expire because they were earmarked solely for emergency response).

The FAQ goes on to recommend tracking assets and inventory for a year to ascertain what your organization’s capabilities and needs might be. But I’m trying to figure out how that “recommendation” (recognizing that the FAQs can be invoked at the level of standards-based requirement) dovetails with the “requirement” for an annual “review” (I remain stymied by the use of “review” as opposed to evaluation; it may just be me, but a review doesn’t have the same action level as an evaluation but perhaps they are to be considered synonymous) of the inventory of resources and assets needed during an emergency. My thought would be that you would be looking at how resources and assets are managed on an ongoing basis and that information used to ensure that the organization has what it needs and has the ability to procure additional resources and assets should it experience a prolonged emergency.

I think the key thing to keep in mind (as when one is addressing each of the TJC-anointed critical functions) is to ensure that for each exercise or actual implementation, there is a process in place for evaluating performance in each of those areas. Someone should be looking at:

  • Communications
  • Staff roles and responsibilities
  • Safety/security
  • Utilities
  • Patient care activities
  • The management of resources and assets

And those someones (whoever they may be) need to be particularly forthcoming because (as we have learned over the years) it is not so much about what went right as it is about what opportunities can be identified to make the next time better. Too many times I’ve encountered folks that are reluctant to “air out the dirty laundry.” Identifying potential vulnerabilities is never a bad thing (true, it can make for some difficult discussions), it is the only thing.