Equipment Library

Over the last 10 years the use of medical equipment has greatly increased, particularly the use of infusion devices in the delivery of medication. As the need for equipment has increased, purchase of equipment by individual wards from budgets and charitable funds has been inevitable and uncontrolled.

At the Royal London Hospital (RLH), there has also been a pool of equipment, mainly infusion devices and suction equipment that was held in a 'loan store'. Accessing this equipment was often on a 'pot-luck' basis and loaning of equipment between wards and departments became commonplace. However earlier this year, following a collaborative project by Nursing & Therapies and Clinical Physics at the Royal London Hospital an 'Equipment Library' was established in an attempt to ensure that the correct specialist equipment is available to patients as and when needed.

As staff became familiar with the library system, a decision was made to take ownership of all the infusion devices within the hospital (apart from specialist areas i.e. ITU, HDU, Labour Ward, and Paediatrics). All the devices previously owned by wards were then combined into the general pool of equipment and made available via the library system.

The Library is staffed by a Librarian from 9.00 am to 5.00 pm Monday to Friday. The Librarian takes equipment to the wards and collects equipment that is no longer being used. Returned equipment is checked to ensure that it is in date and working properly; it is then cleaned and put on charge ready to be loaned out again. Outside of the core hours porters have access to the library and deliver equipment to the wards.

Even though the usage of clinical equipment has increased steadily over the last 10 years, basic training in the use and management of such devices has been somewhat lacking. Nurses undergoing pre-registration training have very little teaching in how to use or manage medical devices. Familiarity with the devices that we use in the care of patients is essential to ensure their safety.

Nurses on generic induction are now introduced to the library system and the safe management of clinical equipment within the Trust and are made aware of their professional and Trust employee responsibilities with regards to clinical equipment. As well as training during generic orientation, monthly training in the use of infusion devices is now available for all staff. This infusion training looks at the basics of infusion device technology and covers the potential hazards associated with using such devices as well as giving practical training in the devices used within the Trust. It is hoped to provide training in other types of clinical equipment such as monitoring and automatic blood pressure devices over the coming year.

Level 1 – 10% reduction in contributions

Level 2 – 20% reduction in contributions

As mentioned earlier, the purchase of equipment within the Trust has been somewhat ad-hoc over the years and the variety of different models has increased. Where there are several different models of equipment available the clinical risk element is greatly increased, as users are not always familiar with all the models. In November 2002 we withdrew one of the ambulatory 10ml syringe drivers to reduce clinical risk, as confusion between the two types of device had led to serious incidents and death in some other Trusts despite the new labelling on the devices.

In line with the Controls Assurance Standards for Medical Devices Management, we now have a Medical Devices Group and a Medical Equipment Procurement Advisory Group, who look at and monitor the usage and purchase of medical equipment within the Trust. These groups, with their broad membership, should help us in looking at ways to reduce the variety of models within the Trust and standardise on one model for each category of clinical equipment that is needed.

Medical Equipment Management Policy

The new policy should come into force in the early part of 2003 and give clear guidance on the purchase, acceptance, maintenance and general management of all equipment within the Trust. The launch of the policy will coincide with the distribution of the 'Medical Devices Folders', which will contain advice and information on how to use and manage clinical equipment. There will be sections on the library, an inventory of equipment held locally, training records, decontamination, Clinical engineering and user manuals.

The Palliative Care Team has now updated the Syringe Driver Policy following the move to a single model of syringe driver within the trust. The policy and drug monographs, which were written by Cancer Services Pharmacy, are being combined into a folder and distributed to all clinical areas. The policy details the setting up of a syringe driver for patient care and the monographs advise on which commonly used drugs may be safely combined in treatment along with recommended dosages. The folder is an excellent resource for all staff and should help in reducing the confusion surrounding the use of this type of device.

Drug Monographs

It is hoped that a joint project with pharmacy can be undertaken to ensure that where it is necessary to administer a drug using an infusion device, the drug monograph clearly states which is the preferred device and model to use for that drug. This should reduce confusion and standardise the way that drugs are administered within the Trust.

1. Medical Devices Agency. Medical Device and Equipment Management for Hospitals and Community-based Organisations MDA 9801, MDA, London

2. Controls Assurance Standards. 'Medical Devices Management', Rev.03 (Oct 2002), accessed 9/01/03.

3. Fox P. Delve M. 'Equipped to Care'. Nursing Times 1994: July 27.

4. Stamper R, Durkin C.  'Loan Rangers'. Health Service Journal, January 4 1996.

5. Clinical Negligence Scheme for Trusts. 'Standards –General Manual' August 2002, accessed 9/01/03