This week’s interviewee is a biomedical technician looking after ward-based medical equipment in an urban area hospital.
I am part of a 15-strong team responsible for maintaining, testing and servicing complex, specialised equipment used to diagnose and treat patients at an urban area hospital and have been doing this job for more than 15 years.
Among the machines I maintain are the ‘point-of-care test’ (POCT) devices, which enable hospital staff to test patient samples on the wards, rather than undergoing the lengthier process of sending the samples to the hospital’s pathology laboratory and awaiting the results.
POCT devices have been around for decades; however, due to improvements in technology, they can run now many new types of tests on blood or urine and have therefore become increasingly prevalent. It is crucial that these tests are being carried out correctly and with good reason, because results are used to plan patient care. In maternity care, for example, a fetal blood sample determines whether a caesarean section should be carried out or not. If the test, which can be carried out with a POCT machine, is carried out incorrectly, the decision to undertake a caesarean could be delayed, creating a risk for the baby.
Doctors or nurses used to be able to obtain advice, extra training and guidance on using POCTs from professional biochemists, who staffed our laboratory around the clock. But now, following a restructuring, work which used to be completed in our own lab is outsourced. This means we have less lab staff on hand to offer help with the POCT machines.
What’s more, while hospital staff used to be trained on how to operate POCT devices by medical professionals like myself, lab staff or employees of the companies providing the devices, they now do their training online. But I do not think it is good practice to assume that someone can learn all he or she needs to know about the use of medical equipment from a computer screen. Some people need the opportunity to raise issues or ask questions during face-to-face training sessions.
We also now have a central electronic register for training and competency; staff are expected to update this themselves annually to say whether their training is up-to-date. However, this tends to be a ‘yes’-box-ticking exercise, as computers used to carry out these refresher courses are not easily available: they’re often being used to update patient notes; log requests for X-rays and medicine; and view X-rays and patient histories. It can be difficult to find the time to do the e-learning courses or to concentrate in an environment as busy as a hospital.
Meanwhile, the machines themselves have to be maintained to ensure they meet national quality standards, which is where my job comes in. However, due to poor record-keeping, many machines are not listed in the hospital’s inventory. How can you make sure everything you have is working to the best standard, if you don’t even know what you have? Additionally, if machines are not on the official inventory, they are also outside the control of my team, which leads to a lack of quality assurance.
Thankfully, we are in the process of carrying out an equipment audit, which started a year ago and is due to be completed soon. Soon we’ll know exactly what we have; in the meantime, though, many machines are being used without the proper quality assurance.
I think the reason that measures to address these issues have been moving forward so slowly is that they have not been a priority for the hospital board, which has many competing priorities, such as meeting financial targets.
There needs to be compliance with national policy, set out by the Department of Health and its arm’s length bodies, on how to manage these machines. But the organisations tasked with monitoring whether hospitals are compliant, such as the Clinical Pathology Accreditation, the NHS Litigation Authority and the Care Quality Commission, are very limited in the extent of their investigations.
The problem with these external bodies is that much of the evidence for the inspections is provided by the hospital trust itself, which means they’d be unlikely to find evidence for POCT problems unless they were following a specific lead.
I think the increasing practice of outsourcing services previously provided by the hospital can lead to less control over quality assurance and safety for patients. If I had the chance to speak to health secretary Jeremy Hunt, I would urge him to put in place measures to make sure all medical equipment meets national standards and guidelines.
There are going to be rapid changes in technology, and less money for staff. There will be an inc