END OF PHASE 1 REPORT

FEBRUARY 2004

Shared Equipment For Children With Special Needs

Changing Children’s Services Fund

Contents

1. INTRODUCTION

2. CURRENT SERVICE

2.1 Brief Overview......

2.2 Procurement/Budgets/Monitoring(1)

2.3 Transport......

2.4 Decontamination & Cleaning......

2.5 Maintenance/Repairs/Servicing......

2.6 Record Keeping......

3. HEALTH & SAFETY/LEGISLATION

3.1 Manufacturers......

4. GAPS IN SERVICE

4.1 Procurement/Budgets/Monitoring......

4.1.1 Procurement......

4.1.2 Budgets......

4.1.3 Monitoring......

4.1.4 Transportation......

4.1.5 Cleaning & Decontamination......

4.1.6 Maintenance/Repairs/Servicing......

4.1.7 Record Keeping......

4.1.8 Storage Space......

5. RECOMMENDATIONS

5.1 Procurement/Budgets/Monitoring......

5.2 Transportation......

5.1 Cleaning and Decontamination......

5.4 Maintenance/Repairs/Servicing......

5.5 Record Keeping......

5.6 Storage Space......

6. PHASE 2 SUMMARY

7. CONTACTS

1. INTRODUCTION

The following report outlines the services presently offered by NHS Grampian, Aberdeen City Council (ACC) and Voluntary Agencies with regards to Equipment for Children with Special Needs. Some information contained in this report may duplicate initial findings already documented within the Preliminary Report (October 2003).

The objectives of Phase 1 were:

  • Identify processes already in place
  • Identify Health and Safety issues not in place
  • Identify roles and responsibilities of Partners and Voluntary Agencies
  • Highlight gaps in service
  • Document the procedures in place

This report documents the findings and sets out recommendations and suggested improvements that will bring us closer towards the Integrated Shared Equipment Service and improve the current service provided in the interim. These recommendations/improvements will be implemented during Phase 2 of the project.

2. CURRENT SERVICE

2.1Brief Overview

  • All partners currently maintain independent systems and separate budgets relating to equipment.
  • All partners provide equipment on loan to children up to the age of 18 years of age.
  • There are varying standards across partner organisations with regard to cleaning/decontamination.
  • There are varying standards across partner organisations with regard to maintenance and servicing.
  • There are varying methods of transportation used across partner organisations.
  • Record keeping is ad hoc with the majority of partners maintaining some form of record with varying degrees of accuracy and in some cases dependant on equipment value. No equipment tracking or maintenance/servicing records are kept.
  • No activity figures kept ie time spent cleaning equipment.
  • The Clinical Audit Department is currently working with the Project Co-ordinators to produce an audit questionnaire. Once completed and the data is analysed this will provide useful information on how users view the current equipment service. This evidence will be a useful tool when making recommendations and influencing change.

2.2 Procurement/Budgets/Monitoring(1)

Aberdeen City Council – Education Service

Subject / Education Service
ACC / Comments
Overall Budget / £76,000 / Includes Special Needs and MainstreamSchools
Budget Allocation / £5,000each
£5,000each / Essential equipment for School for the Deaf and Visually Impaired
Recording of Equipment
Purchased / By individual schools / Paper based system organised by invoices relating to specific school
Monitoring of Equipment / Equipment stays at school until it is no longer serviceable or required. Can be transferred to another school using form.
No log kept of condemned equipment.

Note:WoodlandsSchool offer a loan service of their equipment to HazelwoodSchool and also to carers over holiday periods using a similar form to the staff at the Raeden Centre.

Aberdeen City Council – Social Work
Subject / Social Work
ACC / Comments
Overall Budget / £250,000 / Covers child and adult population
Budget Allocation / £0.00 / No funds are specifically set aside for the 5 to 18 year age group
Budget Allocation / £4,000 / Equipment budget set aside for Raeden Centre (approximate figure)
Recording of Equipment
Purchased / By Patient Record / Equipment is recorded on “Care First” database along with patient details.
Monitoring of Equipment / Letters are sent to parents on a yearly basis to inquire if electrical equipment and equipment over £300 is still required. (See Appendix 10) A log of condemned equipment is kept at the Torry store.

Note:Social Work has a separate budget for adaptation provision.

Social Work also purchase a small amount of equipment for RACH

NHS Grampian
Subject / NHS Grampian / Comments
Overall Budget
/ £0
Budget Allocation / £0 / No dedicated equipment budget.
Recording of Equipment Purchased / Allocated number and logged on clipboard.
Monitoring of Equipment / Not monitored unless battery and/or mains operated.

(1) Preliminary Report October 2003

2.3 Transport

The main forms of transportation that exist in the current service are:

  • Janitorial delivery service (ACC – Education Service)
  • Torry store transport facility (ACC – Social Work)
  • Therapist’s (or other) car
  • Minibus

None of the above methods of transport are dedicated to transporting equipment. Some of the vehicles used are unsuitable for transporting equipment and this has serious implications for Health and Safety.

Recent improvements have been made to the Transport facility at the Torry Store in that an additional purpose built van has been purchased to transport equipment. This van is capable of transporting both clean and dirty equipment simultaneously as the van is adapted with a dividing panel that separates clean from dirty.

The decontamination facility based at InverurieHospital has a dedicated transport system however this facility is at a pilot stage and is unable to accommodate any further pieces of equipment at present.2.4 Decontamination and Cleaning

Initial findings showed that the current standard of cleaning and decontamination vary considerably across partner organisations.

(2)NHS Grampian is piloting a decontamination and cleaning facility at Inverurie. This facility has been purpose built and isolates contaminated and clean equipment from each other. The facility deals mainly with adult equipment, only very occasionally decontaminating children’s equipment. At this stage in the pilot there is no scope to expand into taking on children’s equipment.

(3)ACC – Social Work operate a decontamination facility out of the Torry Store. There is

unfortunately no sign at this facility of the segregated clean and dirty split clearly visible at

the Inverurie Facility.

It is clearly visible from the condition of some of the equipment that the majority of children’s equipment is unclean. There are a number of possible reasons for this:

  • Limited capacity at both decontamination units in operation so unable to accommodate additional equipment
  • Equipment is manufactured from materials incompatible with the decontamination process
  • No budget for dedicated cleaning staff onsite
  • No suitable cleaning area onsite for cleaning equipment
  • Lack of knowledge/guidance on how to clean a piece of equipment to required standard

In order to rectify some of the above a detailed questionnaire was sent to our main manufacturers/suppliers to establish cleaning and decontamination instructions for their equipment.

This information was compiled into a single document and sent for comment to the Infection Control Department, Grampian University Hospitals Trust and also to The Public Health Department. This will enable us to establish if the information received from manufacturers is adequate for infection control purposes and also complies with legislation.

Contact was also made with MHRA to obtain their advice on the level of information manufacturers should supply with regards to cleaning and decontamination.

Outcomes from the above are not yet expected for a number of weeks.

(2) (3)The Preliminary Report – October 2003

2.5 Maintenance/Repairs/Servicing

Initial findings showed that the current standard of regular maintenance and servicing vary considerably across partner organisations.

(4)ACC - Social Work use the services provided by the Torry store. The store has no budget to buy spare parts however the main equipment budget can be used if required. Most equipment is maintained from parts removed from condemned equipment as this is cheaper and more environmentally friendly. No record is kept of repairs carried out on the equipment.

(5)ACC - Education Service are responsible for carrying out their own maintenance and repair of equipment. In general any major repairs would be carried out by the supplier.

(6)NHS Grampian - at the Raeden Centre the Janitor or one of the therapists carries out the

smaller repairs. Grampian University Hospitals Trust Estates Department carries out larger

repairs requiring additional tools or skills.

The maintenance a piece of equipment requires depends on the manufacturer’s guidelines. It is also dependant on the results of a risk assessment of the patient/client in terms of how frequently the piece of equipment is used and how it is used.

It is clearly visible from the condition of some of the equipment that the majority of children’s equipment is not maintained to a satisfactory level. There are a number of possible reasons for this:

  • Equipment is manufactured from materials that prove difficult to maintain ie worn fabrics/vinyl
  • No budget for dedicated maintenance staff onsite
  • No repair budget to buy spare parts
  • No suitable workshop onsite for maintaining equipment
  • Lack of knowledge/guidance on how to maintain a piece of equipment to required standard

In order to rectify some of the above a Maintenance and Re-Issuing Instruction booklet was compiled. All the maintenance information held on the manufacturer’s website and within the equipment’s instruction booklet was collated into one single reference document.

Maintenance/Repairs/Servicing

This booklet enables us to see at a glance maintenance instructions for the most common pieces of equipment and also makes it easier to establish if the information received from manufacturers on maintenance and re-issuing is adequate and complies with legislation.

If the guidance provided by the manufacturer on the maintenance of a piece of equipment is believed to be inadequate then the Medical & Healthcare Regulatory Agency (MHRA) should be informed. Reusable medical equipment placed on the UK market after June 1998 must have reprocessing instructions supplied by the manufacturer.

(4) (5) (6)The Preliminary Report – October 2003

2.6 Record Keeping

Record keeping is ad hoc with the majority of partners maintaining some form of record with varying degrees of accuracy and in some cases dependant on equipment value. No equipment tracking or maintenance/servicing records are kept.

No activity figures are kept ie time spent cleaning equipment.

(7)ACC - Social Work.A record of condemned equipment is kept at the Torry Store

Equipment over £300 out on loan is reviewed yearly to check status of equipment ie whether still required or not

No record is kept of repairs carried out on the equipment.

(8)ACC - Education Service. A record of the repair would be made via the invoice logging system for that school by the Clerical Officer.

No log of condemned equipment is kept

(9)NHS GrampianNo formal records of repairs are kept.

No record of condemned equipment kept

Equipment which is battery and/or mains operated is monitored.

Little has been done to improve this situation in Phase 1 of the project. It is envisaged that this will be a priority for Phase 2 of the project.

(7) (8) (9)The Preliminary Report – October 2003

Authors: Marlene Walker/Malcolm McKie Page 109/29/2018

Record Keeping

TYPE OF RECORD / DETAILS OF RECORDS KEPT/NOT KEPT
Aberdeen City Council –
Education Service / Aberdeen City Council –
Social Work Services / NHS Grampian
Equipment Purchased / Invoice is filed in school file / Recorded on “Care First” system by patient name / Allocated number and recorded on clipboard displayed in “Jill’s Barn”
Asset Number / Localised numbering system / Equipment loaned from Raeden has localised numbering system / Localised numbering system
Loan Tracking / Loan form used / Loan form used within Raeden
Electrical Equipment and Equipment over £300 in value used within the Community is tracked by admin staff and reviewed on a yearly basis. / Loan form used
Decontamination/Cleaning /  /  / 
Maintenance / 
NB Major repairs carried out by supplier would be recorded via invoice filed in school file /  / 
Condemned /  / Records kept at Torry Store (mainly adults equipment only) / 

 Marks where no records are kept.

Authors: Marlene Walker/Malcolm McKie Page 109/29/2018

3. HEALTH & SAFETY/LEGISLATION

There are a number of issues surrounding Health & Safety and Legislation that impact on this project.

Relevant legislation includes:

  • The Health and Safety at Work Act 1974
  • Management of Health and Safety at Work Regulations 1999
  • Manual Handling Operations Regulations 1992
  • Lifting Operations and Lifting Equipment Regulations 1998
  • Provision and Use of Work Equipment Regulations 1999
  • Consumer Protection Act 1987

As employers we have a responsibility to provide and maintain a safe and healthy working environment. This also extends to employee’s safety when using and moving equipment in the course of their work.

As equipment providers we must also ensure that the equipment we issue is maintained in an efficient state, in good repair and fit for purpose. In an effort to provide evidence that satisfactory Decontamination, Cleaning and Maintenance is carried out a sample Maintenance Record Sheet and a Decontamination Record Sheet has been drafted (See Appendix i and ii)

The record sheets would not eliminate the chance of litigation if an incident occurred, it would however, act as evidence to reduce the case for negligence. The record sheets would provide documented evidence that the partners had taken steps to reduce an incident occurring.

Under the Consumer Protection Act (1987) litigation can still occur up to ten years after defective equipment is supplied. All records relating to equipment should be retained for a minimum of ten years.

3.1 Manufacturers

Manufacturers also have legal obligations that they must meet. Under the Consumer Protection Act (1987) they are required by law to supply instructions on the cleaning, decontamination and reprocessing of their equipment, which is classed as non-single use.

The instructions should describe cleaning and disinfection and/or sterilisation processes that are effective and do not adversely affect the performance of the equipment. In addition the manufacturer must also supply information on the number of times that the equipment can be re-issued.4. GAPS IN SERVICE

This section of the report highlights the areas that have no equipment management systems in place and also the areas in the service that have systems in place but which could be improved upon to provide a better service.

4.1 Procurement/Budgets/Monitoring

4.1.1 Procurement


Gaps in Service – Procurement/Budgets/Monitoring

4.1.2Budgets


Gaps in Service – Procurement/Budgets/Monitoring

4.1.3Monitoring


Gaps in Service

4.1.4 Transportation


Gaps In Service

4.1.5 Cleaning & Decontamination


Gaps In Service

4.1.6 Maintenance/Repairs/Servicing


Gaps in Service

4.1.7 Record Keeping

Authors: Marlene Walker/Malcolm McKie Page 109/29/2018

Gaps in Service

4.1.8 Storage Space

5. RECOMMENDATIONS

The following recommendations provide options to improving the current level of service provided.

5.1 Procurement/Budgets/Monitoring

  • Procurement systems need to be developed or improved and should be universal across all partners.
  • Financial resources require to be explored in an effort to achieve project objectives. This should be undertaken in partnership with the Integrated Finance Project.
  • Ideally each partner organisation should have an equipment budget possibly with funds set aside for all aspects of equipment management.

5.2Transportation

Preferred Option

  • Increase in availability of transportation within AberdeenCity for children’s equipment either by:

-Purchase of custom built equipment van specifically for children’s equipment including dedicated personnel.

-Expansion of current transport resources to accommodate children’s equipment.

Interim Option

  • Provide individual staff using their own personal transport with satisfactory method of equipment restraint ie Bootsafe
  • Provide individual staff using their own personal transport with polythene bags to minimise the risk of cross infection when transporting equipment.

Recommendations

5.3Cleaning and Decontamination

  • Expand current decontamination resources to accommodate children’s equipment.
  • Develop additional decontamination facilities specifically for children’s equipment.
  • Improve current decontamination practices with regard to dirty/clean segregation.
  • Maintain records of all cleaning/decontamination undertaken.
  • Investigate possibility of onsite cleaning area ensuring appropriate cleaning materials and protective clothing are available.
  • Recruit suitably qualified dedicated cleaning staff to provide basic cleaning duties onsite.
  • Develop good relationships with manufacturers in an effort to provide equipment suitable to withstand the decontamination process and to provide written guidance on reissuing equipment.

5.4Maintenance/Repairs/Servicing

  • Maintenance systems should be developed and should be universal across all partners.
  • Identify equipment in circulation, record current condition and condemn all unserviceable pieces.
  • Investigate feasibility of setting up onsite workshops with suitably qualified staff undertaking scheduled maintenance and repairs.
  • Investigate cost effectiveness of setting up manufacturer maintenance contracts.

Recommendations

5.5 Record Keeping

  • Develop a comprehensive record keeping system across partner organisations to include the following information:

-Details of equipment purchased

-Universal Asset Tracking Register

(to assist with equipment location and availability queries)

-Decontamination/Cleaning Records

-Maintenance/Repairs/Servicing Records

-Condemned Equipment Records

-Equipment Loan Details

5.6Storage Space

  • Re-organise existing stores to maximise storage space.
  • Source additional storage space.
  • Equipment should only be stored once it is clean. Dirty and clean equipment should not be stored in the same room.

6. PHASE 2 SUMMARY

Phase 2 is the major part of project and is not independent from phase1 it is evidence of the progression of the project. Phase 2 of the project and will commence at the beginning of March 2004, and possibly take up most of the project plan for 2004/2005.

Phase 2 will include:

  • Production of Phase 2 - Project Initiation Document
  • Logging of equipment/Development of an interim Equipment Database

How much equipment is out there?

What condition it is in?

Where is stored?

  • Development of a Website

Information regarding the project will be posted on both the NHS Grampian Website and Aberdeen City Council Website to promote the project and to update all interested parties.

In addition it is envisaged that once equipment is logged, an online equipment catalogue will be constructed. This catalogue will show what equipment is available, how many of a certain type of equipment there is available for loan and whether or not a new piece of equipment needs to be bought.