If it Works, Why Fix It
It could be the cry of the modern Administrator "If it ain't broke, don't fix it!" With current pressure to reduce costs-particularly those not immediately visible to the patient or his insurer-the biomedical engineer or technician is hard pressed to justify the cost of annual maintenance of anesthetic vaporizers. While he may believe that preventive maintenance is good, how does he justify it to administration? The answer must be in the terms that cost-conscious managers appreciate: Safety, Costs and Protection.
Before discussing those factors, let us examine the need for preventive maintenance in the first place. The interior of an anesthetic vaporizer is subjected to one of the worst environments on Earth. It makes Los Angeles' summer seem benign by comparison. The anesthetic agent is a halogenated hydrocarbon in an oxidizing carrier of air or oxygen. Between uses, the unit may be exposed to the air of the operating theater, acquiring trace moisture to convert the gasses to variations on hydrochloric and hydrofluoric acids. Meanwhile, the exterior sees only the benign air of the operating room, where it is kept scrupulously clean and dust-free by routine cleaning.
Safety dictates regular preventive maintenance. The corrosion inside the vaporizer is invisible and all but indefectible in use. At most, it may cause the control knob to be off calibration. In the normal course of surgery, the anesthesiologist relies on that calibration only to set the initial flow; once the patient is anesthetized, adjustment is made by observing the patient and indicators of the effect of the anesthetic, not by studying the setting of a dial. The first indication of internal corrosion may appear when a part breaks or when a flake of corrosion blocks a critical channel or valve. At that point, the well-being or even the life of the patient is at risk. As soon as the anesthesiologist realizes the cause of the failure, he must switch vaporizers while the patient is still under. If he does not immediately recognize the cause, tries to maintain anesthesia by adjusting the invisibly damaged unit, or takes too long to replace it, the patient may be compromised.
Cost dictates regular preventive maintenance. With proper maintenance, a vaporizer can provide reliable service for well over a decade. Primary Medical regularly calibrates and returns to service units which have been working reliably for up to twenty years. The best of them seem likely to be operating within calibration well into the next century. The annual cost of maintenance is a fraction of replacement cost. Budgeting a few dollars a year for maintenance can save thousands in capital equipment replacement.
Protection dictates regular preventive maintenance. The words that most immediately strike fear into the hearts of malpractice lawyers and insurers are "negligence and standard of care." The standard is established by manufacturers who recommend annual preventive maintenance. By documenting that each vaporizer was serviced regularly at that frequency, you ensure that you are not negligent and are within the standard of care. Primary Medical backs that up with certification to you of the calibration of the vaporizer, with documented test results on each unit maintained, and ultimately with liability insurance to protect our customers and our reputation and our business. To date, there has never been a claim against that insurance.
There is an analogy which may help administrators to understand the need for maintenance: your automobile. Superficial, external problems - nicks and scratches - are visible and you deal with them routinely. But many important parameters of the interior are not visible and must be dealt with before they give clear warning. A wise car owner doesn't wait until the U-joints scream to lubricate them, or until the oil-pressure indicator goes on to check and top off the oil. It is good practice-necessary practice if you want your car to keep running-to lubricate and to change the oil on a schedule consistent with its design. If the manufacturer says to lubricate the U-joints every 10,000 miles, you don't wait for them to fail at 80,000 (on the freeway at 55 m.p.h., of course). In practice, you don't even inspect them for lubrication; you simply lubricate them and inspect them concurrently based on the manufacturer's recommendation.
Do your vaporizers deserve less?