Tackling Problems With CPMs and EKGs

Abstract

Q: We have continuous passive motion machines (CPMs or “knee exercisers”) that frequently seem to be in need of repair. We face hand-control failures and errors with the angles not matching. Do you have any ideas on how to reduce these repairs?A: We struggle with this at our hospital too, so you're not alone. A good preventive maintenance (PM) program is key in reducing repairs. A CPM does not have very many parts: a hand control, shaft, motor, a few potentiometers, and a leg rest. The hand control takes a lot of abuse. CPMs are frequently moved from floor to floor and often get dropped. Securing the hand control can reduce the need for repairs. We place plastic Velcro on the back of the hand control and on the CPM base, and stick them together. We then have a short training session with the staff about the types of repairs we generally find and point out the hand control can now be secured. With that one small addition of Velcro, we've reduced our repairs on CPMs by 40%.Another issue that came up repeatedly was that the angle reading on the hand control didn't match the CPM. We would verify this, repair them, and then return them to use—only to have the units come back in a day or so. We observed patients using the machines and found that most thought if they pushed their leg with the machine, they helped the healing process. In other words, they were pushing the leg rest, which was making the hand control read a different number than the angle on the CPM. The CPM company came in and trained the staff, emphasizing that “fighting” the CPM does not decrease healing time; in fact, it can do the opposite.If these two simple fixes don't help, write back.Q: Our portable electrocardiogram (EKG) machines always seem to be broke. Staff is fed up, and the biomed department is under the microscope. How can we reduce repairs and restore the department's image?A: I'll bet a few errors keep cropping up. The first complaint is probably, “The unit will not charge.” Most likely, the users are forgetting to plug in the unit. Most users assume that if a cell phone can last 48 to 72 hours without being charged, then so should an EKG machine. In the past, I tried to tell the staff about battery technology. Usually this resulted in “The Stare”—you know the one. I found a more effective remedy in placing a note, in red and bold, on the EKG machine, advising staff to plug the unit into a wall outlet when idle. We all know the machine will not be plugged in every time, but I guarantee the unit will be plugged in enough to stay charged and this error will quit repeating itself.The second most-frequent complaint is probably that the unit will not analyze all 12 leads. There are several possible reasons. I like to involve and educate the staff in finding the solution—without them knowing it. I start by asking when they last got new patches. More often than not, they have no idea. So I ask them to get a new package and reapply the patches. Usually, this fixes the problem. If not, with the staff watching, I check each lead. Sometimes there will be a bad lead. If the problem persists, I check the connection to the unit. If your machine has a patient module or something similar, check here first. Sometimes one lead will get slightly unplugged. Once you practice this procedure a few times with the staff present, you will see the complaints dwindle. (When the staff calls me now, they've already checked these things.)Remember to bring your patient simulator and plug it in. This restores the staff's confidence in the process because they can see the patient waveform. These days, when I look at equipment, I usually have a “real” machine issue. And the biomed department is valued and sought after because we're really doing repairs.