Addis Ababa Hospitals
Addis Ababa Hospitals
Addis Ababa Hospitals
Executive summary
Addis Ababa public hospitals’ medical and facility equipment inventory assessment was carried
using the EHRIG implementation guidance between Sep 29 to Oct 08/2014 and results showed
that hospitals’ performance on both medical equipment and facility management was the lowest
compared to all other EHRIG chapters. . There was no information on how hospitals plan their
purchases in-service training, maintenance, disposal or replacement on medical equipment and
the availability of Biomedical Engineers or Technicians assigned to healthcare facilities.
There is , therefore, a need for hospitals to have established inventories as inputs to the many
different activities within the HTM life cycle (acquisition, commissioning, maintenance,
calibration, replacement and disposal) and not only strive to meet the five of the medical
equipment operation standards contained in the EHRIC document.
The inventory assessment covered all Addis Ababa (except St. Paul’s) public hospitals’ medical
and some facility management equipment, .The inventory assessment was carried out in eight
days after the two days training on the inventory detailed activities. The target groups for this
pre-job trainer were 64 Biomedical Engineering 2006 EFY Graduates from Jimma University
and31 Biomedical Engineers or Technicians from all Addis Ababa Hospitals and AARHB. At
the end of the two days training the feedback evaluation rated was 36.7%Stromgly agreed,
46.8% agreed, 14.6% average, 1.7%disagreed and 1.2%strongly Disagreed.
Introduction
The Effective Healthcare Technology management requires both human and financial resources.
Healthcare Technology Management of Health Facilities requires special type of training and
awareness how to manage and prioritize all activates on Medical Equipment.
The availability of medical Equipment at all the times in each level of healthcare facility is
crucial for proper health care provision.
These devices should be
Safe,
Effective
Affordable
Quality (meet the required international standard)
Availability in Adequate Quantities
(In very high critical area needs the backup or additional stand-by medical Equipment)
It is Important to indicate that the medical equipment and facility management inventory will
support hospitals to have information for the following problem and to address basic questions
properly, such as:
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
The Medical Equipment Management has nine operational standards; one of these standards is
the inventory. It is recommended to be updated continually so that it provides up to date status of
medical equipment within the health-care facility. Update points include initial data collection;
regular updates when a new piece of equipment arrives or discarded; and during annual
inventory audits. This inventory of medical equipment is used in conjunction with inventories of
additional supportive assets, with the list of spare parts.. During the training of the eleven Addis
Ababa hospitals, AARHB, FMOH/MSD and FMOH/PHID Biomedical Engineers decided on the
level of detail of data to be included in this inventory, in order to satisfy the EHRIG minimum
requirements. Inventory management is carried out using a paper-based and computer based
system, as determined by the resources available (64 BME newly Graduated from Jimma
University, 31 BME/T from eleven AA Hospitals) and as per the aligned plan among
FMOH/MSD - CHAI/EHMI, FMOH/MSD - FMOH/PHID and FMOH/MSD – AA Hospitals.
This established inventory serves as the foundation for moving forward within the HTM system
and ensuring safe and effective medical equipment.
Facility Management
Over view of EHRIG Chapter 8
Availability of site plan of the Hospital
Check list on availability of Water system
Check list on availability of Electricity system
Check list on Kitchen
Check list on Laundry
Check list on toilet
Training Organizer
This training has been organized by Federal Ministry of Health MSD with collaboration of PHID
and AARHB Biomedical Engineering Team. It is sponsored by CHAI/EHMI.
Expected training outputs
At the end of the training, participants have got:
Adequate knowledge and skill who can manage Healthcare Technology Management
Will be able to manage their medical and facility management
Will reduce emergency or unplanned purchasing of Medical Equipment
Will reduce the corrective/unplanned maintenance by utilizing planned maintenance.
Objective/Purpose
Methodology
i) Identifying the participant and the facilities
Identified the inspection team from
1. FMOH/MSD…Agrarian Team
2. CHAI/EHMI
3. FMOH/PHID and AARHB
Identified five federal and six Addis Ababa regional Hospitals as the pilot for
Biomedical Engineering who are graduated from Jimma University in 2007EFY as
the pre- service trainee.
Identified 64 Biomedical Engineer who are graduated from Jimma University in
2007EFY as the pre- service trainee.
Identified 31 Biomedical Engineer/Technician who are graduated from Jimma
University in 2007EFY as the in - service trainee.
ii) Providing Inventory Training.
Introduced the EHRIG Chapter 8 Facility management
Introduced the EHRIG Chapter 9 Medical equipment Management
Introduce the different format related to the Inventory from the Annex part of
EHRIG Chapter 8 and 9
Conduct “Medical Equipment Inventory”
Conduct “Medical Equipment History file”
Conduct “Medical Equipment Need Assessment”
iii) Conducting and inspection the inventory
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
Monitoring:
The training has been monitored on daily basis Inspected using questioning, answering and
group follow up
Trainee Evaluation:
i. Evaluated the participants on pre- and posttest (On-Job Inspection)
Pretest focused on the inclusion criterion of Medical Equipment Inventory
There was different ambiguity among the participants since there is no local rule and
regulation on it.
After lecture we reach on the understanding on the inclusion criterion of Medical
Equipment Inventory
The posttest done as inspection on the site(Job) and provide coaching activities.
ii. Reported on inventory by participant and evaluated as per the training document
All Addis Ababa Hospitals’ submitted the inventory result on both Medical
Equipment and Facility Management except the St poul,
iii. End of training evaluation by participants
At the end of the two days training the feedback evaluation rated was
36.7%Stromgly agreed,
46.8% agreed,
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
14.6% average,
1.7%disagreed and
1.2%strongly disagreed.
This is the inventory result of both Medical Equipment and Facility Management
Functional 137 40 129 805 82 166 133 105 167 135 1899
Total(BME) 205 83 175 965 166 292 156 135 284 192 2653
CSR 7 4 11
Kitchen 38 22 60
Laundry 43 62 105
Boiler 1 3 4
Generator 8 1 9
Incinerator 5 0 5
IV fluid prod 8 0 8
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
2500
2000 Functional in %
1500 Percentage
2397
1000 Qty
500 360 Level of Medical Equipment
5
0
1 2 3 4 5 6 7
Medical Equipment Complexity and the Needs of Skill BME/T in their Level
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
3000
2653
2500
2000 1899
1500
965
1000
805
754
500
292 284
205 175 160 192
166 166 167
137 129 126 133156 105135 117 135
83
68 4043 46 8284 57
000 23 30
0
Hospit AL AM PT TA GD MN RD TB YK ZW Total
als
Federal and AA hospital Medical Equipment Inventory result
Series1
Series2 0 137 40 129 805 82 166 133 105 167 135 1899
Series3
Series4 0 68 43 46 160 84 126 23 30 117 57 754
Series5
Series6 0 205 83 175 965 166 292 156 135 284 192 2653
Series7
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
250
202 Equipment/ Total Total Total
200 Plant
functional Non-fun.
150
105 CSR 7 4 11
100 Kitchen 38 22 60
60
Laundery 43 62 105
50
11 9
Boiler 1 3 4
4 5 8
Generator 8 1 9
0
Incinerator 5 0 5
IV fluid prod 8 0 8
Tot_func
Tot_nonfunc Total(Facility) 110 92 202
Total
Opthtalmology 8 Addis
0 0Ababa
0 Hospitals’
0 5 0 Medical
2 0 and
0 Facility
15 Equipment
4 0 0 2014
0 0 0 0 1 0 0 5
Diabetic Center 0 0 0 6 0 0 0 0 inventory
0 0 Auditing
6 0 report
0 0 0 0 0 0 0 0 0 0
GI unit 0 0 0 9 0 0 0 0 0 0 9 0 0 0 2 0 0 0 0 0 0 2
Internal
Medicine 0 0 0 14 0 0 0 0 0 0 14 0 0 0 20 0 0 0 0 0 0 20
Neurology 0 0 0 6 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0
Cardiac 0 0 0 6 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0
Radiotherapy 0 0 0 6 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0
Rehabilitation 0 0 0 43 0 0 0 0 0 0 43 0 0 0 8 0 0 0 0 0 0 8
Renal unit 0 0 0 7 0 0 0 0 0 0 7 0 0 0 1 0 0 0 0 0 0 1
Nuclear
Medicine 0 0 0 40 0 0 0 0 0 0 40 0 0 0 11 0 0 0 0 0 0 11
Dermatology 0 0 2 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0
ENT 0 0 0 0 0 0 3 0 5 0 8 0 0 0 0 0 0 1 0 0 0 1
OR Eye 11 0 0 0 0 45 17 0 0 0 73 6 0 0 0 0 8 2 0 0 0 16
OPD Adult 0 1 0 0 0 1 0 0 3 0 5 0 1 0 0 0 7 0 0 3 0 11
OPD PedI 0 0 0 0 0 0 0 0 5 0 5 0 0 0 0 0 0 0 1 5 0 6
OPD Ophtal 0 0 0 0 0 29 31 0 0 0 60 0 0 0 0 0 13 1 0 0 0 14
OPD MDR 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0
MainOR 21 0 3 139 16 33 16 26 29 14 297 8 0 0 24 20 11 7 2 26 0 98
MinorOR 5 0 0 26 1 0 0 0 0 4 36 3 0 0 1 0 0 0 0 0 9 13
OR Burn 0 0 0 0 0 0 0 0 23 0 23 0 0 0 0 0 0 0 0 22 0 22
Pharmacy 0 4 30 108 0 0 6 0 0 21 169 0 2 3 0 0 0 2 0 0 2 9
Emergency
pedi 0 0 0 33 0 0 0 0 0 3 36 0 0 0 13 0 0 0 0 0 2 15
Emergency
Gen 8 7 5 24 3 8 0 10 0 7 72 3 2 6 2 0 8 0 1 0 5 27
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
Total(BME) 137 40 129 805 82 166 133 105 167 135 1899 68 43 46 160 84 126 23 30 117 57 754 2653
CSR 0 0 0 4 1 0 0 1 0 1 7 0 0 0 2 0 0 0 0 0 2 4
Kitchen 7 0 14 0 0 4 4 0 5 4 38 4 0 9 0 0 2 2 0 0 5 22
Laundery 6 6 4 2 5 4 3 5 3 5 43 5 5 5 21 5 4 6 0 10 1 62
Boiler 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 2 3
Generator 1 1 0 1 0 2 1 0 1 1 8 0 0 0 0 0 1 0 0 0 0 1
Incinerator 1 1 0 1 0 0 1 0 1 0 5 0 0 0 0 0 0 0 0 0 0 0
IV fluid prod 0 0 0 0 0 0 0 0 8 0 8 0 0 0 0 0 0 0 0 0 0 0
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
Overall Total 152 48 147 814 88 176 142 111 185 146 77 48 60 184 89 133 31 30 127 67 2855 2855
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
Limitation
The focuses of this document is on medical equipment, spare part inventories and Plant or
hospital equipment (Items such as Boilers, CSR Autoclaves, Laundry equipment, Generators,
Incinerator, Kitchen Refrigerator and water distiller).
Discussions of inventories for workshop tools, test equipment, consumables, safety equipment,
and radioactive and hazardous materials and waste are outside the scope of this document.
Challenge
1. The skill gap of the newly graduated BME on inventory process
2. The trend Vs the scientific approach of isolating Medical Equipment from Facility
Equipment (e.g. Refrigerators and Autoclave which is found in clinical area).
3. No National Nomenclature in Medical Equipment
4. Lack of awareness of equipment users on the purpose of inventory
5. Existing poor medical equipment management
6. Existing poor medical equipment data (no recorded document)
7. Some facilities users are locked on their Medical Equipment
8. The arrangement of the Medical Equipment in the store is worst scenario.
Even, we need daily laborer to take data from the medical equipment.
Conclusion
This Medical Equipment Inventory shows that
a. It fulfils the five out of nine medical equipment operational standards in EHRIG. Those
are:
a) Paper or computer based inventory of Medical Equipment
b) Essential /core List of specialty care Medical Equipment and their Risk
Classification
c) Paper or computer based Inventory of Spare Parts
d) History file of Medical Equipment
e) The Need or availability of BME and/or MEC in the Healthcare facilities
b. It is the roadmap for all activities of HTM cycle and the remaining
Operational standards of EHRIG We have to implement “5S” through Maintenance,
Commissioning and calibration campaign. Because from 2653 Medical Equipment the
754(28.4%) aren’t working, more than 70 aren’t commissioned and the remaining
1899(71.6%) are Active.
c. We have to minimizing the variation(type, model, manufacturer and country of
origin) of Equipment during Acquisitions (donation, purchasing, leasing, rental…)
because, our inventory show that there is no standardization in the following parameters
iii. Assembling and/or Refurbishing second hand (not more than 5yr old) or donation
equipment on the bases of the MOU with some world class medical equipment
manufacturers with their area/field of specialties in clinical application.
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
Reference
1. WHO Medical device technical series, (June 2011), “Introduction to medical equipment
inventory management”, Geneva, Switzerland.
2. FMOH, (October 2014), “Medical and Hospital Equipment Inventory data collection from five
federal and six AAR Hospitals”, Addis Ababa, Ethiopia.
3. FMOH, (2010), Ethiopian Hospital Reform Implementation Guide EHRIG volume II Chapter
9 Medical Equipment Management, Addis Ababa, Ethiopia
4. FMOH/MSD, (2014), “MSD-CHAI, MSD-AARH and MSD-PHID alignment plan”, Bishoftu,
Adama and Addis Ababa, Ethiopia
5. FMOH/MSD, (2014), Medical Equipment Facility Management Initiatives
6. FMOH/MSD, (2014), Addis Ababa Hospitals EHRIG and HPMI report
7. Lenel A et al. How to organize a system of health technology management.
‘How to Manage’ series of health care technology guides no. 1. St Albans, Ziken International
(Health Partners International), 2005.
8. Temple-Bird C et al. How to operate your healthcare technology effectively and safely. ‘How
to Manage’ series of health care technology guides no. 4. St Albans, Ziken International
(Health Partners International), 2005a.
9. Recommended practice for a medical equipment management program. American National
Standard ANSI/AAMI EQ56. Arlington, Association for the Advancement of Medical
Instrumentation, 1999.
10. Fennigkoh L, Smith B. Clinical equipment management. Joint Commission on Accreditation
of Healthcare Organizations Plant Technology and Safety Management Series, 2:5–14, 1989.
11. Medical equipment maintenance programme overview. Geneva, World Health Organization,
2011.
12. Wang B, Levenson A. Equipment inclusion criteria -a new interpretation of JCAHO’s Medical
Equipment Management Standard. Journal of Clinical Engineering, 2000, 25:26–35.
13. Wang B et al. Medical equipment management strategies. Biomedical Instrumentation and
Technology, 2006, 40:233–237.
14. Temple-Bird C et al. How to plan and budget for your healthcare technology. ‘How to
Manage’ series of health care technology guides no. 2. St Albans, Ziken International (Health
Partners International), 2005b.
15. Computerized maintenance management system. Geneva, World Health Organization, 2011.
16. Kawohl W et al. How to manage the finances of your healthcare technology management
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17. St Albans, Ziken International (Health Partners International), 2005
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
Appendix
A. Criteria for medical equipment inventory inclusion
a. Items included in an inventory
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
Since we have no National nomenclature and the Inventory identification number in EHRIG
document rarely utilized, here we used the five digit sequential numbers for simplicity
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
Introduction
Healthcare Management Team
Effective Healthcare Technology management requires both human and financial resources.
Healthcare Technology Management of Health Facilities requires special type of training and
awareness how to manage and prioritize all activates on Medical Equipment.
The requested training is for 64 Jimma University 2007EFY graduated Biomedical Engineer plus
31 Addis Ababa Hospitals Biomedical Engineer/Technician. The estimated budget is
298,560:00ETB for the planned Eight days training. The first two days are going to be pure
training at training center in Addis Ababa University. The next six days are going to be for the
practical attachment at all eleven Addis Ababa Hospitals
It is envisaged that the training of these staffs combined with the aligned plan of MSD/EHMI,
MSD/PHID and MSD/AARHB ongoing support from Agrarian Case team, will bring
Knowledge on implementing of EHRG Specially, Medical Equipment and Facility Management
chapters. The ultimate goal is to enable decision maker to plan properly and enhance patient
satisfaction.
Will get adequate knowledge and skill who can manage Healthcare Technology
Management
Will be able to manage their medical and facility management
Will reduce emergency or unplanned purchasing of Medical Equipment
Will reduce the corrective/unplanned maintenance by utilizing planned maintenance.
Target Groups
The target groups for this training are Jimma University Biomedical Engineering 2006EFY
Graduates, Biomedical Engineer or Technician in all Addis Ababa Hospitals and AARHB
Training Methodology
The methodologies to be used for this training include:
Training Materials
LCD;
Laptop
Power point presentations
Flipchart, markers, plasters
Note book and pens
Training date:
ii. October 01, 2014 to October 09, 2014.
Monitoring:
The training will be monitored on daily basis using questions and answering and group follow up
Trainee Evaluation:
Oral pre- and posttest to participants
Reporting on inventory by participant
End of training evaluation by participants
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
D. EHRIG (EHSTG)
ETHIOPIAN HOSPITAL SERVICES TRANSFORMATION GUIDELINES
5. An Equipment History File is maintained for all medical equipment, containing all key
documents for the equipment.
Addis Ababa Hospitals’ Medical and Facility Equipment 2014
inventory Auditing report
6. The hospital has policies and procedures in place for acquisition of new medical equipment,
commissioning, decommissioning and disposal of equipment, the receipt of donations, and
outsourcing technical services for medical equipment repair and maintenance.
7. All new equipment undergoes acceptance testing prior to its initial use to ensure the
equipment is in good operating condition, and are installed and commissioned in accordance
with the manufacturer’s specifications.
8. All equipment operators and personnel are trained on proper operation, safety, and
maintenance of medical equipment with standard operating procedures readily available to
the user.
9. There is a schedule for inspection, testing and preventive maintenance for each piece of
equipment as guided by the manufacturer’s recommendations and that schedule is
appropriately implemented.
10. There is a notification and work order system for corrective maintenance and calibration of
medical equipment based on their level of risk.