Patient care in the balance
Hospitals could potentially save hundreds of thousands of pounds in litigation costs by ensuring their weighing equipment is accurate, fit for purpose and regularly maintained. Here’s how
Since April this year trading standards officers across the country have been visiting their local hospitals to explain the importance of using appropriate equipment and working with medical personnel to improve standards.
The Local Authorities Coordinators of Regulatory Services (LACORS), the local government central body responsible for overseeing local authority regulatory and related services in the UK, says this has not been a ‘name-and-shame exercise’, but a partnership-working initiative between local authorities and NHS hospital trusts.
The initiative arose from pilot studies around the country, with trading standards officers visiting hospitals to inspect scales used for weighing patients and found potentially lethal problems. These included:
* Inaccurate scales being used, affecting dosage of medication and radiotherapy
* Inappropriate equipment in use, i.e. devices with scale intervals that do not show sufficient accuracy
* Well-meaning ward staff bringing in equipment from home, or ordering it from non-approved suppliers. Examples included kitchen and bathroom scales being used to weigh infants in postnatal intensive care units
* Discrepancies between the inventory and the equipment found in wards; scales often ‘walk’ from ward to ward, or go missing altogether
* Old fashioned equipment (e.g. steelyard scales) that staff do not know how to use properly, or that is not set to zero before use
* ‘Dual display’ scales – where they can be used to show metric and imperial measures – being set in imperial when the dosage needs to be in metric
Under the follow-up initiative hospital staff are asked to work with inspectors and explain what the different pieces of equipment are used for and how accurate they need to be. The project will show the benefits of using accurate, appropriate weighing equipment, not the least of which is the ability to demonstrate due diligence should the need arise.
So what can hospitals do to ensure there equipment is fit for purpose? Of utmost importance is the need to order all equipment through one department; for most hospital trusts, this will be the biomedical engineering department.
It should be their responsibility to ensure that equipment ordered is fit for purpose. Weighing scales need to be stamped/stickered as fit for purpose by a trading standards officer or other authorised body if used for medical purposes.
In addition, there are different classes of accuracy for different types of scale. Class III and IV are the most common in medical applications, with Class III being more accurate. Many hospitals have a mixture of both, but given how often scales seem to ‘walk’ from one ward to the next, hospitals are advised to use only Class III equipment, as it is better to be more accurate than necessary.
LACORS suggests that when buying new equipment, get scales that automatically set to zero before weighing, and that only weigh in metric units. The procurement department should ascertain the requirements from ward staff, and then train them.
Where resources allow, hospitals might wish to use an asset management system provided by a reputable independent company. For a fee, such companies will manage some or all of the scales in a hospital, ensure the devices are regularly maintained and calibrated, and order and install new equipment as required.
Some hospitals have already been approached by unscrupulous scale servicing companies offering to make sure the hospital doesn’t ‘fail’ the inspection.
LACORS says hospitals should wait for the trading standards visit – which is free – to find out what work, if any, needs to be done, before commissioning a third party to carry out further inspections or repairs. Trading standards will be able to offer free, impartial advice on reputable suppliers and asset-managers.
The reason for targeting hospitals specifically (rather than, say, GP surgeries or community clinics) is that it was felt that this was the most high-risk area. For example, hospitals are more likely to use scales for calculating dosages, whereas a GP would be more likely to record weight for monitoring.
In reality, weight monitoring can be just as crucial as dosage calculation, particularly in paediatrics or renal dialysis. However, it was felt that hospitals was a good place to start what is a pioneering partnership that has not yet been established on a national scale.
Hospitals are fewer in number and more easily identifiable. Also, for the purposes of the study, private medical facilities are not being inspected. It seemed more fitting to spend limited time and resources on services paid for by the taxpayer and used by local communities.
At the end of the project (in March 2009), it is likely that some areas for further work will be examined, which may include surgeries, clinics, community health practitioners and private hospitals.
Trading standards are in the process of contacting hospitals to arrange the visits. However, it is not always easy to find the most appropriate person to talk to, and it would be helpful if hospitals made contact with trading standards proactively.
To do this, contact your local authority, ask for trading standards, and then ask for whoever is dealing with the National Medical Weighing Project.
To download the project pack,
visit: www.lacors.gov.uk
For local trading standards:
www.tradingstandards. gov.uk/ and enter our hospital’s postcode.
