Is Exception Recording Necessary, Or Is Pass/Fail Adequate?
By: Patrick K. Lynch
I was informed that the Indiana State Board of Health is asking BMETs to begin recording all electrical safety testing results on patient care equipment. The question: “. . . I have a question concerning Electrical Safety (E.S.) and exception reporting. We have been doing exception reporting since 1998. If something fails we create a work order and remediate the repair process. Indiana State Board of Health is asking us to log/annotate and review leakage current on all devices. NFPA and others are starting to minimize the emphasis on electrical safety. Obviously grounding is important. We still do E.S. but do not annotate. Simply pass/fail. Logging and reviewing E.S. from year to year seems to me like it would take a lot of time that would be better spent doing actual PM and performance verifications. Is there documentation and/or other information that I could use to challenge the state’s finding and potential citing? I guess my first question should be do you find value in that requirement? Thanks for your time.”
Since I began in this field in 1975, we have always used exception reporting. Exception reporting is the process of defining the acceptable range of data, and then only reporting the actual numbers if the data is not within these defined limits. Exception reporting is commonly used where the recorded values, if within tolerances, do not matter. It also saves much time – a common motive in health care and industry these days.
Here is an excerpt from “2009 Annual Revision Cycle Report on Proposals” from the National Fire Protection Association (NFPA):
A.22.214.171.124.4 although several approaches to documentation exist in hospitals, the minimum acceptable documentation should convey what was tested, when it was tested, and whether it performed successfully. Adopting a system of exception reporting can be the most efficient form of record keeping for routine rechecks of equipment or systems and thereby minimize technicians’ time in recording the value of each measurement taken. For example, once a test protocol is established, which simply means testing the equipment or system consistent with Chapter 4, the only item (value) that needs to be recorded is what failure or what deviation from the requirements of the chapter was detected when a corrective action (repair) was undertaken. This approach can serve to eliminate, for example, the need to keep individual room sheets to record measured results on each receptacle or to record measurement values of all types of leakage current tests.
CLICK HERE to view/download the full document.
Below is an excerpt from ECRI Institute on documentation of IPM results:
Exception reporting, in which only failures or exceptions to expected results are recorded, is supported in NFPA 99. Although not specifically addressed by The Joint Commission, hospital experience indicates that it is also acceptable to The Joint Commission. The initial use of exception reporting omitted quantitative data (especially electrical safety results) and required only that a task be checked off when completed. However, if the equipment record adequately identifies the device inspected and the procedure used, only the date of inspection and who performed the inspection must be recorded. ECRI Institute’s Biomedical Benchmark supports manual (paper) documentation, paperless documentation, and exception reporting. Forms can be printed and filled in manually or can be completed electronically (e.g., on a laptop). Users can fill in complete information (including quantitative results) and check off each completed task or can just check off a single box (―Passed‖ at the top of the IPM form) to indicate completion of and acceptable findings for all tasks. Hospital policy should be established to determine the level of documentation to be used.
CLICK HERE for more information on the Biomedical Benchmark program.
For a local jurisdiction, such as a state regulatory agency to mandate 100 percent recording of test values is unnecessary. If we in the U.S. are to remain competitive in the global economy, we must rid ourselves of unneeded work and tasks. It appears as if recording passing test measurements falls into the range of non value-added work.
I maintain that this requirement actually decreases the safety of a hospital. Forcing workers to spend their limited time documenting unnecessary results reduced the time they have to spend on equipment and task that truly need their attention.
I urge all state organizations and authorities to refrain from second guessing national norms and to stop implementing requirements that serve only to add work without producing any benefit to patients, workers or the public.
CLICK HERE to view the original article online.
From TechNation Magazine August 2012
Patrick Lynch is a respected author of many articles for and about the field of Biomedical/Clinical Engineering and Healthcare Technology Management. These articles have been published in many trade journals, magazines, and on internet websites everywhere. He is a member, officer, advisor, and contributor to over ten different biomedical societies and healthcare technology management associations all across the country. He is an active member of our OCEA Advisory Committee.
TechNation is the primary monthly magazine and ultimate resource guide for over 12,000 medical equipment service professionals. It’s diverse editorial and information helps Biomeds/CE, Imaging and I.T. professionals keep their finger on the pulse of the healthcare technology community, helping advance their careers and further their profession.