Transcript Meeting the CMS Requements Simply, Easily ans Cheaply

Meeting the CMS Requirements
Simply, Easily and Cheaply
Patrick Lynch
Global Medical Imaging
[email protected]
Who am I?
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CBET, CCE, CPHIMS, CHTS-PW, fACCE
40 years in Biomed
Managed large In-house, ISO and corporate Biomeds
Active in certification of BMETs and CEs
1st Pres of NCBA (North Carolina branch) - 1980
President, HTMA-SC
Treasurer – HTMA-GA
Member of all Biomed Associations (honorary NC, KY, Utah)
Board Member – META, SC, GA
Advisor – OH, KY, TN, UT, VA, NC, Texas
Writes monthly for TechNation and BI&T (AAMI) Heineman Medical Foundation (Guatemala)
• Currently, works for GMI is sales development, who
sponsors my activities
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An operating room with at least 10 overhead booms.
No cords on the floor.
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A small, but typical OR.
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The Problem
• Extension Cords and Multiple Outlet Strips
(Relocatable Power Taps - RPTs)
• Nobody had assigned responsibility for them.
• Nobody tests them regularly.
• Many low-quality RPTs may compromise the
safety of otherwise safe medical equipment.
• Comingling of medical devices and consumer
items may trip breakers, removing power to
necessary medical equipment.
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CMS’s reaction
• Ban RTPs and extension cords totally.
• Well, not really, we were premature in our
total ban.
• Here is what you need to do to use them:
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Problems with Outlet Strips
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Daisy Chaining
Overloading
Wound or knotted cords
No UL label
Plug is hanging out of the receptacle
Device is HOT to the touch
Melted, frayed, discolored wires
It is used as permanent wiring (over 90 days)
Ground pin missing
Ref – www.nachi.org.power-strips.htm
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• Short Power cords will not reach an available
outlet.
– Patient areas - little problems, lots of outlets.
– Large ORs do not allow power cords from tables to
reach the wall.
– If a cord reaches an outlet, it is already used by
other items.
• Non-medical devices compete with medical
devices for power.
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• Too few wall outlets exist
– The quantity of medical devices has
multiplied since the electrical
designs were made for existing
building.
– As the uses for medical spaces
change, outlets are often in the
wrong place, not where needed.
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• Home-made and WalMart outlet strips are
often of poor quality.
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The Real Problem
• Sometimes the extension cords are to mate
dissimilar plug to one another.
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Worst Case Homemade
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• Everybody overlooks the Outlet Strips and
extension cords.
– Facilities test the outlet in the wall annually.
– Biomed tests the equipment to the end of its
power cord.
– Nobody inventories, monitors, tests, or
documents anything regarding RPTs or extension
cords.
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• Too many items plugged into a
single wall outlet or RPT can
trip breakers.
– Patients use hair driers, and
other consumer electrical
devices.
– These can affect the electrical
supply, or increase leakage to
important medical equipment.
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CMS Waiver
Ref S&C:14-46-LSC 9-26-2014
CMS is permitting a categorical waiver to allow for
the use of power strips in existing and new health
care facility patient care areas, if the
provider/supplier is in compliance with all
applicable 2012 LSC power strip requirements and
with all other 2000 LSC electrical system and
equipment provisions.
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CMS Waiver
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Ref S&C:14-46-LSC 9-26-2014
• Power strips may be used in a patient care vicinity to power
rack-, table-, pedestal-, or cart-mounted patient care-related
electrical equipment assemblies, provided all of the following
conditions are met, as required by section 10.2.3.6:
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1) The receptacles are permanently attached to the
equipment assembly.
• 2) The sum of the ampacity of all appliances connected to
the receptacles shall not exceed 75% of the ampacity of the
flexible cord supplying the receptacles.
• 3) The ampacity of the flexible cord is suitable in
accordance with the current edition of NFPA 70, National
Electrical Code.
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CMS Waiver
Ref S&C:14-46-LSC 9-26-2014
• 4) The electrical and mechanical integrity of the
assembly is regularly verified and documented
through an ongoing maintenance program.
• 5) Means are employed to ensure that additional
devices or nonmedical equipment cannot be
connected to the multiple outlet extension cord after
leakage currents have been verified as safe.
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CMS Waiver
Ref S&C:14-46-LSC 9-26-2014
• Power strips providing power to rack-, table-, pedestal-,
or cart-mounted patient care-related electrical
equipment assemblies are not required to be an
integral part of the manufacturer tested equipment.
• Power strips may be permanently attached to mounted
equipment assemblies by personnel who are qualified
to ensure compliance with 10.2.3.6.
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CMS Waiver
Ref S&C:14-46-LSC 9-26-2014
• If power strips are used in any manner, precautions as
required by the LSC and reference documents are required,
including, but not limited to:
1. installing ground fault and over-current protection
devices;
2. preventing cords from becoming tripping hazards;
3. connecting devices so that tension is not transmitted to
joints or terminals;
4. no “daisy chaining” power strips” using power strips that
are inadequate for the number and types of devices, and
5. no overloading power strips with high-load devices.
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CMS Waiver
Ref S&C:14-46-LSC 9-26-2014
• Power strips providing power to patient
care-related electrical equipment must be
Special-purpose Relocatable Power Taps
(SPRPT) as listed in UL 1363A or UL
60601-1.
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Action Plan
• 1. Replace all detachable power cords with 15
to 20 foot long ones.
– Buy a bunch of them from a commercial company.
– Increase wire size from original gauge to 16 or 14
gauge to reduce voltage drop due to longer
length, as needed.
– As you sweep the hospital, remove all RPTs that
become unnecessary due to these longer cords.
– Especially focus on Surgery, Critical Care and NICU.
This step should eliminate 80% of all RPTs.
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• For items with hard-wired power cords (video
carts, OR tables, exam tables, etc.)
1. Purchase male and female twist-lock plugs.
2. Cut the power cord about 6 inches from the
machine.
3. Install a male twist-lock to the equipment cord.
4. Make a new power cord, 15 to 20 feet long, with a
straight-blade male plug and a female twist lock.
Now you have a longer power cord, and have not
had to take the time to actually go inside the unit
to make time-consuming changes.
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ORIGINAL CORD
6 or 10 foot
cord
Medical Equipment
with standard
power cord.
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Male and
female twistLock
connectors
Medical Equipment
with modified
power cord.
15, 28, 20 or
25 foot cord
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Easily purchased
from Lowes or
Grainger.
Quickly installed
without opening the
equipment.
Now you have a modified power cord,
NOT an extension cord.
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• Where you legitimately
need RPTs:
– Purchase Special RPTs from
AIV or Tripp Lite
– They meet extra standards
and have long power cords.
– Inventory them,
– risk-rank them,
– put them on your PM
schedule, as per their risk
ranking.
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How to comply
• Extra steps required for Special RPTs:
– Measure current draw to RPT when all
connected devices are fully operational.
• Current may not exceed 80% of capacity.
– Plug all unused outlets to prevent the
addition of other equipment which
could increase the current draw, or
increase leakage current.
– Use child-proof outlet protectors
• Tripp Lite makes one that is unremovable
except with a special tool.
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Label all High-Current or Life-Support
Device Cords
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Plastic
White on Red
Engraved
approx. 2”x4”
tie-wrapped to cord
near electrical plug.
Important for Ventilators and Anesthesia Machines
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How to test current draw
of an SPRPT
1.Must have all
equipment plugged
in and turned on.
2. Use clamp-on
ammeter and line
cord splitter.
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How to comply
• Collect all unapproved
outlet strips and send
them to Biomeds Without
Borders for distribution to
third world countries.
www.BiomedsWithoutBorders.com
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• Long Power Cords, detachable
– AIV, 18 or 25 feet long, 16 or 14 gauge
• Twist Lock electrical plugs
– Lowes, Hubbell, L5155PZ and L5155CZ
• Clamp-On Ammeter
– Lowes, Southwire, 21060T
• AC Line Splitter
– Extech 480-172
• Outlet Plugs, unremovable
– Tripp Lite, HGOUTLETCVR
• SPRPT
– AIV –Powwermate www.aiv-inc.com
– Tripp Lite – PS-415-HGULTRA www.tripplite.com
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Pat Lynch
[email protected]
704-941-0116
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