5 Fixit Tips to Keep You Out of Trouble

Most ASC facility managers came from a hospital environment: If something malfunctioned or broke, they simply called the maintenance department, and they took care of it. If that sounds like "the good old days," then you've been grappling with the same realities we have here:

• There is no maintenance department.

• If you call someone to fix something, it will cost you, and often dearly.

• As often as possible, you try to fix it yourself.

When we opened our ASC, I was rudely awakened to the fact that my staff and I were not prepared for these realities. We didn't know how to fix things, we didn't have the tools, and we hadn't taken the necessary steps to correct the first two problems!

Of course, we learned all this on the job, as we were trying to do our real jobs. Over time we developed five simple strategies that keep us out of trouble. Perhaps they can help you, too.

1. Plan Ahead.
This may be easier said than done, but thorough planning will go a long way to avert a problem, or equip you to deal with it. Begin the process by walking around your facility, asking "What can go wrong?"

In the first year, all of this should be under manufacturer or contractor warranty. However, you may have to "make do" until a new part or service tech arrives at your facility. For example, the hinge on our OR door self-destructed, and needed to be replaced. But we couldn't just stop surgery for the day or two it took to get the new part. We had to get out our screwdriver and a ladder, and make it work.

What else can go wrong? Light bulbs will burn out-so, make a list of all the different light bulbs you use, and stock one or more spares for every type. In most parts of the country, there's bad winter weather. What do you need to make it safe for patients to come in the door (and they will come-no matter what)? We learned that we needed snow shovels and salt to spread on the ice.

Of course, you must pay particular heed to critical care items. If your equipment has a blinking light or audible alarm that indicates trouble, is the indicator in a place where someone would see or hear it? Think about items that you don't use all the time, but will need in an emergency, such as oxygen or the defibrillator. Do you always have enough on hand? Is the item checked regularly by a qualified person? How do you know all of this is being done?

Think about items you do use all the time, such as your autoclaves. What would happen if the steam generator malfunctioned, and you couldn't sterilize instruments? It happened here, and a panic began until I remembered that one autoclave did have an electrical generator back-up.

An important part of planning ahead is recognizing that you won't be able to fix everything yourself. In fact, you shouldn't try to fix any medical equipment such as your anesthesia machine or patient monitors; leave this to a biomedical contractor. Make sure you select one before you have a problem, and form an agreement for regular maintenance and service (see "Give Your Biomedical Contractor this Quiz").

Other routine jobs will be difficult to accomplish during your busy work day, such as painting, installing shelves or hanging fixtures. For this you will need a handyman or fix-it person. Ask around among small business owners in your area, as they usually need to have someone like this on call. Or, check out the local papers for ads, and give any candidates a small job to evaluate the quality of the work.

2. Practice Makes Perfect.
After you've formed a plan, you should schedule training and practice for anyone who might be counted on to help with a problem. We scheduled an in-service for our entire staff regarding the medical oxygen tanks, to ensure that everyone would have some idea of what to do if the alarm (located in our PACU) went off.

To give your staff an ongoing dose of positive expectations, use positive rather than negative words-for instance, use when rather than if. Avoid giving messages in the negative, such as "If we don't improve our biohazardous waste process we won't get accredited." Rather, phrase the same message in the positive; for example: "We need to implement a new biohazardous waste process by next month to ensure that we meet these criteria." What they'll remember then, is "meet these criteria."

The contractor who supplies the gas gave the in-service, showing us how to attach and detach tanks to the manifold. They also covered things like what to look for that might indicate a problem, how to listen for leaks and how to troubleshoot for leaks. Then everyone, from nurses to medical assistants, learned how to handle the big "H" tanks, which can be very scary.

From this practice, we developed a protocol regarding the tanks. We keep a log of the amounts in the tanks, and order a new tank as soon as one side is empty. A large wrench and a pair of work gloves "live" right next to the tanks, so anyone changing them will have the necessary tools. Complete instructions are posted right there, too.

We usually change a tank every week. This job is rotated around, and whoever has it will pull in someone else from the staff to help. This way, two people get a practice run. We made learning this task part of orientation for every new staff person.

Not every potential problem requires this investment of time, but you certainly brainstorm at staff meetings about what could come up and what the best response should be. Even a mental run-through on possible situations can help to keep you prepared with tools and resources.

3. Get Supplies.
You already got a jump on this in your planning process. Sit down and list every possible malfunction or problem, and then create a shopping list, such as:

• Light bulbs burn out:
  - List every type of bulb you use.

• Snowstorm:
  - Snowshovels (2);
  - Salt;
  - Salt spreader.

• Lose electrical power:
  - Flashlights (4 or 5);
  - Batteries;
  - 5 gal. bottled water;
  - Cell phone (your phone system probably won't work without electricity).

• Insects and rodents:
  - Insecticide (large container w/sprayer);
  - Mouse traps or other pest control device.

• Hinges break/wheels come off:
  - Assorted bolts, screws;
  - Any specialized tools (should have this cov- ered in tool box).

• Toilet, plumbing problems:
  - Household rubber gloves;
  - Plunger;
  - Toilet repair assembly;
  - Drano.

Once you complete the list, sort out which things must be purchased from specialized sources, and which are common household items. Take a trip to Wal-mart or another large discount retailer for the best prices on common items. For the specialized items, shop among suppliers for the best price, and order in volume to save money.

4. Pool Your Resources.
When there's a problem, pool all of your resources to solve it. For instance, we had a toilet that got stuck in the "flush" mode. I didn't know what to do, but one of our staffers did. She closed a valve so that the water would stop. Then we got the part we needed to repair it.

In general, if you're not the handy type, find out who on your staff might be. Or perhaps you're okay with nuts and bolts, but anything to do with plumbing is a disaster. Find out-before there's a problem-who would be the best person to whom to turn with a given problem.

It's also important to fortify your resources in any way possible. Familiarize yourself with the circuit breaker, and with another staff person, develop a protocol for troubleshooting electrical problems. Let's say the electric door between ORs won't open. First check to see if someone inadvertently switched it to "off" (this happened to us; the cleaning staff did it without knowing it). Then check to see if you just need to flip a circuit switch-and save the cost of calling the electrician!

5. Know Your Limits.
Of course, you should never risk injury to yourself or your staff. While a healthy person exercising due caution can shovel a few inches of snow or spread some salt, don't ask someone with a bad back or limited mobility to do this. Likewise, you can't handle every plumbing or electrical problem-that's what plumbers and electricians are for! You just need a few common-sense skills and tools to handle a crisis, and then know whom to call to solve the problem.

As part of your plan to keep you out of trouble, make a list of whom to call for help, such as:

• Biomedical contractor;

• Plumber;

• Electrician:

• All-around handyman;

• Snowplow contractor;

• Custodial contractor; and

• Pest Control

Make sure others on your staff know where this list is, where the toolbox is, and where the supplies are kept. You can't always be there, and you know the light bulbs will blow-and worse-on the day you are out with the ????-??flu. But if you've made a plan and followed through, you and your staff will be well-equipped to deal with trouble whenever it finds you.