2. INTRODUCTION
• The term “equipment” means all items necessary for
functioning of all services of the hospital including
accounting and records maintenance of buildings
laundry nursing unit its extra both movable and fixed
equipments are required for the hospital.
10. Acquisition of Required Items
Can Be Done
• At Departmental On Selection Level That Is Decentralized
• At Hospital Level Centralized Purchase
• By A Group Of Hospitals
• Having Same Management Control That Is Example Maybe
Municipal Government
• Hospital Having Common Governing Body Example Chain
of Corporate Hospitals
• Making Joint Common Purchase Examples Three Or Four
Hospital Situated In Same City
13. Group Purchasing
• Requirement Of More Than One Hospital Club Together For
Making Purchases Post Come Down For A Group Of
Hospital Is It Advisable To Obtain Individual Requirement Of
The Hospital Club Them Together And Then Process The
purchase .
15. Disadvantages
• Selection Of Substandard Items Maybe Inadvertently Done
• Unfair Practices In Purchasing By The Person Enjoying
Absolute Power Cannot Be Ruled Out.
16. Types Of Material
The various types of
material used in
hospital directly or
indirectly related to
various activities that
are undertaken in the
hospital to achieve its
objectives.
17. Materials And For The
Facilities :
• DRUGS AND MEDICINES
• SUPPLIES
• EQUIPMENTS AND INSTRUMENTS
• FACILITY
18. DRUGS AND MEDICINES
• Supplies Equipments And Instruments And Facilities
Drugs And Medicines These Are Used For Prevention
And Treatment Of Various Types Of Ailments Including
Anesthetic Agent vaccine
• And Drugs Required For The Specific Purposes
Antibiotics And Other Drugs
19. PURCHASE OF SUPPLIES AND
EQUIPMENT
• The purchase of supplies and equipments in a hospital is
carried out through;
1. General store
2. Dietary department and
3. Pharmacy department
20. Cont...
• When planning for the purchase of articles , budgeting is
done not only for the actual price of articles but also for
the additional costs that are involved such as, Transport
charges (local delivery reduce the transport charge)
Incidental costs
• Cost of chemicals and other consumable to be used
with the equipment (eg; ECG paper for an ECG
machine )
• Operating cost (hiring a technician )
• Cost of maintenance service; 10-20% of hospital
equipment may remain idle if serving is not done
periodically.
• Cost of technology obsolesces: when a better quality
appears in market there is tendency to discard the old
model.
• Replacement cost of equipment
21. Selection of article
• Articles that meet the criteria specified by the Indian
Standard Institution will be marked by ISI markings.
• The articles bought should provide safety to the patient
and personnel.
• Faulty instruments and equipments cause not only
inconvenience in the patient care, but also it may cause
the loss of life.
22. Purchasing article:
• The material used for any equipment should be durable,
non-corroding, non toxic and safe for use.
• Should have standard shapes and dimensions to fit
into various situations
• Reparability and spare part availability of the article
• Interchangeability of the article
• All surgical instruments used in a hospital should be
sterilisable and they should stand the tests for leakage ,
hydraulic pressure tests for bursting etc
• Should have accuracy in measurements
• Should have ease of operation
23. The central supply service
• Most hospitals have a central department where
equipments and supplies are stored and from which they
are distributed to the units.
• The type of materials that is kept in the central supply
room varies from hospital to hospital.
• In some hospital the central supply room deals with only
the sterile supplies and ward trays.
• In other hospitals all types of equipment such as oxygen,
suction, ward trays, catheters, syringes etc are stored
here.
24. Linen supply: Methods of handling linen supply include;
• a) Departmentalized system: Here the supply of linen
for each department of the hospital is marked for that
department. The head of the department is responsible
for making a linen standard for his own department.
• b) Centralized linen supply: Under centralized system,
linen is issued on exchange basis, that is clean linen is
exchanged for soiled linen.
25. FACTORS TO BE CONSIDERED
• Type of service provided by the hospital: a maternity
hospital requires more equipment related to
gynaecologic procedures than a cardiac hospital.
• Age of patients: children need different type and amount
of equipments than adults.
• Sex- men and women sometime require different type of
equipment.
• Degree and type of illness- neurologic patients
sometimes require more bedsides, rubber mattress and
linen than patients with other type of illness.
• Cost of items- cost of items will limit the purchase of
number of equipment.
26. GENERAL UTILITY SERVICES IN
THE HOSPITAL
• Electric supply and installations
• Water supply
• Disposal of waste –liquids and solids
• Refrigeration, air conditioning, ventilation and
environment control.
• Transport
• Supply of medical gases , compressed air, hot water,
vacuum suction and gas plants
27. • Laundry
• Fire hazard
• Communication system
• Repairs workshop
28. Replacement
• The frequency of ordering new supply is very important
some supplies need to be invented daily some weekly or
others may be monthly or yearly also some items last for
many years and required to be replaced after A long
periods.
• Regularized method for ordering the equipment and
supplies
• Broken perished or no longer in use or maybe
condemned
• The use system followed in almost all hospitals is getting
every payable articles content or sold before issuing new
ones broken or useless articles are presented before the
person or A committee for condemning and getting new
ones issued.
29. Cont..
Water supply
• Since safe water supply is not always assured, hospitals
must have their own purification system.
• Also there should be plumbing system.
Disposal of waste –liquids and solids.
• Disposal of waste both solid and liquid is a totally
neglected area.
• A hospital incinarator good for the waste management.
Refrigeration, air conditioning, ventilation and
environment control.
• Air conditioning is required for protection of sophisticated
electronic equipment, X ray, machines etc.
30. Cont..
Transport
• Lifts are needed for vertical transport.
• There should be separate lifts for patients, visitors, staff and
supply.
• Patients lift should accommodate a standard hospital bed.
• Ventilation, communication and emergency escape system
should be provided on all lifts. As for horizontal transport also
trolleys and ramps with gentle gradient are useful.
Supply of medical gases , compressed air, hot water,
vacuum suction and gas plants
• Piped supply of medical gases , compressed air, vacuum
suction , hot water, steam, necessitates thoughtful planning at
all stages to consider problems of –
– Easy uninterrupted safe supply
– Fire and explosion hazards
– Easy of servicing and maintenance without disrupting
hospital services.
32. Procurement Phase:
• Standardized on models on manufacturers of equipment
• Specify the condition and special requirement in the
purchase order to specify the supplier with hold payment
specified conditions are not met
33. Incoming Inspection
• Incoming equipment should be careful it checked for
possible damage compliance with specifications in the
purchase order and delivery of accessories spare parts and
operating and service manuals
34. Equipment Inventory And
Documentation System
• Inventory entries should include accessories spare
parts and operating and service manuals
• Make copies of the manuals for distribution to the
users while the originals of the manual should be
kept at the technical document library for safe
keeping
35. Commissioning And
Acceptance
Commissioning can be carried out
by Hospital technical staff if they
are familiar with the item of
equipment is commissioning by
suppliers is needed the process
should be monitored by Hospital
technical staff so that any
technical matters can be noted
and recorded .
36. Purchase And Store Department
• The hospital has a separate store and purchase section
under Material Management that also take care of
equipments.
• The Purchase section is directly supervise by purchase
officer and stores by the store officer the store keeper
and the other stuff function under section.
• The Purchase section is responsible for compilation of all
demands finalization of specification floating of tender
enquiry placement of supply order monitoring of
liabilities.
37. Record Keeping a sector
where is the store
department is responsible
for initiation and
compilation and demand
receptors goods testing
and quality control
Record Keeping in stock
ledger pleasures issue of
equipments bill
verification and
maintaining supply
38. Equipment Maintenance And
Repair Department
Each Hospital has separate Department of
workshop for maintaining and repairing
equipment a Biomedical engineer resume
appointed to supervise the important activity a
history sheet of all the Hi Tech equipments are
maintained in each department the sister in
charge of the unit is responsible for the getting
the equipments repaired and also for the
maintenance .
39. Process of stock verification and
condemnation of equipments and articles
An annual physical stock verification:
Annual physical stock
verification of all words tools
departments unit is done by the
deputy officers within Hospital.
The ground balance is checked
with the balance in stock ledgers
and entries are checked and
initiated major losses and heavy
surplus and noted and informed
to the head of Institution
40. Cont..
• Cyclic System: This is a periodic inventory system
where the physical stock position is reviewed at periodic
/ fixed intervals and orders are placed depending on the
stock on hand and rate of consumption.
• Two-Bin System: This is a perpetual inventory system
where, conceptually the stock of each item is held in two
bins, one larger bin containing sufficient stock to meet
the demands during the interval between arrival of an
order quantity and placing of a next order,
• The other bin containing stocks large enough to satisfy
probable demands during the period of replenishment.
• When the first bin is empty, an order for replenishment is
placed, and the stock in the second bin is utilized until
the ordered material is received.
42. INPUT
The main objective of the input component is to ensure
adequate supply of equipment and supplies of nursing
unit the nurse manager need to :
• Take active part in estimating the demand of equipment
and supplies
• Be aware of hospital policy for requirement indenting
stock etc.
• Nursing homes for equipment and supply as per Nursing
Council.
48. INVENTORY CONTROL
• Inventory control principles seek to minimize investment
on materials so that sufficient working capital is made
available for other more important activities of the
organization.
• The primary purpose of inventory control is therefore to
decrease material costs by minimizing stock-out costs
while at the same time preventing over-stocking of
materials which results in locking up of capital, possible
pilferage and obsolescence.
49. Cont..
• Laundry- A hospital laundry has 2 separate areas, with
provision for decontamination and sterilising of soiled
linen.
• Fire hazard- there should be consideration of ventilation,
exhaust systems and adequate earthing of all electrical
installation.
• Communication- public telephone and internal
telephones are required in each hospital.
• Repairs workshop-There should be provision for repair
and maintenance of necessary equipments used in the
hospital .
50. Cont..
• Lead Time: This is the time required to obtain the supply
once the need is determined, i.e. it is the average
number of days between placing an indent and receiving
the material.
• Lead time is specific for each item and for each supplier
and is dependent upon factors such as availability in the
market, form of availability, location of the manufacturer /
supplier, vendor response time, etc.
• Minimum Stock or Safety / Buffer Stock: This is the
amount of stock that should be kept in reserve to avoid a
stock-out in case consumption increases unexpectedly
or in case the lead time turns out to be longer than
normal.
51. Cont..
• 1. Continuous supply: – A continuous flow of input
materials is ensured by the system of material control, so
that the production and service departments function
flawlessly.
2. Optimum Investment: – Investment in various
inventories is kept at optimum level , taking into
consideration the operating requirements and resources.
Thus it helps to minimize the carrying cost.
3. Procurement at Minimum Costs: – Purchase of
quality materials and other inputs at the minimum rate
from a regular supplier is ensured under the system of
material control.
4. Minimum Total Cost: – There is a reduction in Total
cost, which includes ordering and carrying costs, under
the system of material control.
52. Cont..
5. Avoids Wastages and Losses: – Wastages during the
storage and usage of materials due to various factors is
avoided to a great extent.
6. Proper records: – The system makes sure, accurate
and up to date record keeping of inventories.
7. Provides Information: – The system ensures providing
requisite information, with regard to the inventories, to the
management promptly, which facilitates decision making by
the management.
8. Prevents Lag- time of Production: – Uninterrupted
supply of materials and other necessary inputs ensures
that there is no lag-time of production.
53. MAINTENANCE
• Proper maintenance of equipment is essential to obtain
sustained benefit and to preserve capital investment
equipment must be maintained in working order and
period periodically calibrated for effectiveness and
accuracy proper maintenance has a direct impact on the
quality of care.
• Proper maintenance of equipment, furniture and fixtures
not only ensures their almost continuous availability for
use but also an extended life and productivity for the
items, thus resulting in lower material costs. Time and
costs of maintenance can be reduced by consideration
of the following factors during purchase of the capital
assets:
54. Cont..
• (a) Durability: Since the equipment, furniture, etc. will
be handled by multiple users and will be subjected to
varying forms of abuse, it is necessary to provide for an
element of ‘over-specification’ so that the item is more
sturdy than that available for single person use in the
home environment.
• (b) Periodical disincfection: Equipment and furniture
become contaminated during use and hence must be
subjected to periodical cleaning and Disinfection.
• The external surface of such items should therefore be
washable and it should provide for sterilization by moist
heat, Formalin vapour, spirit, glutaraldehide or other
chemical disinfectants.
55. Cont..
• (c ) Repairability: In choosing furniture particularly, it is
preferable to go in for items which are more easily
repairable (eg. Welding of steel in contrast to repair of
aluminum or wooden furniture).
• (d) Spare-parts availability: Standardization of items
and opting for those easily available in the market
ensures easy availability of spare parts required for
repair and maintenance.
• (e) Operation and Service Manuals: When purchasing
sophisticated equipment, it is essential to obtain the
operating manual.
• It is also necessary to ensure supply of service manual,
including circuit diagram, so that repairs can be attended
to by the hospital maintenance department without
relying perpetually on the supplier.
56. Cont..
• (f) Service-contracts: Better terms for service are
possible by negotiating service contracts for
maintenance prior to purchase of preventive
maintenance overhaul schedules, unlimited breakdown
calls service charges with escalation clauses, bank
guarantee and down-time payment to ensure better
performance etc.
• (g) Stand-by-units: Since the hospital work must carry
on even when the equipment is down, wherever
possible, it is necessary to provide for replacements to
tide over the period of repair.
57. ESSENTIAL EQUIPMENTS FOR A
50 BEDDED DISTRICT HOSPITAL
(WHO)
1) Scope of services
• Essential clinical services- medicine, surgery, pediatrics.,
OBG, and acute psychiatry (when necessary)
• Optional clinical services – oral surgery, orthopedic
surgery, otolaryngology, neurology and psychiatry.
• Essential clinical support- anesthesia, radiology and
clinical laboratory
• Optional clinical support services- pathology and
rehabilitation including physiotherapy.
58. 2) Essential medical equipment
• Diagnostic imaging equipment –it include x-ray and ultrasound
equipment. X-ray equipment can be stationary in one room or
mobile
• laboratory equipment –
– microscope
– blood counter
– analytical balance
– calorimeter( spectrophotometer)
– Centrifuge – a small centrifuge that can accommodate six 15ml
tubes should be available.
– Water bath – used for stabilizing temperature at 25, 37, 42, or
56 degree Celsius.
– Incubator/oven- a small hot air oven to carry out standard
cultivations and sensitizations.
• Refrigerator – an ordinary household refrigerator with a freezer unit,
for storing preparations, vaccines, blood etc.
• instillation and purification apparatus - it should be made of metal
that resists acid, and alkali and should be free standing.
59. 3) Electrical medical equipment.
• Portable electrocardiograph
• Defibrillator( external)
• Portable anesthetic unit – 2 small aesthetic units should
be obtained, complete with a range of masks.
• Respirator – it should be applicable for prolonged
administration during post operative care.
• Dental chair unit- a complete unit should be available to
carry out standard dental operations.
• Suction pump –one portable and one other suction pump
are required.
• Operating theatre lamp- one main lamp with at least 8
shadows lamp and an auxiliary of 4 lamp units.
• Delivery table- it should be standard and manually
operated.
60. 4) Other equipment
• autoclave – for general stabilization
• Small sterilizers- for specific services- eg. Stabilizer
• cold chain and other preventive medical equipment
• ambulance
5) Small , inexpensive equipment and instruments
• Equipment and instrument, such as BP apparatus,
oxygen manifolds, stethoscope, diagnostic sets and
spotlights.
61. ROLE OF NURSE MANAGER
• Ensuring regular and adequate flow of supply
• Monitoring quality and safety of the materials
• Indenting, receiving ,storing, checking for all necessary
equipment and supply
• Maintaining of emergency stocks
• Arranging and assisting in audit
• Participation in policy making for material management
62. • Evaluating the efficacy of the material management
system followed in particular nursing unit.
• Make sure that all the personnel in the ward should be
clearly known who may use ward articles and equipments
and who assumes responsibility for it.
• The head nurse must be vigilant and prevent waste or
misuse by educating the staff in the economical and
appropriate use of all equipments and materials
63. ROLE OF NURSE IN CHARGE
• Responsible for keeping an adequate amount of equipment
and supplies in the ward.
• Make sure that equipments and supplies are in good
condition
• Put in requisition for necessary equipments for repair and
maintenance when needed
• Make sure that equipments and supplies are conveniently
located.
• Make sure that all the personnel in the ward should clearly
know who may use ward articles and equipments and who
assumes responsibility for it.
• The head nurse must be vigilant and prevent waste or
misuse by educating the staff in the economical and
appropriate use of all equipments and materials.
64. • She may sometimes arrange a ward class to enable the
staff to know the cost of the equipment and materials.
• She takes three steps to ensure an adequate stock of
available supplies in the ward or unit.
• Set a standard for the quantity of each item to be
maintained in the ward all the time.
• Have a satisfactory system for replacement of broken or
worn out equipment.
• Make regular inventories of all the items
65. RESPONSIBILITIES OF THE WARD
SISTER
• Keeping in mind the sufficient supply of materials
• Materials should be in good conditions
• Giving responsibilities to handle supply and equipments
• Checking for misuse and how to minimize it.
• Educating the ward staffs and other health care workers
in the economical use of materials.
67. Introduction
• Medical equipment is an essential health intervention tool used
by nurses for prevention, diagnosis and treatment of disease
and for rehabilitation of patients. However, access to
functioning medical equipment is a challenge in low- and
middle-income countries. The World Health Organization
estimated that 50 to 80 percent of medical equipment in
developing countries is not working, creating a barrier to the
ability of the health system to deliver health services to
patients. This study explored and described the lived
experiences of nurses working at a district hospital with a
critical shortage of medical equipment.
Methods
• A qualitative, exploratory, phenomenological and descriptive
study design was used. A purposive sampling was used to
select participants and due to saturation of data 14 nurses
participated in the study. Research ethics were observed. Data
was collected through semi-structured interviews using an
interview guide. Interviews were audio-taped and field notes
were taken. Voice recordings were transcribed verbatim and
Tesch’s open coding method was used for data analysis.
Findings were confirmed by an independent coder.
68. Results
• Critical shortage of medical equipment at the hospital
occurred in the form of unavailability of equipment, low
quality and poor maintenance of the few that were
available. Shortage impacted negatively on nursing care,
nursing profession and the hospital.
Conclusion
• Nurses should be provided with functional medical
equipment in order to provide quality nursing care.
Management, leadership and governance structures
should be strengthened to ensure that procurement and
maintenance plans for medical equipment are developed
and implemented.
69. CONCLUSION
• Health care services are the result of a number of materials
used in the process. As hospital administrators nurses
should also know about the materials. Medical items such
as perfusion materials, surgical disposables,
instruments, electrical, civil and engineering items for
maintenance , house keeping materials, linen, biomedical
equipment . drugs, food items etc pay an effective role in
improving the quality of health care services.
