Healthcare professionals, neonatal units, hospitals, and health services
Statement of standard
Safe use of equipment in neonatal care is ensured using standardised operating procedures and systematic monitoring and reporting of incidents.
Rationale
The goal is to assure safe equipment use in the complex environment of neonatal intensive care units (NICU). It is important to understand factors that contribute to failures in patient safety. (1–4) In NICUs a large variety of different technological devices is used, and their inappropriate use may lead to unplanned, critical events. Despite built-in safety systems, the occurrence of device related errors and their consequences for patient outcomes are still not well-defined. (1–12) In a recent prospective study using random safety audits, the rate of appropriate use of NICU equipment was only 34%, while critical incidents were reported in 2.3%. (13) Besides individual human aspects (inexperience, fatigue (14)), system factors (e.g. staffing, crowding, team process, complexity of clinical workload, obsolete equipment) play an important role for the risk of adverse events.(4) Adverse events occur at 74 events/100 infants in NICUs, e.g. hospital-acquired infections, dislocation of catheters and accidental extubations. (15) Considering the high rate of short term morbidity and long-term complications of extreme prematurity and the potential impact of equipment use, a patient safety culture is essential in the NICU environment and should be embedded in the organisation’s efforts to enhance resilience and to assure patient- and family-satisfaction. (15–19)
Benefits
Short-term benefits
Better informed parents on the benefits and risks of the use of equipment (consensus)
Facilitated systematic reporting of inappropriate equipment use (1,4,19)
Long-term benefits
Reduced morbidities as a consequence of inappropriate exposure to medical equipment (consensus)
Improved healthcare professional training and understanding of the use of health technologies (1)
Improved care by implementation of a “safety culture” (transparency, disclosure, feedback) (6,19) (see Patient safety & hygiene practice)
Components of the standard
Component
Grading of evidence
Indicator of meeting the standard
For parents and family
Parents are informed by healthcare professionals about equipment used. (1,3,6)
A (Moderate quality) B (High quality)
Patient information sheet1
In situations where parents will use and interpret information from medical equipment and their possible side effects they are educated and updated regularly by healthcare professionals in its use. (16)
A guideline for all intensive care equipment including checklists for development, implementation and regular updates is adhered to by all healthcare professionals.
A (High quality) B (High quality)
Guideline
Training on reporting and learning from adverse events and inappropriate use of equipment is attended by all responsible healthcare professionals. (1,6,19)
A (Moderate quality) B (High quality)
Training documentation
For neonatal unit and/or hospital
A guideline for all intensive care equipment including checklists for development, implementation is available and regularly updated.
B (High quality)
Guideline
Training on reporting and learning from adverse events and inappropriate use of equipment is ensured to optimise the use of equipment, including simulation of clinical team working. (20)
A (Moderate quality) B (High quality)
Training documentation
Equipment maintenance is specified and audited regularly. (7)
A (Moderate quality)
Audit report2
Adverse events and inappropriate use of equipment are audited and feedback is given on a regular basis. (19)
A (Moderate quality) B (Moderate quality)
Audit report2
For health service
Local safety investigations are collated nationally, monitored and reported. (3,6,19,21)
B (Moderate quality)
Audit report2
1The indicator “patient information sheet” is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator “audit report” can also be defined as a benchmarking report.
Where to go
Further development
Grading of evidence
For parents and family
Parents are involved in the design and delivery of education about medical equipment.
B (Moderate quality)
For healthcare professionals
Healthcare professionals are involved in the design and delivery of education about medical equipment.
B (Moderate quality)
For neonatal unit
Develop a structure of critical incident root-cause analysis and feedback and communicate learning. (22)
A (Moderate quality)
For hospital
Provide dedicated medical technical support for neonatal equipment.
B (Moderate quality)
For health service
Develop a national network for benchmarking of safe equipment use including parent organisations, healthcare providers, industry, and other stakeholders.
B (Moderate quality)
Getting started
Initial steps
For parents and family
Parents are verbally informed by healthcare professionals about safe equipment use.
For healthcare professionals
Attend training on reporting and learning from adverse events and inappropriate use of equipment.
Report critical incidences.
For neonatal unit
Develop and implement a guideline for all intensive care equipment including checklists for development, implementation and regular updates.
Develop information material on safe equipment use for parents.
Implement a formal system to record errors/adverse events.
For hospital
Support healthcare professionals to participate in training on safe equipment use.
Provide time and resources for effective safety management and support.
For health service
Develop service wide sharing of information on equipment use.
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November 2018 / 1st edition / next revision: 2023
Recommended citation
EFCNI, Härtel C, Tissières P et al., European Standards of Care for Newborn Health: Safe equipment use. 2018.
