Health Technical Memorandum (HTM) 02-01 provides pivotal guidance to healthcare estate management and healthcare engineering personnel working in this specialist field, but understanding such guidance, and actually delivering what is set out in it, are two different things. Providing practical learning that follows the guidance in the HTM, allowing learners to take away real-life knowledge and experience, is imperative to ensuring compliance at all times. Tangible steps such as creating workstations that meet the needs of the work required, and encouraging networking with peers, and discussion on current issues facing Estates teams, are all part of the inclusive learning experience that comes with practically applied training.
At Eastwood Park Training, not only do we provide this live, hands-on experience, but we also appreciate that across all Trusts there will be a range of different equipment used, both old and new, and from a range of manufacturers. That is why we provide a plethora of different equipment for learners to work on, so they will be familiar with many different pieces of equipment when they return to their workplace. One such example of this is our medical gas alarms training, where we showcase these different models, and learners get to grips with their functions. This is a vital part of the hands-on training, and one that has already saved Trusts money in call-outs and maintenance.
Practical training: why do we need it?
As a starting point, HTM 02-01 states that ‘it is essential that all training courses include practical elements […].’ (HTM 02-01 Part B, section 7, paragraph 7.9). In the context of this article, the term ‘practical elements’ should not be taken as just hands-on practical activities using tools. Instead, the term is used to encompass a wide range of tasks and skills, such as the calculation of actual consumptions, creation of daily and weekly check sheets, and the planning and undertaking of shutdowns to enable pipelines to be broken into.
It should never be assumed that a learner can competently undertake a task, which is why the process of demonstration, practice, and assessment, is crucial to the development of skills and confidence. The creation of workstations to enable learners to practise techniques and then be assessed is critical to the process of practical training. This can vary from a relatively basic task, such as the setting up of a backfeed kit and connection, to more complex activities such as changing desiccant in dryer columns.
The value of practice
It is clear that the value of practice, and carrying out tasks on a safe, real, live system, with no patient involved, are critical to the development of Authorised and Competent Persons. Such practice enables individuals to gain the necessary experience prior to working on a live system with patients connected, which is supported by Health and Safety Executive (HSE) guidance.
While developments within HTM 02-01 may require a different methodology to Authorised and Competent Persons’ national qualifications in the future, the need for organisations to ensure that staff are competent is essential to meet the requirements of the HSE. On-the-job training is a valid method of developing skills, and this is recognised by the HSE, which says: “ ‘On-the-job’ training should be structured and linked to risk assessments and associated control measures, including procedures. In safetycritical environments, on-the-job training should be supported by other forms of training where appropriate, e.g. classroom training, and simulation.”
The changing medical gas landscape
Numerous lessons have been learnt from the COVID-19 pandemic, both from a technical standpoint, and from the managerial relationships within healthcare organisations. All of these will undoubtedly inform the content in any future revision of HTM 02-01
While there are a number of documents that have been issued, we will look at three of these and their key points: Performance of healthcare cryogenic liquid oxygen systems, NHS ref C0871 (November 2021),2 Oxygen issues during the COVID-19 pandemic, 3 and Medical Gases – Clinical oversight of storage, supply and usage (NHS Pharmaceutical QA Committee – Medical Gas Sub Group).4
Performance of healthcare cryogenic liquid oxygen systems
Predominantly a technical guide focusing on oxygen, the document describes optimum supply and distribution systems to mitigate the effects of high oxygen flows during pandemic conditions. While our experience indicates that this document has not been widely circulated, it outlines a method of investigation and evaluation of oxygen medical gas pipeline systems (MGPS). Additionally, the guidance within the document has been incorporated in Authorised Person (AP) courses and practical exercises enhanced to aid APs in carrying out the suggested tasks.
Oxygen issues during the COVID-19 pandemic
This is an independent report by the Healthcare Safety Investigation Branch. It says: “This investigation describes an emerging safety risk where there has been an increased demand for oxygen on hospital wards during the COVID-19 pandemic.” The report and its recommendations are more focused on the collective management of medical gas pipelines, as opposed to it being an ‘Estates function’.
The report said: “Organisations that utilised a multidisciplinary approach to understanding and planning the MGPS involvement in the COVID-19 response, including the impact of ward moves and the choice of oxygen therapy, were better able to respond to demands on the MGPS system.”
HSIB makes a number of recommendations to improve crossdisciplinary understanding of oxygen systems. These included changes to the management structures, the ownership of medical gas systems, and improved training for all involved with the delivery of medical gases. (Healthcare Safety Investigation Branch I2020/022).
One of the key takeaways from the two documents above is the strong recommendation that the Chief Pharmacists chair the Medical Gas Committee, and as such the following document was issued in January 2021 to Chief Pharmacists: Chief Pharmacist Responsibilities: Medical Gases – Clinical oversight of storage, supply and usage (January 2021, Version 2.1).4 Feedback from MGPS APs indicates that many NHS Trusts do now indeed have the Chief Pharmacist chairing the Medical Gas Committee
New training facility at Eastwood Park
With these developments in mind, the training at Eastwood Park has evolved to incorporate shifts in medical practices, with a new Training Centre recently competed and having become operational on the site. The facility has been comprehensively fitted out with a mixture of older and new plant to ensure that delegates on the Centre’s courses can gain experience on as wide a range of equipment as possible. Trends that are already affecting, and will in the future impact on, healthcare engineering practice, and the way a variety of equipment is installed, used, and maintained by such personnel, include developments in medical technology such as the use of robotics and semiinvasive surgery, shifts in management practice, the drive for carbon-neutral – including via a reduction in the use of Nitrous Oxide, and advances in medical gas pipeline systems. The Centre’s new medical gas system is a mix of old and new, with components from different manufacturers and suppliers to replicate current healthcare systems. The aim is for the learners to gain confidence and familiarisation with their systems. Within our new medical gas training facility, we have incorporated equipment from suppliers such as:
Beacon Medaes.
Precision UK.
MMPL.
P3.
Shire Controls, and
MEC Medical.
Able to work at their own pace
Learners are able to work at their own pace, away from the pressures of a live hospital site, while building confidence and becoming more familiar with how the tools and materials work, feel, and function. Using a mixture of approaches when teaching ensures that learners are fully engaged. Beyond this, we are constantly looking at other ways to improve and adapt our practical training to reflect current issues facing Estates teams
We have added a significant amount of new kit and initiatives at our facility, including:
Live workstations to enable learners to maintain/replace capsules, install physical breaks, replace terminal units, second fixes, and commissioning.
Calibrate pressure switches.
Install and commission local alarms, including digital panels.
Live working areas to carry out permit to work exercises.
Brazing stations so that small groups can train simultaneously.
Facilities to allow learners to install pipework and carry out purging and engineering tests on terminal outlets as specified in the HTM, using the correct test equipment.
A central alarm workstation, creating a central alarm facility.
Medical gas alarms
In response to feedback on medical gas alarms, a practical course has been developed for CPs and APs to attend to further expand their practical knowledge of fault-finding and working on alarm systems. As HTM 02-01 states, the medical gas piped system is installed to provide a safe, convenient provision of medical gases to the clinical and nursing staff. Patient safety is paramount in the design, installation, commissioning, and operation, of medical gas pipeline systems. The basic principles of safety are achieved by ensuring quantity of supply, identity of supply, continuity of supply, and quality of supply
The MGPS alarm system is part of the continuity of supply principle. The warning and alarms systems are covered in HTM 02-01 (chapter 12, part A). HTM 02-01 (2006) provided guidance on the requirement to have dedicated alarm systems. With the ongoing development of computer-based integrated patient / building management systems, the current HTM 02-01 is now outdated. As stated in the HTM, sites using a building management system only should consider how they will ensure that all users are satisfied that it is in good working order. It is important that operational checks on the system are also carried out
A valuable learning experience
Gill Butler, an Estates manager at the Queen’s Medical Centre in Nottingham, attended our Medical Gas Alarms Maintenance and Management course in November 2022. She says her main ‘pain point’ prior to the course was her limited understanding and experience of medical gas alarm systems, and therefore having to call out contractors to deal with every issue with them, resulting in long waiting times and significant expense. By completing this course, she hoped to gain the knowledge and confidence from practical training to deal with these situations herself in the first instance, saving both time and money. Following the course, she shared the following insight: “We have a lot of alarm faults that we have to pay a contractor to come out to, and it is possibly something that we can rectify ourselves in the first instance. I found it really useful to be in the Eastwood Park training environment, and you get a good insight into what you need to know, and when you need to know it. I’ve gained more knowledge than I hoped to get. I certainly didn’t think I’d be able to program alarms by the end of this.”
Digital alarm panels
With the use of transducers rather than pressure switches, drifting is no longer an issue. Medical gas manufactures have now developed, and are supplying, digital alarm panels. Some are a direct replacement for their previous alarm systems. The main benefits are:
Accurate pressure monitoring.
Visual live pipeline pressure indicators.
Early amber warning indicators.
A touchscreen display
Power indicators.
Data logging.
Conclusions
The aim of this article was to demonstrate why hands-on practical experience is a vital part of medical gas training. The value of this practical training, building on theoretical knowledge, is that it is a key building block to competency, thereby enabling tasks to be undertaken safely, and systems operated reliably
Eastwood Park Training prides itself on delivering specialist, innovative training that enables delegates on its courses to remain up to date with the ever-changing landscape of healthcare engineering. Our new training centre provides all the elements of a medical gas piped system, with both new and old equipment for learners to see and practise tasks, enabling them to develop skills and understanding in a time-efficient manner
Michael Ell
Michael Ell, Medical Gases Portfolio manager at Eastwood Park Training, leads and develops medical gas training there. Formerly a marine engineer, hospital engineer, an Estates manager in a 750-bed general hospital, and a medical gas risk specialist and trainer, he has over 30 years’ hospital engineering experience. He has in-depth knowledge of the role of a medical gas AP, as well as the management of medical gases on a range of sites. His course delivery encourages as much interactivity and practical elements as possible.
Mark Williams
Mark Williams, lead Medical Gases trainer at Eastwood Park Training, has worked for a number of years as an Authorised Person (MGPS) and a Competent Person for both NHS Trusts and private organisations, and is an expert in his field. He was responsible for handing over completed medical gas projects to Estates teams. He has experience in project managing installations, as well as working both directly with hospitals and as a sub-contractor. This includes working on projects ranging from minor alterations to major developments, undertaking installation of piped and alarm systems, maintenance, and breakdown repairs. He has also been responsible for surveying medical gas pipeline systems, providing a comprehensive, photographically illustrated report of their compliance with HTM 02-01.
References
1 Human factors: Training and competence. Health & Safety Executive. https://tinyurl. com/2s4z925s 2 Performance of healthcare cryogenic liquid oxygen systems. NHS ref C0871. NHSE/I. November 2021. https://tinyurl. com/2wcz5e9r 3 Oxygen issues during the COVID-19 pandemic. Healthcare Safety Investigation Branch. June 2021. https://tinyurl. com/3dnustn4 4 Chief Pharmacist responsibilities: Medical Gases – clinical oversight of storage, supply and usage. Specialist Pharmacy Service (NHS Pharmaceutical QA Committee – Medical Gas Sub Group) (January 2021, Version 2.1)