Chapter 11: Apply basic patient care and medical ethics knowledge

11.1 Basic patient care

Patient care is the set of actions that keep a person safe, comfortable and treated with dignity while they are diagnosed, treated or monitored. Nurses, doctors and other clinical staff give much of it, but a biomedical engineer works at the bedside whenever a ventilator is installed, a monitor is tested or an infusion pump is repaired. The engineer therefore needs the same basic habits: protect the patient from harm and infection, notice when something is wrong, speak respectfully and leave clinical decisions to clinical staff.

Example: an engineer asked to replace the battery of a bedside monitor in a ward does not simply switch it off. The engineer first asks the nurse in charge whether a patient is connected, waits for a replacement monitor to be set up, and only then begins the work.

An engineer does not give treatment, does not change a patient's settings and does not interpret a patient's condition. The role is to make sure that the equipment around the patient is safe, working and handled with care, and to know enough about patient care to avoid getting in its way.

Patient needs

A patient has needs beyond the illness that brought them to the facility. Equipment installation, testing and repair happen in the patient's space, so each of these needs can be helped or harmed by the way an engineer works.

Physical needs:

• Comfort and position: a patient may be able to lie in only one position. A monitor cable or ventilator hose placed across the bed can force them to move or can pull on a sensor.
• Rest and sleep: noise from drills, alarms being tested and bright work lights disturb recovery. Work in a patient area is done quietly, and noisy tasks are moved to the equipment workshop where possible.
• Warmth and breathing: unwell patients may chill easily and may depend on oxygen. Doors, curtains and oxygen supply points are left as the nursing staff set them.
• Pain and mobility: a patient in pain or with limited movement cannot step aside from a trolley or a cable. Equipment is positioned so that no one has to move suddenly.
• Nutrition and hydration: meals, drinks and medicines follow a timetable. Planned work is arranged around it, in agreement with the nurse in charge.

Emotional and social needs:

• Reassurance: unfamiliar machines make many patients anxious. A short, calm explanation of what you are doing and that the equipment is being checked for their safety reduces fear.
• Privacy and dignity: a patient may be partly undressed or receiving a private examination. Wait, use the curtain or screen, and do not stare at the patient or the chart.
• Cultural and personal respect: patients differ in language, religion, age and customs. Greet politely, address adults formally unless invited otherwise, and ask a member of the clinical team to help when language is a barrier.
• Family and company: relatives often sit with a patient. Ask them politely to give you space and do not discuss the patient's condition with them.
• Sense of control: patients often feel that things are done to them. Asking permission before touching a bed, a stand or a cable gives some control back.

Hygiene, infection prevention and control

Patients in a facility are often weak or have wounds, tubes and lines, so an infection that a healthy person would resist can become serious. Equipment moves between patients and between the ward and the workshop, and an engineer's hands and tools can carry organisms if they are not controlled.

Hand hygiene is a central habit of infection control. Clean your hands with soap and water or an alcohol-based hand rub:

• Before approaching a patient or their bed space: this protects the patient from what you carry in.
• Before handling anything that enters the body or touches broken skin: for example before connecting a sensor or tubing that a nurse will use.
• After contact with blood, body fluids or contaminated equipment: this protects you and the next patient.
• After touching a patient or their bed and surroundings: this stops organisms leaving the bed space on your hands.

Protective equipment and waste:

• Gloves: disposable gloves are used for one task or one patient and are then thrown away. They are never washed or reused, and hands are cleaned after removing them.
• Gowns, masks and eye protection: these are worn when there is a risk of splashes or when a patient is in isolation. The ward staff will say what is needed, and you follow it.
• Clinical waste: used gloves, dressings and contaminated disposables go into the clinical waste container, not the ordinary bin.
• Sharps: needles, blades and broken glass go into a puncture-resistant sharps container and are never recapped or reused. An engineer who finds a loose sharp reports it and does not pick it up by hand.
• Spills: blood or body fluid on a device or the floor is reported to the ward staff or cleaning team, who deal with it using the facility's spill procedure.

Procedure for servicing equipment that has been in contact with a patient:

1. Confirm with the clinical staff that the equipment is no longer connected to a patient and that a replacement is in place if the patient still needs the function.
2. Clean your hands and put on the protective equipment that the area requires.
3. Switch the equipment off, disconnect it from the mains supply and remove any leads on the patient side, so that no live lead is left near a patient bed.
4. Check that the equipment has been cleaned and disinfected by the user. If it has not, ask for this to be done or use the facility's decontamination routine before you open it.
5. Carry out the service or repair, keeping used parts, swabs and packaging in a waste container and not on the bed or floor.
6. Dispose of single-use items, remove protective equipment in the correct order and clean your hands again.
7. Label the equipment clearly as repaired and tested, or as out of service, so that no one connects it to a patient by mistake.
8. Tell the nurse in charge the state of the equipment before you leave the area.

Patient safety around equipment

Many injuries linked to equipment come from ordinary causes, such as a loose cable, a missed alarm or a device returned to use before it was tested. The engineer's habits at the bedside reduce these risks.

• Electrical safety: a device connected to a patient is checked for earth continuity and leakage current after any repair, using the test method set by the facility. A damaged power cable, plug or sensor lead is taken out of use at once.
• Alarms: alarms exist to call staff to a patient. An engineer who tests alarms warns the nurse beforehand, and never silences or changes alarm limits on a monitor in use. Those limits are set by the clinical team.
• Cables, tubes and hoses: leads are routed so they cannot be pulled, trodden on or caught in bed rails. Oxygen tubing, drains and drip lines are left undisturbed.
• Patient identification: a monitor or pump that is moved between beds can end up recording or treating the wrong patient. Equipment is not swapped between beds without the clinical team's knowledge.
• Back-up: when a life-supporting device such as a ventilator needs work, the patient is first supported by another device or by manual means arranged by clinical staff. An engineer does not take such a device out of use alone.
• Fault reporting: a fault found during a routine visit is reported to the responsible person even if it seems small, and the device is labelled until a decision is made.

Vital signs and patient monitoring

Vital signs are measurements that show how well the body's basic functions are working. Monitors, thermometers and blood pressure meters produce them, so an engineer who tests these devices must know what a sensible reading looks like. The table gives typical resting values for a healthy adult. A clinician interprets any reading for a particular patient, and a value outside the range does not by itself mean a device is faulty.

How blood pressure arises is taught in Blood pressure; here the point is to recognise the readings that a monitor displays.

Example: an engineer checking a pulse oximeter on a healthy colleague sees 98 per cent and a pulse of 72 beats per minute, which is sensible. A reading of 60 per cent on the same colleague suggests a poorly placed probe, a flat battery or a fault, and the probe and device are checked before the device is returned to use.

Safe handling and movement

Moving patients is a clinical task with its own training. An engineer who needs a patient moved asks the nursing staff, and does not lift or turn the patient personally. Engineers do move equipment, and that must also be done safely.

• Beds and trolleys: the brakes are applied after moving, and side rails are put back as found.
• Heavy equipment: devices such as imaging units, suction machines and dialysis machines are moved with a trolley and a second person, with the lead wound up and the path kept clear.
• Lines and leads: before a bed or a device is moved, every line and cable is checked so that none is pulled from the patient.
• Own posture: bend the knees, keep the load close and avoid twisting, to protect your own back.
• Stairs and lifts: equipment is not carried across areas used by patients without telling the area's staff, and a lift is not blocked.

Communication in the care area

Clear, courteous communication reduces errors and keeps patients and staff at ease.

• Introduce yourself: give your name and role, show your identity badge and say what you are there to do.
• Ask before you start: speak to the nurse in charge before entering a bed space, and to the patient before touching the equipment next to them.
• Use plain words: tell the patient what the machine does in everyday language, avoiding technical terms.
• Listen and pass on: if a patient says that a device hurts, beeps or feels wrong, take it seriously and report it to the clinical staff at once, without trying to diagnose.
• Hand over: tell the clinical staff what you did, whether the equipment is ready for use and what to watch for, then record it in the work record.
• Keep patient information private: what you see or hear in the care area is not discussed in corridors, canteens or social media. The reasons are explained in Medical ethics.

Responding to an emergency

If a patient collapses, an alarm sounds with a patient in obvious distress or a device smokes, shocks or sparks, the first aim is to get skilled help quickly. The procedure is the facility's own, and an engineer follows it.

1. Stay calm and look at the situation without touching the patient.
2. Call for help using the facility's emergency call method, and say clearly where you are and what is happening.
3. Make the surroundings safe: if a device is the cause and it is safe to do so, switch it off at the wall socket and move away from any liquid or damaged cable.
4. Do not move the patient unless they are in immediate danger, for example from fire.
5. Stay with the patient until clinical staff take over, and follow their instructions.
6. When asked, bring equipment such as a suction machine or a defibrillator, and do not alter its settings unless instructed.
7. Afterwards, write down what you saw, the device, and what was done, and report the incident as the facility requires.

Basic life support and first aid are skills learned in an accredited course with practice on a manikin, and an engineer who works in patient areas should hold them. These notes do not replace that training.