By Richard Parker, MBA, CHFM, CLSS-HC, FASHE, FACHE
Richard Parker
Do you have power strips or surge protectors in your operating rooms? These relocatable power taps (RPT) are a common cause for findings during accreditation and regulatory surveys. In 2014, the Center for Medicare & Medicaid Services (CMS) offered a categorical waiver for the use of RPTs in patient care areas if certain conditions are met (CMS S&C: 14-46-LSC, Categorical Waiver for Power Strips Use in Patient Care Areas).
OR leaders and staff need to understand how these devices may be used, as well as how they may not be used.
What is a Relocatable Power Tap (RPT)?
NFPA 99-2012 Health Care Facilities Code describes an RPT as a multiple outlet connection with “two or more power receptacles supplied by a flexible cord.” This includes power strips (also known as outlet strips or multiplug adapters), which are essentially extension cords with a lot of outlets, and surge protectors, which include an internal element that prevents an electrical surge from reaching the device that is plugged into it.
RPTs are useful and therefore a common fixture in all kinds of settings, including ASCs and hospitals. You find them under desks, powering computers, printers and other office items. They also are commonly found in equipment storage rooms to charge equipment such as IV pumps.
Additional considerations come into play when a multiple outlet connection is used in patient care areas.
RPTs in Patient Care Areas
RPTs are permitted where patient care occurs, if CMS requirements are met. Those requirements include:
- A special purpose RPT listed as UL 1363A or UL 60601-1 must be used to provide power to patient care-related equipment.
- RPTs in the patient care vicinity may not be used for non-patient care electrical equipment.
- RPTs in the patient care vicinity must meet criteria defined in NFPA 99-2012: 10.2.3.6:
- The RPT must be permanently attached to mounted equipment assemblies, carts or IV poles. “Permanently attached” means by a method that requires a tool to remove.
- The RPT is not required to be an integral component of manufacturer tested equipment.
- The sum of the amperage (electrical load) of all appliances connected must not exceed 75 percent of the rating of the RPT.
- The electrical and mechanical integrity of the RPT is routinely verified and documented.
“Patient care vicinity” encompasses ORs and procedure rooms based on the definition found in NFPA 99-2012: 3.3.139:
A space, within a location intended for the examination and treatment of patients, extending 1.8 m (6 ft) beyond the normal location of the bed, chair, table, treadmill or other device that supports the patient during examination and treatment and extending vertically to 2.3 m (7 ft 6 in) above the floor.
Common misuse of RPTs
RPTs that are not permanently mounted represent the most commonly cited deficiency on accreditation surveys. Surveyors find RPTs on the floor of operating rooms. In an environment that may be considered a wet location or one that routinely has fluids on the floor, the risk of hazardous shock is present when outlet strips are not mounted. There is also the risk of shorting out critical equipment that is in use during a procedure.
Less common is the routine verification of the integrity of the devices, and the monitoring of the 75 percent electrical load allowance. Just as electrical supply cords for medical equipment are inspected regularly during preventive maintenance, RPTs must be similarly checked.
Managing compliance for RPTs
There are two key strategies to manage these devices:
- Raise awareness with operating room staff – many are unaware of the importance of this requirement to protect staff from shock and the patient from equipment abruptly shutting off. Sharing the knowledge once may not be enough (see item 2).
Staff turnover and rotation create a need for continuing education. Finding a non-compliant outlet strip is a good trigger, but adding it as an agenda item for scheduled, ongoing training is best practice. - Conduct regular safety rounds with your facility manager. Too often, leaders address a challenging issue like this and believe that fixing it once fixes it forever. Well-intended staff may take the initiative to solve an issue and bring in outlet strips that do not comply. A routine inspection will catch this and keep patients and staff safe, and maintain compliance.
- Documented safety rounds can be used to verify the electrical and mechanical integrity of the device.
- When permanently mounted to equipment assemblies or carts, clinical engineering can also verify electrical and mechanical integrity of the device.
Note: Areas outside the patient care vicinity can use an RPT for both patient care-related electrical equipment and non-patient care-related electrical equipment and must be listed as UL 1363.
– Richard L. Parker is associate director, physical environment and life safety at Accreditation Commission for Health Care Inc. where he provides guidance to customers and surveyors in the ASC and hospital programs.
