Background: Medical equipment (ME) maintenance retains an asset’s original anticipated useful life and preserves its reliability and cost-effectiveness. This study developed and trialled a multi-component program to improve ME maintenance in nine Sri Lankan hospitals. Methods: This pre-post study involved an initial baseline assessment of existing ME maintenance systems in nine hospitals, the development and implementation of a multi-component improvement program, and a three-month post-evaluation. Five target ME were selected for the study: oxygen regulators, electrocardiogram (ECG) machines, suction apparatus, blood pressure (BP) apparatus and mini autoclaves. A validated questionnaire of randomly selected nursing officers (n=101) and healthcare assistants (n=120) was used to obtain baseline ME maintenance data. Six focus groups and 24 interviews were conducted with key stakeholders to co-design the multi-component interventions, which included: developing a standard operating procedure (SOP) targeting preventive maintenance activities; establishing focal points to provide technical and logistic support; staff training; and the introduction of institutional ME maintenance documents. Program effectiveness was assessed at three months post-implementation. Results: Baseline assessment identified no ME maintenance programs implemented in any of the hospitals. Following program implementation, improvements were noted in: the availability (p<0.05) and functional level (p<0.05) of all selected ME; equipment maintenance processes (p=0.000); as well as staff knowledge, skills, perceptions and satisfaction. Conclusions: The program improved the use and maintenance of ME and was widely supported by key stakeholders. The approach is likely relevant to other resource-poor hospital settings where inadequate ME maintenance causes health system inefficiencies.

Aim: To conduct the first systematic synthesis of existing evidence reviews on interventions to enhance medication safety in RACS, to establish and compare their effectiveness. Method: This umbrella review included examination of meta-analyses, scoping and systematic reviews. Four electronic databases (MEDLINE, EMBASE, CINAHL, and The Cochrane library database of Systematic Reviews) were explored for eligible reviews. Those meeting the inclusion criteria were critically appraised using the JBI Critical Appraisal Instrument for Systematic reviews and Research Syntheses by two authors. Results: Fourteen reviews covering 166 unique, primary studies were included. Interventions were grouped according to type: medication review (n= 12); staff education (n= 8); multidisciplinary team meetings (n= 6); computerised clinical decision support systems (n= 5); and transferring medicines information between health care settings (n= 1). Most reviews showed mixed evidence to support interventions’ effectiveness, due to the significant heterogeneity between original research studies in respect to sites, samples sizes and intervention periods. However, in all intervention categories, pharmacists’ collaboration with other health care professionals was most beneficial, showing definitive evidence for improving medication safety and quality of prescribing in RACS. The evidence suggests that combining two or more interventions is the most promising approach, despite this presenting implementation barriers in the resource-limited environments of many RACS, and methodological challenges in identifying the precise contribution of individual interventions, when implemented concurrently. Conclusion: Health stakeholders should explore a combination of at least two interventions, such as medication review and staff education, to improve medication safety in RACS.