Functional maintenance program sample

The prime objective is to prevent failures and other equipment problems before they take place. Throughput changing operations and scheduling of maintenance can maximize the cost benefits of maintenance operations in a situation where machines can perform their functions under different settings. Routine maintenance activities are performed while manufacturing systems and equipment is in service. Traditionally, routine maintenance is scheduled on meter-based or time-based schedule derived from predictive or preventive maintenance strategies.

Cleaning, visual inspection, functional tests, lubrication, measurement of operating quantities and oil tests are some of the examples of routine maintenance activities. Maintenance testing involves the use of test equipment to examine conditions in the offline state.

These activities are predictable and easy to schedule and budget. A maintenance team may schedule them on a meter or time basis. A plan is in place to ensure parts and labour are available to get the asset up and running, or replaced, as soon as possible. Routine maintenance consists of basic maintenance tasks, such as checking, testing, lubricating, and replacing worn or damaged parts on a planned and ongoing basis.

For example, realigning a part during a routine inspection. Preventive maintenance refers to any regularly scheduled machine maintenance intended to identify problems and repair them before failure occurs.

Preventive maintenance can be split up into two predominant types: Time-based preventive maintenance and usage-based preventive maintenance. Time-based preventive maintenance are tasks scheduled at a certain time interval, such as the last day of every month or every 10 days. Usage-based preventive maintenance is when work is scheduled based on the operation of equipment, such as after miles or 15 production cycles. Condition-based maintenance depends on monitoring the actual condition of assets in order to perform maintenance when there is evidence of decreased performance or upcoming failure.

This evidence can be obtained through inspection, performance data, or scheduled tests, and it can be gathered either on a regular basis or continuously, through the use of internal sensors. Predictive maintenance builds on condition-based maintenance, using tools and sensors to track machinery performance in real-time.

This enables the identification of potential problems so they can be corrected before failure occurs. Prescriptive maintenance automates the maintenance process even further through the use of machine learning and artificial intelligence AI.

With a prescriptive maintenance strategy in place, sensors track machinery performance in real-time and uses AI to let you know what maintenance work needs to be done and when. There are four main areas to focus on when aiming to improve machine maintenance at your facility: Planning, precision, protection, and measurement.

Many maintenance plans will include both planned and scheduled maintenance , which will identify problems before failure occurs, and planned unscheduled maintenance, which ensures that failures are repaired, and assets are returned to working order as quickly as possible. Going digital is a great way to improve the work order request and fulfillment process.

A digital system promotes transparency and communication while ensuring the work order always makes its way to the appropriate maintenance technician or staff member. A digital system also supports real-time updates and allows for pictures or other files to be submitted with requests. Making sure your equipment is always up to date with all compliance and safety standards is a crucial part of running an efficient facility.

Implement a system to keep track of all historical data regarding your equipment in one place, along with product requirement documents, warranty information, safety guides, and anything else pertinent to your operations. Keeping this data organized and up-to-date will make audits and proper maintenance much easier.

Level two goals are aimed at facilities leaders that have successfully streamlined the processes outlined in level one. As you move forward with maintenance automation it becomes more and more beneficial to implement maintenance software to support your facility. CMMS software centralizes maintenance management and helps to streamline processes, such as those in level one. Using maintenance software to manage your facility will allow you to collect data on facility performance, pointing to strengths and weaknesses in the current operations.

By streamlining processes and improving communication, your facility will begin to see a natural increase in productivity. Less time sorting through maintenance requests means more time in the field working. Although this goal sounds broad, productivity can be analytically tracked with metrics such as unplanned downtime and work order response time. Implementing a maintenance software system or downtime tracking software helps to track these metrics.

Creating a dynamic system to stay on top of spare parts inventory will ensure your facility rarely sees equipment failure as a result of poor planning. Therefore, for both these drugs the potential benefits are unlikely to outweigh the increased risks of adverse events.

Apart from acetylcholinesterase inhibitors and memantine, a number of other putative compounds or popular remedy preparations have been suggested or investigated.

In addition, the potential for developing compounds that modify the disease process in the dementias is exciting, as our knowledge of the underlying pathological changes is growing dramatically. Acetylcholinesterase inhibitors increase the availability of acetylcholine in the synapse.

An alternative approach utilising the same system would be to increase the efficiency of the post-synaptic cholinergic receptors, both muscarinic and nicotinic, by the use of agonists or modulators for a recent review, see Standridge, No satisfactory compound has, as yet, been discovered that combines adequate clinical efficacy together with acceptable tolerability.

There are many different agents in the extract, produced from the maidenhair tree, and the potential mechanisms of action include vasoactive effects, antiplatelet activity, increasing neurone tolerance to anoxia and prevention of membrane damage caused by free radicals. Antioxidants, such as vitamin E, have the theoretical potential to reduce concentrations of free radicals, which appear to be involved in the process of neurodegeneration seen in all the dementias.

Anti-inflammatory agents might appear potentially useful because an inflammatory and immunological response has been shown to contribute to the formation of neuritic plaques and neurofibrillary tangles, but these compounds have significant adverse effects, particularly in elderly populations.

The evidence for older compounds currently available in the UK or Europe, like hydergine, piracetam and naftidrofuryl, will also be included in the review if relevant studies are found. Those products that are available to purchase over the counter or via the internet are taken at the discretion of the individual, who may also seek professional advice.

Those preparations currently available on prescription but not licensed for the treatment of dementia should only be prescribed as part of a clinical trial. Where a recent systematic review of adequate quality was found, we searched for more recent RCTs relevant to the review.

Study information table for trials of other medicines versus placebo in people with dementia — cognitive symptoms. Eight systematic reviews and three new trials met the guideline eligibility criteria, providing data on 10, participants further information about the new trials can be found in Appendix 15e. The full evidence profiles can be found in Appendix Summary evidence table for other medicines versus placebo in people with dementia — cognitive symptoms.

We found no sources of evidence that met the eligibility criteria set by the GDG relating specifically to the experience of treatment with other medicines in people with dementia. The evidence suggests that the benefits of ginkgo may outweigh a low risk of adverse events.

However, because the meta-analysis was based on a completer analysis and a variety of measures of cognition, it is difficult to determine the clinical importance of the observed effects.

In VaD , concurrent physical illnesses such as hypertension, diabetes, heart disease and hypercholesterolaemia will be treated with recommended drugs for the management of these problems. It is assumed that the control of the comorbid conditions reduces the risk of further cerebral damage, but there is no assumption that there will be any effect on cognitive function. Study information table for trials of drugs that control VaD risk factors versus placebo for the treatment of cognitive symptoms.

Four systematic reviews and one new trial met the guideline eligibility criteria. However, only one review and one trial reported appropriate data on the outcomes of interest. Evidence from critical outcomes is presented in Table Summary evidence table for trials of drugs that control VaD risk factors versus placebo for the treatment of cognitive symptoms. We found no sources of evidence that met the eligibility criteria set by the GDG relating to the experience of treatment with drugs that control VaD risk factors.

In the studies reviewed, cognitive symptoms, global functioning and ADLs were not reported as outcome measures of the research, except for propentofylline, but the evidence was of poor quality.

There is therefore currently no evidence to suggest that these treatments, for conditions deemed to be vascular risk factors, have any beneficial effect on cognitive symptoms.

The quality of the evidence for propentofylline is low and the benefits marginal, so these are unlikely to outweigh the risk of adverse events. The evidence reviewed concerning the effectiveness of pharmacological interventions for dementia has primarily been derived from systematic synthesis and meta-analysis of randomised controlled trials.

Typically, this approach measures outcomes for people with dementia, and sometimes for their carers, in terms of a range of instruments such as scales or questionnaires from which quantified data can be derived.

A limitation of this approach is that in most cases the results contain little reportage of the direct voice of people with dementia and their carers. To complement this analysis, a search was made for qualitative research that reported in their own words the views of people with dementia and their carers on the experience of receiving pharmacological treatment and its outcomes. Evidence from 64 carers of people with dementia attending a memory clinic who completed questionnaires that explored their views on dementia drugs indicates that carers value them Bayer, Most carers feel that the benefits of medication for dementia should be discernible for about 6 months, and if not it is not worth taking the drug, but those carers less in touch with people with dementia thought the benefits of drugs should last about 1 year.

Another survey of people caring for older relatives explored their attitudes to and experiences of managing medication for them Smith et al.

While not focussed on dementia care, the survey did include carers of people with dementia and furthermore appears relevant as many carers reported having to remind care recipients and help them with medication.

Smith and colleagues interviewed people caring for older relatives and found that they had worries about medication that need to be addressed.

Two personal accounts are also relevant. One documenting the physical and mental difficulties and exhaustion experienced by one carer of a person with dementia reports that home helps and respite were much appreciated, and that medication was used to help settle the person with dementia at night Anon, This case study points to a need for the experiences of the person with dementia and carers to be taken into consideration when managing medication.

This survey did not use qualitative methodology, but is noteworthy as the number of respondents was high of over 4, respondents, 2, had experience of at least one medication used for the treatment of dementia and there is a paucity of other evidence on the experiences of people with dementia and their carers of medication for dementia.

Given the magnitude of public response to policy changes in relation to the availability of treatment for dementia, the dearth of well-conducted qualitative research would appear to be a potential priority for future funding. Evidence on the experiences of people with dementia and carers indicates that, when managing medication, the feelings of the person with dementia and carers should be taken into consideration, including their feelings about whether side effects are tolerable.

For people with AD , are cognitive stimulation activities involving cognitive processing; usually in a social context and often group-based, with an emphasis on enjoyment of activities , acetylcholinesterase inhibitors donepezil, galantamine or rivastigmine or combined treatment clinically and cost effective in terms of cognition, global functioning, ADLs and quality of life when compared with placebo over 6 months? No randomised studies have directly compared cognitive stimulation with an acetyl-cholinesterase inhibitor, and few randomised studies have compared the combination with an acetylcholinesterase inhibitor alone in people with mild-to-moderate AD.

Evidence suggests that cognitive stimulation is effective in people with dementia, but it is difficult to compare the magnitude of the effect with that of acetylcholinesterase inhibitors.

Health and social care staff should aim to promote and maintain the independence, including mobility, of people with dementia.

Care plans should address ADLs that maximise independent activity, enhance function, adapt and develop skills, and minimise the need for support. When writing care plans, the varying needs of people with different types of dementia should be addressed.

Care plans should always include:. When developing a care plan for a person with a learning disability newly diagnosed with dementia, an assessment using the AMPS 59 should be considered. People with mild-to-moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation programme.

This should be commissioned and provided by a range of health and social care staff with appropriate training and supervision, and offered irrespective of any drug prescribed for the treatment of cognitive symptoms of dementia. The three acetylcholinesterase inhibitors donepezil, galantamine and rivastigmine 63 are recommended as options in the management of people with AD of moderate severity only that is, those with an MMSE score of between 10 and 20 points , and under the following conditions.

Although it is recommended that acetylcholinesterase inhibitors should be prescribed only to people with AD of moderate severity, healthcare professionals should not rely on the MMSE score in certain circumstances. For people with learning disabilities, tools used to assess the severity of dementia should be sensitive to their level of competence. Options include:. When the decision has been made to prescribe an acetylcholinesterase inhibitor, it is recommended that therapy should be initiated with a drug with the lowest acquisition cost taking into account required daily dose and the price per dose once shared care has started.

However, an alternative acetylcholinesterase inhibitor could be prescribed where it is considered appropriate having regard to adverse event profile, expectations around concordance, medical comorbidity , possibility of drug interactions, and dosing profiles. Memantine is not recommended as a treatment option for people with moderately severe to severe AD except as part of well-designed clinical studies.

For people with vascular dementia , acetylcholinesterase inhibitors and memantine should not be prescribed for the treatment of cognitive decline, except as part of properly constructed clinical studies. For people with MCI , acetylcholinesterase inhibitors should not be prescribed, except as part of properly constructed clinical studies. Here, and elsewhere in the guideline, each study considered for review is referred to by a study ID in capital letters primary author and date of study publication, except where a study is in press or only submitted for publication, then a date is not used.

McKeith et al. Marcusson et al. The AMPS should be carried out by someone with formal training in its use. Evenhuis et al. Nevertheless, following NICE protocol, the technology appraisal recommendations have been incorporated verbatim into this guideline where one of these recommendations appears, it is indicated as NICE TA The guidance applies to the marketing authorisation held for each drug at the time of the appraisal.

Hon et al. Ball et al. Gedye, All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

Enquiries in this regard should be directed to the British Psychological Society. Turn recording back on. National Center for Biotechnology Information , U. Search term. In particular: While the pharmacological intervention can be conveniently packaged and standardised, with a measured dose, non-pharmacological interventions can be more difficult to evaluate.