Who Signed for the Defibrillator
The defibrillator is not in theatre two. Somebody moved it, for a good reason, and the person who knows which reason is off until Thursday. What a custody register records, what it refuses, and the one thing about equipment it does not do.
The infusion pump was in the ward on Monday. On Wednesday it is not, and four people are certain about four different things: it went for repair, it went to the annexe, it was the one that was condemned, or it is behind the curtain in bay six.
All four are said with confidence, because in each case the person is remembering a real event involving a pump. There are eleven pumps. They are identical.
This is not a record-keeping failure in the usual sense. Nobody neglected to write anything down, because there was nothing anybody was asked to write down. Equipment moves in a hospital constantly, urgently and correctly, and unless the moving itself is the thing being recorded, the location of any given machine is a matter of collective recollection.
The difference between a list and a register
Most facilities have an equipment list. Far fewer have a register, and the distinction is not administrative pedantry — it determines which questions can be answered.
A list tells you
- What you own, and roughly how many of each.
- What it cost, if somebody entered that.
- Where it was when the list was last compiled.
- That eleven pumps exist somewhere in the building.
A register tells you
- Where this specific unit is now, and who has it.
- Every move it has made, when, and who authorised it.
- When somebody last physically confirmed it exists.
- Which of the eleven pumps has never been seen since April.
The last line of the right-hand column is the one that pays for the whole exercise. In any facility of size there is equipment that has been quietly absent for months, and a list cannot surface it, because a list has no concept of last-seen.
A list knows eleven pumps exist. A register knows which one nobody has seen since April.
What gets recorded
Custody is recorded as movements rather than as a field that gets overwritten, which is the structural decision everything else follows from. A field tells you where something is; a sequence of movements tells you how it got there and who is answerable at each step.
| Action | What it means |
|---|---|
| Checked out | A person has taken it — custody moves to them |
| Checked in | It has come back |
| Transferred | Custody moves from one holder to another |
| Relocated | It has moved location without changing hands |
| Verified | Somebody has physically confirmed it exists, here, now |
| Marked damaged | Its condition has changed and that is on the record |
| Marked lost | It cannot be found, recorded as a fact rather than a rumour |
| Retired | It has left service |
Each carries who did it and when. Movements can be captured from a barcode or a QR scan rather than typed, which matters more than it sounds — a custody record that requires somebody to sit at a desk and describe what they did is a custody record that gets written on Fridays for the whole week, from memory.
Verified is the action people overlook
Of those eight, the one that changes a register from a filing system into a control is the fifth, and it is the one nobody uses unless somebody deliberately asks them to.
A verification is the asset equivalent of a stock count: a person stood in front of this machine, on this date, and confirmed it was there. It changes nothing about the asset. It records that somebody looked.
Its value is entirely in the aggregate. Once verifications are happening, you can ask the question a list can never answer — which assets have not been physically confirmed in six months — and that list is where the losses are. Not the equipment somebody reported missing; that gets chased. The equipment nobody has thought about, which is why nobody has noticed.
Verification by ward, on a rota, beats an annual audit
An annual equipment audit is a large disruptive exercise that produces one data point a year and is frequently rushed. Twenty minutes per ward per month, with the phone scanning labels, produces twelve data points a year, catches a disappearance within weeks rather than within a year, and never requires anybody to clear a diary. It is also considerably more likely to actually happen.
Where the register refuses
Two refusals are worth knowing about, because both exist to protect the record from being tidied into uselessness.
A movement is checked against the asset's current status, so an action that makes no sense from where the asset is now is refused rather than accepted and reconciled later. An asset that is already out cannot be checked out again, and a retired one cannot be issued.
More interestingly, a custodian who holds assets cannot be deleted — you are told to reassign or return them first. And a custodian who has any movement history cannot be deleted at all, whatever their current holdings: they are set inactive or exited instead, precisely so the audit trail survives them.
That second one is a deliberate refusal of a very ordinary request. Somebody leaves, an administrator tidies up the list, and a year of custody history for a dozen machines would vanish with the name. The record is about what happened, and what happened does not stop being true when somebody resigns.
What AWRA OpsHub does today
- Custody recorded as movements, not as an overwritten field — check out, check in, transfer, relocate, verify, mark damaged, mark lost, retire, each with who and when.
- Movements can require approval, moving through pending to approved or rejected, so a machine leaving the building is a decision rather than an event.
- Actions are guarded against the asset's current status, so a sequence that could not have happened is refused rather than recorded.
- Movements can be captured by barcode or QR scan, so the record is written where the work happens rather than at a desk on Friday.
- A custodian with movement history cannot be deleted — inactive or exited, so the trail survives the person.
- Verification is a first-class action, which is what makes "not seen in six months" a question you can ask.
What it does not do
- No maintenance or service record. Two movement actions for sending to and returning from maintenance exist in the code and are written by nothing at all, so the paired dates that would give you days out of service are never created. A maintenance status can be set on an asset by editing it, which writes no movement and no date, and flipping it back leaves no trace. A biomedical schedule alongside this register is the honest answer today.
- No calibration record, for the same reason. Calibration due dates, certificates and intervals are not fields the register holds.
- The depreciation figure is not book value. A single flat rate is applied across every asset class, it posts to no ledger, and it will not agree with your audited accounts. Treat it as a planning chart and do not quote it to a board.
Not ours, by choice
- We will not let a register be tidied into a fiction. A custodian who has moved equipment stays on the record as inactive rather than being deleted, because a clean list that has lost a year of custody history is worse than an untidy one that has not.
- We will not infer a location. If nobody recorded a movement, the register says where it last was and when — it does not guess, and a system that quietly updates a location on no evidence is telling you something it does not know.
Maintenance and calibration scheduling — service intervals, due dates, downtime from paired timestamps, certificates against an asset — is a small and well-defined build rather than a ceiling. The movement model, the approval path, the document vault and the scheduled reminder infrastructure all exist and work; the two dead movement actions are literally waiting for a service layer.
If maintenance scheduling is the reason you are looking at asset software, be clear with yourself that this register does custody rather than biomedical engineering. What it does well — what you own, which unit, who has it, where, when it was last physically seen — is genuinely useful and is a different problem from the one a maintenance calendar solves.
Setting it up so it survives contact with a ward
Equipment registers fail in implementation far more often than in software. The pattern is always the same — an enormous initial data-entry effort, three weeks of diligent recording, and then a quiet return to remembering.
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Register the equipment that moves and matters
Not everything. Portable, valuable, clinically critical or easily confused with its neighbours. A fixed theatre light bolted to a ceiling does not need custody tracking; eleven identical pumps do.
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Label physically, at the same time
A register entry with no label on the machine means every movement requires somebody to work out which unit this is, and they will guess. Label as you register, in one pass, and put it where a hand naturally holds the device.
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Define who a custodian is
A person, a ward, or a department? All three work and they answer different questions. A ward is more durable and survives staff turnover; a person is more accountable and more accurate. Pick per equipment class rather than trying to settle it globally.
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Decide what needs approval to move
Not everything, or the approval becomes a formality that gets clicked. Equipment leaving the building, high-value items, and anything clinically critical — a short list that people can remember without reading it.
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Put verification on a rota from day one
Not after the register is complete, because it never will be. One ward per week, twenty minutes, scanning as you go. This is the habit that determines whether the register is worth anything in a year.
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Review what has not been seen, monthly
One report, one meeting, five minutes. Anything unverified for six months is either genuinely missing or in a place nobody thinks to look, and both are worth finding out about while somebody still remembers.
What "lost" should mean
Marking something lost feels like an admission and it is often deferred indefinitely, which is how equipment stays officially present for years after it stopped existing.
It is worth reframing internally. Marking an asset lost is not a conclusion about anybody's conduct — it is a statement that the register no longer knows where something is, recorded as of a date, so that the search can be bounded and the replacement can be budgeted. An honest register with three items marked lost is a far more useful instrument than a tidy one where all three are still shown as present in a ward that has not had them since last year.
Before marking something lost
- Read the movement history — where was it last recorded, and who held it then?
- Ask that person directly rather than asking the ward. Custody was theirs and they may simply know.
- Check whether a similar item was marked damaged or retired around the same time; identical units get confused in both directions.
- Check the places equipment goes and does not come back from — a repair bench, a store room, another site, a vehicle.
- Record it lost with the date and what you checked, so the next person does not repeat the same search from nothing.
The maintenance side of equipment management is worked through honestly in medical equipment maintenance, the schools version of the same register discipline in school asset registers, and the controlled-item custody pattern in controlled medicines.
Our take
Register the equipment that moves and matters, label it in the same pass, and put verification on a weekly rota from the first day rather than waiting for the register to be complete. The verification habit is what turns a list into something that can answer "which of these has nobody seen since April", and that question is where the losses are. Be clear about the boundary too: this is a custody register, not a biomedical maintenance system. Service intervals, calibration and downtime are not here, and a facility that needs them needs a schedule alongside this rather than an assumption that it is included.
See the custody register
Movements rather than an overwritten location field, approval on the moves that warrant it, barcode and QR capture at the point of work, verification as a first-class action, and custodians who cannot be deleted out of the audit trail.
Explore asset managementFrequently asked questions
How do we know where a specific machine is?
Custody is recorded as a sequence of movements rather than as a location field that gets overwritten, so the register holds where it was last recorded, who moved it, and when — plus every step before that. Movements can be captured from a barcode or QR scan rather than typed, which matters because a custody record that requires somebody to sit at a desk and describe their week is one that gets written on Friday from memory. If nobody recorded a move, the register tells you where it last was and when, rather than guessing.
What is a verification, and why does it matter?
It is the asset equivalent of a stock count — a person confirms this machine exists, here, on this date. It changes nothing about the asset; it records that somebody looked. Its value is entirely in the aggregate, because once verifications are happening you can ask which assets have not been physically confirmed in six months. That list is where losses actually are: not the equipment somebody reported missing, which gets chased, but the equipment nobody has thought about, which is precisely why nobody has noticed.
Does it track servicing and calibration?
No, and this is the honest limit of the module. Two movement actions for sending to and returning from maintenance exist in the code and are written by nothing, so the paired dates that would produce days out of service are never created. A maintenance status can be set by editing the asset, but that writes no movement and no date, and flipping it back leaves no trace. Calibration due dates, intervals and certificates are not held either. A biomedical schedule alongside this register is the honest answer, and those fields are a small, well-defined build if a facility wants to push for them.
Can we delete a custodian who has left?
Not if they have any movement history — you set them inactive or exited instead. That refusal is deliberate, and it refuses a very ordinary request: somebody leaves, an administrator tidies the list, and a year of custody history for a dozen machines would disappear with the name. If they currently hold assets you are asked to reassign or return those first, which is a separate and earlier check. The record is about what happened, and what happened does not stop being true when somebody resigns.
Can we trust the depreciation figure on the asset dashboard?
Not as book value. A single flat rate is applied across every asset class regardless of what the asset is, it posts to no ledger, and it will not reconcile with your audited accounts. Read it as a rough planning chart for replacement horizons and nothing more — and specifically, do not quote it to a board, because a number that does not agree with the audited figure is noticed and it costs you the credibility of everything else on the page.
Should we mark equipment lost, or keep looking?
Mark it, with the date and a note of what you checked. Marking something lost is not a conclusion about anyone's conduct — it is a statement that the register no longer knows where it is, recorded as of a date, so the search can be bounded and a replacement can be budgeted. A register with three honest losses is a far better instrument than a tidy one showing three machines present in a ward that has not had them since last year, and the note means the next person does not repeat your search from nothing.
