How to Keep Your Code Carts from Crashing and Burning

Being ready for situations where your patient requires resuscitation is critical. Staff complete training in basic/advanced life support, and some staff complete more advanced skills in pediatric and neonatal resuscitation, as appropriate. There has been increased focus on drills and simulation to better prepare the team in these life-saving measures. However, has anyone looked at your code cart to ensure it is ready? With alarming frequency, we are seeing organizations that have equipment and supplies that are not ready to support the patient during a cardiac arrest. Many staff members cannot demonstrate the proper code cart check procedure, or they just go through the motions without regard to why these checks are important. Here are some key tips and tricks to ensure your code cart is ready to go:

Tips and Tricks:

• Ensure your staff are aware of the Manufacturer’s Instructions for Use (MIFU) for all equipment items. This includes any device such as AED/Defibrillator, Pacing device, suction machine, etc. Staff should have access to the MIFU and know to use it to determine how to use the device, how to test it for function and how to clean it. If the MIFU is lengthy, consider developing a one-page summary and placing it on top of the full MIFU for staff ease in finding the pertinent information that they need.

• Ensure staff know how to perform routine code cart checks according to your organization’s policy. This should include checking supplies, equipment, oxygen, etc. Many organizations assign various departments to check various components of the cart. Make certain staff are aware of who checks which components. For instance, the number one expired crash cart item is blood specimen tubes. Who checks yours?

• Make training on how to set up the code cart for resuscitation events robust. This should include fully setting up and using equipment. Do staff know where supplies are located? Can they quickly pull supplies to start an IV? Ensure staff can validate their ability through return demonstration. Include this training on at least an annual basis especially if you do not have many resuscitation events. Consider mixing things up during the return demonstration. For instance, remove the laryngoscope handle from the cart. This pushes staff to apply their critical thinking skills. Where would they seek another handle from?

• Train staff on how to complete a routine code cart check and ensure that staff can demonstrate the process (do you follow MIFU for AED checks?). Evaluate staff performance periodically.

• Simplify your code cart check off process and documentation. Ensure it meets the requirements of the task but is not a documentation liability. Consider a check off sheet that walks them through the process or place a laminated copy of the flow on the crash cart.

• Ensure staff know how to replace malfunctioning equipment or outdated/missing supplies expeditiously. Make sure they adjust documents to reflect the changes made.

• Ensure your supply checklist is comprehensive and includes all supplies needed for resuscitation based on your patients’ needs (suction canister inserts, connection tubing, stethoscopes, manual BP cuffs, etc.).

• Ensure staff are properly assessing any oxygen tanks on the code carts for appropriate volume.

• Ensure staff are checking all supplies for expiration dates. Did you know that AED pads and lubricating jelly packets expire? Follow the MIFU.

• Consider using labels on each drawer or a master supply sheet with the expiration dates for quick reference. Make sure you keep the label or check list up to date with supply replacement. Be mindful that the use of adhesive labels can create a risk of infection.

• Check equipment for up-to-date maintenance labels. Ensure your medical equipment team is on top of required checks.

• Make sure references on your cart are up to date. This includes having the most recent version of pediatric tapes that provide medication dosing, endotracheal tube sizes and other resuscitative information based on height – a common deficiency.

• Leadership should be rounding for documentation compliance.

Maintaining resuscitation equipment and supplies is life critical. Ensure staff take routine checks seriously and perform them flawlessly. The patient’s life is dependent on access to resuscitative equipment and supplies in case of cardiac arrest. Take time to review your practice to determine if your organization has gaps in compliance.

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