APP-KSMC-127 - (V4) - Crash Cart Checking & Maintenance Rev120314

Ministry of Health
King Saud Medical City

Total Quality Management
Riyadh, Kingdom of Saudi Arabia
ADMINISTRATIVE POLICIES AND PROCEDURES (APP)
DEPARTMENT: King Saud Medical City
:POLICY TITLE/DESCRIPTION
POLICY NUMBER AND VERSION
Crash Cart Checking and Maintenance
APP -KSMC-127-(V4)
EFFECTIVE DATE: 07 April 2014
REPLACES NUMBER AND VERSION:
APP -KSMC-127-(V3)
REVISION DUE: 06 April 2016
NUMBER OF PAGES: 8
APPLIES TO: All staff in Pharmacy and Nursing Department and other concerned
.disciplines of King Saud Medical City, Riyadh
1. STATEMENT OF PURPOSE:
1.1To guide nursing / pharmacy staff to keep the crash cart complete and standardized.
1.2 To maintain crash cart for prompt use in case of emergency code.
1.3To ensure proper function and availability of the emergency equipments and supplies.
2. DEFINITION(S):
2.1 Crash cart -is a portable trolley containing all equipment and drugs required for
cardiopulmonary resuscitation and emergency care. Crash cart maintenance is a
method of keeping unit based crash carts properly supplied, organized and maintained.
2.2 Crash cart maintenance/standardization-is the process by which cardio-respiratory
resuscitation carts (crash carts) in the hospital are kept identically supplied, organized
and maintained. This facilitates an efficient code response and meets JCIA standard
COP.3.2 -Policies and procedures guide the use of resuscitation services throughout
the organization.
2.3 Code Master defibrillator check- is the process of confirming the functioning
status of the defibrillator batteries and is a planned downtime when the electrical
system has to be made unavailable to the user (nurses) due to maintenance or system
upgrade. Scheduled code master defibrillator check is communicated to the users
well in advance of the event and is normally scheduled to take place during non-prime
time i.e. at night or during the weekend. Longer periods of scheduled code master
defibrillator check could extend into prime time shifts.
3. MATERIAL/EQUIPMENT/FORM(S):
3.1 Emergency cart with locking drawers
3.2 Emergency cart checklist
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3.3 Airway equipment
3.4Oxygen equipment
3.5Suction equipment
3.6Monitor leads
3.7Defibrillator
3.8Oscilloscope
3.9IV therapy equipment
3.10 Emergency drugs
3.11 Intubation set
3.12 Endotracheal tubes different sizes
3.13 Crash cart check list
4. POLICY STATEMENT(S):
4.1. This policy states that a qualified nurse and other members of the code blue
committee shall be responsible to use and maintain the crash cart. The standardization
(Arrangement of content) of crash carts must be maintained to all patient care areas
and other departments.
4.2. Each unit must have a crash cart in a visible and accessible area.
4.3. All drawers must be kept locked; integrity of locks to be checked during crash cart
check and documented with lock number.
4. 4.Crash cart contents shall be checked for completeness and expiration date by the
assigned nurse using the daily crash cart check list every shift for the external
equipment of the cart and every month using the monthly check list (on the first
Thursday of the Gregorian month) or after each CPR for the equipment inside the
cart with lock following the crash cart checklist with legible signature; and if the
lock number is damage (broken) it should be checked.
4. 5.Defibrillator will be checked by the biomedical staff periodically (at least every six
(6) months) and by nurses every shift. Sticker is attached with complete technician
identification, date , time, due date for the next check and will be plugged
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continuously, except during code master defibrillator check that it is unplugged
from electrical power to ensure the functioning status of the battery.
4. 6. The pharmacy department coordinates with the nurses and ensures that crash cart
medications are updated every 2nd week of the Gregorian month, replenished timely
and appropriately after each CPR or medical emergency in accordance with the
guidelines of the Hospital CPR committee.
4. 7. The pharmacy department will be responsible to perform the monthly checking of the
availability of crash cart medications, lock log sheet and the expired drugs within one
month from the expiry date (if there are no new expiration date, the drug can be used
until the last date of expiration).
4. 8. Sterile reusable equipment will be re-sterilized monthly. Refer to Central Sterilization
Supply Department (CSSD) Policy.
4. 9. The supply of red tag locks will be kept by the head nurse in a secured locked area,
and is accessible when off duty and off shift hours.
4. 10. The CPR committee must approve any modification to the crash cart in writing.
5. PROCEDURE :
5.1. Procedure for checking the crash cart:
5.1.1 The assigned Registered nurse checks the crash cart, oxygen cylinder levels,
defibrillator, and document on Crash cart check list every shift with signatures.
a. All crash carts will be opened and checked for contents monthly and
following each use. Sterile items will be checked for packaged integrity and
expiration date. Items which expire are replaced during crash cart check.
5.1.2. The integrity of the lock and lock number is also checked every shift and recorded
in the crash cart check list (Ambulatory care units that do not function on a 24
hours basis is checked once daily except weekends.
5.1.3. The crash cart is locked at all times, and if the lock is not intact; the Head nurse
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will be notified (with a filled-up Occurrence Variance Accident Report form)
and after appropriate investigation is taken, missing supplies will be replaced
appropriately.
5.1.4 Fasten cardiac arrest board on the cart so as not to be lost or misplaced.
5.1.5 Check the defibrillator, with cable and leads, on top of the cart every 8 hours.
Perform Code master test fire at the beginning of each shift at 100 joules or as
indicated depending on the manufacturers specifications.
5.1.6. Check the portable oxygen tank located at the side of crash cart for the amount
of oxygen available that will fall to the level of 500 psi or less, at the beginning
of each shift and after each use. Call the Oxygen technician to refill or replace the
oxygen cylinder immediately or forward the empty tank with the request form.
5.1.7. Check the portable suction and plug-in to check the functioning status every shift.
5.1.8 The Head Nurse is responsible to assure proper checking of the crash cart. Test
strips of defibrillator should be attached to the checklist and all checklist paper
is discarded after three(3) months.
5.1.9 Disinfect and cleanse the cart by following the Infection Control Guidelines in
cleaning the environmental surfaces using 1tablet of presept dissolved in 10 liters
of water. (Refer to the Infection Control Guidelines)
a. After each code, wipe outside of the cart and mechanical equipment.
b. As necessary, wipe from the top to bottom shelves, sides, monitor, and
defibrillator and cardiac arrest board.
5.1.10 Check the functioning status of laryngoscope bulbs and expiration date of
batteries after each use and monthly and change batteries if needed.
5.1.11 The Central Sterile Supply Department is responsible to cleanse and disinfect
the laryngoscope blades, ambu bag with mask with the hospital prescribed
disinfectant by rinsing with running water, dry and pack for plasma sterilization.
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5.1.12 Cleanse the handle of the laryngoscope with 70 % ethyl alcohol.
5.1.13 Maintain the cleanliness and orderliness of the crash cart.
5.1.14 Pharmacy staff checks all Emergency carts for proper drug storage, stock level,
and unit inspection log as determined by pharmacy policy.
5.2. Procedures for Replenishing Crash Cart Trolleys:
5.2.1.
Upon the completion of the cardiac / respiratory arrest code, the code blue team
leader/physician documents the medication used by the patient onto the physician order
sheet form and encodes on to the computer. The charge nurse forwards the prescription
with the empty ampoules to the inpatient pharmacy for replacement of the emergency
drugs used.
5.2.2. If the Code blue occur during evening or night shift or in the weekends, the CPR
medications are refilled from the inpatient pharmacy.
5.2.3. The Pharmacist /technicians working at the inpatient pharmacy dispense all crash cart
medications used during the given shift.
5.3. For Crash Cart Checking refer to attached Monthly Nursing Crash Cart Checklist
(Appendix-A1 & A2), Monthly Pharmacy Crash Cart Drug Check List (Appendix-B1
& B2), Daily Nursing Crash Cart Check List (Appendix-C), Defibrillator Checking
Instructions (Appendix-D) and Adult Crash Cart mapping (Appendix E1 & E2).
6. RESPONSIBILITY:
6.1 The Charge Nurse is responsible in the daily inspection of the crash cart.
6.2 Pharmacy is responsible to:
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6.2.1 Supply the red tag lock
6.2.2 Monthly check of the crash cart
6.3 Bio-medical to conduct periodic preventive maintenance.
6.4 CPR committee is responsible for the random on the spot checking of all crash cart trolleys.
7. REFERENCES:
7.1 Taylor, C., Lillis, C., Le Mone, p. (4th Ed.) (2001). Fundamentals of Nursing, The Art
and Science of Nursing Care. USA
7.2 Lippincott ,Williams and Wilkins (6th Edition ) 2008 , Fundamentals of Nursing
7.3 Lippincott Williams and Wilkins. . (8th Ed.) (2006) The Lippincott Manual of Nursing
Practice
7.4 DPP- PHD - 026. (Emergency cart policy).
7.5
APP-KSMC-001 (QMD- P/P Format
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APP -KSMC-127-(V3)
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9. POLICY AND PROCEDURE HISTORY:

Initial PP: Version 1 APP -KSMC-127-(V1)
Dated: 11 November 2009
Replaced by: Version 2 APP -KSMC-127-(V2)
Dated: 15 January 2010
Replaced by: Version 3 APP-KSMC-127-(V3)
Dated: 05 March 2011
Replaced by: Version 4 APP-KSMC-127-(V4)
Dated: 07 April 2014
Deleted Date: _____________________________

Replaced by New PP: PP No. Version ______________
Dated:____________
Page 8 of 8

APP-KSMC-127 - (V4) - Crash Cart Checking & Maintenance Rev120314

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Ministry of Health

King Saud Medical City

Version (4) 07 April 2014

APP-KSMC-001 (QMD- P/P Format

Version (4) 07 April 2014

Version (4) 07 April 2014

9. POLICY AND PROCEDURE HISTORY:

Dated: 11 November 2009

Replaced by: Version 2 APP -KSMC-127-(V2)

Dated: 15 January 2010

Replaced by: Version 3 APP-KSMC-127-(V3)

Dated: 05 March 2011

Replaced by: Version 4 APP-KSMC-127-(V4)

Dated: 07 April 2014

Deleted Date: _____________________________

Version (4) 07 April 2014

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