Policies & Procedures for Nursing Department

Issue Date: 01/01/2005

Revision Date: 01/06/2013
Code #: ND/GNCB/002
Page 1 of 8

1.0 TITLE: STANDARDIZATION AND MAINTENANCE OF

CRASH CART

2.0 POLICY:

Crash Cart arrangement is standardized in all Wards/Units. Each Crash Cart should be
equipped with a numbered lock and kept locked at all times unless in use.

3.0 PURPOSE:

3.1 To provide a systematic methods of organizing emergency equipment and

medication for easy access and use.

3.2 To ensure a properly stocked emergency cart will be readily available.

3.3 To identify appropriate drug used in emergency situations.

4.0 DEFINITION:

4.1 Crash Cart - also known code cart is a set of trays/drawers/shelves on wheels
used in hospital for transportation and dispensing of emergency medication
and/or equipment at site of medical/surgical emergency to potentially save
someone’s life.

5.0 PROCEDURES:

5.1 It is the responsibility of the unit or department where the Crash Cart is located to
ensure that it is checked routinely as follows:

5.1.1 Unit Nursing Supervisor will check Crash Cart every month and
document in monthly checklist.

5.1.2 Head Nurse or designee of each ward will check Crash Cart weekly and
documentation should be maintained in Crash Cart checklist:

5.1.2.1 Verify Crash Cart was consistently checked per shift.

5.1.2.2 Review the daily shift Crash Cart Checklist for compliance.

5.1.2.3 Ascertain Crash Cart Checklist details are updated, e.g. expiration
dates are indicated.

KAAH ND-GNCB-002
Policies & Procedures for Nursing Department
Issue Date: 01/01/2005
Revision Date: 01/06/2013
Code #: ND/GNCB/002
Page 2 of 8

5.1.2.4 Ensure that details (e.g. name, expiry date) of medications and
supplies to expire (a month before) have been encircled and
highlighted.

5.1.2.5 Notify Pharmacy Staff for replacement of near expiry medications

and update Crash Cart Checklist form once new medications
supplied.

5.1.2.6 Ensure all equipments and medications are clean, orderly, properly
arranged and with clear labels in each drawers as per Crash Cart
Checklist arrangement.

5.1.2.7 Monitor for Periodic Preventive Maintenance of defibrillator and

suction machine by Biomedical Department and report to Nursing
Supervisor for non-compliance.

5.1.2.8 Assign a Staff Nurse to perform a Crash Cart check who will
review the daily shift Crash Cart Checklist at the beginning of
each shift and following each Code Blue.

5.1.2.8.1 Crash Cart is to be checked at the beginning of each

working day for Department/Units that provide Out
Patient Services (e.g. OPD, Radiology Department,
ESWL, Hyperbaric, Endoscopy).

5.1.3 Staff Nurse assigned to check the Crash Cart Checklist should ensure the
following:

5.1.3.1 The integrity of the lock – the fully stocked Crash Cart should
have a safety device to alert staff that the cart is fully stocked.

5.1.3.1.1 Verify that the Crash Cart lock number corresponds

with the one written on the checklist.

5.1.3.1.2 Crash Cart drawers are locked at all times unless in use
e.g. Code Blue or replacement of expired medications
or supplies:

5.1.3.2 That Crash Cart Checklist is completely filled up as to the

required details e.g. expiration dates, lock number.

5.1.3.3 There is no expired supply or medication based on the expiration

label.

KAAH ND-GNCB-002
Policies & Procedures for Nursing Department
Issue Date: 01/01/2005
Revision Date: 01/06/2013
Code #: ND/GNCB/002
Page 3 of 8

5.1.3.3.1 Replace/replenish expired/missing Crash Cart items.

5.1.3.3.2 Encircle and highlight details of near to expire ( at least

a month before) medication and supplies on the Crash
Cart Checklist)

5.1.3.4 Functionality of the defibrillator unplugged and plugged

5.1.3.4.1 Verify that the ECG has sufficient amount of ECG

tracing paper

5.1.3.4.2 Inspect the cables for any break or tear.

5.1.3.4.3 Defibrillator is checked as per manufacturer's

guidelines

5.1.3.4.4 Plug in for charging defibrillator on Uninterrupted

Power Supply (UPS)

5.1.3.4.5 Ensure cables are properly connected to defibrillator.

5.1.3.5 Functionality of the Suction Machine

5.1.3.5.1 Plug in suction and power on and perform a suction

testing

5.1.3.5.2 Ascertain suction tubing are properly connected

5.1.3.5.3 Suction canister/filters are replaced following each use.

5.1.3.6 Functionality of the portable oxygen and delivery device

5.1.3.6.1 Ensure portable oxygen cylinder in the Crash Cart have

>500 PSI (Pound per Square Inch).

5.1.3.6.2 Request from Medical gas to refill or replace oxygen

tank when less than the required remains.

5.1.3.6.3 Ambu bag (Adult, Pediatric) with reservoir are

available.

5.1.3.7 Functionality and maintenance of the Laryngoscope

KAAH ND-GNCB-002
Policies & Procedures for Nursing Department
Issue Date: 01/01/2005
Revision Date: 01/06/2013
Code #: ND/GNCB/002
Page 4 of 8

5.1.3.7.1 Has been checked monthly and following each use.

5.1.3.7.2 Has been cleaned thoroughly according to the

manufacturer’s manual following each used.

5.1.3.8 Refer immediately to BioMed any equipment found inoperable

during inspection

5.1.3.9 There is cardiac board on the front of the cart.

5.1.3.10 The availability of all the items on the cart and compare with the
listing, and all machines and equipment are in working condition.

5.1.3.11 Affix signature with identification number on space provided in

the checklist.

5.1.4 The following is delegated to be the responsibility of:

5.1.4.1 Charge Nurse - to check that a shift crash cart check has been
performed by the assigned Staff Nurse.

5.1.4.2 Code Blue Team Nursing Supervisor – will open and check all
Crash Cart for correct quantity of contents, for package integrity
and expiration date, and sterility of items every month, and a
written report will be submitted to Nursing Department for filing
and trending.

5.1.4.3 Pharmacy will check all Crash Carts for proper drug storage,
stock level as determined by Pharmacy Policy.

5.2 In case Crash Cart is found opened at anytime other than reason of Code Blue.

5.2.1 The Head Nurse/Charge Nurse or Team Leader has to be informed.

5.2.2 The Cart is to be checked by the assigned Staff Nurse.

5.2.2.1 Conduct a detailed inventory of the Crash Cart items and any
missing item has to be replaced.

5.2.2.2 Ascertain Crash Cart is clean of any visible soiling.

KAAH ND-GNCB-002
Policies & Procedures for Nursing Department
Issue Date: 01/01/2005
Revision Date: 01/06/2013
Code #: ND/GNCB/002
Page 5 of 8

5.2.2.3 Relock Crash Cart and document the new lock number on the
column provided in Crash Cart Checklist.

5.3 In case Crash Cart was used during Code Blue, the Staff assigned :

5.3.1 Should conduct a detailed inventory of the Code Cart and replace all used
medication, forms, supplies and equipment after each Code Blue,
immediately.

5.3.2 Clean Crash Cart of any visible soiling.

5.3.3 Relock the Crash Cart and document the new lock number on column
provided in Crash Cart Checklist.

5.3.4 Crash Cart borrowed from another department or unit during a Code Blue
should be returned by the borrowing department or unit with all the used
forms/supplies/equipment properly replaced.

5.4 Replenishment of expired Crash Cart items:

5.4.1 Medications and IVF:

5.4.1.1 Inform Head Nurse/Charge Nurse/Team Leader.

5.4.1.2 Discard the expired medication/s according to its waste

category and Pharmacy Policy and Procedure.

5.4.1.3 Follow up the requested medication from the Hospital

Pharmacy.

5.4.1.4 Immediately replace and arrange medication according to

labels on the drawer/ tray

5.4.2 CSSD supplies e.g. ambu bag, cut-down set

5.4.2.1 Ascertain to send expired items to CSSD for sterilization.

5.4.2.2 Replace expired items.

5.4.3 Other supplies e.g. syringe, blood tubes

5.4.3.1 Discard according to its waste category

KAAH ND-GNCB-002
Policies & Procedures for Nursing Department
Issue Date: 01/01/2005
Revision Date: 01/06/2013
Code #: ND/GNCB/002
Page 6 of 8

5.4.3.2 Replace and arrange according to labels on the drawer/tray.

6.0 FORMS/ EQUIPMENT:

6.1 Crash Cart Trolley

6.2 Defibrillator

6.3 Code Blue Form

6.4 Cardiac Board

6.5 Sharp Container

6.6 Crash Cart Checklist

6.7 Plastic trash bag

6.8 Adult and Pediatric Ambu Bag with reservoir

6.9 Oxygen source and delivery devices

6.10 Suction equipment and supplies

6.11 Airway adjuncts

6.12 Intubation equipment

6.13 IV therapy supplies

6.14 Central Venous Catheterization set

6.15 Specimen collection materials

6.16 Medications

6.17 ECG paper

6.18 Cut down set

KAAH ND-GNCB-002
Policies & Procedures for Nursing Department
Issue Date: 01/01/2005
Revision Date: 01/06/2013
Code #: ND/GNCB/002
Page 7 of 8

7.0 REFERENCE(S):

7.1 Sagith Kumar, RN, RM (2010) Crash Cart. http://www.emergency

medicine.mims.com/articles_details.php?id=16

7.2 Emergency Equipment (Crash Cart) Maintenance, Preparation and Exchange Process
(2012).http://www.gmhc.org/gmhc_new/ARR6%20FUND%202010%Departmental%Pol
icies%202010/2013SNY/6580-044.pdf on May 2013.

7.3 Code Blue Cart – Content and Use (2013). Saskatoon Health Region.
http://.saskatoonhealthregion.ca/.../Code_Blue_Cart_Contents_and_Use=1069.pdf

8.0 REVISION:

8.1 This policy shall be reviewed every 2 years.

KAAH ND-GNCB-002
Policies & Procedures for Nursing Department
Issue Date: 01/01/2005
Revision Date: 01/06/2013
Code #: ND/GNCB/002
Page 8 of 8

9.0 APPROVALS:

9.1 Prepared by: ___________________________ ______________

Ms. Maria Eustelle S. Vergara Date
Nursing Quality Staff

9.2 Prepared by: ___________________________ ______________

Ms. Valsamma Ponnamma Date
Nursing Supervisor, ICU

9.3 Reviewed by: ___________________________ ______________

Ms. Hayat Hadi Majrashi Date
Head of Nursing Quality

9.4 Approved by: ___________________________ ______________

Ms. Taibah Shaiban Al Dwiry Date
Director of Nursing Services

9.5 Approved by: ___________________________ ______________

Dr. Mohammad Bin Faisal Al Mobarak Date
Supervisor General

KAAH ND-GNCB-002