PROCEDURE:CRASHCART

Section: CLINICAL/PATIENT CARE Responsibility: CHIEF MEDICAL

PROCEDURES OFFICER

Effective Date: 11/81; Revised: 6/03: 5/05 Procedure Number: CPCP1

Reviewed: 4/05; 12/06Related: APP9; CPCP11; RM12

Purpose:TO ESTABLISH A POLICY OF PREPAREDNESS FOR PATIENT EMERGENCIES IN THE HEALTH CENTERS.

Scope:Medical Providers, Other Health Providers, Administration, Nursing, Medical Assistants, Specialist Registration Services

Exceptions:NONE

Description:

  1. The crash cart should be locked at all times. The integrity of the lock should be checked daily. Any time the crash cart is opened for any reason, nursing must check all contents prior to attaching a new lock. Crash cart locks should be stored separately from the crash cart. Locks should be breakaway and numbered or initialed.
  1. Once each quarter, all personnel who may be involved in the use of the crash cart equipment will be given in-service training to review the use of the equipment. The Clinic Manager or designee will coordinate training and document appropriately.
  1. A Code Blue/Patient Emergency Procedure exists and outlines the responsibility of each HealthNet associate in the event of a patient code. All clinic associates are to be familiar with this procedure. Code Blue Drills to test the emergency procedure will be held quarterly overseen by the Health Center Manager or designee.

4.AllMA’s, LPN’s, RN’s, physicians and midlevel providers who are involved in direct patient care will be required to take the Basic Life Support for Healthcare Providers course offered by Clarian Health. It is a policy of HealthNet that all appropriate associates take the course and be certified, unless medically excused. This course includes CPR, as well as upper abdominal thrust instruction (formerly Heimlich Maneuver) and other emergency life support procedures.

5. CPR-certified associates will receive training every 2 years as a refresher in emergency life support.

6.All medications will be checked monthly for expiration date. Supplies will be checked (monthly also) to verify they are present and in sufficient quantity. Each center manager will designate a nurse to review the crash cart contents. S/he will note exceptions and ensure that deficiencies are addressed. (See form below.)

HealthNet Life Support: Medications and Guidelines for Use

Medications

Dextrose
D50 / Epinephrine
1:1000 / Racemic
Epinephrine / DiphenhydrAMINE
50mg / Nitroglycerin
Sublingual tablet / Aspirin
How
Supplied / 50 ml
bristojet / 1ml vial
(1mg/ml) / 2.25% solut.
(7.5 ml) / 50mg/ml
syringe / 0.4mg tablet / 81 mg tablet
Typical
Indication / Hypo-Glycemia assoc. with coma or seizure / Anaphylaxis / Severe croup
laryngeal
edema / Severe allergic
reactions / Anginal chest
pain / Possible
or confirmed
myocardial
infarction
Warning
Adverse
Reactions / Hyper-Glycemia / Tachycardia,
hypertension / Tachycardia / Sedation,
nausea,
vomiting / Hypotension
tachycardia,
headache / Bleeding,
gastric
irritation,
allergy
Dose/Route / Adult:
1 ampule
IV / 0.01ml/kg per dose subcutaneous
(max 0.5ml) / 0.05ml/kg
per dose nebulized
(max 0.5 ml) dilute
to 3 ml with Normal
Saline / 1-2mg/kg
per dose
IV or IM
(max dose
50 mg) / 1 tablet
dissolve SL,
may repeat
Q5 minutes x
3 doses / 1 tablet,
chew and
swallow

Quick Reference Dosing

Medications

Dextrose
D50 / Epinephrine
1:1000 / Racemic
Epinephrine / DiphenhydrAMINE
50mg / Nitroglycerin
Sublingual tablet / Aspirin
Adult
1 ampule IV / 0.3-0.5 ml subcutaneous / 0.5ml with 2.5ml NS / 1ml IV or IM / 1 tablet SL / 1 tablet
Pediatric
1yr/old / 0.1ml subcutaneous / 0.5ml with 2.5ml NS / 0.4ml IV or IM
3yr/old / 0.l5ml subcutaneous / 0.5ml with 2.5ml NS / 0.6ml IV or IM
5yr/old / 0.2ml subcutaneous / 0.5ml with 2.5ml NS / 0.75ml IV or IM
8yr/old / 0.25ml subcutaneous / 0.5ml with 2.5ml NS / 1mlIV or IM
12yr/old / 0.3ml subcutaneous / 0.5ml with 2.5ml NS / 1ml IV or IM

CRASH CART CHECK-OFF

Instructions: Each center manager will designate a nurse to review crash cart contents every month. The nurse will check the minimum quantity of each item is present and (when applicable) the expiration date has not passed.

Exceptions noted should be documented in the third column, plus what was done to fix the problem. Example: Nurse finds only one pocket mask. She should write, “Missing one. Submitted written request to Office Coordinator on 9/1/6 for one pocket mask. “ Nurse will note his/her initials and the check-off date in the last column.

Medications

/

Quantity

/ Note Exception/
Action Taken / Staff Initials and
Date
50% Dextrose e.g. Bristojet / 2
Nitroglycerin 0.4 mg SL / 2
ASA enteric coated 81mg tablet / 1 bottle ( 36 )
Racemic Epinephrine 2.25% ( 7.5ml) / 1
Smelling Salts / 2
DiphenhydrAMINE Syringes 50mg/ml / 6
DiphenhydrAMINE capsules 25 mg
DiphenhydrAMINE syrup 12.5mg/5ml / 1 bottle
Epinephrine ampules 1:1000 1mg/ml / 6
Airways Supplies / Quantity / Note Exception/
Action Taken / Staff Initials and
Date
Masks:
Adult / 1
Pediatric / 1
Infant / 1
Nasal Cannula:
Adult / 1
Pediatric / 1
Infant / 1
Extension Tubing / 2
Ambu:
Adult size with mask / 1
Pediatric size with peds and infant / 1
Mask
CPR Mask:
Pocket Mask / 2
Microshield / 2
Oral airways
Size 2 / 2
Size 3 / 2
Size 5 / 2
O2 bottles with regulator / 1
Suction Euipment:
Pediatric / 2
Adult / 2

CRASH CART CHECK-OFF

IV Supplies / Quantity / Exceptions Noted/
Action Taken / Staff Initials and
Date
Syringes:
3 ml / 2
5 ml / 2
1 ml / 2
Bulb / 2
Angiocaths:
18 / 2
20 / 2
22 / 2
Arm Boards:
Pediatric / 1
Adult / 1
Buretrol / 1
IV Start Kits / 2
Test Tubes
Red Top / 2
Lavendar Top / 2
Butterfly 22 G / 4
IV Tubing:
Microgtt / 2
Macrogtt / 2
IVF:
1000 ml NS / 1
500 ml NS / 2
250 ml NS / 2
Miscellaneous / Quantity / Exceptions Note/
Action Taken / Staff Initials and
Date
Latex Free Gloves:
Medium / 1 box
Low / 1 box
XL / 1 box
Code Form
Tape:
1” / 1
2” / 1
Coban-3” / 1
Scissors / 1
Razor
Needles
18 g 1 ½” / 3
21 g ¾” / 3
23 g ¾” / 3

CRASH CART CHECK-0FF

Miscellaneous / Quantity / Exceptions Note/
Action Taken / Staff Initials and
Date
25 g 3/4” / 3
25 g 5/8” / 3
Sharp Container / 1
Lancets-safety flow
Tourniquet-latex free
Blood Pressure Cuff
Adult / 1
Adult Large / 1
Child / 1
Stethoscope / 1
Latex Safe Blood Draw Kit / 1
Band-Aids / Assorted
K-Y Jelly / 1 tube
Cotton balls / Assorted
2” Gauze / Assorted
Yankauers / 3
Portable Suction / 1
Alcohol Pads / 1 box
Code Form / 1
Epinephrine Dose Card / 1