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Crash carts contain the supplies you hope you'll never need. But with higher-acuity patients being cared for in the outpatient setting, having carts fully stocked, smartly organized and always at the ready is anesthesia's essential safety net. Here's a drawer-by-drawer look at some of the medications and supplies your providers need to have easy access to at a moment's notice.
Drawer 1: Airway
The top drawer is typically reserved for airway management equipment for adult and pediatric patients, including oral and nasal pharyngeals, nasal cannulae, a non-rebreather mask, endotracheal tubes, stylets and syringes. The drawer should also contain a bougie, laryngoscopes, and Miller and MAC blades. Make available all equipment necessary to follow the ASA/AANA airway algorithm for difficult airway management. Check laryngoscope batteries and bulbs daily. (Also be sure to stock extras of each.)
STOCKING TIPS
Keep Carts Primed and Ready
Sheldon Sones, RPh, FASCP, a pharmacy consultant to surgical centers throughout New England, offers this advice for maintaining your crash carts.
- Perform regular audits. Have different staff members audit the cart each month. Set an annual schedule and assign staff for each monthly validation. Document that you checked medications at least monthly and validated cardiac monitors and defibrillators daily.
- Organize it. Providers will have a difficult time finding the drugs and supplies they need during high-stress codes if items are randomly strewn across drawer slots or trays. Label assigned drug locations in a large, clear font.
- Replace outdated drugs. Expired medications should never remain in crash carts. Buy needed drugs about a month before they're due to expire so you're not left shorthanded.
— Daniel Cook
Drawer 2: Drug vials
Alphabetize the drugs by name. Keep in mind that drugs might be stored under alternative names. For example, Ativan is sometimes labeled under the generic lorazepam. When administering drugs, locate the needed medication, draw up the appropriate dosage, and verbally state the drug and dosage before administering it to the patient. Be sure to dispose of used needles in the sharps container located on top of the cart. Differentiate similar medications with labels identifying them as look-alike, sound-alike drugs. Make sure that all meds required by state or accrediting agencies are on formulary, in the cart and not expired.
Drawer 3: Circulation
The circulation drawer contains IV fluid and tubing, needles, syringes and adhesive tape. Stocking a variety of styles and sizes of IV cannulae is important. So is having a pressure bag on hand for rapid IV infusion.
Drawer 4: Boxed medications
Pre-packaged drugs can be stored here, including epinephrine and sodium bicarbonate. The availability of pre-packaged drugs can help avoid incorrect dosages. Have as many of these available as possible, particularly lidocaine, epinephrine and atropine.
Drawer 5: Breathing
This drawer contains laryngeal mask airways and chest tubes. Make sure your continuing education efforts regularly review the use of these items.
Drawer 6: Additional supplies
The cart's miscellaneous drawer contains a central line kit, Foley catheter and additional fluids. Have a video laryngoscope available, perhaps in this drawer, as well as an ambu bag that delivers positive pressure and a variety of masks. Make sure this area doesn't turn into a catchall junk drawer.
THE 5 S's
Standardize Your Anesthesia Carts
When anesthesiologists and nurses at Scottsdale (Ariz.) Healthcare tired of wasting valuable time searching for supplies in different anesthesia carts arranged in different ways, Abdul N. Mansour, MHA, DBA, took action. Here are 5 steps the director of lean and process improvement and quality enhancement services used as part of his efforts to standardize carts in the health system's 52 ORs.
- Sort. Eliminate waste items during an initial cleaning by sorting what you really need from what you don't need. Ask your anesthesia providers and anesthesia techs to sort through supplies, and remove items based on their decisions. Challenge their current thinking and habits. Hesitant to remove what might be a needed supply? Move it to a holding area and see if it's missed.
- Simplify. Arrange workplaces for safety and efficiency. During this process, have your anesthesia providers identify storage locations for supplies, including determining the location and quantities of items stored within the carts' specific drawers.
- Sweep. Perform daily cleaning and visual sweeps to see how supplies are stocked and pulled on the front line. Utilize checklists and pictures to help staff comply with your standardizing efforts. Hang laminated pictures and lists of supplies along with corresponding numbers on drawer bins so staff know exactly where supplies are stored.
- Standardize. Once you've standardized your carts, don't stop innovating. If a staff member comes up with a suggestion for improvement, study its feasibility and implement it if it's sensible.
- Sustain. Maintain standardization gains and improve upon them. This is hard to do, as old habits die hard and staff often resist change. Collect baseline data at various stages of the standardization project (at 3, 6 and 12 months and after full implementation, for example) and compare the level of improvement or non-improvement at each stage. Develop visual tools (graphs, pictures) to keep staff updated on their compliance efforts.
— Daniel Cook
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