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    4 Things to Look for in your Crash Cart

     When an emergency arises, a crash cart that is difficult to move, disorganized and/or missing vital products negatively affects the ability of your medical staff to provide patients in distress with the high-quality care you strive to offer.Here are some tips to make sure your cart is the perfect match for  your facility. 

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    5 Important Criteria in a Crash Cart

          1. Maneuverability

    Today, there are medical carts that are constructed of lightweight polymer, this material is light and easy to move but also very durable. So, you don't have to worry about your carts if they take a little beating. Steering is also important, having proper steering components can provide staff the assurance they need to get the cart to the code quick and safe. The  best system on the market today,  providing crash cart control, is a  5th wheel steering assist system. The 5th wheel, located under the center of the cart, is engaged while grabbing the handle to provide straight travel down long corridors and less effort maneuvering around corners.  When at the code, full maneuverability is restored when the handle is simply let go. When at the code, the cart should be able to transition from a fully maneuverable cart, to a stable workstation.  Ask for total-lock (locks rotation and swivel action of caster) casters on the front of the cart.  That way staff has easy access to lock two wheels to steady the cart.

             2. Organization

    Maintaining a fully-stocked crash cart is much easier when it is organized properly. To accomplish this, there must be adequate room for each product, which is why many hospitals and healthcare facilities are creating their own custom-designed medical carts.
    The cart’s design should have the ability to hold specific devices on the exterior of the cart, like the defibrillator, back board, oxygen tank and suction pump.  The more advanced carts will have built-in accommodations for these, without adding to the footprint of the cart.  While having all the necessary equipment contained on the cart is vital, having supply organization is just as important. The ability to divide medications and supplies helps staff quickly identify the product they need.  Utilizing drawer trays with dividers adds the convenience of having pre-stocked trays at the ready to  speed the turnover time it takes to put a crash cart back into service.  This key to minimize down time  or coverage of the affected area or reduce the number of extra crash carts needed for exchange.  Since there are multiple code response carts throughout your healthcare facility, clearly labeling each drawer makes code cart refreshers for staff more meaningful and finding the needed medications and supplies during a code much more efficient.

           3. Customization Options

    While all of the code carts should be standardized throughout the facility, you should have the ability to customize a configuration at the onset.  Some options may be included in carts that are designed specifically for code response, like a recessed top storage area that offers a clear, removable cover. This storage area allows staff members to have instant access to airway equipment or first-line medications without obstructing access to any of the drawers.  Some areas will require a the use of the cart’s backboard during the code, while others have beds designed to support compressions, in either case a backboard will be standard on all carts. However, more advanced carts will allow you to mount the board on the front (even if to only act as a reminder) or mount it on the rear out of the way, especially in areas like the trauma bay.
    Your crash cart will be carriage for several portable devices that need to be charged while not in use. The cart should be equipped with a “medical grade” outlet strip to consolidate the cords to one to the wall, and needs to have a cord management system that keeps all the cords organized and makes sure that the equipment remains protected.
    Other compliments to the work area can include a storage bin, an IV pole and a defibrillator platform that will swing closer to the patient and free the work area on top of the cart.  All storage areas should be secured to ensure nothing is “borrowed” from the crash cart and missing during a code.  This includes side storage bins, which should be enclosed and secured by the cart’s main security seal to maintain integrity, without increasing the onus on periodic cart checks.

     

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           4. Simultaneous Access

    During a code, multiple products need to be obtained quickly. A cart designed specific for a code will have design features allowing multiple functions access to their supplies without having to wait for someone else to finish retrieving theirs.  Bins holding PPE and/or IV bags, can be accessed on the side, while the first line meds are being retrieved from the top, and the defibrillator is swung closer to the patient and prepared for use, while at the front of the cart respiratory is accessing their airway equipment.  Seconds count, whether the event is a Rapid Response or an actual code, the cart should be able to support C-A-B simultaneously, not sequentially.  

          5. Security

     

    The Joint Commission (TJC) calls for crash carts to be secure.  TJC Standards do not discuss nor recommend locking crash carts.  Specific regulations in regard to crash cart security are: CMS §482.25 as it relates to medication security … [medications] must be stored in a locked room, monitored location, or secured location that will ensure the safety of the drugs or biologicals; TJC Standard MM.2.30  Emergency medications and/or supplies, if any, are consistently available, controlled, and secured. One can argue that a lock on the cart puts being consistently available at risk. So what is “secure”?  Secure is defined as : 1.) areas where staff is providing patient care, or staff is present and effectively ensures that access to the area is restricted to authorized individuals  2.) areas where patients and visitors are not allowed access to the area without the supervision or presence of a health care professional or  3.) cart is located in a locked room i.e. after hours storage.  TJC standards go on to state  that emergency medications are sealed or stored in containers (for example, crash carts, tackle boxes, emergency drug kits, closed bags that are clearly labeled, and so forth ) in such a way that staff can readily determine that the contents are complete and have not expired  The most common way to accomplish this with use of serialized plastic security seals.  Carts designed specifically for a code will provide the capability to secure all storage areas, including side bins, with the use of one seal.  This is the most efficient way for staff to maintain daily audits of the cart.  Another common practice is to provide a seal for each function and even for each drawer, which is very popular for pediatric crash carts.  Multiple seals, while more complex for daily tracking of each seal, is a big efficiency gain when reprocessing a used cart.  The efficiency is derived from only having to clean and replenish drawers or storage areas that have a broken seal.  If a drawer seal is not broken and the expiration date is not near, the drawer will not have to be touched, saving the time it takes to restock a drawer times the number of drawer seals still in tact.

     

    When choosing a crash cart, remember to choose one that is easy to maneuver with options that allow you to create custom-designed compartments and maintain security. In addition, choose a crash cart that permits immediate access to a variety of products, simultaneously. A well-designed medical cart can make an enormous difference in the quality of care the staff members at your hospital or healthcare facility can provide your patients. 

    Interested in a new cart for your facility? Check out these advanced Crash Carts 

     

     

    About the author

    Dave Salus has been with Intermetro for over 25 years. He is currently the Market Manager for the Healthcare division, which includes carts , shelving, baskets, carts, tables, work centers, and a large variety of specialty products. Dave's tenure at Metro has provided him with first- hand experience in all departments in a hospital. His market research provides a unique perspective from the end user’s viewpoint, that is brought within the company and embedded in the new products, programs , and written material he creates.
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