crash carts & accessories

Technical Bulletin

Crash Carts & Accessories

Introduction ..........................................................................2

Organization, Control, Security and Accountability ........2

Site Specificity ......................................................................2

How to Improve Organization and Efficiency....................2

1. Crash Cart Drawer – Trays and Boxes ..........................3

2. Drawer Dividers ................................................................3

3. Foam Inserts ......................................................................3

4. Labels, Magnets, Clings and Label Overlays ................4

5. Drug/Supply Expiration I.D. Tags ...................................5

6. Security Seals and Bags....................................................5

7. Cart Attachments – Oxygen Tank Brackets, Ambu Bag Holder, Cart IV Pole, ......................................Monitor/DefibrilatorShelf, And Emergency Supplies ..Dispenser ........................................................................6-7

8. Wheeled Supply Case and Mobile Storage System ....7

Summary ................................................................................8

INTRODUCTION

As one peruses the literature on crashcarts one finds articles on design,supply, restocking, hospitalwideprograms and exchange programs,and the list goes on and on. One thingthat stands out in a literature reviewof this area is that there are as manydifferent ways of approaching crashcarts as there are institutions andfacilities that have them.

As a result, customization andflexibility are key factors in the supplyof crash carts and their correspondingaccessories.

This technical bulletin will focus onthe variety of crash cart accessoriesthat are available through HCL toallow for complete site-specific designand customization of a crash cart.

ORGANIZATION,CONTROL, SECURITY &ACCOUNTABILITY

Organization should be the primaryconcern of those responsible forcreating a site-specific crash cartsystem. An organized crash cart canbe reassuring in the throes of a codesituation when time is of the essenceand lives are at stake.

As a pharmacist assuming theresponsibility for the disposition of all drugs in the institution, control,security and accountability alsobecome factors.

Factors of control, security andaccountability that pharmacy shouldintegrate into a crash cart exchangesystem are:

i. the drugs on the cart are those thatare needed

ii. assuring the crash cart is properly stocked at all times

iii. that all drug products have good dating

iv. the drugs on the cart are secure and protected from pilferage

v. replenishment is completed quicklyafter cart is used

vi. charges for drugs used are captured

vii.personnel that have accessed the cart are identified

SITE SPECIFICITY

Even though the ideal is tostandardize crash carts within theinstitution so that no matter whichcrash cart is used the medications andsupplies would always be in the samelocation, this ideal is difficult at bestto achieve.

Just as different institutions havedifferent and varying needs for thecomposition of drug products on acrash cart, differences can existthroughout the various departmentswithin the same institution.

The crash cart on the pediatric unitwill differ from that which is on ageneral med-surg unit versus thatwhich is in labor and delivery.

Again, there is a need for flexibilityand customization.

HOW TO IMPROVEORGANIZATION ANDEFFICIENCYImproving crash cart organization andefficiency can be achieved through theuse of a wide variety of accessoriesthat aid in customization andflexibility.

The remainder of this technical2

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bulletin will focus on variouscategories of accessories that can beutilized to improve organization andefficiency.

They are:

1. Crash Cart Drawers - Trays andBoxes

2. Drawer Dividers

3. Foam Inserts, Self Customizable,and Custom Cut

4. Labels, Magnets, Clings and LabelOverlays

5. Drug/Supplies Expiration I.D. Tags

6. Security Seals and Bags

7. Cart Attachments, Holders, andBrackets

1. CRASH CART DRAWER — TRAYS AND BOXES

• Crash cart boxes are available in fulland half drawer sizes with handlesthat make for easy placement andremoval. They are used to organizemedications and supplies in thedrawer. Being modular they allow foreasy removal and easy access duringa “code” situation as well as duringthe replenishing of stock. Theyprovide the pharmacy with theflexibility necessary to develop aworkable system of replenishmentand exchange.

• These crash cart boxes are sized tofit the majority of the crash cartsused in institutions today.

• See-thru lids can be added to thebox to contain and secure itscontents.

• Lids are available in both a clearplastic or amber plastic.

• The amber plastic lid meets USPspecifications for light resistanceand is used in situations where lightsensitive drugs are stocked on thecrash cart.

• Lids and boxes have security holesto accommodate security seals.

• The security seals prevent pilferage,maintain control and serve asindicators of use when seal is brokenflagging the pharmacy to replenishproducts.

2. DRAWER DIVIDERS

• To further enhance crash cartdrawer organization, plastic drawerdividers are available for shallowand deep cart boxes. The dividersare grooved so they can beinterlocked to provide a stable andsecure fit. They allow uniformity oflayout in the boxes.

• Divider sets can be measured andcut to fit any crash cart box when

customizing box layout. Cuttingtemplates as well as a retractableknife are available to facilitate thecustomization process.

• Divider sets are available in a varietyof sizes; for shallow or deep crashcart drawers; with scoredinterlocking grooves or plastic stripswith bendable clips.

• They provide a simple andeconomical means to organizedrawers, boxes or trays or otherwork area.

3. FOAM INSERTS

• Just as plastic drawer dividersenhance crash cart organization amore permanent customizationsolution can be achieved by usingfoam inserts. These inserts areavailable in both full and half crashcart box sizes.

• The foam inserts are thick foamedblue polyurethane. They can be cut to accommodate any size or shapemedication container. They areattached to the drawer, box or traywith a special two-sided tape. Securing the foam insert in thismanner prevents movement andprovides stability. If the foambecomes soiled it can easily beremoved and replaced.

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• The foam inserts can be cut tospecification in the pharmacy. Forconvenience a “Pinch & Pull” pre-scored foam grid pad is available.Customization can be achieved bysimply pulling out the removable,pre-scored 1/2” cubes until thedesired area is exposed

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• A even more convenient method forutilization of foam inserts is customcut-foam. A layout with dimensions,shapes and labeling is provided bythe pharmacy. A computer drawingof the layout is made and approvedby the pharmacy. Upon finalapproval, dies which are designedfor each shape and size, are pressedinto the foam to cleanly cut and formthe custom foam insert. Optionallabeling overlays are available sothat each foam cutout is labeled with

a description of the productintended for the cutout space. Thismethod provides the ultimate in easeand customization. The inserts cometo the pharmacy cleanly pre-cut tomeet site specific crash cart needs.Stock designed dies are available in avariety of shapes and sizes toaccommodate ampules, vials,syringes and boxes. If special shapesare needed, custom dies can bedesigned for an additional charge.

4. LABELS, MAGNETS, CLINGS, AND LABEL OVERLAYS

• Labels are an important adjunct in the layout and organization of acrash cart. Labels aid the healthpersonnel that use the cart to finditems they need quickly andefficiently in a time of great urgency.

Labels, Magnets, and Clings canbe used to:

• designate that the cart is a crashcart or emergency cart

• label the various drawers of acrash cart as to contents (i.e.,medications, sterile supplies,equipment and/or Drawer 1,Drawer 2, etc)

• classify particular sections of adrawer

• identify the particular items inthe drawer to speed handlingand minimize picking errors

• serve as an indicator as to whatneeds to be placed in a drawerduring the restocking task

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• Custom overlays are available thatcan be placed over pre-cut foaminserts used in a tray or box asdescribed above. They provide apre-labeled template that identifiesthe drug or supply item thatcorresponds with the designatedopening used to hold or secure thedrug or supply item in the box ortray. They can be a standard blackon white label or color-coded.

5. DRUG/SUPPLIES EXPIRATION I.D. TAGS

• Identification tags fit most types ofsecurity seals or fit into self adhesivepockets to quickly identify the firstdrug or supply to expire in a cart,box, drawer, etc. Two styles of tagsare available: Blank - tags arecompletely blank to print your owninformation by hand or with a laserprinter Pre-Printed - These tags are pre-printed with First Drug/Supply toExpire and a date line. They aredesigned for the nurse or pharmacistto print or write their drug or supplyinformation.

6. SECURITY SEALS AND BAGS

• For crash cart security andaccountability, plastic security seals,padlock seals and plastic securitybags are available for use. Theseitems can be integrated into aninstitutions’ crash cart exchangesystem to prevent pilferage, promoteuser accountability, indicate that acart is stocked and ready or needingto be restocked.

• The plastic security seals are one-piece self-locking units that can bepurchased sequentially numbered orun-numbered (plain). They are easyto use and have multiple lockingpositions to accommodate mostapplications. They are large enoughto permit writing of verificationinformation (e.g., date, time, initials,etc). These tamper-evident sealsallow for quick access to thecontents of a tray, box or drawer asthey can be easily broken by hand.

Once the seal is broken, it is evidentthat the unit was used and flags thepharmacy to restock. The plasticsecurity seals can be integrated intocart exchange programs in a varietyof ways to mesh with each particularinstitutions’ protocols.

• The barrel design on the HCL PullTight Seal is designed to fit into theholes in the crash cart box lids.Thiskeeps the seal tucked away so thatthe cart drawer can easily open andclose without the seal being in theway. It also allows numbers on sealsto be easily identified.

• Padlock seals are another usefuldevice used to secure crash carts orsmall emergency medication boxes.These are also self-locking seals thatresemble small padlocks and areavailable in colors and sequentiallynumbered. Integrated into a crashcart or narcotic control system theyprovide a heightened level ofsecurity and accountability.

• Crash cart security bags are plasticbags that slip over and seal crashcart boxes or trays. They secure thecontents of the box or tray andprovide a level of tamper resistance.They are easily opened during acode situation by tearing at aperforation. Once opened theyindicate usage and need forrestocking or possible pilferage.

7. CART ATTACHMENTS:OXYGEN TANK BRACKETS, AMBU BAG HOLDERS, CART IV POLES, EMERGENCY SUPPLIES DISPENSER,AND MONITOR/DEFIBRILATOR SHELF,

• Cart attachments in the form ofholders and brackets can be affixedto a crash cart to accommodatelarger items such as oxygen tanksand resuscitating devices.

They usually have adjustable strapsor velcro closures to securelytighten and hold various sizes ofbags, tanks or equipment. Integratedinto a crash cart system they allowfor a new level of emergencyequipment to be stocked on the cart.

• Often ambu bags are hung from IV poles and are not secured. TheAmbu Bag Holder offers a convenientand secure way to store your ambubag.

The IV pole provides two storagehooks for IV bags, eliminating theneed for a doctor or nurse to holdbags when they could be assisting inanother area. The pole can beadjusted to different heights.

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The bag holder can beclosed and easily sealedwith a breakaway securityseal.

• The Emergency Supplies Dispenseris designed to hold emergencysupplies such as resuscitationequipment, CPR masks, and tubingfor quick access. It can be mountedon carts, walls, counters, or anywhere supplies and equipment areneeded quickly. The dispenser canbe closed and easily sealed with abreakaway security seal.

• The Monitor/Defibrilator Cart Shelffeatures a swing arm which movesthe monitor/defibrilator withoutmoving the cart. A hook and loopclosure strap can be adjusted to fitdifferent monitors anddefibrilators. The Swing ArmMonitor/Defibrilator Shelf attachesto most carts with 4 screws. Screwsare included.

8. MOBILE STORAGE SYSTEM AND WHEELED SUPPLY CASE AS INTERMEDIATE CRASH CARTS

• Portable units can be used asintermediate type crash carts and asa second back up. Their compactsize allows them to be used for ACLSsystems in physicians offices and fortransport to remote locations.

• The Mobile Storage System is aportable storage station thattransports larger quantities ofsupplies and equipment needed bymedical workers in the field or insupply areas. Zippered pockets andpantry doors can be secured with a smallpadlock or security seal. The system

has a long metal telescoping handleand two 5" (127mm) diameter wheelsto push or pull with ease.

• The Wheeled Supply Case providesportable storage for equipment andsupplies. A telescoping aluminumhandle and two rubber wheels allowpushing or pulling with ease. Theinside of the tote has a padded clothinterior and a removable hook andloop liner with removable shelf. Theinterior and liner protect suppliesand equipment during transport. Theshelf allows equipment and suppliesto be divided for product safety ororganization. Pouches, pockets, andthe front door on the case can besecured with a small padlock orsecurity seal.

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SUMMARY• Establishing an efficient crash cartexchange program is a majorresponsibility of the pharmacy. Itneeds to be done in conjunction withthose personnel (nurses andphysicians) that will be utilizing thesystem and designed with them inmind. It needs to be well organizedand managed. All personnel involvedwith its use need to be well trainedon its proper use.

• The program needs to be wellorganized so that all elements ofcontrol, security and accountabilityare maintained to assure that anyemergency situation can be dealtwith efficiently and quickly in orderto save lives.

• This technical bulletin touched onmany of the elements of an efficientcrash cart exchange program. Itattempted to inform as to the manyorganizational and controlaccessories that are available tobuild in efficiency.

• If after reading this you have need to understand any of the itemsdiscussed above or would like topurchase them, please direct yourattention to the latest Health CareLogistics catalog or talk to one ofour informed Customer ServiceRepresentatives.

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