Hospital pharmacists, nurses, and emergency physicians know all about crash carts and operating room carts — those rolling cabinets that transport medication trays, kits, and equipment for emergency and anesthesia use. But as a hospital leader, how much do you really know about them?
Here are 10 important items you might not know about the crash carts that your clinical teams — and patients — rely on daily:
1. They're audit magnets
Several medication safety shortfalls can render your facility more likely to be audited by the Joint Commission — and several of them can be linked to emergency crash carts.
Expired medications, recalled medications, out of compliance lots, and a lack of documentation regarding the movement and use of the medications in crash carts are all factors that can lead to an unexpected audit possibly resulting in costly fines or citations. There are new systems, such as TraySafe, that can automate this process and document compliance, which protects your hospital from audit risk.
2. Piles of paperwork
Properly stocking, locating, managing, and tracking crash carts involves considerable paperwork. Many facilities verify crash cart contents via paper checklists and attach lists to the cart to verify the movement of their contents. Manual documentation for crash cart activities represents a significant logistical burden for busy providers, nurses and pharmacy staff.
3. Many trays, many flavors
In a busy hospital, there may be as many as 30 different tray configurations, with combinations of up to 150 different drugs — yet there are no universal standards for tray or cart configurations.
In the absence of automation, the appropriate configurations must be prepared and checked manually for each specified cart combination. A patient centered approach to care demands that crash cart layouts are exactly what the clinician expects to see in an emergency situation — verifying tray configurations cannot be rushed. Accuracy is essential.
Technicians and pharmacists are spending considerable time checking cart configurations by hand, which isn't the most optimal use of hospital resources.
4. Same look, different drug
Two vials containing two different drugs can look identical at a glance. In an emergency situation, time is of the essence. Similar vials that aren't properly labeled can delay crucial interventions.
When crash carts are manually stocked, human error is unavoidable. Medications can be placed in the wrong slot, or worse, not be present in the tray at all. Does your facility use industry standard barcode labelling on crash cart drugs?
5. Stocking isn't easy
It takes significant time and effort to restock a crash cart. Even if only a few items in the cart are used, in the absence of automation, restocking it properly requires considerable time and attention to detail. The reconciliation of medications in a crash cart can take 15 to 30 minutes or more. Hospitals are increasingly exploring the use of automated options to increase accuracy and reduce demands on technician and pharmacists' valuable time.
6. Cross-department coordination
In many facilities, multiple departments must coordinate in order to ensure proper restocking of medication trays and kits within crash carts. Typically, the central supply and pharmacy departments must work together to make sure the correct medications are transported from stock to the patient unit in a timely manner. In the operating room a crash cart is typically replenished and managed by skilled individuals from the pharmacy department. With multiple departments coordinating with each other to produce a fully and accurately stocked crash cart, a central medication tracking system can do wonders for operational efficiency in your hospital.
7. They go missing
Due to a recent use, sometimes crash carts simply aren't where they need to be, when they need to be there. Instead, they are being restocked, cleaned or having their contents verified. In an emergency situation, such delays can cause an urgent patient safety crisis. Most places have a swap system...it needs to say in a busy hospital several carts may be in the replenishment process causing delays....
8. They change hands — a lot
Between central supply staff, pharmacy technicians, pharmacists, nurses, emergency physicians, and environmental services personnel, a crash cart can change hands several times in a single rotation. In the absence of a streamlined, centralized tracking system, each touch point offers an opportunity for an item to be used, moved, replaced, or even misplaced creating an opportunity for errors or delays in care to occur.
9. They weren't designed by medical professionals
Crash carts have been used by emergency clinicians in some form since at least the 1970s. Although the configuration of carts for emergency medical use was pioneered by a surgical resident in 1965, the cart design itself was actually invented by automotive mechanics. These mobile, shelved containers were re-adapted for medical use. As a result, the crash cart user experience continues to be ergonomically strenuous for many users.
10. They're inventory eaters
Between keeping crash carts stocked for emergency use, maintaining safety stock and backup stock, crash carts can house a lot of inventory that might otherwise be kept in the pharmacy or central supply. They make it more difficult for pharmacy managers, procurement personnel, and other staff to accurately keep track of inventory. Without a centralized medication inventory tracking system, crash carts can be the root cause of labor inefficiencies, medications error, drug wastage and drug shortages.
Joe Constantin received a BS in Pharmacy from the University of Pittsburgh School of Pharmacy. He has over 17 years of experience in healthcare technology and automation. Joe is currently Vice President of sales at Aethon where he concentrates his efforts on improving pharmacy logistics. He works with hospital pharmacies interested in medication tracking and automation including the automation of the tray replenishment process using Aethon's newest product, MedEx TraySafe.
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