Crash Cart Checks Part 1: Making A Plan

Crash carts are designed to help responders save lives. When all the equipment needed to manage an emergency is within arm’s reach, responders are free to focus on the task at hand: resuscitating the patient as quickly and effectively as possible. But if not maintained properly, crash carts can have the opposite effect. Common issues like missing items or malfunctioning equipment can lead to a delay in care when responders (and patients) can least afford it: during a life-threatening, no-time-to-spare emergency.

Of course, hospitals have processes to prevent these kinds of issues from interfering with the code — known as crash cart checks. But the reality is that even with a system in place, routine cart checks and maintenance are far from error-proof at most hospitals today.

That’s why we created a 2-part series all about crash cart checks: why they matter, how to create a plan for crash cart maintenance, and tips for reducing risk.

In our first installment, we cover the basics your hospital needs to set itself up for success. Keep reading to learn more about creating awareness among staff, determining what types of cart maintenance will be performed and how often, and having a written plan.

Create awareness

It’s not difficult for clinicians to grasp the importance of crash cart checks. Without them, responders would be left scrambling for necessary supplies in the middle of a high-stakes emergency. But given that crash carts continue to be a common source of preventable risk at many hospitals today, it’s worth taking a closer look at the data and regularly reminding staff just how essential crash cart checks are for regulatory compliance, patient safety, and optimal outcomes.

From a safety standpoint

• Studies show that a 1-minute delay in an emergency situation due to difficulty accessing crash cart supplies is associated with an approximately 10% decrease in resuscitation success rates.¹
• A study performed by the Pennsylvania Patient Safety Authority in 2008 — and subsequently cited in a report by The Joint Commission (TJC) — found that many hospital crash carts contain hidden issues that could impact patient safety. Common problems included: medication errors and mix-ups, missing or expired equipment, and carts not checked or inspected according to policy and procedure.²
• As the last point suggests, hospitals often struggle to implement crash cart safety measures effectively. In one study performed at a large UK teaching hospital, one ward only completed daily cart checks 35% of the time during a month in which there were 2 cardiac arrests — leaving patients and staff vulnerable in an emergency.³

From a regulatory standpoint

• Crash carts are a common compliance risk and often lead to findings by regulatory bodies.
• In 2022, TJC surveyors ranked missing or expired crash cart items as one of the top 5 most common clinical problems not associated with infection control or suicide prevention.

At your own hospital

Lastly, the most compelling evidence — and the kind most likely to stick with staff members — can often come from your own hospital. If you’re not already, start collecting and sharing hospital-specific data on crash cart safety at cold debriefs or other regular staff meetings. Staff might be surprised to learn what’s happening at their own facility — and more motivated to ensure crash cart safety is treated as a priority, not an afterthought to other clinical tasks.

Determine cart check types & frequency

Two of the most important questions hospitals must determine are: What should be included in the cart check, and how often should they be performed? Ultimately, these requirements are up to each hospital and will depend on its specific needs and supporting crash cart inventory management technology. But at many hospitals, a crash cart maintenance plan might look like this:

• Daily checks of the equipment on top of/outside the cart (defibrillator, oxygen tank pressure, etc.)
• Monthly expiration checks for medications, defibrillation pads, and other supplies.
• As needed inventory checks of cart contents. These checks typically occur after a specific event, such as a Code Blue or cart tampering incident, when medications and supplies need to be fully accounted for and restocked.

This general plan can — and should — be customized depending on the hospital. For example, some hospitals choose to increase the frequency of checks, opting for twice-daily (not once daily) checks of the equipment on top of/outside the cart. They might also add a routine inventory check monthly, in addition to the “as needed” inventory checks that occur after specific events.

Consider factors like the frequency of codes at your hospital, staffing resources, and what types of crash cart issues are most common when determining the right setup for your hospital.

Have a written plan

Once you have effectively communicated the “why” behind your hospital’s crash cart check policy and determined the right types of checks and frequency, the next step is to put the plan in writing.

Why is a written plan important?

Having a written plan is required for compliance at TJC-accredited hospitals. But beyond the regulatory requirements, it’s essential at any hospital to ensure action, clarity, and accountability. Without a plan in place — and with all the other pressing demands on clinicians’ time — crash cart maintenance is likely to fall by the wayside and happen inconsistently, incorrectly, or both.

What should the written plan cover?

Make sure your hospital’s plan outlines the following:

• Frequency of cart checks and staff responsible
• Policy for checking expired supplies and medications
• Policy for restocking supplies and medications as needed
• Policy for maintaining and testing equipment based on manufacturer instructions for use
• How staff will be trained to carry out cart maintenance procedures per protocols
• Any other information needed at your hospital