How To Prepare Crash Carts For A Regulatory Survey

Expired medications, missing supplies, drained batteries: While most clinicians are familiar with these common crash cart issues, they might be surprised to learn just how pervasive and persistent the problem of crash cart safety really is.

It’s pervasive enough that despite the daily, weekly, and monthly checks required, crash carts are frequently a weak area during regulatory reviews — and often lead to a finding. Case in point: As of 2022, surveyors from The Joint Commission (TJC) are still reporting that missing or expired items on crash carts are a top clinical problem for hospitals to address.

So what can hospitals do to prepare crash carts for a regulatory survey and improve compliance? In this article, we’ll cover 3 key areas to focus on: defibrillators, cart readiness and security, and staff preparation. Following these tips will not only help your hospital pass inspections and maintain compliance, but — most importantly — ensure crash carts are always ready in an emergency.

1. Check defibrillators

When it comes to crash cart equipment, defibrillators can be a common weakness during regulatory reviews. To avoid any findings, your hospital will want to ensure that:

• Defibrillators are plugged into a continuous power source.
• Annual preventative maintenance (PM) is completed, and tags are clearly visible.
• Daily, weekly, and monthly PM checks are performed according to the Instructions For Use (IFU) and are documented in a standardized fashion — without missed dates.
• Regular audits of this data are maintained in a centralized location.
• Staff members can speak to how the defibrillator checks are done (manual or automatic?), and their reports do not conflict with each other.

2. Ensure crash cart readiness & security

Surveyors want to see that crash carts are organized, stocked, and secured to ensure clinicians have access to everything they need in an emergency. To prepare crash carts for a regulatory survey, make sure that:

• Crash cart contents are organized and free of mess.
• Carts are secured. If a cart was opened, it was documented, re-checked, and re-secured.
• Medications and other items are not expired. Items should be sealed, and expiration dates clearly marked.

It is also important not to neglect the items on top of the crash cart. This means:

• Telemetry and/or electrocardiogram tabs are dated if opened (and disposed of if opened and past due). Be sure to follow the IFU for each item, as some might have different time frames for expiration after opening: 7 days, 10 days, etc.
• Automated external defibrillator pads are not expired. For easy use, they should also be attached to or stored close to the defibrillator.

3. Prepare staff members

How to prepare crash carts for a regulatory survey goes beyond the cart contents themselves. It’s also about ensuring staff members are knowledgeable about crash cart storage, contents, and policies. Prior to a regulatory visit, make sure of the following:

• Staff know the location of all crash carts/emergency equipment in the area.
• They are well-versed in the policies related to crash carts, cart checks, and emergency equipment and storage. Leadership staff should also be able to speak to the audits performed to confirm compliance with this policy.
• Staff members can comfortably walk a surveyor through a code cart check/documentation process. This goes for all staff, so think about clinicians who might be less comfortable performing this job (e.g., newer staff members who are less familiar with the policies), and make sure they are equally prepared.

It can also be helpful to run “mock surveys” to give staff the opportunity to practice what they would be required to do during an actual regulatory visit. Not only will this give clinicians the chance to become comfortable with the process, but it can help hospitals proactively identify and address any gaps.

The bottom line

Don’t overlook crash carts when it comes to preparing for a regulatory survey. Crash carts are an important part of compliance — and a common weak spot for many hospitals. The better prepared your hospital’s carts are for a regulatory survey, the greater likelihood of a successful inspection. Plus, it will give your hospital peace of mind that crash carts and emergency equipment are in a constant state of readiness in the event of an actual emergency.