A Joint Commission survey earlier this year revealed a unit at Miami Children's Hospital had missed checking its crash cart for a day. While the hospital had been meeting the Joint Commission's 90% compliance for checking the carts, staff took the oversight as a wakeup call and decided to update the pediatric facility's cart checking and cart systems, says Jackie Gonzalez, ARNP, MSN, NEA-BC, FAAN, senior vice president, chief nursing officer and patient safety officer, Miami Children's.
In May 2008, Miami Children's introduced a hospital-wide revamp of the crash cart system, including the purchase of Broselow-Luten Color Coding Kids color-coded carts and tapes, as well as the launch of a Web-enabled system for cart checking.
Web-based crash cart check
Nikole Sanchez-Rubiere, RN, BSN, MBA, director of nursing operations at Miami Children's, honed Microsoft's SharePoint software to enable hospital charge-capable RNs and LPNs to check the status of the hospital's crash carts at any given point.
"The system is a tracking system so that on any given day, we'll know hospital-wide who have checked their crash carts, versus me having to physically walk to those locations," Sanchez-Rubiere says. "Before, we had an actual [paper] log on each crash cart."
With the new system, monthly cart checks alert staff to anything near expiration, prompting the appropriate departments to change the medicines and supplies. The system sends Sanchez-Rubiere three notifications daily, beginning at noon, of which carts have and have not been checked. By 7 p.m., "we know, as a hospital, that we're 100% compliant in checking the crash carts," she says.
In May 2008 (the first full month with the new Web-based process), Miami Children's was 99.8% compliant with checking crash carts.
Since it's a Web-based system, nurses can go to any computer in the hospital to access the information. The high-tech process is easier on nurses, says Miami Children's ER charge nurse Benjamin Levy, RN. He explains that the drop-down menus on the computer are less confusing than lined items on paper.
"It was hard to tell who checked what, when. And the online check is more thorough, so you're really assured that all these things were checked," Levy says. "For the nurse, it ensures that you're getting accurate information, and, for the patients, it ensures that the equipment that they might need in a cardiac or respiratory arrest situation will be there."
Colors replace calculations
The hospital's new crash carts and tapes, based on The Broselow-Luten System, save nurses time and eliminate the need to make calculations during life-and-death emergencies, Levy says. "Most of our nurses, especially the charge nurses, actually carry around the Broselow tape," he says.
The Broselow Pediatric Emergency Tape is divided into color-coded segments that estimate a child's weight based on length. The tape provides corresponding doses of emergency medications; sizes of commonly used equipment, including endotracheal and nasogastric tubes; and IV fluid volumes.
Nurses use the new color-coded carts in conjunction with the tapes, opening the drawers that correspond to the colors indicated on the tapes. For example, if the tape indicates a patient is in the white category, the nurse would find everything he or she needs (sized and dosed for the specific patient) in the crash cart's white drawer.
"This system definitely cuts down on the amount of time between physician order and implementation of the procedure," Levy says.
While the system is too new to have proved it cuts down on medication errors during codes, Levy says nurses who are in tense situations with patients who are decompensating or crashing often have to calculate pediatric medicine doses when doctors give the orders. There is no need for those calculations with the color-coded system.
Simplifying the otherwise complex processes for nurses in children's hospitals instills confidence and should improve outcomes, says Gonzalez.
Lisette Hilton is a freelance writer.
