Quality Improvement Project on Crash Cart Management with numbered seal

Jesvin George

Quality Nurse, Department of Nursing, Kauvery Hospital, Electronic City, Bangalore

*Correspondence: Tel: +91 80950 15040; Email: qualitynursing.ecb@kauvery.in

Background

The aim of this quality improvement project is to reduce the risk of unavailability and expiry of items in the crash cart with minimum check and maximum output.

Period of study

1st October 2022 to 31 January 2023 (4 Months)

Area of study

Emergency Department, Kauvery Hospital, Electronic City

Inclusion Criteria

Crash cart of Emergency Department

Exclusion criteria

Crash cart in other Departments

About the process to reduce the risk

Crash cart should be sealed until opened with a reason

Crash carts will be opened only during:

A crash
Expiry and Count checking

Crash carts will be closed:

Within 30 minutes after settling/ shifting the patient
If opened for checking, immediately after completion of the check (the person cannot take/ allocate any other task during the check)
Near Expiry Drugs has to be replaced (3 months prior to the Date of Expiry)
Quality & Expiry check has to be done and documented by allocated nurse fortnightly
All the process has to be supervised by incharge/ team lead
Overall responsibility of the process and the policy is with crash cart champion

About seal

Single use
Accountability
Easy to open
Easy to lock

Pre-implementation Scenario

1st October 2022 to 30th November 2022 (2 Months Pre-implementation)
Before the introduction of new process, the crash cart was locked with key and the key was tied with tie on the right-hand side of the cart. Checking was done in each shift, and documented. The cart lock has no count of opening and closing, even though most of the time cart has compliance as per the list but sometimes it was not.
Audit conducted 30 times and it was found that 24 times the compliance was adhered to and the rest times it was not compliant as per the list.

Snapshots of Pre-implementation process analysis

Pre-implementation Process flow

Post implementation

1st December 2022 to 31st January 2023 (2 months post-implementation)

After the implementation of control numbered tag for crash cart the check was reduced to a crash and Expiry checking. Each shift the staff only need to check the tag is intact and the things kept outside the cart. Post implementation audit conducted for 30 times and it was compliant all the time.

Snapshots of Post-implementation process analysis

Post-implementation Process Flow

Analysis of Old process V/s New process

Process	Process Average Man Hour in minutes
Process	Pre	Post
Each shift check (For one shift)	16 min	2.5 min
Expiry and Count checking	26 min	26 min

Analysis of Process Pre V/s Post at the period of study.

Period of study	Number of check	Number of Expiry and Count check	Average Man Hour in minutes Packing
Period of study	Number of check	Number of Expiry and Count check	Each shift and after crash	Expiry and Count check
October 2022	105	2	1680	52
November 2022	99	2	1584	52
December 2022	103	2	257.5	52
January 2023	106	2	265	52

Audit and analysis of the process

Period of study	Number of times audited	Complied		Not complied
Period of study	Number of times audited	In numbers	In Percentage	In numbers	In Percentage
October 2022	15	13	87	2	13
November 2022	15	11	74	4	26
December 2022	15	15	100	0	0
Januvary 2023	15	15	100	0	0

Benefits

Reduced the risk incompleteness
Time taken for each shift check reduced from 16 minutes to 2.5 minutes
Accountability increased

Recommendation/ Way forward

The same can be replicated to all crash carts of the hospital.

Mr. Jesvin George

Quality Nurse