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-analysis

Pre-implementation Process flow

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

Pre-implementation-process-analysis-1
crash-eart-seal

Post-implementation Process Flow

ka-6

Analysis of Old process V/s New process

Process  Process Average Man Hour in minutes
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
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
number-of-cart-checks
number-of-expiry-count-check
average-man-hour-in-minutes
average-man-hour-in-minutes-1

Audit and analysis of the process

Period of study Number of times audited Complied Not complied
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
compliance-analysis
process-deviation

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

Mr. Jesvin George

Quality Nurse

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