Standardized Code Environments

[typical]

Hello There,

I've noticed of late that my current hospital doesn't have a standard operating procedure for where the code cart goes and who has access to it during a code. Instead, I notice during codes that everyone in the room seems to have their hands in the drawers (gloved hands!).

My previous hospital had very strict rules about the code cart...and strong rationales for those rules:

Cart was parked outside of room (keep space around bed clear, gives med nurse or pharm space and noise reduction to calculate and draw meds)

Defibrillator placed on end of bed (keep environment free of wires that staff can walk into or trip on, reduce risk of leads being pulled off patient or risk of defibrillator falling on floor)

A person or persons not touching the patient passed off meds and equipment to a nurse pushing meds or doing procedures (reduce risk of contaminating inside of code cart and it's contents with bodily fluids)

Everyone I talk to in my hospital seems to have a different idea of how a code should be set up. So we're going to develop a team to work on standardizing the environment.

Does anyone out there work someplace where there is a standard in place??

I'd love to hear what your hospital is doing if you feel like it is effective and works.

Thanks!

[Rose_Queen, BSN, MSN, RN]

We have spare crash carts kept in pharmacy. When a cart is used (and it's right in there next to the patient, isolation or not), the whole thing is taken to pharmacy where it is cleaned and restocked and becomes the spare crash cart while the fully stocked one is taken to the floor. Frequently, the only drawer opened is the med drawer because a lot of patients who code are either already intubated, or anesthesia was called for a stat intubation and have their own supplies there.

[calmrn]

We call pharmacy as soon as we all done with codes. They come to our unit to take crash cart and restock, lock, and bring back to the unit.

[typical]

Do you know if they turn over ALL of the stock inside the drawers accessed?

[BrnEyedGirl, BSN, MSN, RN, APRN]

Our code carts get pulled right to the bed side! The pt is charged for the entire code cart and the entire cart goes to be cleaned et restocked. The cart is sent back with a pt sticker, they leave us a new one and replenish the old one.

[typical]

Thanks so much! That seems like the right thing to do from an infection control standpoint.

We recently had a whole debacle around supply drawers in patient rooms....the end result was that the infection control department told us they had to go. I feel like it's the same rationale with code carts. If you're touching the contents with gloved hands, everything inside needs to be turned over for the next patient. Since my hospital thought that wasn't a cost savvy practice, they just said get rid of the drawers all together. Why should there be a different standard for the code cart? If anything, hands inside the code cart are 100x more contaminated with the nasties than plain old gloved hands on a medical floor doing day to day patient care!

[NICU Guy, BSN, RN]

The previous hospital I worked at, the code cart remained outside the room. The med drawer had a removable tray. Once the code was done, pharmacy (pharmacist attends all codes) took the med tray with all the remaining meds and replaced it with a full stocked tray (it had a plexiglass top that had a security tag attached). That way the med drawer is reset as soon as soon the code is done.