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When it comes to supplying the code team with medications and equipment for cardiac arrest, William Salkin, CPhT, leaves nothing to chance.
Created three years ago by the standing CPR committee, the code team is a multidisciplinary emergency approach based on BWH data as well as national research on successful resuscitation efforts.
In an effort to speed BWH response time when seconds are critical, the committee recognized the pivotal role that code carts play. Each patient floor has a cart and formerly, anytime a staff member used an item from the cart, they would replace the item used. “Many hands were involved,” said Salkin. “Despite our best intentions, responders would go to codes and find cart supplies in a different section in the cart on one floor than they would on another. So the idea was to simplify, standardize and maintain the supplies,” he explained.
Salkin oversees 151 code carts that are found within the hospital, as well as 12 emergency kits for off-site locations. “In 2003, we opened and exchanged 1,497 carts,” he added. BWH carries three different types of carts, each specific to adult, neonatal and pediatric patients. In Salkin’s hands, cart organization has become a science – with each one featuring a photo and schematic layout so that team members can immediately find items in their exact locations. Carts also include resource information on code response and drug preparation and administration.
In addition to making the carts user friendly, Salkin ensures no gaps in cart coverage. After one has been opened for a code, the transportation staff immediately replaces it with a restocked cart, ready for the next code. “The Pharmacy has a dedicated Code Cart Room furnished exclusively with code cart supplies, so that when carts are replenished, only the appropriate contents go into them,” Salkin added. And, to maintain medication efficacy, he closely tracks expiration dates by reviewing every cart in the system twice per year.
The cart also contains forms for the important task of recording detailed, timely data on every event. Incident reports have become increasingly important to the code effort, enabling the CPR Committee to analyze what went well and what future improvements need to be made. BWH is also a participating member of The American Heart Association’s National Registry of Cardio-Pulmonary Resuscitation (NRCPR) that reports on national code response trends based on data collected from hospitals around the U.S.
Salkin said that staff members have responded positively to the code cart improvements. “They love this system because they don’t have to worry about the cart. It’s as prepared to save lives as they are,” he said.