The trusted source for
healthcare information and
Are you ready for an emergency? Don't get caught unprepared
Equipment, supplies often unavailable in life-threatening emergencySupplies that were the incorrect size. Missing items. Empty oxygen tanks. Drained batteries on equipment. Unstocked or unlocked crash carts.
These actual incidents were reported to the Pennsylvania Patient Safety Authority, which recently released a data review of 2008 reported safety events.1
"Emergency equipment and supplies often are not readily available when a patient experiences a life-threatening emergency," the authority said.
The authority identified 56 reports related to emergency equipment. Thirty-five dealt with emergency carts, and 21 dealt with missing supplies or malfunctioning equipment during an emergency. The issue of having rapid access to these items is common, says Franchesca J. Charney, RN, MSHA, CPHRM, CPHQ, CPSO, FASHRM, director of educational programs at the Pennsylvania Patient Safety Authority in Harrisburg. The reports come from hospitals, ambulatory surgery facilities, birthing centers, and certain abortion facilities. PA nursing homes report health care-associated infections only.
"The practice that I have seen used most successfullyis daily assignment of this duty to staff personnel," Charney says. "This assignment will become part of the daily duties of the assigned individual and therefore help to ensure functioning equipment and up-to-date supplies."
Chris Lavanchy, engineering director of the Health Devices Group at ECRI Institute, which helped conduct the data review, says, "When there's an emergency, afterward you have to replace supplies. You also have to make sure they're within the expiration date."
Clinical staff might find this is a lower priority and somewhat of a monotonous task, Lavanchy warns. "If you did it every day, and you don't find something specifically with an expired expiration date, you may become complacent," he says. To avoid that situation, have oversight, Lavanchy advises. For example, an administrator periodically can check inventory to make sure it's being kept up to date, he says. Also, periodically rotating this staff responsibility offers others the opportunity to learn, and fresh eyes might see more, experts say.
Consider these additional preparedness strategies:
Convene a team to evaluate the needs of the unit/facility.
Who is on this team depends on your population and facility type, according to Charney. "However, you most certainly need the care providers who would respond to the emergency situation," she adds.
Select appropriate equipment and supplies (e.g., automated external defibrillators).
"You want to again focus on the population you serve, but most importantly you need to re-establish the airway and circulation," Charney says. "You would then want to choose the appropriate equipment for your population and clinical staff skill level intubation equipment/ventilator versus oral airways/ambu bag."
For the crash cart, many facilities use a standardized checklist, the authority said. (A sample checklist is available.) Miami Children's Hospital used Microsoft's SharePoint software to develop a Web-based crash cart tracking system. The system sends nurse managers three notifications daily, beginning at noon, of which carts have not been checked, according to the authority. Monthly cart checks alert staff to any item near expiration, it said.
To avoid shortages of supplies and equipment, The Joint Commission recommends facilities use a continual process to manage its inventory, the authority said. The Accreditation Association for Ambulatory Health Care (AAAHC) requires adequate equipment, supplies, and medications be available as part of providing a safe environment for delivering care in ambulatory surgery centers (ASCs).
Jack Egnatinsky, MD, a surveyor, new surveyor faculty, and a medical director of AAAHC from Christiansted, U.S. Virgin Islands, says, "With
the current shortages of many drugs and medications used in ASCs, our surveyors generally do ask about how the organization is handling this in their organization."
Train and educate staff.
Document your training, and periodically retrain your staff, the patient safety authority advised.
Consider your population, Charney advises. For example, if you serve pediatrics, your staff should be certified in pediatric advanced life support (PALS). If you serve an adult population, you may have advanced cardiac life support (ACLS) certification. Be sure to include your anesthesia providers in such certification, as well as training, since they often "lead" the response to the code, experts advise.
Also consider training on emergency supplies, Charney says. "This training within the environment where the emergency situation may occur is very helpful to staff in terms of education of where supplies are, what equipment needs to be moved in or out of the room, etc.," she says.
Standardizing drug and crash carts, so the same items are in the same drawers in the same order where possible, cuts down on confusion and saves time, experts advises.
Also consider training on how to activate an automated external defibrillator (AED), Charney says. "This may be a suggestion for facilities/ locations where defibrillators are infrequently used or in an area where staff do not have rhythm recognition skills and would not be able to use a manual defibrillator," Charney says. "Some of my peers have noted acute care facilities' transformation to AEDs [automated external defibrillators] in public areas and areas where clinical staff is not familiar with manual defibrillators."
The patient authority strongly encouraged staff education any time new equipment is brought into the clinical area, she says. "This education may be done by the manufacture or an educator and may include troubleshooting of the equipment as well," Charney says.
Make sure equipment is maintained so it can be used when needed, Lavanchy emphasizes. For example, follow manufacturer instructions for checking defibrillators, he says.
Maintain a state of readiness (e.g., through mock drills).
"I really like mock drills," Charney says. "You learn so much. The team learns, and issues are addressed immediately so when it is not a mock drill the team reacts in a more predictable response.
Mock drills can help identify problems with protocols or equipment, the authority said. All staff on all shifts should participate in at least one annual mock drill, the authority says, but consider holding such drills at least twice a year.
Holding a mock drill for malignant hyperthermia allows staff to experience how to mix drugs correctly, experts point out.
For drills and code responses, have a "recorder" who writes down times actions are taken and which drugs were administered, experts advise. Such recordings help with reviews, they say.
Charney says, "Hold unannounced mock drills, tape the drill, and then have the team review the drill and answer the questions: one, what did we do well, and two, what do we have the opportunity to improve."
How to establish a written plan
Avoiding problems during an emergency
What's the most important facet of addressing emergencies?
"I think the key issue here is dealing with emergencies, you really need to have protocols in place in advance that you've covered," says Chris Lavanchy, engineering director of the Health Devices Group at ECRI Institute. "That's a fundamental tenet of dealing with emergencies effectively." ECRI Institute helped conduct a review of 2008 safety events reported to the Pennsylvania Patient Safety Authority.1
The Joint Commission and the Accreditation Association for Ambulatory Health Care (AAAHC) require a written plan for emergencies. In developing a written plan, ask these questions, the patient safety authority suggested:
According to the authority, the written plan should include the following: clinical protocols and details on where and how the emergency care should be delivered. "Protocols should account for the emergency skills of each employee and the assignment of each employee to specific responsibilities," the authority said.
At a minimum, a written plan addresses equipment, supplies, medications, ordering and maintenance, emergency protocols, training and competency of staff, emergency drills, and assignment of responsibility for continued oversight of the process, according to the authority, quoting as its source MAG Mutual Insurance Co.
Designate a location for emergency care and for storing emergency equipment, the authority advises. If your layout makes this step difficult, you can make the emergency portable, such as on a rolling cart, and store in a common location.
According to the authority, components to consider for a written plan include:
Evaluate Ability to Manage Emergency
9 areas to evaluate