Crash carts must be locked; beware of delays involved

Question: I understand that the Joint Commission on Accreditation of Healthcare Organizations requires that crash carts be locked when not in use during an emergency, but how must they be locked? It seems that some obvious solutions wouldn’t be practical because they might delay access to the crash cart. Is it OK to just use some sort of safety seal that reveals tampering?

Answer: The Joint Commission does require that crash carts be locked when not in use, but the accrediting body also acknowledges that a typical lock could delay access in an emergency. Other types of locks can suffice, according to Joint Commission spokeswoman Charlene Hill. For more information, she directs Healthcare Risk Management readers to the Joint Commission’s web site at www.jcaho.org, where you will find the following information.

In short, the Joint Commission has recently changed its attitude about how to lock crash carts, allowing breakaway plastic locks that many providers have found are the easiest way to secure the carts. Standard TX.3.5.5 requires that any emergency medication, including those kept on crash carts, be made "secure" between emergencies. Though providers always should strive to keep dangerous medications locked away, the standard actually is intended to ensure that lifesaving medications are on the crash cart whenever it is needed. The standard is directed at crash carts ready for emergency use; the Joint Commission specifically states that it is not concerned about the security of used crash carts on their way to the pharmacy for medication refills, as long as that crash cart is considered out of commission and not to be used for emergencies until refilled. As soon as it is refilled, it must be secured. All schedule II drugs (narcotics) must be secured under lock and key, so if you have narcotics on your crash cart, that obligates you to use a lock and key. But the Joint Commission advises against keeping narcotics on the crash cart, partly for that reason.

The Joint Commission specifies that the cart can be secured by using at least one of three methods:

  • Use a breakaway plastic lock or a heat-sealed plastic wrap. The Joint Commission had previously said those methods were not acceptable, but the interpretation was changed in 2002 to state clearly that these methods may be used.
  • Store the crash cart in a locked room.
  • Store the crash cart in an area that is under constant surveillance or supervision, such as behind the nursing station.

In addition to ensuring that the crash cart medications have not been tampered with, the breakaway plastic locks or plastic wrap can be used to indicate that the contents are not past their expiration date. If a seal is used and the expiration date is noted, the Joint Commission does not require you to check the contents of the cart until that seal is broken or the marked expiration date is reached. Some providers use a system in which they use different color breakaway locks, such as one to indicate the crash cart is complete and ready to use, and another to indicate that it is in need of restocking. The Joint Commission approves such systems.