Dr.~ · 3.4 the contents of emergency trolleys should be checked every week and ... 4.3.1 intubation tray containing: disposable laryngoscope plus blades (size 2

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I-E Mid Western Regional Hospital Dooradoyle, Limerick, Ireland

Feidhmeannacht na Seirbhise SL:lime B~alth Scr.'ice Executive

TITLE : Layout and Contents of Emergency Trolleys (Full Text)

EDITION NO: 04

REVIEW INTERVAL: 2 Years AUTHORIZED BY:

DATE OF ISSUE:

COPY: b~

TITLE:

JJ-o.~~~ ~ ~R.~ MSrM(;r1ra FAtzgerald

Date' /0 · j-J... •• rO . ""0 'AlDirector of Nursing

_l+-\-[:_ )....p::l1-:.........::::."'---___ Date: ~ Dr.~.uin

AUTHORS:

Marie O'Hora

Ann Kenny Ryan Resuscitation Officers

LOCATION OF COPIES 18; 1C; 1D;2B;2C;2D;3A;38;3C;3D; 48; Trauma, ICU; HDU; CCU; HODU; AMAU; XRAY; Endoscopy ,Haemodialysis; SDW; Sunshine; Rainbow; Caterpillar; OPO; Pulmonary Function; CAAU; Main Theatres; Day Theatres; Eye Theatres; NPDU; ADON Office; DON Office; 58 H.E.A.RT. Unit; GUSTO; E.D. Breast Unit; Cath Lab; Cardiology Dept; Oral/Max Fac Unit;4C;ECG; Physiotherapy Dept; St Joseph's Ward, St Anne's Ward; St Patrick's Ward; Theatre MWROH; Day Ward MWROH; Physio Dept MWROH; Nursing Office MWROH;M1 ;M2;M3;Labour Ward; Antenatal Clinic; C~oscopy Clinic; Nursing Office MWRMH; Resuscitation Training Dept;

Chairperson, Resuscitation Committee

TITLE:

Resuscitation Officers, Mid-Western Regional Hospitals

RELATED DOCUMENTS Manual Handsfree and Automated External Defibrillation Policy, Management of Adult Respiratory and Cardiac Arrest.

DOCUMENT REVIEW HISTORY Review Date Reviewed/Edited By Signature


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Mid Western Regional Hospital Dooradoyle, LimerickJ Ireland

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TITLE: Layout and Contents of Emergency Trolleys (Full Text)

1. Purpose: All staff who participate in resuscitation will have access to a standardised set of equipment.

2. Applies to: Medical,Nursing and Ancillary staff who participate in resuscitation of patients.

3. Principles:

3.1 THE FOLLOWING POLICY ON THE LAYOUT AND CONTENTS OF EMERGENCY TROLLEYS HAS BEEN COMPILED BASED ON CURRENT RESEARCH AND BEST PRACTICE RESUSCITATION GUIDELINES

3.2 THE LAYOUT AND CONTENTS OF THE EMERGENCY TROLLEYS FOLLOWS THE ABCD APPROACH OF RESUSCITATION AND MUST NOT BE DEVIATED FROM IN ANY WAY

3.3 THE POLICY SHOULD BE LAMINATED AND DISPLAYED ON THE EMERGENCY TROLLEY

3.4 THE CONTENTS OF EMERGENCY TROLLEYS SHOULD BE CHECKED EVERY WEEK AND AFTER EACH EMERGENCY EVENT TO ENSURE ALL ITEMS ARE IN DATE

3.5 THE DEFIBRILLATORlMONITOR SHOULD BE CHECKED ON EACH SHIFT

3.6 THE EMERGENCY TROLLEY CONTENTS AND EQUIPMENT SHOULD BE CLEAN IN ORDER TO COMPLY WITH INFECTION CONTROL GUIDELINES

3.7 THE EMERGENCY TROLLEY SHOULD BE EASILY ACCESSIBLE, UNOBSTRUCTED AND SECURE

3.8 PLEASE ENSURE THAT A RECORD OF EMERGENCY EVENT FORM IS COMPLETED AFTER EACH EVENT AND RETURNED TO THE RESUSCITATION TRAINING DEPT.


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4. Procedure

PLEASE COMPLY WITH FOLLOWING LA YOur:

4.1 TOP OF TROLLEY

4.2 DRAWER 1 (MISCELLANEOUS DRAWER) ....

4.3 PAEDIATRIC EQUIPMENT ONLY

4.4 DRAWER 2..., 'A' FOR AIRWAY

4.5 DRAWER 3- 'B' FOR BREATHING

4.6 DRAWER 4 - 'c' FOR CIRCULATION

4.7 DRAWER 5 - '0' FOR DRUGS

4.8 DRAWER 6 - LV. FLUIDS ETC

MISC DRAWER - TO BE UTILISED ONLY IN AREAS WITH EXTRA PAEDIATRIC

EQUIPMENT


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Feidhmeannacht na Seirhhlse Sliinle Health Service Exccuti~l!

mLE: Layout and Contents of Emergency Trolleys (Full Text)

4.1 TOP OF TROLLEY

4.1.1 MONITOR AND DEFIBRILLATOR (WITH HANDS FREE CABLE ATTACHED IN MWRH ONLY)

4.1.2 TRAY CONTAINING: DEFRIBRILLATOR PADS X 1 PACK MWROHI MWRMH

4.1.3 IN MWRH ONLY: HANDSFREE MULTIFUNCTION PADS X 1 PACK (PAEDIATRIC MULTIFUNCTION PADS X 1 PACK AS A APPROPRIATE TO LOCATION) IN MWRH ONLY: OHMS TEST LOAD FOR SHIFT SYSTEM CHECK

4.1.4 LAERDAL POCKET MASK X 1

4.1.5 OROPHARYNGEAL (GUEDAL) AIRWAYS (SIZES APPROPRIATE TO ADULT AND PAEDIATRIC AREAS)

4.1.6 DISPOSABLE FACE MASK SIZE 4 AND 6 FOR ADULT REQUIREMENTS (FACE MASK SIZE 2, 4 AND 61N AREAS WITH PAEDIATRIC PATIENTS)

4.1.7 DISPOSABLE ADULT BAG VALVE MASK (BVM) SUPPLIED WITH SIZE 5 FACE MASK

4.1.8 BVM SUPPLIED WITH SIZE 3 MASK (PAEDIATRIC AREAS)

4.1.9 BVM SUPPLIED WITH SIZE 1 MASK (PAEDIATRIC AREAS)

DISPOSE OF BVM AFTER SINGLE PATIENT USE

4.1.10 OXYGEN TUBING ATIACHED TO OXYGEN CYLINDER

4.1.11 OXYGEN CYLINDER ON THE SIDE WITH OXYGEN KEY

4.1.12 CIN-BIN (6 LITRE) ATTACHED TO I.V. POLE


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4.2 DRAWER 1- MiSe DRAWER PAEDIATRIC EQUIPMENT ONLY

4.2.1 SMALL PORTEX TRACHEAL INTUBATION STYLET (SIZE 2.0)

4.2.2 SMALL MAGILL FORCEPS

4.2.3 NON-CUFFED E.T. TUBES SIZES 2.5 - 6 (ONE OF EACH)

4.2.4 CUFFED E.T. TUBES SIZES 5 - 7 (ONE OF EACH SIZE)

4.2.5 DISPOSABLE LARYNGEAL MASK AIRWAYS (L.M.A.) (Size 2.0X1 AND 2.5 X 1)

4.2.6 SMALL YANKEUR X 1 AND SUCTION CATHETERS (sizes 6 X 1, 8 X 1 and 10 Xi)

4.2.7 AYRES T-PIECE IN SEALED PACK (Paediatric Anaesthetic CircuitlMapleson F)

4.2.8 PEOI CAP END-TIDAL C02 DETECTOR Xi

4.2.9 WATER FOR INJECTION X 5 AMPOULES

4.2.10 I.V. CANNULAE 24G X 6

4.2.11 PAEDIATRIC BLOOD BOTTLES WITH APPROPRIATE NEEDLE ATTACHMENTS

4.2.12 SMALL BIO-OCCLUSIVE DRESSINGS X 3

4.2.13 BURETROL X 1

4.2.14 PAEDIATRIC INTRAOSSEOUS NEEDLES X 2

4.2.15 ELASTIC BANDS FOR SCALP VEIN INSERTION

4.2.16 IF CENTRAL VENOUS CATHETER LINE AND STITCH SET IS REQUIRED IT CAN BE OBTAINED FROM I.C.U. (M.W.R.H) AND THEATRE (M.W.R.O.H. CROOM)


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4.3 DRAWER 2 - 'A' FOR AIRWAY

4.3.1 INTUBATION TRAY CONTAINING:

DISPOSABLE LARYNGOSCOPE PLUS BLADES (SIZE 2. 3 AND 4 IN ADULT AREAS PLUS SIZE 0 AND 1 MILLER BLADE IN AREAS WITH PAEDIATRIC PATIENTS) Dispose of handle and blade after single patient use. Remove batteries from handle prior to disposal and reinsert into replacement handle

4.3.2 XYLOCAINE SPRAY 1%

4.3.3 SURGILUBE IN SINGLE SACHET X 1

4.3.4 SPARE BATTERIES X 2

4.3.5 1 INCH COTTON BANDAGE

4.3.S 10ML SYRINGE X 1- SEALED

4.3.7 20ML SYRINGE X 1 - SEALED

4.3.8 EASY CAP END~TIDAL C02 DETECTOR X 1

4.3.9 LISTER ANGLED BANDAGE SCISSORS (Also required for clipping chest hair)

4.3.10 GUM ELASTIC BOUGIE (ESCHMANN WOVEN INTRODUCER) 15eh X SOem (Dispose of after single patient use)

4.3.11 MAGILL FORCEPS X 1


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4.4 DRAWER 3 - '8' FOR BREATHING

4.4.1 E.T. TUBES: SIZE 6.5 - 8.5 AS APPLICABLE TO AREA (ONLY ONE OF EACH SIZE)

4.4.2 DISPOSABLE LARYNGEAL MASK AIRWAY (Size 3 x 1, size 4 x 1, size 5 x 1)

4.4.3 DISPOSABLE ADULT ANAESTHETIC C-CIRCUIT (MAPLESON C.CIRCUIT) IN SEALED PACK X 1

4.4.4 MARK 2 WALL FLOW-METER WITH CONNECTION NIPPLE

4.4.5 MAXI Y ANKEUR SUCTION CATHETER X 1

4.4.6 SIZE 12 SOFT SUCTION CATHETER X 1

4.4.7 SIZE 14 SOFT SUCTION CATHETER X 1

WARD 2C, A&E, I.C.U. ONLY PLEASE KEEP A SELDrNGER MINITRACHEOSTOMY SET WITH SIZE 5 - 6 ENDOTRACHEAL CUFFED TUBE)


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4.5 DRAWER 4 - 'C' FOR CIRCULATION

4.5.1 TOURNIQUET X 1

4.5.2 I.V. CANNULAE: SIZE 14G X 3, SIZE 16G X 3, 18G X 3, 20G X 3, 22G X 31N DIVIDERS

4.5.3 APPROPRIATE DUAL CONNECTION X 3 (CLAVE CONNECTOR) COMPATIBLE WITH MINIJET SYSTEMIIV FLUIDS

4.5.4 RED OBDURATORS X 4

4.5.5 UNIVERSAL GIVING SETS X 2

4.5.6 AIR INLET X 2

4.5.7 BIO-OCCLUSIVE DRESSINGS - 3 LARGE AND 3 SMALL

4.5.8 MEDI-SWABS IN DIVIDER X 20

4.5.9 A.B.G. SYRINGES X 2

4.5.10 BLOOD BOTTLES WITH APPROPRIATE NEEDLES: U & EX 1, F.B.C. X 1, B.G. X 1, GROUP & X - MATCH X 1, COAG. SCREEN X 1, FAST ANALYSIS U&E BOTILE (GREEN TOP) X 1

4.5.11 REGAL SWABS X 1 SMALL PACKET

4.5.12 BLOOD GIVING SET X 1

4.5.13 TAPE X 1 ROLL

4.5.14 BAND AIDS

4.5.1 5 BIO~HAZARD BAGS X 2


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4.6 DRAWER 5 .. ID' FOR DRUGS

4.6.1 TRAY FROM PHARMACY:

FIRST LINE DRUG TRAY

SECOND LINE DRUG TRAY

PAEDIATRIC DRUG TRAY

PRE - ECLAMPSIA TRAY (As applicable to each area)

4.6.2 DRUG ADDITIVE LABELS

4.6.3 SYRINGES - 2ML. X 5 , 10 ML. X 20 AND 20ML X 5

4.6.4 NEEDLES - GREEN X 20


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4.7 DRAWER 6 -I.V. FLUIDS, EXTRAS

4.7.1 GELFUSION ~ SOOML

4.7.2 SOLUTION 18% - 500 ML

4.7.3 RINGERS LACTATE - 500 ML

4.7.4 SODIUM CHLORIDE 0.9% - 500 ML

4.7.550% DEXTROSE 50ML X 1 VIAL

4.7.6 SALINE 0.9% 100 ML X 2 (Connect to one port of dual connector and use for flushes x

20m I following each drug administration)

4.7.7 DEXTROSE 5% 100mls.X 1

4.7.8 SODIUM BICARBONATE 8.4 % X 1 VIAL

4.7.9 SPARE LARYNGOSCOPE HANDLE AND BLADES AS APPROPRIATE TO EACH AREA

4.7.10 GIVING SET SUITABLE FOR ALL INFUSION PUMPS X 1

4.7.11 DISPOSABLE GLOVES X 1 BOX

4.7.12 GOGGLES X 6 PAIRS

4.7.13 SKINTACT W60 ELECTRODES (REPLACE WITH FRESH, IN·DATE PACK WHEN

OPENED)

4.7.14 EXTRA DEFIB PADS (IN MWROH AND MWRMH ONLY)

IN MWRH ONLY: HANDSFREE MULTIFUNCTION ADULT PADS X 1 PACK (PAEDIATRIC

MULTIFUNCTION PADS X 1 PACK AS APPROPRIATE TO LOCATION)

4.7.15 SPARE MONITOR PAPER (THERMAL GRAPH) X 1 ROLL

4.7.16 SPARE E.T. TUBES 2.5 - 8.5 AND LMAs AS APPROPRIATE TO EACH WARD - ONLY

ONE OF EACH


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Appendix

Supporting Documentation 3.1 Content Conformity to Hospital Policy. The Hospital Policy on the Layout and Contents of the Emergency Trolley has been drawn up based on the current research and best practice resuscitation guidelines. (American Heart Association, 2005) Guidelines for CPR and ECC. Dallas: American Heart Association.

3.2 Drawer and Drawer Contents Designation: The drawer designation has been devised with the ABCD approach of CPR in order to remind each person of the contents of each drawer. BLS for Healthcare Providers Manual (American Heart Association, 2005).

3.2. Overstocking: See recommendation as above.

3. 1 Display of Hospital Policy: The Policy on the layout and contents of the Emergency Trolley should be laminated and hung on the emergency trolley so that the policy is accessible and identifiable and can be easily consulted as needed. Guidance to Nurses and Midwives on the Development of Policies. Guidelines and Protocols 7.4 (An Bord Altranais, December 2005)

4.1.10 Mobile Oxygen Capacity and delivery check: The American Heart Association recommends that Health Care Providers should use supplementary

oxygen greater than 40% at a minimum flowrate of 10-12 litres per minute when available (American Heart Association 2005) . Therefore it is imperative to have an adequate supply of oxygen ready for delivery on the Emergency Trolley at all times. Oxygen Capacity Checks should be carried out once per week only, when carrying out routine emergency trolley content checks so as to avoid unnecessary wastage of oxygen. Note: When the oxygen capacity in the cylinder is at half full, please inform the Porter to have the oxygen cylinder changed. The gauges on oxygen cylinders differ through out the hospital complex. Please become familiar with the gauge in your location so as to recognize when the oxygen cylinder is at half full.

3.4 Content Expiry Dates: The expiry date of all equipment and drugs on the emergency trolley should be checked once weekly. Items which are out of date should be replaced immediately in order to comply with the manufacturer's recommendations.

3.5 Monitor/Defibrillator Readiness checks:

The manufacturer's manual recommends shift/system operational checks are completed on every shift to verify proper operationlreadiness of the defibrillator/monitor. Please inform Clinical Engineering when the amount of time remaining on the data card reaches two hours. This will allow adequate time to have the data card changed.


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3.6 Cleanliness (Free of dust, grime spills) See Mid-Western Regional Hospitals Guidelines for Cleaning and Disinfection of Equipment and the Environment (2004).

3.7 Unobstructed Access: The American Heart Association recommends that the Health Care Provider who treats cardiac arrest in hospital should use the defibrillator as soon as it is available. (American Heart Association 2005) . Therefore emergency trolleys should have unobstructed access.

3.7 Trolley Location: The location of the emergency trolley needs to be in an area of unobstructed access. See standard on unobstructed access. The emergency trolley contains medicinal products therefore the emergency trolley should be stored in a secure location and kept locked when not in use. (An Bord Altranais June 2003) Storage of medicinal products 2.11 (d) Guidance to Nurses and Midwives on Medication Management.

3.7 Drawer Locking Mechanism: The drawer and the wheel locking mechanism should be fully operational on the emergency trolley _See recommendation on unobstructed access and trolley location standard above.

3.7 Wheel Lockina Mechanism: See unobstructed access recommendation as above.


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Bibliography:

American Heart Association, (2005) . ACLS Provider Manual. Dallas: American Heart Association.

American Heart Association, (2005). Guidelines for CPR and ECC. Dallas: American Heart Association.

American Heart Association (2005) BLS for Healthcare Providers Manual Dallas: American Heart Association

An Bord Altranais, (2005) Guidance to Nurses and Midwives on the Development of Policies. Guidelines and Protocols. Dublin: An Bord Altranais.

An Bord Altranais, (2003) Guidance to Nurses and Midwives on Medication Management. Dublin: An Bord Altranais.

Mid-Western Regional Hospitals Guidelines for Cleaning and Disinfection of Equipment and the Environment (2004).

Documents

Dr.~ · 3.4 the contents of emergency trolleys should be checked every week and ... 4.3.1 intubation tray containing: disposable laryngoscope plus blades (size 2