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Emergency Kits - Crash carts in ambulatory care clinics

  • 1.  Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-14-2023 13:15

    Hi what do you use in your clinics as "crash cart" type of response kits? 

    Are there any services out there that manage/maintain the kits and replace expired meds like epi/narcan? 

    Does anyone have a good policy they can share as well? kurquhart@covenantcommunitycare.org 

    Ours needs a major overhaul in our clinics! Thanks!! 

    Keri Urquhart, MPH, BSN, RN
    Director of Nursing
    Covenant Community Care



    ------------------------------
    Keri Urquhart MPH BSN RN
    Covenant Community Care- FQHC
    Clinton Twp MI
    (586)215-3448
    kurquhart@covenantcommunitycare.org
    ------------------------------


  • 2.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-14-2023 15:49

    All of our clinics have IM Epi in them but that would be the only emergency drug we keep on hand.  Our rural health clinics have to keep certain things just to maintain their rural health status.  We do have ambu bags in all clinics of course and AEDs. 



    ------------------------------
    Ryan Taylor MSN, RN, CPN, NE-BC
    Director of Medical Practice Management
    Memorial Hospital and Health Care Center
    Jasper, Indiana
    812-996-8489
    ------------------------------

    Original Message


  • 3.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-15-2023 08:55
      |   view attached

    Good morning! 

    Our ambulatory clinics carry a "jump-kit" with basic BLS medications and supplies. We have a policy that lists what is needed, etc. The supplies can be customized based on specialty; however, the decision comes to me if there is a customization request. Staff and managers are responsible to maintaining the kits. Hope this helps! Please let me know if you have any questions. 



    ------------------------------
    [Tammy] [Soles] [MSN, RN, CNL]
    [Director of Clinical Care & Staff Development]
    [Northeast Georgia Physicians Group]
    [Gainesville] [GA]
    [770-219-9165]
    ------------------------------

    Original Message


  • 4.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-22-2023 14:25

    Thanks for your response and sharing - its very helpful! Do any of your clinics carry "emergency" medication to give if a patient is having a seizure - or do you have any specific protocol in place for that? Thanks! 



    ------------------------------
    Keri Urquhart MPH BSN RN
    Covenant Community Care- FQHC
    Clinton Twp MI
    (586)215-3448
    ------------------------------

    Original Message


  • 5.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-15-2023 09:08

    In addition to oxygen and AEDs, we have emergency kits that contain the following: Nitro tabs, epipen adult and Jr, glucose tabs, IM Glucagon, Aspirin, Benadryl tabs, albuterol inhaler, and naloxone.  These kits are maintained by practice staff. 



    ------------------------------
    Katharine Weeks
    Director of Clinical Operations
    Wentworth Douglass Hospital
    ------------------------------

    Original Message


  • 6.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-15-2023 11:44
    Edited by Malia Davis 03-15-2023 11:45

    Hello-

    We rolled out ECB Emergency Care Bags with standard supplies and 5 protocols with meds for Chest Pain, Anaphylaxis, Seizure, Opiate overdose and hypoglycemia to our 170 clinics. This involved creating standard approved protocols, having each clinic build and audit their bag, train all staff and do annual training including a mock cor lead by a provider. 

    This is a lot of work to do initially, but the safety impact is huge. We have used the bags in both Primary and Specialty care about 60 times in 20 months including saving 2 patients...overdose and anaphylaxis. 
    Malia



    ------------------------------
    Malia Davis
    VP/CNO Ambulatory Services
    Intermountain Healthcare
    Denver CO
    (303)425-8136
    ------------------------------

    Original Message


  • 7.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-16-2023 19:09

    That is great!

    Did you use any evidence based organization to guide what you chose for the bags and/or the protocols?



    ------------------------------
    Jaclyn Schindler, MPH, PMC, FNP-BC
    Director, Clinical - Ambulatory Medicine
    Northwell Health
    Manhasset, NY
    jschindl@northwell.edu
    (516) 637-8843
    ------------------------------

    Original Message


  • 8.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-18-2023 17:34

    Are you able to share your protocols?



    ------------------------------
    Jaclyn Schindler, MPH, PMC, FNP-BC
    Director, Clinical - Ambulatory Medicine
    Northwell Health
    Manhasset, NY
    jschindl@northwell.edu
    (516) 637-8843
    ------------------------------

    Original Message


  • 9.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-15-2023 13:02

    We have full crash carts with  airway supplies, IV supplies and a drawer of emergency meds. It is locked with the lock and AED (on top) checked daily. Once a month the cart is unlocked, contents checked for outdates and replaced as needed, then relocked.

     

    Debra Galatioto MSN, RN, CIC

    Chief of Nursing Initiatives & Infection Control Officer

     

    Hudson Headwaters Health Network

    The George Purdue Administrative Building

    9 Carey Road, Queensbury NY, 12804

    (518) 761-0300 Ext. 31122

    (518) 222-3447 Mobile

    dgalatioto@hhhn.org

    www.hhhn.org

     

         

                          

    CONFIDENTIALITY NOTICE: This email transmission, and any documents, files or previous email messages attached to it, may contain confidential information that is legally privileged. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of any of the information contained in or attached to this message is STRICTLY PROHIBITED. If you have received this transmission in error, please immediately notify us by reply email or by telephone at (518) 761-0300, and destroy the original transmission and its attachments without reading them or saving them to disk.  Thank you.

     

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    Original Message


  • 10.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-16-2023 19:02

    Hi, this is a great topic!

    We are a multispecialty ambulatory arm of our organization with 350 practices.

    For a minority of our sites, where there are procedures with anesthesia / sedation performed, we use an ACLS, locked cart with an AED or defibrillator.

    Same for stress lab area in cardiology.

    For other areas in those practices, and all other sites, we are in the process of standardization, and will be including meds / supplies in an emergency kit with the aim of stabilizing, reversing any immediately life-threatening condition with non-invasive methods while awaiting higher level of care. (ambulance) No IV therapy, no intubation, no oxygen (as it has not been shown to impact outcome of a basic BLS intervention. That said, each practice can stock whatever extra they deem necessary, and have staff qualified to use. Outside of the emergency kit.

    Kit and emergency response designed to treat anyone who could present, not just patients, not just particular to specialty. could be visitors, adults, children, off the street, fellow employee.

    Kit contents:

    Epinephrine - for anaphylaxis

    IM injections: Steroid, Benadryl

    Albuterol inhaler (can't keep nebulizer in kit)

    Glucagon and glucose paste -  hypoglycemia

    Bandages & tourniquet - severe bleed

    Narcan - opioid overdose

    Supplies:

    •4x4 – sterile pads
    •Surgical tape
    •Bandages
    •Trauma Dressing
    •Combat Tourniquet
    •Scissors
    •Bandage
    •Compress Cold
    •Bag locks

    Equipment:

    •Stethoscope
    •Sphygmomanometer – assorted sizes
    •Airway Kit – Pedi / Adult
    •Bag Valve Mask – Adult, Pediatric, Neonatal

    AED

    Debating about ASA and nitroglycerine - ASA could wait until ambulance arrives (and unconscious patient can't chew or swallow) and nitroglycerine won't help an infarct!

    And does anyone use smelling salts?

    Intent is to have minimum necessary, to decrease confusion.

    We do mock emergencies in our annual skills lab with nurses and medical assistants and intend to bring into the practices.

    Would love to see anyone else's lists and how you came to choose what is used in bag, is there a vetting process?

    Jaclyn Schindler, MPH, PMC, FNP-BC
    Director, Clinical - Ambulatory Medicine
    Northwell Health
    Manhasset, NY
    jschindl@northwell.edu
    (516) 637-8843



    ------------------------------
    Jaclyn Schindler, MPH, PMC, FNP-BC
    Director, Clinical - Ambulatory Medicine
    Northwell Health
    Manhasset, NY
    jschindl@northwell.edu
    (516) 637-8843
    ------------------------------

    Original Message


  • 11.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-17-2023 07:10
    Edited by Ray Snider 03-17-2023 07:12
      |   view attached

    I have attached our Emergency Kit information. Each clinic has this kit and an AED. The kits are cheeked daily. The clinics order and stock medications independently through a direct delivery process with McKesson so each clinic maintains the supplies. Whenever restocked the expiration dates are recorded for each item and are reviewed during checks. The checklist are typically in a plastic sleeve that is secured to the box. 

    Clinic sites that administer sedation or perform riskier procedures have full crash carts that we coordinate with our hospitals.



    ------------------------------
    Ray Snider DNP MSN RN NEA-BC
    Senior Manager Clinical Operations
    Emory Healthcare
    ------------------------------

    Original Message


  • 12.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-18-2023 17:29
    Thank you for sharing this list and information. Do you have any issue obtaining smaller amounts of meds from McKesson? It is hard for us to get a few items per cart delivered directly to the practice from our distributor.


    Original Message


  • 13.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-20-2023 09:46

    Yes we do have problems getting small quantities from Mc Kesson. We are lucky to have a purchasing Dept to buy boxes centrally then move around and transfer costs from one place to another.

    For protocols we have the ACLS algorithms posted for tachycardia, bradycardia, cardiac arrest and ROSC

     

    Debra Galatioto MSN, RN, CIC

    Chief of Nursing Initiatives & Infection Control Officer

     

    Hudson Headwaters Health Network

    The George Purdue Administrative Building

    9 Carey Road, Queensbury NY, 12804

    (518) 761-0300 Ext. 31122

    (518) 222-3447 Mobile

    dgalatioto@hhhn.org

    www.hhhn.org

     

         

                          

    CONFIDENTIALITY NOTICE: This email transmission, and any documents, files or previous email messages attached to it, may contain confidential information that is legally privileged. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of any of the information contained in or attached to this message is STRICTLY PROHIBITED. If you have received this transmission in error, please immediately notify us by reply email or by telephone at (518) 761-0300, and destroy the original transmission and its attachments without reading them or saving them to disk.  Thank you.

     

    Due to the prevalence of protected information in electronic communication, Hudson Headwaters enforces TLS encryption on all outbound email. If your email provider does not support TLS encryption you will have received this message through our secure email portal.




    Original Message


  • 14.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-20-2023 14:55

    We also have Emergency Kits at all of or locations, including the schools we service. About 10 family practice sites and 5 school-based sites. sites.

    We have what is like a tackle box with a closure you can attach a plastic safety tag with a number on it.

    -Safety tags are changed every month when nurses do monthly inventory checks, when a new med is placed in the kit or a medication is removed for use on a patient.

                      -Tags cannot be stored near the ER Kit

                      -ER Kit must be locked while clinic is closed

    -ER Kit is checked by the MA opening the clinic to assure the tag is not compromised. Ma places Kit to locked area at closing.

    -We have plastic sleeved attached to the ER Kit with a Zi tie  for the inventory list, the form to document removed meds for administration and tag monitoring list.  

     

    We are TJC accredited and they have reviewed all of these forms w/o issues! 

    Attached are examples of the forms we use.

    Hope this helps!

     

     

     

    Heidi Spielmaker

    (Pronouns: she/her)

    Manager,  Community Health Nursing

    Hspielmaker@tap360health.org

    Follow us at: www.tap360health.org

     

     




    Original Message


  • 15.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-21-2023 08:13

    I am not sure how it was set up with McKesson as that was before I was in my role.  Our clinics order all medications directly from McKesson and receive timely deliveries of small quantities.  Each clinic is set up with an account that has a limited catalog of what they can order which is how we maintain our formulary.  We have nearly 250 clinics spread across the state.



    ------------------------------
    Ray Snider DNP MSN RN NEA-BC
    Senior Manager Clinical Operations
    Emory Healthcare
    ------------------------------

    Original Message


  • 16.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-21-2023 13:23

    Thanks this is very helpful! Wondering if you have specific protocols for training/education purposes on responding to each "type" of emergency? 



    ------------------------------
    Keri Urquhart MPH BSN RN
    Covenant Community Care- FQHC
    Clinton Twp MI
    (586)215-3448
    ------------------------------

    Original Message


  • 17.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-21-2023 13:41
      |   view attached

    We incorporated our protocols into the documentation form.

    We also have a patient safety Liaison program where each clinic has a representative and they routinely provide education, reminders, and updates to clinic staff. 



    ------------------------------
    Ray Snider DNP MSN RN NEA-BC
    Senior Manager Clinical Operations
    Emory Healthcare
    ------------------------------

    Original Message


  • 18.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-22-2023 14:26

    Again, thanks for your response and sharing - its very helpful! Do any of your clinics carry "emergency" medication to give if a patient is having a seizure - or do you have any specific protocol in place for that? Thanks! 



    ------------------------------
    Keri Urquhart MPH BSN RN
    Covenant Community Care- FQHC
    Clinton Twp MI
    (586)215-3448
    ------------------------------

    Original Message


  • 19.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-23-2023 07:48

    Our clinics avoid stocking controlled substances unless required for specific procedures.

    For seizures we rely on basic Life Support and calling EMS.

    Some of our Neurology Clinics that specialize in seizures may have medications available but not part of standard. 



    ------------------------------
    Ray Snider DNP MSN RN NEA-BC
    Senior Manager Clinical Operations
    Emory Healthcare
    ------------------------------

    Original Message


  • 20.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-17-2023 11:16

    We recently updated ours to align with Medical Managed Care survey requirements.

    https://providers.anthem.com/docs/gpp/california-provider/CA_MMP_FSR_MRR_PrepChecklist2020.pdf?v=202207261515



    ------------------------------
    Stacie Banister MSN, RN
    Assistant Director Ambulatory Nursing and Professional Development
    UC San Diego Health
    Poway CA
    (619)733-6543
    sbanister@health.ucsd.edu
    ------------------------------

    Original Message


  • 21.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-24-2023 11:43

    Hello!  I am happy to see this conversation. I cover all our Ambulatory areas which include many offsite locations. I also am a REdI ACLS PD and part of our Code Team. We are working to ensure every area has a clear Emergency Protocol and that staff are trained.

    ACC areas on our main campus have crashcarts with Defibs - they get the full hospital response. 

    There are Emergency Med kits in many areas - separate from the Crashcart.  These meds can be accessed for managing medical emergencies prior to code team  (allergic reaction, hypogycemia, etc). NOTE: RN cannot administer medication without an order. If there are standing orders then they can administer or is they have an advanced care provider.

    We have a Vaccine clinic in one of the hospital clinics - they recently got a smaller emergency med kit (Tylenol, Benadryl, Epi) - the issue is they cannot prescribe or administer without an order. They often run solo and do not have a provider - so the kit is not that helpful

    Our offsite ACC areas have AED and Emergency kits. They manage the basics including BLS and wait for 911. Few of the providers would have ACLS and none of the nurses do. A strong BLS layer is the most important.  

    It is important to ensure that RNs know they cannot administer ACLs drugs even if ACLS certified without an order - this would mean they diagnosed the rhythm and made a decision of treatment. This is not in theri scope. So keeping things to the BLS layer is always the safest. 



    ------------------------------
    Cynthia Shum
    Nursing Professional Development Specialist
    VA Palo Alto Health Care System
    San Jose CA
    (408)531-5859
    ------------------------------

    Original Message


  • 22.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-26-2023 21:20

    Hi,

    These are great points re: ACLS.

    In NYS which is usually the most stringent, we are able to add emergency response to anaphylaxis to our non-specific patient standing orders.

    Includes epinephrine. Must be an RN to open this order and must have BLS certification.

    However, point well taken that they couldn't give glucose for hypoglycemia without a (verbal) order.

    Also, re: seizure question. Our first line would be wait and protect, always call an ambulance no matter the length or severity.

    some providers asked for ativan however this would require more checking and documentation due to the class and requires someone proficient in IV access which we don't have in all ambulatory practices. We don't stop a provider from stocking it but not in the standard emergency kit.

    What is the opinion on SL nitroglycerin or baby ASA? And does anyone still use smelling salts?



    ------------------------------
    Jaclyn Schindler, MPH, PMC, FNP-BC
    Senior Director, Nursing and Clinical Operations
    Faculty Group Practice
    NYU Langone Health
    1 Park Avenue
    New York, NY 10016
    Jaclyn.Schindler@nyulangone.org
    (646) 276-3005
    ------------------------------

    Original Message


  • 23.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-27-2023 12:29

    Hi,

    Thanks for asking the nitro question Jaclyn.  We pulled it a couple of years ago but now a some providers are asking for it back.  Mostly in our acute access clinic. My question to them is if you give it and the pt's BP goes south can you, as a primary care provider, fix it quickly?  

    Oddly, the dental clinics are still required to have it in their emergency kits.  We got rid of ammonia inhalants (smelling salts) a while back and no one seems to miss those. (Maybe because they are horrible relic of the 13th century.)   Again, dental insisted on hanging on to them for some time. 



    ------------------------------
    Rebekah Sherman
    Director of Nursing
    La Clinica de Valle
    Medford OR
    (541)221-3040
    ------------------------------

    Original Message


  • 24.  RE: Emergency Kits - Crash carts in ambulatory care clinics

    Posted 03-27-2023 17:49

    Thanks for response!

    Some of our practices wanted to retain the 'salts,' however, when pressed, acknowledged they never actually used this.

    Re: nitro. Our initial rationale was that we want to keep it simple, and include only those interventions that will really turn around a situation that can't wait for the ambulance.

    If someone is infracting, the nitroglycerine is not going to help!

    However, as you mentioned, some people feel more comfortable.




    Original Message


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