Opportunities for improvement- the crash box.

Ah the crash trolley, crash box or cart. The magical storage unit that is responsible for saving lives and a whole heap of other things should the contents be believed.

Here’s the issue though, the crash box/trolley/drawer or box is just that. A crash box, box will keep the rest of this simple. Part of the in-house CPR training involves a simulation in situ. So, using the practices table and resources. The only thing they can use is Bob the IKEA dog (other dogs are available) and this proves to be rather insightful.

Most commonly the simulations highlight issues with the crash box and the stocking of it. Over the last year I’ve seen a range of issues during this part of the in-house CPR training and I’m going to share some of them with you so that we can hopefully avoid repeating these blips.

The crash box- can there be too much of a good thing?

Excessive number of medications is probably up there as the top opportunity for improvement. Now if you are an OOH provider then your box may have a slightly different function but it’s still important to consider the stock levels. An excessive number of medications that are not used in a crash, Bricanyl anyone, mean that trying to access the drugs we do need becomes more challenging. Same as having to wade through a copious amount of Lidocaine. Yes, you may need Lidocaine, but will you need enough for 3 Great Danes simultaneously, I think not.

Syringes and needles. To the point where they cascade over the edges. Again no. We want easy access; we don’t want to be delayed by the stock in the box.

 Speaking of stock, it’s worth mentioning that some sort of system for restocking is imperative. I was just glad we discovered the empty adrenaline box during the training rather than during a crash! Drawn up drugs and flushes are often asked about but this wouldn’t be something I advocate. Pre-drawn up flushes that are sold in sterile packs ready for use, yes but not ones we’ve drawn up ourselves. And having adrenaline drawn up in the crash box is asking for it to go out of date or be confused with something else. I would recommend having it readily available if you suspected a crash or dealing with a high ASA.

Chilly or cooking your crash box?

Finally, temperature monitoring. Often theatre is cold and then hot, this means our drugs are stored out of ‘ambient’ temperature range. We are not able to use drugs that have not been stored correctly so perhaps consider this when locating your crash box. Not recording temperature? You need to be.

There are the common blips that often occur with crash boxes, trust me it happens to us all but hopefully we learn from each other and make our lives a little easier during that crash.  Next up in the blog, curating the perfect crash box.