Summary Report: Nursing Perspectives on Code Cart Operation
Study Purpose
Describe code cart mobility and safety from the perspective of experienced acute care nurses.
Background/Significance
- Each minute delay in resuscitation during cardiac arrest leads to a 7-10% decrease in success.
- Code carts need to be equipped and organized in a way that affords easy and quick access for care providers
- Code carts should be designed with human factors in mind so that healthcare workers are supported during critical patient care scenarios
Code Cart History
- First code cart, then called “crisis cart” was developed by Anita Dorr, RN in the 1960s3 but she did not receive a patent
- Dr. Nobel invented a similar concept around the same time, received a patent, and is often credited as the inventor of the crash cart
- Since then, the code cart has become invaluable to emergency care
- While incremental improvements in the code cart have been made over time, the fundamental design and usability have remained largely unchanged
Relevance to Nursing
- Code carts should be designed with end user nurse engagement and human factors design
- This is an opportunity for nurse led innovation to improve a piece of equipment vital to patient care and most intimately understood by nurses
- Improvements come with significant safety implications for both patients and clinicians
Methods & Results
- Social media and direct recruitment
- Data was collected using an anonymous 25-item online survey
- Acute care nurses (N=41)
- Descriptive data analysis
| Variables (Frequency), Primary Shift | N | % |
|---|---|---|
| Days | 30 | 73.2% |
| Nights | 4 | 9.8% |
| Evenings | 1 | 2.4% |
| Variable | 6 | 14.6% |
| Variables (Frequency), Travel Nurse | N | % |
|---|---|---|
| Yes | 3 | 7.3% |
| No | 41 | 92.7% |
| Variables (Frequency), Patient Population | N | % |
|---|---|---|
| Adult | 40 | 97.6% |
| Pediatric | 1 | 2.4% |
| Variables (Frequency), Clinical Area | N | % |
|---|---|---|
| Med-surg | 4 | 9.8% |
| Critical Care | 17 | 41.5% |
| Step-down/PCU | 8 | 19.5% |
| Operating Room | 3 | 7.3% |
| Emergency Department | 3 | 7.3% |
| Other | 6 | 14.6% |
| Nurse | Mean (SD) | Range |
|---|---|---|
| Age (Years) | 33.7 (9.4) | 23- 66 |
| Nursing Experience (Years) | 8.5 (7.6) | 2.5 - 35 |
| Number of codes in past 12 months | 15.9 (23) | 1 - 100 |
Survey Results
Which of the following items must be unplugged from the wall outlet before mobilizing the art to the code? (please check all that apply)
| Variables (Frequency) | N | % |
|---|---|---|
| Defibrillator | 40 | 97.6% |
| Suction | 9 | 22.0% |
| Other | 2 | 4.9% |
The code carts I am familiar with require the following prior to mobilization.
| Variables (Frequency) | N | % |
|---|---|---|
| Unplug 3+ cords from the wall outlet | 1 | 2.4% |
| Unplug 1 equipment cort or master cord from wall outlet | 24 | 58.5% |
| Unplug 2 cords from the wall outlet | 15 | 36.6% |
| No unplugging of cord is required | 1 | 2.4% |
Unplug 2 or more
%
Have you ever forgotten to unplug the code cart power cord(s) when responding to a code?
| Variables (Frequency) | N | % |
|---|---|---|
| Yes | 12 | 29.3% |
| No | 29 | 70.7% |
Yes
%
I have personally witnessed equipment falling onto the floor during emergency response to cardiac arrest because it was not unplugged before mobilization.
| Variables (Frequency) | N | % |
|---|---|---|
| Yes | 6 | 14.6% |
| No | 35 | 85.4 |
Yes
%
Conclusion
- An experienced group of nurses participated in this survey, the majority of whom cared for adult populations and experienced an average of 15 codes per year
- Respondents felt safety would be improved by improving cart mobility and quick-release power disconnect