Name of Policy: Code Blue Carts (Contents & Locations}

.HEALTH Policy Number: 3364-100-45-10

Department: Hospital Administration

Approving Officer: Chief Executive Officer - UTMC THE UNIVERSITY OF TOLEDO

Responsible Agent: Chief of Staff

Scope: The University of Toledo Medical Center and its Effective Date: 6/1/2017

Medical Staff Initial Effective Date: June 1, 1990

New policy proposal X Minor/technical revision of existing policy Major revision of existing policy Reaffirmation of existing policy

(A) Policy Statement

All code carts will be uniformly and fully equipped throughout the University of Toledo Medical Center in order to implement cardiorespiratory and cerebral resuscitation.

(B) Purpose of Policy

The purpose of the code cart policy is to standardize the appearance and contents of all code carts so that they are fully functional and easily recognizable to those persons attempting cardiorespiratory and cerebral resuscitation.

(C) Procedure

I. All code carts will be standardized as bright red carts.

2. Each code cart should have a monitor-defibrillator which will not be removed from the code cart except for cardiorespiratory resuscitation.

3. The locations of the code cart will be determined by the Medical Executive Committee with input from the Code Blue Committee (see appendix A).

4. All code carts will be identical and therefore interchangeable.

5. a.

b.

Nursing will be responsible to check that the seal on the code cart is intact and that the 0 2 cylinder has adequate pressure daily in all areas except those listed in "b" below. If deficiencies are discovered, they will be corrected. Respiratory Care will be responsible to check that the seal on the Broselow cart is intact. If deficiencies are discovered, they will be corrected by Respiratory Care. Due to access restrictions in the following areas, CVL, OR, Cardiac Rehab Phase II & III (Morse Center), Outpatient pharmacy, Endoscopy Unit, Outpatient Physical Therapy and George Isaac Center, the daily checks described in (a) will be the responsibility of department management. It will be the responsibility of department management to check the function of the defibrillator/monitor machines on a daily basis in the acute care areas that provides care to patients on a 24/7 basis. Other patient care areas that have operational hours that are not 24/7 will have the defibrillator/ monitor machines checked during normal hours of operation. If a defective machine is discovered, it will be exchanged.

6. After use, the code cart will be restocked by Pharmacy and Central Service. Those individuals doing the restocking will sign their names on an inventory (check-off list). The check-off list will remain in those departments.

7. All code carts will be checked by Pharmacy and Respiratory Care at six month intervals to check for any outdated or missing items.

8. The list of equipment and drugs in the code cart will be reviewed annually by members of the Code Blue Committee (see appendices B and C).

9. It is the responsibility of Respiratory Care to exchange the code cart immediately at the conclusion ofa code, and to take the used cart to Pharmacy.

Policy No. 3364-100-45-10 Code Blue Carts (Contents & Locations) Page2

Approved by:

,-J~~~ Daniel Bar~N, BSN, MBA Chief Executive Officer - UTMC

Review/Revision Completed By: HAS Chairman, Code Blue Committee Chief of Staff

Nursing Administration

~l{J"'evi {<l l1 Date

Policies Superseded by This Policy: 7-45-10 Code Blue Carts (Contents & Locations)

Review/Revision Date: 10/14/92 6/1 /2017 4/14/93 10/13/93 9/11 /96 7/14/99 7/10/02 2/12/03 7/ 13/05 8/10/05 10/22/2008 4/27/201 I 5/25/2011 5/1 /2014

Next Review Date: 6/1 /2020

.~ IC281 DATE 01/14/14

Time 02:18

Company 1000 - THE UNIVERSITY OF TOLEDO Par Inventory 1/orksheet

Page

Par . Location ; C0DE1 .- CDS:Adult/Ped Code Cart.

Shelf Seq Location Item

Manufacture Information Chargeable Charge Nbr Description Par Level Count

---~---------------~-----~--- --~------ ----~---- ------~-----------~---- -------------1 D2001 71186

2 02002 71185 N

3 D2002A 71180 N

4 02004 71403 N

5 03000 2141 N

6 D3001A 71572 N

7 D3001 71399 N

8 D3002 60500 N

9 D3003 60501 N

10 D3004 31972 N

11 D3006 31973 N

12 D3007 31971 N

13 D3013 · 49809 N

14 03014 49284 N

15 03008 53854 N

16 D3009 53853 N

17 D3010 5385"\ N

ALOS CARE 10010454 3.0000 SET,INFUSION,0.2 FILTER LATEX FREE, 20 EA/CS

ALOS IVCO 10012496 2.0000 STOPCOCK, 4 WAY · 600 EA/CS ! ExpOi!te!

ALOS IVCO 20019E 1.0000 SET, Y EXTENSlON,2 VALVE, 9.SIN 100 EA/CS

BECO NEEDLE, FILTER,BLUNT

COVI PAO,ALCOHOL PREP,70%

BECD

305211 !ExpOate!

6818 200 EA/BX

364880 DEVICE,BLOOD TRANSFER W/LUER !ExpOate!

BECD NEEDLE, BLUNT FILL

305180 !Expoate!

2. 0000

1.0000

3 .0000

6.0000

APLl S-1101 3.0000 50 EA/BX !ExpDate!

APLl P-1001 3 .0000 IODINE,POVIDONE,PREP PA0,10% 200 EA/BX !Expoate!

BECO BAPA 367281 1.0000 SET,BLOOO COLLECTION,21GX3/4" BUTTERFLY 21GA,50 EA/BX;200/cs

BECD BAPA 367283 1.0000 SET,BLOOD COLLECTION,23GX3/4" BUTTERFLY 23GA,50 EA/BX;200/CS

BECD BAPA 367285 1 .0000 SET,BLOOD COLLECTION,25GX3/4" 50 EA/BX; 200 EA/CS

BECD NEEDLE,SAFETY,23GX1 11

305762

BECD 305781

100 EA/BX

NEEDLE,INJECTION W/SYR,25GXS/8 50 EA/BX

BBRN BRON 4252586-02

1.0000

1 .0000

2.0000 CATHETER,IV, SAFETY, 16GX1-1 /4" IV CATH SAFETY 16G 1-1/4", ! Exp

BBRN BRON 4252560-02 4.0000 CATHETER, IV, INTRO CAN, 18X1 .25 SO /BX; 200 / CS ! ExpOate !

BBRN BRON 4252535-02 4.0000 CATHETER,IV,INTROCAN,20X1.25 50/BX;200/CS !ExpDate!

UOM

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" • IC281 DATE 01 /14/14 Company 1000 - THE UNIVERSITY OF TOLEDO Page 2

Time 02:18 Par Inventory \./orksheet

Par Location : COOE1 - . CDS:Adult/Ped Code Cart

Shelf Manufacture Information

Seq Location Item Chargeable charge Nbr Description Par Level count UOM

~---~------------------------ ---------- --------- -----------------~------ ----------~-18 D3011 53850 N BBRN BRON 4252519-02 2.0000 EA

CATHETER,IV,SAFETY,22GX1" ! ExpDate!

19 D3012 50078 N BECD 305763 10.0000 EA NEEDLE,SAFETY,22GX1-1/2 11 100 EA/BX; 1200 EA/CS

20 D3012A 63236 N MDLN OYNDV1500 2.0000 EA KIT,IY START,100 EA/CS

21 D3012B 9366 N CRBA 0641910 1.0000 EA SET ,INFUSION,BENT, 19GX1 11 20 EA/CS

220 D3015 12296 BECD BAPA 405184 2.0000 EA NEEDLE1 SPINAL,18GX3-1/2" SPIMAL NEEDLE 18G 3 1 /2"

221 03028 1052 N BECD VASY 363083 1.0000 EA . YACUTAINER,BLUE,\·1/ADD,2. 7ML 10 EA/PK; 10 PK/CS

222 03029 1046 N BECO VASY 367815 1.0000 EA YACUTAINER,REO,N/A00,6ML

223 03030 1049 N BECD VASY 367884 1.0000. EA VACUTAINER,GRN,LITH HEP,4ML 10 EA/PK; 10 PK/BX

224 03031 3501 N BECD VASY 367921 1.0000 EA VACUTAINER,GRAY,W/ADD,2ML

225 D3032 1053 N BECD VASY 367861 1.0000 EA YACUTAINER,LAVENDER,EDTA,4ML 100 EA/BX; 10 sx/cs

226 D3018 2194 N BECD BAPA 309620 1.0000 EA SYRINGE,CATHETER TIP,20Z SYRINGE CATHETER TIP 60CC

227 D3019 2192 N BECD BAPA 302832 2.0000 EA SYRINGE, LUER-:-LOK,30ML 56 EA/BX 224 EA/CS

228 D3016 2059 N ALEG AVM DIN1515X 1.0000 EA NEEDLE, ILLINOIS,BONE MARI!, 15

229 D3017 2180 N BECD BAPA 309604 10.0000 EA SYRINGE,LUER-LOK, 10ML SYRINGE LL 10ML,100 EA/BX

230 D3020 2172. N SMTH PRTX 4588P-2 4.0000 EA SYRINGE,ARTERIAL SAMPLE,23 GA 200 EA/CS

231 03033 829 N 3MHC MDSU 1538-2 2.0000 EA TAPE,SILK DURAPORE,2"X10YD 211 SILK TAPE/ 6 EA/BX

232 03034 2'\42. N COVI 2506 6.0000 PK SPONGE,GAUZE,8-PLY,STER,2X2" 2 EA/PK; 1500 PK/ CS

,,. IC281 liATJ: 01/14/14

'rime 02:18

-~):ii~~;.~.. . . · tompc1r1y{6b~i \ ·THE UNlVERSlTY OF TOLEDO

Par Inventory Worksheet

Par Location : CODE1 - CDS:Adult/Ped Cod~ Cart

Seq

Shelf

Location Item ·· '··

Chargeable · charg~ Nbr

Manufacture Infor.ination

Oes·cription Par Level

~-.. -~---· - . ---------------------------- ------- --------- --------------· -- ' ---- -------------234 D3021 222.4 N

235 D4001 17421 N

236 .D4002 17360 N

237 D4003 17422 }I

238 D4004 . so ·N

239 D4005 10971 N

240 D4006 . 54110 N

241 D4007 50515 N

242 04037 17115 N

243 . D402? 14468 N

244· D4029A 61282 N

245 00212 312

246 04008 · 61280 N

· .: · . '

. ..

247 04009. · 61281 N

248 D4010 9543;· N

249 D4035 N

250 04012

DYAD . HCS5003A 2.0000

TOURN!QUET,NON-LATEJC;1ax1.11 250 EA/BX; 1000 EA/cs

VTLS

AIRWAY,BERMAN,INFANT,40MM

VTLS · 2560

AIRWAY ,BERMAN, CH!L.0D ;60NM

VTLS 2580.

AlRf/AY ,BERMAN,ADUL T,S!•l,BOf·iM ;

.VTls 2590

AIR~JAY ,BERMANrADUL t ,MED,,90Mt1

V°TLS 2500EU

AIRIJAY;BERMAN,ADULJ',LG, 100MM

1.0000

1.0000 ;

1.0000

1.0000

1.0000

TYCO KHC 311157~8 1.0000

ELECTRODE,ECG MONITORING ' 12 PK/BX; 10 BX/cs

-TYC.O kHC 01'148600 1.0000

ELECTRbriE,CLOTH,PED . 25 EA/PK - 12 PK/cs'

CPIN 6562 . 1 ;0000

PACEMAKER,MAGNET

· SAVI.. 02a1c.:0205-43 · 1:0000 ·

S\JRGILUal: LUBRICANT,3G 144 EA/BX

MCOT · coDE CART 1.0000

LARYNGbSCOPE HANDLE,ADULT: CODE CART

DURA PC1400 2.0000

BATTERYA(KALINE·, 11 C" 12 EA/CT

l{CbT . CODE CART 1,0000

. · . . ,F,()~CEf'.;.M~GlLL_;.Abl)LT-CODECART .CODE CART

BRMI 708 2.0000

TAPE, HIILL,WHITE, 1/211 TWILL TAPE

TF.i:x,... 4551001 1.0000

. 20J;A/BX

·page 3

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-, IC281 DATE 01/14/14 Company 1000 - THE UNIVERSITY OF TOLEDO Page 4

Time 02:18 Par Inventory Worksheet

Par Location : C0DE1 - CDS:Adult/Ped Code Cart

Shelf Manufacture Information

Seq Location Item Chargeable Charge Nbr Description Par Level Count UOM --------------------------~---- ---~----- ---------- -~---------------------- -------~--~

251 04013 81066 N TFLX 4551002 1.0000 EA BLAOE,LARYNGOSCOPE,MAC,2 20 EA/BX

252 D4014 81067 N TFLX 4551003 1.0000 EA BLADE,LARYNGOSCOPE,MAC,3 20 EA/BX

253 04015 81068 N TFLX 4551004 1.0000 EA BLADE,LARYNGOSCOPE,MAC,4 20 EA/BX

254 D4016 81069 N TFLX 4550000 1.0000 EA BLADE,LARYNGOSCOPE,MILLER,0 20 EA/BX

255 D4017 81070 N TFLX 4550001 1 .. 0000 EA BLADE,LARYNGOSCOPE,MILLER,1 20 EA/BX

256 04018 81071 N - TFLX 4550002 1.0000 EA BLADE,LARYNGOSCOPE,MILLER,2 20 EA/BX

257 D4019 81072 N TFLX 4550003 1.0000 EA BLADE,LARYNGOSCOPE,MILLER,3 20 EA/BX

258 D4021 . 1734 N TYCO KHC 8888247023 1.0000 EA AIRWAY,NASAL,26FR,6.5MM

259 D4022 1735 N TYCO KHC 8888247031 1.0000 EA AIRl,AY,NASAL,28fR, 7 . OMM

· 260 04023 1736 N TYCO l<HC 8888247049 1.0000 EA AIR~IAY,NASAL,30FR,7 . 5MM

261 D4024 1737 N TYCO KHC 8888247056 1.0000 EA AIRIIAY, NASAL,32FR,8. OMM

262 D4025 1738 N TYCO KHC 8888247064 1.0000 EA AIR\,AY,NASAL,34FR,8.5MM

263 04026 3263 N HRCI 200-59 4.0000 EA SALINE,NORMAL,5ML UD

264 D4032 12168 N TYCO KHC 5-15102 1.0000 EA STYLET,PED,5FR

265 D4033 1908 N . MDLN DYND43514 2.0000 EA STYLET,INTUBATING,W/LUB,14FR 20 EA/BX

26f, D4036 1692 N ALEG AVM K61 1.0000 EA TUBE,SUCTION,YANKAUER,REG YANKAUER REG

267 D4034 2264 N MDLN MDS202075 4.0000 EA BLADE,TONGUE,STERILE,6 11 TONGUE BLADE,100 EA/BX;1000/CS

.r ' IC281 DATE 01 /1ft/14

Time 02:18

.. >};1::: :t?;~,tt:.·.· :~~_,>~:, . CcimpMiy"100~:::;..., ·rHE UNI.~ER~lTY OF. TOLEDO

Par lnventory ~lorksheet Page

Par Location : C0DE1. - CDS:Adult/Ped Cod~- Cart

Shelf Manufaoture Informeition

Seq Loca1;fot:{ Item Chargeable Charge Nbr Descrfptfon· .. . Par Level Count UOM ·--~-~~-~-•. -.... ----------------------- ---------

268 D4031 . .· .329? N

. 269 D4028 .-3293 N

270 · D4030 35290 N

271 D4029 3291 N

272 D4039 3357 N

273 05015 2146 N

274 D5019 2230 N

275· 05020 2231 N

276 D502-1 · 53722 N

277 ·os-022 53723 N

278. \ 6~023 53724 N

279 05014B 64144 N

280 D5014A · 64143 N

281 D5014 111.76 N

282 D5001 3321 · ·. ·· : N

283 D5002 332z . N

284 D5003 3323 N

·_._,...., __ . - .--- . . ----------- -· -----------SALT .· ·· 1602

CANNULA,NASAL,PED

HRCI !·!ASK, s IM"PLE Ip ED

. HRCI.·

1035

1103 .

CANNULA,NASAL, sniGLE ·usE

1.0000

1 . 0000

1.0000

50 EA/CS

EA

EA

EA

HRCI MASK,NON-REBREATHER

1.0000 __ EA

NPB EASYGAP Il6 1.0000 EA EASY CAP

...

CDVI ··)?539 . . 1.0000 BX SPONGE,GAUZE,12-PLY~STER,4X.411 -. KERLIX BOAT,128 TY/CS

TYCO KHC : 88882661:30 1.0000 EA TUBE,.SALEM SUMP, 16FR1 4~i, SALEM SUMP 16FR

TYCO i<HC 8888264986 1 . 0000 EA TUBE,SALEM SUMP1 18FRA8" SALEM SUMP 18FR

MDLN MDS194085 1.0000 PR GLOVE,NITRILE1 STERILE,SM SO PR/BX

. , MD\.:N MDS194086 1 . 0000 PR GLOVE;,NllRILE;STERILE/MED so PR/BX

MDLN MDS194087 1.0000 PR GLOVE,NITRILE,STERiLE,LG ,' 50 PR/BX; 200 PR/CS

MDIN .. 1199.6-000093

PAD.,PAt:ING/DEFIB, PED QUICK-COMBO

1.0000 EA

MDIN 11996-00917

QUICK-COl•IBO

1 . 0000 ;. __ EA

P.O,D, PACING/DEFIB1 ADULT : .,._\!<'·~:' .- .. .. . . .

PR

EA

MMIN 86223 EA

TUBE, TRACH,UNCUFFED,3 . 0Mt'1°

EA li!MIN'. "· 86224 TL1BE,TRAtH,UNCUFFEP.*~5~if)·

1.0000

.. .,· .

5

;.

IC281 DATE 01/14/14 Company 1000 - THE UNIVERSITY OF TOLEDO Page 6 Time 02: 18 Par Inventory Worksheet

Par Location : CODE1 - COS:Adult/Ped Code Cart . . . ..

Shelf Manufacture Information Seq Locat1on Item Chargeable Charge Nbr Description Par Level Count UOM

-------------~-----------~---- ---------- ------- --------~-----~-------- -------------285 05004 3324 N MMIN 86225 1.0000 EA

TUBE,TRACH,UNCUFFED,4.0MM 10 EA/BX

286 05005 3325 N MMIN 86226 1.0000 EA TUBE, TRACH, UN CUFFED A, SMM

287 05006 3326 N MMIN 86227 1.0000 EA TUBE,TRACH,UNCUFFED,5.0MM

288 D5007 3327 N MMIN 86108 1.0000 EA TUBE,ENDOTRACH,CUFFED,5.5MM

289 D5008 3328 N MMIN 86109 1.0000 EA TUBE, ENDOTRACH, CUFFED ,6. OMM

290 D5009 3329 N MMIN 86110 2.0000 EA TUBE, ENDOTRACH, CUFFED ,6. 5MM

291 oso10 · 3330 N MMIN 86111 2.0000 EA TUBE,ENDOTRACH,CUFFED,7.0MM

292 05011 3331 N MIUN 86112 2.0000 EA TUBE,ENDOTRACH,CUFFED,7.5MM

294 D5012 3332 N MMIN 86113 2.0000 EA TUBE,ENDOTRACH,CUFFED,8.0MM

295 05013 3333 N MIHM .86114 1.0000 EA TUBE,ENDOTRACH,CUFFED,8.5MM

296 D6019 1813 N BALD MDPR 2V2210 1.0000 EA SYSTEM,SUCTION,CLSD TRACH,14FR

297 D6008 611 N CRD 2K8050 1.0000 EA MASK,ANESTHESIA,NEONATAL DISP W/RED RING

298 D6009 1n1.8 N CRD 2K8051 1.0000 EA MASK,ANESTHESIA,INFANT DISP W/RED RING

299 .D601 0 7980 N VIAS 8802 1.0000 EA MASK,ANESTHESIA,PEDS,SM

300 D6011 612 N CRD 2K8052 1.0000 EA MASK,ANESTHESIA,TODDLER/CHILD 20 EA/CS

301 D6012 6276 N VIAS 8801 1.0000 EA · MASK,ANESTHESIA,ADUL T ,MED

302 D6013 603 N CARE 2K8055 1.0000 EA MASK,ANESTHESIA,ADULT,LG

, < "

IC281 DATE 01/14/14 Company 1000 - THE UNIVERSITY OF TOLEDO Page 7 Time 02:18 Par Inventory Worksheet

Par Location. : CODE1 - CDS:Adult/Ped Code Cart

Shelf Manufacture Information Seq Location Item Chargeable charge Nbr Description Par Level ·count UOM

---------~-~-----~-~-------- ---------- ---------- ------------------------- -------~--303 D6014 48627 N AMBU 199-002-020 1.0000 EA

VALVE,PEEP

304 D6015 48626 N ANBU 520212000 2.0000 EA BAG, RESUSCITATOR,MANUAL

306 D6002 1769 N TYCO KHC 30677 1.0000 EA KIT,CATHETER,SUCTION,PED,6FR SUCTION CATHETER 6FR

307 D6003 1780 N TYCO l<HC 30877 1.0000 EA KIT,CATHETER,SUCTION,PED,8FR SUCTION CATHETER 8FR

308 D6004 1791 N TYCO KHC 31079 1.0000 EA KIT, CATHETER,SUCTI0N,10FR SUCTION CATHETER 10FR

309 06005 1812 N TYCO l<HC 31479 1 ,0000 EA KIT,CATHETER,SUCT!ON,14FR SUCTION CATHETER 14FR

310 D6007 2381 N CREW UV2000 1.0000 EA GLASSES 1 SAFETY 10 EA/BX

311 06001 29133 N ALEG AVM 65651-395 1.0000 EA CANISTER,SUCTION,fl/TUBE, 1200cc

313 06018 2022 N KICL 47117 1.0000 BX MASK,iSOLATION,HI-PERORMANCE 50 EA/BX - 10 BX/CS

314 D6006 20609 N MDLN 486802 1.0000 BX GLOVE, NITRILE, ICE,MED 200 EA/BX; 10 BX/Cs

315 · 05024 61291 N MCOT CODE CART 1.0000 EA CLIPBOARD FOR CODECART CODE CART

316 05025 61292 N MCOT CODE CART 3.0000 EA FLOHSHEET,CODE BLUE-CODECART CODE CART

317 D52026 61293 N MCOT CODE CART 3.0000 EA EVALUATON,CODE BLUE-CODECART CODE CART

318 05016 3738 N TYCO KHC 10632900 1.0000 RL PAPER, THERMAL,EKG, 1-CHANNEL 10 RL/BX

319 D5017 1705 N ARII AK-09903-S 1.0000 EA KIT,1NTR0DUCER,PERCUTANEOUS,9F

320 05018 82474 N ARII CDC-42703-XP1A 1.0000 EA KIT, CENTRAL LINE INSERTION 16 5 EA / CASE

330 05030 2014 M KICL 48247 1 .0000 BX MASK,SHIELD,SPLASHGUARD,ORANGE 25 EA/BX - 4 BX/CS

J • ....

IC281 DATE 01/14/14 Time 02: 18

Company 1000 - THE UNIVERSITY OF TOLEDO Par Inventory 1/orksheet

Page

Par Location : C0DE1 - CD.S:Adult/Ped Code Cart

Shelf Seq Location Item

331 D5036 61294

332 D5037 61295

333 05038 83318

334 D5039 83319

Manufacture Information Chargeable Charge Nbr Description Par Level

N

N

N

N

~~~------------------ ---~--------MCOT CODE CART 1.0000

WALL SUCTION DEVICE-CODECART CODE CART

MCOT CODE CART 1.0000 FLOWMETER,l~/NIPPLE ADAPTER CODE CART

CODE CART 1.0000 MCOT YELLO\.I CODE CART TUBE 1 Tube per Code Cart

MCOT CODE CART 1 .0000

count

LAB SHEET & BIOHAZARD BAG 1 Lab Sheet & Biohazard Bag

8

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Cart Location Cart Number Lock Number Notes Morse Center PFT Respiratory Respiratory Respiratory Respiratory Respiratory Respiratory Respiratory The George: Endo The Geor~e: OR '

The George: Recovery ED ED ED CT CVL Holding Cath Lab Gath Lab Cath Lab Heart Station Heart Station 2nd Fl Infusion Center Dental Clinic SICU OR OR Pre-OP PACU Hemodialysis CVU 3A cvu 38 CVU 3C cvu 30 MICU MICU 4AB 4CD 5A 58 5CD BB Rehab 6CD

1/22/201 4

Date: