NNI QT-External CCart Audit Tool

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Crash cart is in place and accessible

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Crash cart is locked with number of the lock recorded on the checklist per checking- integrity of locked checked

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Drawers are properly labeled (airway, medication, breathing, circulation)

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Crash cart is clean and functional

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Defibrillator available, clean and disinfected- functionality checked in accordance with operator's manual-PPM up to date

  Select Fully Met Partially Met Not Met Not Applicable

  • Fully Met
  • Partially Met
  • Not Met
  • Not Applicable

• Defibrillator plugged into an emergency power

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Portable suction machine available, functionality checked-plugged into emergency power- PPM up to date

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Oxygen cylinders checked- have at least 1000 psi

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Resuscitation bag connected to oxygen cylinder's flow meter using clean oxygen tubing-resuscitation bag connected to a mask

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Pressure bag available and functional

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• ECG Electrodes complete pack available and not expired (1 pack)

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Extra ECG paper available- 1 Roll

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Defibrillator Pads available and not expired (Adult- 2 packs)

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Sharps container available and not more than 3/4 full

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• KY Jelly available- 2 sachets

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Stethoscope (1)

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Non-sterile gloves (Large, 1 box)

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Clip board (1 pc) & Checklist (5pcs,)

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Code BLue & Quality Audit Forms available (5 each)

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Cardiac Arrest Board (1)

  Fully Met

  Partially Met

  Not Met

  Not Applicable

• Skin -Des Antiseptic Hand Spray (1 bottle)

  Select Fully Met Partially Met Not Met Not Applicable

  • Fully Met
  • Partially Met
  • Not Met
  • Not Applicable

• Xylocaine/Lidocaine Spray or Gel (1 either)

  Fully Met

  Partially Met

  Not Met

  Not Applicable

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