Resuscitation Trolley Fortnightly Check (Ward)

• Conducted on

  Date

• Prepared by

Checklist

• Checklist completed daily

  Yes

  No

Top of Trolley

• Defibrillator checked (remove battery and reinsert to start self-test)

  Yes

  No

• Defibrillator pads in date

  Yes

  No

• x1 pair if scissors, x1 razor and paper towels in AED case

  Yes

  No

• Sharps box on side of trolley

  Yes

  No

• x1 stethoscope and sphygmomanometer on side of trolley (Manual BP monitor)

  Yes

  No

• Hypoglycemic box on top of trolley

  Yes

  No

• Suction machine on top of trolley with yankauer sucker attached

  Yes

  No

• Oxygen canister in date and at least 3/4 full

  Yes

  No

• HemoCue box on top of trolley

  Yes

  No

• Emergency IV fluid tray on top of trolley

  Yes

  No

Draw 1 - Airway & Breathing

• ET Tube x2 size 7 AND x2 8

  Yes

  No

• Nebuliser kit with face mask x1

  Yes

  No

• Anaesthetic face mask x1

  Yes

  No

• Oxygen face mask x1

  Yes

  No

• Flexi-lock catheter mount x1

  Yes

  No

• I-gel - x1 size 4 AND x1 size 5

  Yes

  No

• Airway tray consists of - ribbon, gauze, x1 syringe & lubricant

  Yes

  No

• Guedel Airways - x1 size 3 AND z1 size 4 AND x1 size 5

  Yes

  No

• Guide tube (blue) x1

  Yes

  No

• Magil forceps x1

  Yes

  No

• Laryngoscope blade x2

  Yes

  No

• Goggles/eye protection x1 pair

  Yes

  No

• FFP3 mask x1

  Yes

  No

Draw 2 - Circulation

• x2 2ml syringes

  Yes

  No

• x2 5ml syringes

  Yes

  No

• x2 10ml syringes

  Yes

  No

• x2 20ml syringes

  Yes

  No

• x1 tourniquet

  Yes

  No

• x3 SC/IM needles (x1 green/x1 orange/x1 blue)

  Yes

  No

• x3 cannulas (x1 pink/x1 blue/x1 green)

  Yes

  No

• x3 blunt needles

  Yes

  No

• x1 gauze

  Yes

  No

• x2 cannula dressings

  Yes

  No

• x2 alcohol wipes

  Yes

  No

• x1 roll of micropore tape

  Yes

  No

• x2 10ml saline pods

  Yes

  No

• x1 bung

  Yes

  No

• x1 extension clave

  Yes

  No

• x1 tap connection for cannula

  Yes

  No

Draw 3 - Fluids

• x1 bag of 1000mls of Hartmann's solution

  Yes

  No

• x1 IV giving set

  Yes

  No

• x1 fluid pressure bag

  Yes

  No

Draw 4 - Breathing and Suction Equipment

• x6 deep suction catheters

  Yes

  No

• x1 yankauer sucker

  Yes

  No

• x1 suction connection tube

  Yes

  No

• x1 bag valve mask (face mask & reservoir)

  Yes

  No

• x1 breathing circuit/resuscitation bag

  Yes

  No

Draw 5 - Emergency Drugs

• x1 adrenaline (epinephrine) 1:100,000 injection for IV, IO or ET tube use

  Yes

  No

• x1 atropine solution for infection 3mg/10ml for IV use

  Yes

  No

• x2 pre-filled ephedrine syringes

  Yes

  No

• x2 amiodarone solution for infection 150mg for IV use

  Yes

  No

• x1 filter needle

  Yes

  No

• x1 10ml syringe

  Yes

  No

Draw 5 - Naloxone Box

• x1 5ml syringe

  Yes

  No

• x1 10ml syringe

  Yes

  No

• x1 10ml 0.9% sodium chloride

  Yes

  No

• x2 alcohol wipes

  Yes

  No

• x2 filter needles

  Yes

  No

• x1 bung

  Yes

  No

• x3 naloxone 400mcg/ml ampules

  Yes

  No

Draw 5 - Anaphylactic Box

• x3 2ml syringes

  Yes

  No

• x2 10ml syringes

  Yes

  No

• x1 20ml water for injection pod

  Yes

  No

• x2 10ml 0.9% sodium chloride pod

  Yes

  No

• x2 vials of adrenaline 1:1000

  Yes

  No

• x1 10mg vile of chlorphenamine

  Yes

  No

• x1 10mg vial of hydrocortisone

  Yes

  No

• x3 blunt needles/drawing up needles

  Yes

  No

• x1 blue needle

  Yes

  No

• x1 green needle

  Yes

  No

• x1 orange needle

  Yes

  No

• x3 alcohol wipes

  Yes

  No

• x1 extension clave

  Yes

  No

Additional comments

• Additional comments:

Signatures

• Staff Signature

  Sign

• Auditor Signature

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