Resuscitation Trolley

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

Checklist

• Checklist completed daily

  Yes

  No

  N/A

Top of Trolley

• Defibrillator Checked

  Yes

  No

  N/A

• Defibrillator serial number and type

• Defibrillator pads in date

  Yes

  No

  N/A

• Defibrillator pads connected

  Yes

  No

  N/A

Side of Trolley

• E size Oxygen cylinder at least 3/4 full

  Yes

  No

  N/A

• Box of medium size gloves

  Yes

  No

  N/A

• Suction machine connected and working

  Yes

  No

  N/A

• Yankeur suction catheter (3)

  Yes

  No

  N/A

• Suction catheters size 12fg (4)

  Yes

  No

  N/A

• Suction catheters size 14fg (4)

  Yes

  No

  N/A

Intravenous Infusion Pole

• Bag valve mask

  Yes

  No

  N/A

Draw 1 Advanced Airway

• ET tube size 6,7,8,9

  Yes

  No

  N/A

• Laryngoscopes handle with disposable size 3 blade

  Yes

  No

  N/A

• Laryngoscopes handle with disposable size 4 blade

  Yes

  No

  N/A

• Magills forceps

  Yes

  No

  N/A

• Scissors

  Yes

  No

  N/A

• Catheter Mount

  Yes

  No

  N/A

• 20ml syringe

  Yes

  No

  N/A

• Ribbon Gauze

  Yes

  No

  N/A

• Spare batteries for laryngascope

  Yes

  No

  N/A

• Waters circuit

  Yes

  No

  N/A

Draw 2 Airway & Breathing

• Non-rebreathe oxygen mask (high flow)

  Yes

  No

  N/A

• Oro-pharyngeal airways size 2,3,4

  Yes

  No

  N/A

• Naso-pharyngeal airways size 6,7

  Yes

  No

  N/A

• Laryngeal mask airways size 4,5

  Yes

  No

  N/A

• Pocket mask

  Yes

  No

  N/A

• 50ml syringe

  Yes

  No

  N/A

• Lubricant gel

  Yes

  No

  N/A

Draw 3 Circualtion

• Orange cannula 14g (6)

  Yes

  No

  N/A

• Grey cannula 16g (6)

  Yes

  No

  N/A

• Green cannula 18g (6)

  Yes

  No

  N/A

• Pink cannula 20g (4)

  Yes

  No

  N/A

• Micropore tape (half inch)

  Yes

  No

  N/A

• Micropore tape (one inch)

  Yes

  No

  N/A

• IV dressings (8)

  Yes

  No

  N/A

• 5ml syringe (4)

  Yes

  No

  N/A

• 10ml syringe (8)

  Yes

  No

  N/A

• 20ml syringe (4)

  Yes

  No

  N/A

• Blood gas syringe (4)

  Yes

  No

  N/A

• Pack of gauze swabs (6)

  Yes

  No

  N/A

• Alcohol impregnated swabs (20)

  Yes

  No

  N/A

• Green needles 21g (20)

  Yes

  No

  N/A

• Sodium Chloride 0.9% ampules 10mls (10)

  Yes

  No

  N/A

• Razors (2)

  Yes

  No

  N/A

• Long intravenous line size 14g, 16g

  Yes

  No

  N/A

• Three way tap with extension (2)

  Yes

  No

  N/A

Draw 4 Circulation

• IV giving set (2)

  Yes

  No

  N/A

• Large bore blood giving set (2)

  Yes

  No

  N/A

• Volplex 500mls

  Yes

  No

  N/A

• Normal Saline 500mls

  Yes

  No

  N/A

• Normal Saline 1000mls

  Yes

  No

  N/A

Draw 5 Drugs and Miscellaneous

• Blue cardiac arrest drugs box

  Yes

  No

  N/A

• Pressure infusion bag

  Yes

  No

  N/A

• Pack of ECG electrodes

  Yes

  No

  N/A

• Spare pack of defibrillation pads

  Yes

  No

  N/A

• Sharps bin

  Yes

  No

  N/A

Signatures

• Staff Signature

  Sign

• Auditor Signature

  Sign