Cart System Among Nurses In Selected Hospitals, Bangalore

1

“A Descriptive Study To Assess The Practice Of Organized Crash

Cart System Among Nurses In Selected Hospitals,

Bangalore; With A View To

Develop A Protocol”.

By

SIBI ALEXANDER

Dissertation submitted to the Rajiv Gandhi University

of Health Sciences, Bangalore, Karnataka

in partial fulfillment

of the requirements for the Degree of

Master of Science in Nursing

in

Medical Surgical Nursing

Under the guidance of

Prof.Victorial Selva Kumari. C

HOD Medical Surgical Nursing

Sarvodaya College of Nursing

Agrahara Dasarahalli, Bangalore – 560079

November 2007

2

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

DECLARATION BY THE CANDIDATE

I here by declare that this dissertation entitled “A Descriptive Study to

Assess The Practice Of Organized Crash Cart System Among Nurses In

Selected Hospitals, Bangalore; With A View To Develop A Protocol ”is a

bonafied and genuine research work carried out by me under the guidance of

Prof.Victorial Selva Kumari, HOD -Medical Surgical Nursing.

Date: Signature of the Candidate Place: Bangalore (Sibi Alexander)

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3

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A Descriptive Study to Assess

The Practice of Organized Crash Cart System among Nurses in Selected

Hospitals, Bangalore ; With A View To Develop a Protocol ” is a bonafied

research work done by Mr.Sibi Alexander in partial fulfillment of the requirements

for the degree of Master of Science in Medical Surgical Nursing.

Date: Signature of the Guide

Place: (Prof.Victorial Selva kumari. C

HOD- Medical Surgical Nursing)

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ENDORSEMENT BY THE HOD, PRINCIPAL OF THE INSTITUTION

This is to certify that the dissertation entitled “A Descriptive Study to Assess

The Practice of Organized Crash Cart System among Nurses in Selected

Hospitals, Bangalore; With A View to Develop a Protocol ” is a bonafied research

work done by Mr.Sibi Alexander under the guidance of Prof..Victorial Selva

kumari, HOD-Medical Surgical Nursing.

Seal & Signature of the HOD Seal & Signature of Principal (Prof.Victorial Selvakumari. C) (Prof. T.Bheemappa) Date: Date: Place: Bangalore Place: Bangalore

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5

COPY RIGHT

DECLARATION BY THE CANDIDATE

I here by declare that the Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka shall have all the rights to preserve, use and disseminate this

dissertation in print or electronic format for academic/Research purpose.

Date: Signature of the Candidate Place: (Sibi Alexander) © Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

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ACKNOWLEDGEMENT

“My grace is sufficient for thee ” II cor. 12:9

The investigator owes a deep sense of gratitude to all those who have

contributed to the successful completion of this endeavour.

I express my gratitude to Almighty God for His grace and blessings, who

has been the guiding force behind all my efforts.

I wish to express my thanks to Mr.Narayanaswamy, Chairman, Sarvodaya

College of Nursing, for his support throughout the course of this study.

I extend my thanks to Prof. T. Bheemappa Principal, Sarvodaya College of

Nursing, for his support and guidance in completion of the study.

My heart felt thanks to my guide Prof. Victorial Selva Kumari.C, HOD

Medical Surgical Nursing for the expert guidance, suggestions and support rendered

throughout the study.

I wish to express my special thanks to Asst.Prof.Revathi R, department of

medical & surgical Nursing, for her guidance and support throughout the study.

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I wish to express my heartfelt gratitude to Prof. .Hemalatha R,HOD,Child

Health Nursing who has given the basic ideas of research.

My heartfelt thanks to Prof.J.Lovera Grace Lilly Rani, Child Health

Nursing and Research for her guidance and support for the study.

I take this opportunity to thank the entire faculty members and research

committee, Sarvodaya College Of Nursing, for their guidance and support in each

major step of study

.

My special thanks to Mr.H.S.Surendra Asso. Prof. Biostatistics, GKVK

Agricultural University, for his validation of tool and guidance in statistical analysis.

Its my privilege to convey my sincere thanks to the experts who have

validated the research tool and have guided me with their valuable suggestions and

corrections.

My heartfelt thanks goes to the Librarians of Sarvodaya College of Nursing

Mr .Balu Rathore and Ms Niveditha for extending the library facilities throughout

my study.

I thank all the participants who have extended their kind co-operation and

participation in this study.

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I thank all my classmates and the enlightened company of my good friends

whose souvenir of prayers was of help and support throughout my thesis work.

I am greatly indebted to my wife Mrs. Sherine, for her immense help and

support, constant encouragement, who was beside me throughout this work.

I thank all the participants for their cooperation without whom every effort

would have been in vain. My sincere thanks to all those who directly and indirectly

helped in the successful completion of this study.

Date: Signature of the candidate

Place: (Sibi Alexander)

viii

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LIST OF ABBREVATIONS USED

1. SD : Standard deviation

2. X2 : Chi Square

3. Df : Degree of freedom

4. p value : Probable value

5. CCU : Coronary Care Unit

6. ICU : Intensive Care Unit

7. ISO : International Standards Organization

8. < : Greater than

9. < : Lesser than

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TA BLE OF CONTENTS

SL. NO

CONTENTS

PAGE NO

1.

INTRODUCTION

1-8

2.

OBJECTIVES

9-10

3.

REVIEW OF LITERATURE

11-16

4.

METHODOLOGY

17-26

5.

RESULTS

27-40

6.

DISCUSSION 41-43

7.

CONCLUSION

44-47

8.

SUMMARY

48-51

9.

BIBLIOGRAPHY

52-55

10.

ANNEXURE

56-84

x

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LIST OF TABLES Sl. No

Tables

Page .No

1.

Assessment of practice level regarding crash cart among nurses.

36

2.

Aspects Wise mean practice on emergency crash cart system among nurses.

37

3.

Association between practice score and selected variables.

39

xi

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LIST OF FIGURES Sl.No

Figures

Page No

1.

Conceptual framework

8

2.

Schematic representation of research design

20

3.

Distribution of respondents by age, gender and marital status

29

4.

Distribution of respondents qualification, area of working and experience

30

5.

Association between age and practice levels

31

6.

Association between marital status and practice levels

32

7.

Association between qualification and practice levels

33

8.

Association between experience and practice levels

34

9.

Association between area of working and practice levels

35

Xii

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ABSTRACT Statement of the problem:

“A Descriptive Study To Assess The Practice Of Organized Crash Cart

System Among Nurses In Selected Hospital, Bangalore; With A View To Develop

A Protocol ” was undertaken as a partial fulfillment of requirement for the degree of

Master of science in Nursing at Sarvodaya college of Nursing, Bangalore during the

year 2006-07.

Background:

Crash cart is an essential part of emergency procedure in any hospital. An

organized crash cart can bring a sense of structure to a potentially chaotic situation.

Crash cart is usually stocked with emergency medications for almost all potential

emergency situation. Apart from emergency medication, they contain various other

equipments like resuscitation set, organized into various drawers & modules like

intubation module, intravenous module etc. Many research studies reveal that,

generally the practice level of nurses are inadequate.

Objectives

1. To assess the level of practice of nurses regarding organized crash cart system.

2. To find out the association between practice of nurses regarding crash cart and

selected variables.

3. To develop a protocol on organized crash cart.

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Assumption

It is assumed that nurses lack efficiency in utilization of crash cart system.

Methods:

Descriptive design was used to assess the practice of organized crash cart

system among nurses in selected hospital, Bangalore; with a view to develop a

protocol.

The target population of the study was nurses who are working in Emergency,

CCU and ICU departments. A total of 50 nurses were selected by using purposive

sampling technique.

An observational checklist was used to collect the data. Reliability of the tool

was tested and validity was ensured in consultation with guides and experts in the

fields of nursing and medicine.

The study was carried out in Sarvodaya Hospital and Trinity Hospital,

Bangalore from 3rd September to 3rd October 2007.

Results:

• The overall mean practice score of the subjects was 13.86, the mean

percentage was 51.3 and SD was 13.7

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• Out of the 50 subjects 21(42 percent) have unsatisfactory level of practice i.e.

less than 50% and 29 (58 percent) have moderately satisfactory practice levels

i.e. 51-75%.

• These findings show that no subjects have satisfactory practice levels i.e.

above 75%.

• There was significant association found with practice score of the subjects

and age as well as area of working of the subjects.

Interpretation and Conclusion:

This study showed that none of the subjects had satisfactory level of practice

regarding crash cart and it insists the importance of educating the staff nurses

regarding the practice of organized crash cart system.

Key Words:

Practice; Crash cart ; Protocol.

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1.IN

17

TRODUCTION

“Wrong decision in wrong time is a disaster

Wrong decision in right time is a mistake

Right decision in wrong time is unacceptable

But right decision in right time is a success” -John c Maxwell

Crash cart is an essential part of emergency procedure in any hospital. An

organized crash cart can bring a sense of structure to a potentially chaotic situation.

Crash cart are usually stocked with emergency medications for almost all potential

emergency situation. Apart from emergency medication, they contain various other

equipments like resuscitation set, organized into various drawers & modules like

intubation module, intravenous module etc.

A well organized crash cart can save a lot of time & confusion during an

emergency, which in turn can save a life. Some crash carts are organized into drawers

with color code for different types of situations.1

In hospital emergency rooms, intensive care units and other areas cardiac arrest

is quite common. When this occurs immediate care must be provided with in few

minutes to prevent permanent brain cell damage. To speed the delivery of necessary

drugs and equipment, crash carts are used by designated teams of nurses and doctors.

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The crash cart may be hex angle in shape with caster wheels arranged so it can

be easily turned on a central axis. Each of the sides is readily accessible at the same

time with one of the sides being quickly removable for use as a cardiac arrest

board which is placed under the patient’s back during resuscitation. The cart is made

of aluminum and plastic for light weight and maneuverability. The sides of the cart

are transparent panels which are colour coded, so equipment and drugs stored inside

can be quickly identified and removed. 2

Further the upright shape of the cart provides better mobility and requires less

floor space than conventional rectangle shaped boxes and cart. This is extremely

important considering the congestion usually surrounding a patient during

emergencies. After an emergency the removable panels can be quickly entered for

restocking and made ready for use again in a few minutes.

The crash cart for use in storing equipment and drugs in a hospital and the like

includes a lower housing having caster wheels mounted on the bottom thereof. The

lower housing has side panels which may be opened for entrance into the housing.

One or more of the side panels may be transparent for viewing the items stored

therein. An upper housing is mounted on top of the lower housing with the upper

housing having one or more transparent side panels for viewing items stored therein.

The side panels may be opened for entrance into the housing. A flat rotate able shelf

is mounted on top of the upper housing and is adapted for receiving equipment such

as a defibrillator thereon. 3

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Types of standard carts are adult cart; the adult emergency cart is usually a

three drawer cart. It is colour coded red or grey and items for treatment of adult

patients. A few of these cart may have five drawers and the pediatric cart; the

pediatric emergency cart is a five drawer cart and is painted blue. It contains items for

pediatric use. 4

Need for the study

There is reason behind everything in nature.

-Aristotle

It is a well known fact that crash cart system is an integral part of emergency

procedures in any hospital. But it is felt that this system is not used to its potential in

most of the hospitals. During emergency situation, nurses are left with confusion &

hurry in getting the emergency medications.6 A well organized crash cart can save a lot

of time & confusion during an emergency, which in turn can save the life. Some crash

carts are organized into drawers with color code for different type of situations. 7

These are some of the item found on a crash cart: Defibrillator, the goal is to

shock the heart back to normal. Endo-tracheal intubation equipment, the tube allows

artificial respiration equipment to take over the job of breathing for the patient,

Central vein catheters, cardiac drugs and many other life saving drugs.

To insure availability of all drugs and equipment necessary to initiate advanced

life-support measures and uniformity of crash cart throughout the units. All crash cart

will be checked; defibrillator and cardiac monitor shall be checked and appropriately

20

documented for performance on both battery and electrical current once in every 24

hours. The defibrillator will remain plugged into an electrical outlet at all times, except

during battery testing. The department will be contacted immediately when a

defibrillator problem is documented once in every shift. 9

Responsibilities of the nurse in charge are restocking of crash cart immediately

after every shift, verifying contents of the cart with the supply personnel, verifying the

presence and expiry date of all items on carts at least every month, reporting to supply

department if expiry date is exceeded or seal is broken.

Because of the number of personnel on an emergency team and the necessity

for speed in the delivery of care, confusion quite often occurs when the first drugs to

be administered were in one drawer while an equally important piece of equipment

was in another drawer. Because of the structure of the equipment box access to more

than one drawer at a time was impossible causing serious delays. Further these carts

were organized in as much as first used drugs were in a specific drawer, respirator

equipment in another drawer etc. This means one drawer after another must be opened

and closed repeatedly.

Here it was felt that a study was needed to assess the knowledge about the full

potential of crash cart system among nurses. Further, the study will go into the existing

crash cart practices among the nurses. This would help in bringing out the need for

organized crash cart system awareness among nurses on the need & importance of

crash cart system.10

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Problem Statement:

“A Descriptive Study To Assess The Practice Of Organized Crash Cart


A Protocol ”.

Operational Definition:

1 Practice of organized crash cart system: It refers to the deliberate effort

taken by the staff nurses to arrange crash cart in a systematic order after every

shift.

2. Organized crash cart: It refers to a systematically arranged emergency

trolley.

Assumption:

It is assumed that nurses lack efficiency in utilization of organized crash

cart system.

Inclusion criteria:

Nurses who are working in Emergency, CCU and ICU departments at selected

hospitals.

Nurses who are willing to participate in the study.

Projected outcome:

This study will help the staff nurse to practice better organized crash cart

system in different wards.

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Conceptual Frame Work:

Conceptualization refers to the process of developing and refining abstract. A

conceptual model provides logical thinking for systematic observations and

interpreting the observed data. The model also gives direction for relevant questions

on phenomena and point out solutions to practical problems.

The present study aims at assessing the practice of organized crash cart system

among nurses in selected hospitals, Bangalore; with a view to develop a protocol.

The framework of the present study (Fig.1) was developed by investigator

based on quality assurance model by Donabedian in 1992, which consists of three

components like structure, process and outcome.

The structure part consists of identifying the structure standards and criteria,

the process part consists of identifying the process standards and criteria and the

outcome part consists of standards and criteria to evaluate outcome.

Here the quality assurance model focuses on existing policies for crash cart

use, philosophy, objectives, ISO recognition and experiences of the staff nurses as

well as in the process part it assess the organization of the crash cart system and the

practice of nurses. If criteria is not met, protocol development as the problem solving

choice to improve the practice.

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Figure 1: Conceptual Framework Modified Donabedian’s Quality assurance model (1992)

Structure Standards & Criteria * Existing policies for Crash Cart use. * Philosophy, Objectives * Equipment, Resources * ISO Recognition * Hospital Utilization Review Committee * Experience of the Staff

Process Standards & Criteria *Practice of Nurses (Crash Cart) *Observation check list to assess the organization of Crash cart system

Efficient utilization

of organized crash cart.

STRUCTURE PROCESS

OUTCOME

SATISFACTORY

DEVELOPMENT OF PROTOCOL

UNSATISFACTORY

PLANNING EVALUATION

ASSESSMENT

25

2. OBJECTIVES

Statement of the Problem:

“A Descriptive Study to Assess The Practice Of Organized Crash Cart


A Protocol”.

Objectives of the Study:

1. To assess the level practice of nurses regarding organized crash cart system.

2. To find out the association between practice of nurses regarding crash cart and

selected variables.

3. To develop a protocol on crash cart.

27

3.REVIEW OF LITERATURE

Review of literature is an integral component of any study or research project.

This chapter deals with the selected studies, which is related to the objectives of the

proposed study. It enhances the depth into the crux of the problem. Literature review

troughs light on the studies and their findings reported about the problems of the

study.

Review of literature is a systematic identification, location, scrutiny and

summary of written materials that contain information on research problem.8

Review of literature is an essential step in the research project. It provides basis

for future investigation, justifies the need for the study, throws light on the need for

the study, reveals constraints of data collection and relates the findings from one study

to another with a hope to establish a comprehensive study of scientific knowledge in a

professional discipline from which valid and pertinent theories may be developed.

The studies and literature reviewed is organized and presented as follows:-

Section I- Studies and literature related to the standardization of crash cart.

Section II- Studies and literature revealing the advantage of crash cart and its

maintenance

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Section I- Studies and literature related to the standardization of crash cart.

Telesca K narrated that an organized crash cart can bring a sense of structure

to potentially chaotic situation. By standardizing every crash cart, time and

confusion can be saved during an emergency situation.1

Laufman H, Badner B, Zeiner L conducted a system study on existing

bedside emergency resuscitation carts and a new design for a bedside cart was

suggested with list of emergency medications and equipment, every item of which is

visible and available without opening drawers for it, and be kept on every nursing

station and every special care department of a hospital.

Adams B D, Shih H, Stuffel E, Robinson A M conducted a study to

investigate whether a brief video of how to properly inspect crash carts and

defibrillators would improve the quality and frequency of this inspections. The

study was a before-after cohort design. The video-based training programme

improved the frequency and quality of defibrillator inspections, but not crash cart

inspections. It was felt that a short video training programme could be viewed on a

ward computer at a convenient time.3

Agarwal S, Swanson S, Murphy A, Yaeger K, Sharek P, Halamek L P

conducted a study on comparing the utility of a standard pediatric resuscitation cart

29

based on a Broselow tape. It was found that despite less prior experience with the

Broselow cart, subjects in the study found it easier to use and preferred it to the

standard cart, they located intubation equipment, and naso-gastric tubes significantly

faster

Reynolds HN,Haunt MT, Carlson RW conducted a study to make a policy

for Louisiana state university science health science center. Here they suggested that

Central Medical Supply should provide Crash carts on an exchange basis to al

patient care areas to initiate emergency life- support measures.12

Section II- Studies and literature revealing the advantage of crash cart and its

maintenance.

Manouchehr Saljoughian conducted a study on medical emergencies. He

states that in addition to supportive measures, quick therapeutic interventions are

essential in most cases. Therefore, access to the right medication to resolve the

problem is critical. A selection of drug that is most effective and appropriate in these

situations are kept in a special cart known as “crash cart” in all hospital departments

responsible for patient care.4 The pharmacy departments are responsible for

providing these medications and regularly checking them for stability, replacement

and expiration dates. The most important indications, contraindications, dosage, and

administration of these drugs are reviewed as a reminder for the physicians, nurses

and pharmacists who serve on cardiac arrest (code) teams or who are involved in

other emergencies.

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Colleen. J. O’Connor, in the fourth quarter of 2001, several staff members at

St. Marks Hospital recognized the need to simplify and standardize the medications

in the crash carts. The crash carts contained many medications that were not being

utilized and only served to clutter the carts and lead to the potential for medication

errors. The medications were also placed in foam containers right side up so that

you could not see the label on the container. In addition, Cordarone (aminodarone)

was placed in a plastic bag along with a syringe, bottle of normal saline, filter needle

and regular needle, which made this medication difficult to identify in a code

situation.13

Simon Phaneufet, conducted a study on the accessibility of medical

emergency treatment cart, which is of a generally rectangular configuration and has

a pair of opposed sides and a pair of opposed ends, the cart having first and second

modules at opposed ends of the cart. The first module may be classed as an airway

module and includes means for storing an oxygen container and a plurality of

storage drawers; a second module may be classified as a nursing station and has at

least one storage drawer moveable into and out of a storage position and which is

also mounted so as to be rotatable whereby access to the drawer may be had from a

side or an end of the cart. An upper surface has turntable means for receiving a

monitor and includes a medicament storage compartment. The cart provides

ergonomic access for all members of medical emergency treatment team responding

to emergencies such as cardiac arrest.15

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Watson conducted a study to standardize a policy for maintenance of cart.

The Hospital Pharmacy and Central Sterile Supply jointly maintain standardized

emergency carts throughout the hospital and the Ambulatory Care Center. All carts

with intensive care units and the Emergency Department are standardized and are

sealed with an integrity seal. Contents of the standardized cart will be determined on

approval of the Patient Care Issues Committee.8

Stewart Taylor conducted a study on crash cart exchange procedure. Anytime

the Emergency cart is entered, the integrity seal must be broken. A broken seal

signals the need to exchange the cart. Immediately after the cart is used, the staff on

the Unit must put a patient label on a Charge Ticket. The unit then returns the used

cart to Central Supply and exchanges it for a checked sealed cart.. At the time of

exchange, the representative from the unit rechecks the cart with a representative from

Central Supply to confirm that all supplies are present. A crash cart receipt slip is

signed by both checkers. One copy stays with the cart and one stays in CSS.11

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4.METHODOLOGY

Methodology of research organizes all the components of the study in a way

that is most likely to valid answer to the sub problems that have been posed (Burns

and Grove, 2002). In this study, it refers to the various logical steps that are

generally adopted by an investigator in studying the research problem.

The present study was aimed at assessing the practice and developing

guidelines for staff nurses regarding organized crash cart system.

Research approach

Research approach indicates the procedure for conducting the study. In order

to accomplish the objectives of the study, a descriptive observational approach was

adopted.

Descriptive approach describes situations, as they exist in the world and

provides an accurate account of characteristics of particular individuals, situation or

groups. The outcome of descriptive research provides a basis for future quantitative

research.

Research design:

Research design is an investigator’s overall plan for obtaining answers to the

research questions

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In many aspects of nursing, there is a need for a clearer picture or description

of the phenomenon before casualty can be examined.

For the present study, a descriptive design was adopted, as it was a virtue of a

situation that naturally happens. The schematic representation of study design is

presented in the fig.2.

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Figure 2: Schematic representation of the research design

Selected Hospital, Bangalore

Purpose

To Assess The Practice Of Organized Crash Cart System Among

Nurses

Research Design Descriptive Design

Target Population

Nurses who are working in the Emergency, CCU, ICU

Departments

Sample

50 Nurses

Sampling technique

Purposive sampling

Data collection instrument

Observational Checklist

Data analysis

Descriptive & inferential statistics

Finding and conclusion Protocol development

36

Setting of the study

The setting is the location where a study is conducted (Burns and Grove,

2002).

For the present study, Sarvodaya and Trinity hospital was selected.

Sarvodaya is an exclusively dedicated 250 bedded hospital to provide tertiary

care. The hospital comprises of 100 staff nurses, including one nursing

superintendent, all specializations including cardiology. Trinity is a 100 bedded

hospital exclusively for cardiology.

The selection of the setting was done on the basis of –

• Geographical proximity,

• Feasibility of the study and

• Availability of samples.

Population:

The population referred to as the target population, which represents the entire

group or all the elements like individuals or objects that meet certain criteria for

inclusion in the study.

In the present study, the populations consist of staff nurses working at

Emergency, CCU and ICU departments.

37

Sample:

Sample refers to subset of a population that is selected to be participating in a

particular study. It is a portion of a population, which represents the entire population.

In this study, non-probability, purposive sampling referred to as judgment or

theoretical sampling, which involves the purposive selection of the subjects, was

followed by the investigator.

Sampling criteria

The samples were selected with the following pre-determined set criteria.

Inclusion criteria

• Nurses who are working at Emergency, ICU and CCU departments in selected

hospitals.

• Nurses who are willing to participate in the study.

Data collection instrument:

The instrument is a vehicle that could best obtain data pertinent to the study at

the same time adds to the body of knowledge in the discipline.

Based on the objectives of the study observational checklist was developed to

assess the practice of nurses regarding crash cart. It was considered to be an

appropriate instrument.

38

In this study the data collection instrument consists of two sections. They are

Section A: Demographic data

Section B: Assessment of practice regarding crash cart

Selection of the tool

An observational checklist was selected on the basis of the objectives of the

study as it was considered to be most appropriate instrument to assess the practice of

the subjects.

Development of tool

The instrument selected in research should be as far as possible the vehicle

that would best obtain data for drawing conclusion, which were pertinent to the study.

Based on the past experience of the investigator and on the opinion of subject

experts, and with the intense research of related literature an observational checklist

was developed, for assessing the practice of nurses regarding crash cart.

The tool was developed:

• After reviewing the related literature

• After preparation of the blue print

• Based on the past experience of the investigator and

• Based on the opinion of the subject experts.

Description of the tool:

The investigator developed an observational checklist, which contained items

under the following sections.

39

Section A: Demographic data:

This section consisted of 9 items, pertinent to the staff nurses regarding age,

gender, marital status, professional qualification, experience, area of working , in-

service education and source of information.

Section B: Assessment of practice regarding crash cart

This section consists of 27 statements related to location, maintenance,

arrangement, post emergency nursing actions and credibility of nurses. The

investigator has to ( √ ) mark against the correct practices in the box provided.

Testing of the validity:

A. Content validity

Validity refers to, whether a measure instrument accurately measures what it is

supposed to measure.

The prepared instruments along with the objective, operational definitions,

blue print, score key and a criteria checklist for validation was submitted to 7 experts

which included 4 nurse educators, 1 nursing superintendent, 1 doctor and 1 statistician

to establish content validity. The recommendation and suggestions were considered

and the tool was reframed accordingly.

B. Reliability

Reliability of the research instrument is defined as the extent to which the

instrument yields the same results on repeated measures (Polit and Hungler, 1999).

40

In order to establish the reliability of the tool, it was administered to 10 staff

nurses of Soubhagya hospital, Bangalore.

Pilot Study:

Pilot study is a smaller version of a proposed study conducted to develop or

refine the methodology, such as the instrument or the data collection process. The

pilot study was conducted in Soubhagya hospital, Bangalore. The permission to

conduct the study was obtained from the nursing superintendent of the hospital.10

subjects were selected by purposive sampling. Data analysis was done using

descriptive and inferential statistics.

Data collection procedure:

Prior permission was obtained from the concerned authority to conduct the

study. The investigator personally visited Soubhagya hospital and introduced to the

nursing superintendent and explained the purpose of the study. Data was collected

from 06-08-2007 to 11-08-2007.

Plan for analysis of data:

The data was planned to be analyzed on the basis of objectives and

assumptions of the study.

• Demographic data was planned to represent in terms of frequency and

percentage.

• The practice level of staff nurses was planned to analyze using number,

percentage, mean, median, range and standard deviation and

41

• The association between practice level of staff nurses with selected

variables was planned to analyze by using chi-square formula.

Summary:

A descriptive observational approach was adopted in order to assess

the practice. An observational checklist was developed for assessing the

practice of staff nurses regarding crash cart. Validity and reliability of the

same were tested. Data was collected from the sample after obtaining

permission from the concerned authority. Collected data was analyzed using

descriptive and inferential statistics and presented in terms of tables and

graphs.

43

5.RESULTS

The data themselves do not provide us with answers to, our research questions.

Ordinarily, the amount of data collected in a study is extensive to be reliably

described by mere perusal. In order to meaningfully answer the research question, the

data must be processed and analyzed in some order, so that relationship can be

discerned.

The term analysis refers to number of closely related operations, which are

performed with the purpose of summarizing the collected data and organizing the data

in such a manner that they answer the research questions.

This section presents the analysis and interpretation of data collected from 50

staff nurses in order to assess the practice regarding the crash cart system. The data

collected were organized, tabulated, analyzed and interpreted by means of statistical

tables and graphs.

The main objectives were:

1. To assess the practice of nurses regarding organized crash cart system.

2. To find out the association between practice of nurses regarding crash cart

and selected variables.

The data is presented under following sections.

Section A

Description of demographic variables of the subjects and association with practice.

44

Section B

• Assessment of level of practice regarding crash cart

• Association between practice score and demographic variables

45

SECTION A

44

40

16

30

70

78

22

0

10

20

30

40

50

60

70

80Re

spon

dent

s (%

)

23-2

5

26-2

8

29-3

1

Mal

e

Fem

ale

Sin

gle

Mar

ried

Age (Yrs) Gender Marital status

Figure 3:

Diagram showing age, gender and marital status distribution of the subjects

Figure 3 shows that 22 (44 percent) of the subjects were in the age group of

23-25 years, 20 (40 percent) in 26-28 years and 8 (16 percent) were in the age group

of 29-31 years. Majority of the subjects 35(70 percent) were females and only 15(30

percent) were males. 39(78 percent) of the subjects were single and 11(22 percent)

were married

46

30.0

38.0

20.0

40.040.0

78.0

22.0

32.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Diplom

a

Gradu

ate ICU

ICCU

Emergen

cy

1 yea

r

2-3 y

ears

4+ ye

ars

Qualification Area of work Experience

Resp

onde

nts

(%)

Figure 4 Diagram showing the qualification, area of working and experience of the subjects

Figure 6 shows that 39(78 percent) of the subjects were diploma and 11(22

percent) were graduates. 20(40 percent) of the subjects were working in ICU, 20(40

percent) were working in CCU and 10(20 percent) were working in Emergency

departments.19(38 percent) of the subjects have 1year, 15(30 percent) were between

2-3 years and 16(32 percent) were having more than 4 years of experience.

47

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

23-25 26-27 28-31

63.6

30.0

12.5

36.4

70.0

87.5

Respondents

Age Group (years)

Uns atisfactory Moderate ly Satisfactory

Figure . 5 : Association between Age and practice level on Emergency crash cart system

48

48.7

18.2

51.3

81.8

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Single Married

Marital status

Res

pond

ents

(%)

Low Practice Moderate Practice

Figure . 6 : Association between Marital status and practice level on Emergency crash cart system

49

48.7

51.3

18.2

81.8

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Res

pond

ents

(%)

Diploma Graduate

Professional Qualification


Figure . 7 : Association between Qualification and practice level on Emergency crash cart system

50

42.1

57.960.0

40.0

25.0

75.0

42.0

58.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Res

pond

ents

(%)

1 y

ear

2-3

year

s

4+ y

ears

Com

bine

d

Total Experience (years)


Figure . 8 : Association between Experience and practice level on Emergency crash cart system

51

0.0

65.0

40.0

100.0

35.0

60.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

ICU ICCU EmergencyArea of Working

Res

pond

ents

(%)


Figure . 9 : Association between Area of working and practice level on Emergency crash cart system

52

SECTION B

Table – 1 Assessment of level of Practice on Emergency crash Cart system among Nurses

Respondents

Practice Levels

Number

Percent

Unsatisfactory (< 50%)

21

42.0

Moderately satisfactory (51-75%)

29

58.0

Total

50

100.0

Table showing the total practice level of the subjects

Table 1 shows that 21(42 percent) of the subjects have unsatisfactory level of practice and 29(58 percent) were moderately satisfactory.

53

Table – 2 Aspect wise Mean Practice on Emergency crash Cart system among Nurses

n = 50 Practice No. Practice

Aspects Statements Max.

score Range Score Mean Mean

( % ) SD

( %) I

Location

3

3

1-3

2.72

90.7

19.1

II

Maintenance

11

11

1-10

4.84

44.0

20.5

III

Arrangement

8

8

2-7

5.30

66.3

16.0

IV

Post emergency nursing action

3

3

0-2

0.74

24.7

25.9

V

Credentials of nurses

2

2

0-2

0.26

13.0

24.3

Total

27

27

8-20

13.86

51.3

13.7

Table 2: Depicts the aspect wise mean practice on emergency crash cart system

among Nurses.

The above table is interpreted as follows:

The range of score on location of crash cart was 1-3. Subjects scored a mean

score of 2.72, the mean practice score percent was 90.7 and the standard deviation

score was 19.1

54

The range of score on maintenance of crash cart was 1-10. Subjects scored a

mean score of 4.84, the mean practice score percent was 44.0 and the standard

deviation score was 20.5

The range of score on arrangement of crash cart was 2-7. Subjects scored a

mean score of 5.30, the mean practice score percent was 66.3 and the standard

deviation score was 16.0

The range of score on post emergency nursing action of crash cart was 0-2.

Subjects scored a mean score of 0.74, the mean practice score percent was 24.7 and

the standard deviation score was 25.9

The range of score on credentials of nurses was 0-2. Subjects scored a mean

score of 0.26, the mean practice score percent was 13.0 and the standard deviation

score was 24.3

55

Table 3: Association between practice score and demographic variables.

Practice

Unsatisfactory Moderately

Satisfactory Total

Sl. No.

Demographic Variables

n % n % n %

X2

d f

P Value

1

Age 23-25 26-27 28-31

14 6 1

63.6 30.0 12.5

8 14 7

36.4 70.0 87.5

22 20 8

22 20 8

8.27 *

2

0.016

2

Gender Male Female

6 15

40.0 42.9

9 20

60.0 57.1

15 35

15 35

0.04

1

0.851

3

Marital Status Single Married

19 2

48.7 18.2

20 9

51.3 81.8

39 11

39 11

3.28

1

0.070

4

Professional Qualification Diploma Graduate

19 2

48.7 18.2

20 9

51.3 81.8

39 11

39 11

3.28

1

0.070

5

Total experience 1 year 2-3 years 4+ years

8 9 4

42.1 60.0 25.0

11 6 12

57.9 40.0 75.0

19 15 16

19 15 16

3.89

2

0.143

6

Area of working ICU CCU Emergency

8 13 0

40.0 65.0 0.0

12 7 10

60.0 35.0 100.0

20 20 10

20 20 10

11.62*

2

0.003

* Significant at 5 % level

56

Table no.1 shows association between selected demographic variables and

practice of crash cart .There is no significant association between variables like

gender, marital status, and professional qualification and total experiences of the staff

nurses.

Significant association is found between age and area of working with the

practice of crash cart.

Association between age and practice level on emergency crash cart system:

Chi-Square value obtained (8.27) denotes a significant association between

age of the staff nurses and their level of practice.

63.6 percent (23-25 years of age) are under unsatisfactory level of practice

where as 87.5 percent (28-31 years of age) are under moderately satisfactory level of

practice.

Findings thus far suggest that as age increases responsibility of practices also

increases.

Association between area of working and practice level on emergency crash cart

system:

Chi-Square value obtained (11.62) denotes a significant association between

area of working of the staff nurses and their level of practice

100.0 percent of the staff nurses (10) working in emergency departments are

showing moderately satisfactory level of practice and 65 percent (13) staff nurses who

are working in CCU departments show unsatisfactory level of practice.

58

6.DISCUSSION

The present study was conducted with an objective to assess the practice of

organized crash cart system among nurses in selected hospital, Bangalore. In order to

achieve the objectives of the study a descriptive observational approach was adopted

and purposive sampling technique was used to select the samples. The study was

conducted over a period of 4 weeks. The data was collected from 50 subjects by using

observational checklist. The instrument consists of two sections.

Section A: Demographic data

Section B: Checklist to assess the practice of staff nurses regarding crash cart.

The first objective was to assess the practice of nurses regarding

organized crash cart system.

The practice regarding crash cart system was assessed and tabulated in table 2.

It reveals that out of 50 subjects 21 (42%) had unsatisfactory level of practice and 29

(58%) of staff nurses had moderately satisfactory levels. The overall mean practice

score percent was 51.3 with a standard deviation of 13.7. These findings show none of

the subjects have highly satisfactory level of practice.

The second objective was to find out the association between practice of nurses

and selected variables

The relationship of nurse’s practice regarding crash cart system and

59

demographic variables are shown in table 1. There is no significant relationship found

with any of the listed demographic variables like gender, marital status, professional

qualification and total experience.

There was inferential significance found with the age, area of working and

practice of the staff nurses regarding crash cart.

Demographic variables of the subjects.

In the present study it was found out that

• 22 (40percent) of the subjects were in the age group of 23-25 years, 20 (40

percent) were of 26-28 years and 8(16 percent) of 29-31 years of age.

• 15 (30 percent) of the subjects were males and 35 (70 percent) were females.

• 39 (78 percent) of the subjects were single and 11(22 percent) were married.

• 39 (78 percent) of the subjects were diploma and 11 (22 percent) were

graduates.

• 20 (40 percent) of the subjects were working in ICU, another 20 (40 percent)

were in CCU and 10 (20 percent) were working in Emergency departments.

• 19 (38 percent) were having 1 year of experience, 15 (30 percent) were having

2-3 years of experience and 16 (32 percent) of the subjects were having 4+

years of experience.

.

61

7.CONCLUSION

The present study was undertaken to assess the practice of nurses regarding

organized crash cart system and to associate it with selected demographic variables.

Objectives of the study were:


2. To find out the association between practice of nurses and selected

variables.

3. To develop a protocol.

Assumption:

• It is assumed that nurses lack efficiency in utilization of organized crash cart

system.

The following are the conclusions drawn from the study:

• 21 (42percent) of subjects had unsatisfactory level of practice and 29 (58percent)

of staff nurses had moderately satisfactory levels. These findings show none of the

subjects have highly satisfactory level of practice regarding organized crash cart.

• The overall range of practice score was between 8-20, mean practices score

percent was 51.3 with a standard deviation of 13.7.

• There is no significant relationship found with any of the listed demographic

variables like gender, marital status, professional qualification and total

experience.

62

• There is significant association found between age, area of working and

practice of the staff nurses regarding crash cart.

• None of the subjects had satisfactory level of practice (>75 percent).

Implications of the study

Findings of the study have implications in the following areas:

1.Nursing Education:

The present study emphasizes on enhancement in the practice of staff nurses

regarding organized crash cart system. In order to achieve these nurse educators

should come forward to provide more information and practice opportunities to the

student nurses.

2.Nursing Practice:

Nurses are the key person of the health team, who play a major role in the

health promotion and maintenance of the health status. The protocol developed in the

present study will serve to improve the nurse’s practice on crash cart. In-service

education and training programmes can be organized to improve the practice levels of

the staff nurses.

3.Nursing Research:

The findings of the present study serve as the basis for the professionals for

further research studies. The generalization of the study result can be made by

63

replication of the study. The essence of research is to build a body of knowledge in

nursing, as it is an evolving profession striving for perfection and standard.

Recommendations:

• The study can be replicated on a larger sample in a different setting.

• Follow up study can be done to evaluate the effectiveness of protocol.

• A similar study can be conducted on nursing students.

• A similar study can be conducted to assess the knowledge and practice

of nurses regarding crash cart system.

65

8. SUMMARY

The purpose of the study was to assess the practice of nurses regarding

organized crash cart system in selected hospitals, Bangalore; with a view to develop a

protocol. The study was descriptive in nature. The study was conducted in Sarvodaya

and Trinity hospital, Bangalore. A total of 50 staff nurses who are working in ICU,

CCU and Emergency departments, who met the inclusion criteria were selected using

purposive sampling technique. The investigator first introduced himself to the ward in

charge and obtained the consent for the present study. The conceptual model adopted

for the study is the modified quality assurance model proposed by Donabedian in the

year 1992.The instrument used for the study was an observational checklist.

An observational checklist was prepared to determine the practice level of

staff nurses regarding crash cart system. The checklist consists of two sections.

Section A – Demographic Variables

Section B – Practice checklist

The prepared instrument was submitted to the experts to establish the content

validity. In order to establish the reliability of the tool, inter rated method was used.

The reliability of the tool was 0.72. So the tool was found to be reliable for the data

collection.

66

The data obtained from the study subjects was analyzed and interpreted in

terms of the objectives and assumption of the study. Descriptive and inferential

statistics were used for data analysis; the level of significance was set at 0.05.

Major findings of the study 1. Findings regarding the demographic variables of the subjects.

• 22 (40 percent) of the subjects were in the age group of 23-25 years, 20 (40

percent) were of 26-28 years and 8(16 percent) of 29-31 years of age.

• 15 (30 percent) of the subjects were males and 35 (70 percent) were

females.

• 39 (78 percent) of the subjects were single and 11(22 percent) were

married.

• 39 (78 percent) of the subjects were diploma and 11 (22 percent) were

graduates.

• 20 (40 percent) of the subjects were working in ICU, another 20 (40

percent) were in CCU and 10 (20 percent) were working in Emergency

departments.

• 19 (38 percent) were having 1 year of experience, 15 (30 percent) were

have 2-3 years of experience and 16 (32 percent) of the subjects mere have

4+ years of experience.

67

2. Findings regarding the practice score of the subjects regarding crash cart

The practice regarding crash cart system was assessed and tabulated in table 2.

It reveals that out of 50 subjects 21 (42%) had unsatisfactory level of practice and 29

(58%) of staff nurses had moderately satisfactory levels. The overall mean practice

score percent was 51.3 with a standard deviation of 13.7. These findings show none of

the subjects have highly satisfactory level of practice.

3. Findings regarding the practice score of the subjects and selected variables

The relationship of nurse’s practice regarding crash cart system and

demographic variables are shown in table 1. There is no significant relationship found

with any of the listed demographic variables like gender, marital status, professional

qualification and total experience. There was inferential significance found with the

age, area of working and practice of the staff nurses regarding crash cart.

.

69

9.BIBLIOGRAPHY

1. Telesca K, A simplistic approach to restocking crash carts. Hosp Parm 1992 Dec;

1068-70

2. Laufman H, Badner B, Zeiner L, A new bedside emergency resuscitation cart, Med

Instrum 1978 Mar-Apr;110-113.

3. Admas B D, Shih H, Stuffel E, Robinson A M, A video based training programme

improves defibrillator inspection compliance. Am J Cardiol2006 Feb15;578-579

4. Socity of Critical Care Medicine.Consensus report for critically ill or injured

children.Crit Care Med.2000,28:236-238

5. Mann HJ.Pharmacy technology of the ICU:today and tomorrow.Cric

CareClin.2000,6641-645

6. Americian college of critical care medicine, Society of critical care

medicine.1999,27:422-423

7. Pollack MM,Cuerdon TC.Pediatric intensive care units: result of a national

survey.1993,21:607-609

8.Defibrillator/Monitor/pacemakers. Health devices 2005 Jun;181-218

70

9. Reynolds HN, Haunt MT,Carlson RW.A policy for Louisianan stare university

health sciences center. 1988,260: 3446-3450.

10 Crash cart medical emergency kit(online) (cited 2006 April 14); available from

url:http//www. miami-med.com/emergency kits.htm

11.Crash cart: MOH and Sultan Qaboos University Hospitals policy on Crash Cart.

12. Advanced Cardiac Life Support (ACLS), American Heart Association, 2002.

13.Joyce M Black & Jane Hokanson. Medical Surgical Nursing, Clinical

management of positive outcomes, volume 1,7th edition, Elsevier publication

2005, Missouri,Pg 1244-1262

14. Blumenthal. Resuscitation (online)2005 (cited 2006july 18); Available from

url:http://www.cms.hhs.gov

15. University of Missouri Health Care (online) (cited 2006 April 18); Available

from url:http://www.pubmed.gov.

16.Effective crash cart utilization (online)1998 August(cited 2006 july 5).; Available

from url:http://www.pubmed.gov.

17. Kothari CK. Research Methodology. Methods and Techniques, 2nd

71

Rev.ed.NewDelhi:New Age International (p) Ltd.,Publishers:2004.p.7-8

18. Burns N, Grove SK. The Practice Of Nursing Research Conduct, Critique

andUtilization.4th .ed. Philadelphia(USA):W.B.Saunders Company 1993.p.10

19.Treece EV, Trees JW. Elements of research in Nursing. 6th ed. St. Louis:Mosby

1982.p.4-12

20. Best Jw, Kahn JV. Research in Education. 2nd ed. New Delhi: Prentice-Hall of

India Pvt.Ltd:1999.p.5-14.

73

LIST OF ANNEXURE

Sl. No

ANNEXURE

Page No

1. Letter seeking permission for conducting pilot study 58

2. Letter granting permission to conduct the pilot study 60

3. Letter seeking permission for conducting the main study

61

4. Letter granting permission to conduct the main study 63

5. Certificate of content validity Letter seeking expert guidance for contentvalidity of the tool

64

6. Certificate of content validity 66

7. Certificate of editing 67

8. Consent form for the respondents 68

9. Tool for data collection 69

10. Evaluation criteria check list 73

11. Scoring key 74

12. Protocol 75

13. List of experts 83

74

ANNEXURE -A

LETTER SEEKING PERMISSION FOR CONDUCTING PILOT STUDY From,

Sibi Alexander

II Year Msc Nursing student

Sarvodaya College Of Nursing

#11/2, Magadi Main Road

Agrahara Dasarahalli,

Bangalore-560079.

To,

The Nursing superintendent

Soubhagya Hoapital

Bangalore

Through

The Principal


Bangalore-560079

Respected sir,

Sub: Letter seeking permission for conducting pilot study.

I, Sibi Alexander is a bonafied P. G student of Sarvodaya college of nursing

affiliated to Rajiv Gandhi University of health sciences, Bangalore, with a

specialization in Medical-Surgical Nursing.

I have to conduct a research for the purpose of partial fulfillment of my

75

course. The subject for the study is “A Descriptive Study To Assess The Practice

Of Organized Crash Cart System Among Nurses In Selected Hospital,

Bangalore; With A View To Develop A Protocol ”.

In this regard, I kindly request to you to grant me permission to conduct a pilot

study in your esteemed institution.

Hope you will consider my request and will do the needful.

Thanking you,

Yours faithfully, Date: Place: Bangalore (Sibi Alexander)

76

ANNEXURE - B

LETTER GRANTING PERMISSION TO CONDUCT THE PILOT STUDY

From,

The Nursing superintendent

Soubhagya Hoapital

Bangalore

To,

Sibi Alexander





Bangalore-560079.

Dear Student, As per your request forward through the principal Sarvodaya College

of Nursing; you are permitted to do the pilot study in Soubhagya Hospital as

mentioned in your letter.

Date: (Signature of the Nursing Superintendent) Place: Bangalore

77

ANNEXURE -C

LETTER SEEKING PERMISSION FOR CONDUCTING THE MAIN STUDY From,

Sibi Alexander





Bangalore-560079.

To,

The Medical Superintendent

Sarvodaya Hoapital

Bangalore

Through

The Principal


Bangalore-560079

Respected sir,

Sub: Letter seeking permission for conducting the main study.

I, Sibi Alexander a bonafied P. G student of Sarvodaya College of nursing

affiliated to Rajiv Gandhi University of health sciences, Bangalore, with

aspecialization in Medical-Surgical Nursing.

78

I have to conduct a research for the purpose of partial fulfillment of my

course. The subject for the study is “A Descriptive Study To Assess The Practice

Of Organized Crash Cart System Among Nurses In Selected Hospital,

Bangalore; With A View To Develop A Protocol ”.

In this regard, I kindly request to you to grant me permission to conduct the

main study in your esteemed institution.

Hope you will consider my request and will do the needful.

Thanking you,

Yours faithfully,

Date:

Place: Bangalore (Sibi Alexander)

79

ANNEXURE -D

LETTER GRANTING PERMISSION TO CONDUCT THE MAIN STUDY From,

The Medical Superintendent

Sarvodaya Hoapital

Bangalore

To,

Sibi Alexander II Year Msc Nursing student Sarvodaya College Of Nursing #11/2, Magadi Main Road Agrahara Dasarahalli, Bangalore-560079.

Dear Student,

As per your request forwarded through the principal Sarvodaya

College of Nursing; you are permitted to do the main study in Sarvodaya Hospital as

mentioned in your letter.

Date: (Signature of the Medical Superintendent) Place: Bangalore

80

ANNEXURE-E LETTER SEEKING EXPERT GUIDANCE FOR CONTENT

VALIDITY OF THE TOOL From,

Mr.Sibi Alexander




Bangalore -560079.

To, Through

The Principal


Bangalore-560079.

Respected Sir/Madam,

Sub:-Requesting the opinion and suggestions of experts for

establishing content validity of the tool.

I Mr.Sibi Alexander, II Year Msc Nursing student of Sarvodaya College of

Nursing, humbly request you to go through the tool which is to be used for data

collection of my study for my research project.

81

Title of the topic:

A Descriptive Study To Assess The Practice Of Organized Crash Cart System

Among Nurses In Selected Hospital, Bangalore; With A View To Develop A

Protocol.

Objectives:


2. To find out the association between practice of nurses and selected

variables.

3.To develop a protocol on crash cart.

With regard to this may I kindly request you to validate my tool for its

appropriateness and relevancy.

Kindly sign the certification of validation, your kind cooperation and expert

judgment will be highly appreciated.

Thanking you,

Enclosures:

1. Observational check list

2. Content validity certificate

Thanking You,

Yours faithfully

Place:

Date: Bangalore (Sibi Alexander)

82

ANNEXURE-F

CERTIFICATE OF CONTENT VALIDITY

I here by certify that I have validated the tool of Mr. Sibi Alexander who is

undertaking a descriptive study to assess the practice of organized crash cart system

among nurses in selected hospital, Bangalore; with a view to develop a protocol.

Signature of the experts:

Place:

Date: Name and Designation:

83

ANNEXURE-G CERTIFICATE OF EDITING

This is to certify that data analysis done by Mr.Sibi Alexander, second year

Ms.c.nursing, Sarvodaya College of Nursing, Bangalore, in his study titled” A

Descriptive Study To Assess The Practice Of Organized Crash Cart System

Among Nurses In Selected Hospitals, Bangalore; With A View To Develop A

Protocol” has been edited by me.

Place: Bangalore Signature

Date

84

ANNEXURE-H

CONCENT FORM FOR THE RESPONDENTS

Dear participants,

I Mr.Sibi Alexander II Year M>Sc Nursing Student of Sarvodaya

College of Nursing as part of the partial fulfillment of the course, has to conduct a

study and the problem selected is “A Descriptive Study To Assess The Practice Of

Organized Crash Cart System Among Nurses In Selected Hospital, Bangalore;

With A View To Develop A Protocol ”. I would like to get some information

regarding your practice related to crash cart system. The information will be kept

confidential and will be used for study purposes only. This is for your information

and kind participation . Kindly sign the consent form given below.

Thanking you,

Yours Sincerely

Signature of the investigator

I am willing to participate in the study and aware that the information provided will

be kept confidential and used for the study purpose.

Place : Bangalore

Date : Signature of the participant

85

ANNEXURE-I

TOOL FOR DATA COLLECTION

An observational check list to assess the practice of organized crash cart

system among nurses in selected hospitals, Bangalore; with a view to develop a

protocol.

A tool has been constructed for data collection, it consist of two parts.

Section A deals with demographic data

Section B deals with crash cart check list

Section A

Part-I Demographic Data 1. Code Number : 2. Age (Years) : 3. Gender : a) Male :

b) Female :

4. Marital Status : a) Single : b) Married : c) Widow : 5. Professional qualification : a) Diploma : b) Graduates :

86

6. Total experience (Years) : 7. Area of working (Ward) : ICU/ICCU/Emergency 8. In-service training undergone a) Yes : b) No : 9. Source of information a) Media : b) Health Personnel : c) Mass Media :

87

Section B EMERGENCY CRASH CART CHECKLIST YES/NO 1. Are emergency crash carts available at emergency treatment areas? 2. Are the emergency crash carts conveniently located?

3. Does the emergency crash cart have a list of medications & I-V fluids? 4. Does the emergency crash cart have the stock list of equipments? 5. Are the medications & I V fluids were labeled properly? 6. Are the medications arranged according to their actions? 7. Are the drawers of the crash cart clearly labeled?

8. Are the medications arranged in sequence and in order? 9. Are the medications checked periodically & exchanged based on the expiry date? 10. Are the sterile items checked for package integrity? 11. Is the inventoried equipment checked monthly i.e. laryngoscope batteries working? 12. Is the crash cart periodically monitored by the ward in charge? 13. Is inventoried equipment checked daily on each shift? 14. Is the equipment inventory documentation updated, as per changes? 15. Is the defibrillator checked daily for working condition?

88

16. Is the vital signs monitor checked and appropriately documented for performance on both battery and electrical current? 17. Are the emergency crash carts accessible to all wards/departments during emergency?

18. Is there skilled nursing personal assigned to monitor crash cart? 19. Is there a special training certification record maintained in the credential file?

20. Is the in charge paying careful attention to rearrange the crash cart after each use?

21. Is the oxygen cylinder secured to the crash cart by a portable stand? 22. Is the oxygen level of all oxygen cylinders checked on a weekly basis?

23. Is the oxygen cylinder check and documented?

24. Are the cylinders serviced on a regular basis? 25. Is the crash cart kept locked unless in use?

26. Is experience learned from an emergency response discussed openly with other Staff? 27. Are quality improvement processes implemented to promote the emergency response process?

89

ANNEXURE-J

EVALUATION CRITERIA CHECK LIST

Each correct response carries One mark, incorrect response carries Zero marks.

Total Score - 27

Unsatisfactory - < 50%

Moderately satisfactory - 51-75%

Satisfactory - >75%

90

ANNEXURE-K

SCORING KEY

Scoring key of practice of nurses regarding crash cart system

Section B

Q .no.

Options

Score

1-27

Yes

2

No

0

91

ANNEXURE-L

PROTOCOL

This protocol is a recommended guideline to be used where applicable to

establish policy and procedure for crash cart.

DEFINITION

Crash Cart

A crash cart - is a special cart (with drawers) containing emergency drugs and

equipment needed for cardiac-pulmonary resuscitation. It provides an easier access to

the emergency drugs and equipment.

PURPOSE

1. To have the crash cart and Defibrillator constantly ready for use in case of life

threatening condition such as cardiopulmonary arrest

2. To establish standard practice, which is required to maintain and utilize the

crash cart and the defibrillator. The Crash Cart policy will assist nursing staff

to:

* Describe the role of nursing staff in maintaining crash cart medication

and equipment.

92

* Establish a uniform method of documentation and inspection of

emergency medication and equipment.

* Establish a procedure of topping-up (re supplying) crash cart.

* Establish the quantity of medication and equipment required as well as

the location of these items in the crash cart.

* Describe the exact location of the crash cart.

RESPONSIBILITY:

1. All nurses should be familiar with the contents and locations of all medication

and equipment in the crash cart

2. Crash carts should be available in all clinical areas stocked with medication

and equipment needed for immediate emergency interventions. All supplies in

the crash cart should be maintained and topped-up on an ongoing basis. In

addition, periodic inspection will assure that there are not outdated drugs

and/or supplies in the cart

3. A staff nurse should be responsible for checking the crash cart including all

external contents e.g. oxygen cylinder levels, defibrillator, and document on

crash cart checklist

4. Crash cart should be kept locked unless in use. If opened and/or used, the cart

should be checked and topped-up (as per institutional policy).

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5. The defibrillator shall be checked and appropriately documented for

performance on both battery and electrical current once every 24 hours

(according to user manual). The defibrillator will remain plugged into an

electrical outlet at all times, except during battery testing. The Biomedical

Department should be contacted immediately when a defibrillator problem is

detected.

6. Sterile items should be checked for package integrity and expiry date. Items

with expiry dates within a month should be replaced.

7. Laryngoscopes should be checked prior to placement on the cart.

8. Oxygen cylinders (2) should be replaced when the tank has < 500 psi. . Full

tanks are obtained from General Stores on an exchange basis. Keep one

always full.

9. Pharmacy should check all emergency carts for proper medication storage,

stock level, and unit inspection log as determined by Pharmacy policy (as per

institutional policy).

10. The crash cart checklists and test load strips should be maintained for each

crash cart for 12 months (after use).

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11. Drawers of crash carts should be clearly labelled to identify contents in

general categories e.g. medication, cardiac/chest procedures, circulation,

breathing, and airway.

12. The Crash cart should be kept always in sight and in reachable place.

13. The list of medication and equipment to be maintained in the crash cart should

be determined by the Cardiopulmonary Resuscitation (CPR) Committee (as

per institutional policy).

14. The Unit Staff should be responsible for weekly inspection, maintenance and

replacement of drugs in the crash cart (as per institutional policy).

15. The staff nurse should be knowledgeable of the crash cart contents and

location to prevent any delay during cardiac arrest.

16. The staff nurse should be responsible for cleaning the carts, inspecting and

replacing emergency drugs as well as checking the defibrillator, cardiac

monitor, autoclaved items, and oxygen tank.

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CRASH CART

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Crash Cart Drawer Equipment (external) SN Item N0. 01 Defibrillator with E.C.G leads 1 02 Electrode Jelly / Pads 1 03 Resuscitation Bag (Mask Valve Bag Set) with different sizes 1 04 Pulse oxy meter 1 05 Resuscitation Record sheet 1 06 Resuscitation board 1 07 I.V. Stand 1 08 Clock timer 1 09 Sphygmomanometer 1 10 Oxygen cylinder on the side of trolley for O2 Administration 1 11 O2 Cylinder Key 2 Crash Cart Drawer Emergency Medications SN Item Stock 01 Adenosine 6mg/2ml vial 02 Amiodarone 150mg/3ml ampule 03 Epinephrine 1mg/Ml 1:1000 04 Epinephrine 1 Mg/10ml 1:10000 (Minijet syringe) 05 Magnesium Sulfate 1 Gm/2ml vial 50% 06 Naloxone O.4mg/Ml 1ml Ampule 07 Nitroglycerin (Tridil) 50mg/10ml vial 08 Nitroprusside 50mg Vial 09 Norepinephrine 4mg/4ml ampule 10 Vasopressin 20U/Ml 1ml vial 11 Verapamil (Isoptin) 5mg/2ml vial 12 Sodium Chloride 0.9% 10ml Flush 13 Dobutamine 250mg 14 Dopamine 200mg/5ml 15 Atropine 1mg/10ml (Minijet syringe) 16 Atopine 0.6mg/ml 17 Calcium Chloride 10% 18 Calcium Gluconate 10% 19 Dextrose 50% 20 Lidocaine 100mg/5ml (Minijet syringe) 21 Lidocaine 2% (vial) 22 Sodium Bicarbonate 8.4% 23 Isoprenaline (Isopril) 2mg/2ml 24 Distilled Water vial

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Note It is recommended to have more than single dose patient as per Advanced Cardiac Life Support (ACLS) policy. Aspirin, Nitroglycerine tablet and Morphine (if there is a narcotic lock) could be added. Special medications (Aminophilline, Hydrocortisone, Inderal, Digoxine, Dilitizem, Lasix) could be added in critical specialized units preferably in CCU and Accident & Emergency. Crash Cart Drawer Breathing and Airway Equipment

SN Item Stock 01 Oxygen Face Mask (High Flow): Different sizes 02 Oropharangeal Set: Different sizes 03 Laryngoscope Airway: Different sizes 04 Nasopharangeal Airway: Different sizes 05 Laryngeal Mask 06 Lubricant (preferably Lidocaine gel) 07 2 C Cell Batteries 08 1 Laryngoscope Light Bulb 09 Mouth Gag 10 Adhesive Tape or pre-made ET Tube Holder 11 Oral Yankauer suction catheter 12 Straight Connector 13 ET Tube: 2 each size 14 Disposable Gloves 15 Megills Forceps 16 Scissor 17 Intubation Stylet: Different sizes 18 Tracheotomy set

Crash Cart Drawer Circulation IV Supplies

SN Item Stock 01 Cannula: 2 each of different sizes 02 3-Way Y Stopcocks 03 Blood Tubes 04 Needles: Different sizes 05 Alcohol Swabs 06 Betadine swaps (if available) 07 Adhesive Plaster 08 I.V Set 09 Syringes: Different sizes 10 Disposable Raser 11 Micro-dropper

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Crash Cart Drawer Intra-Venous Solutions

SN Item Stock 01 Lactated Ringers 500ml 02 Normal Saline 0.9% 500ml (2 bottles) 03 Dextrose 5 % 04 Dextrose 10% 05 Dextrose 25% 06

Soda bicarbonate

Crash Cart Drawer Cardiac and Chest Procedures

SN Item Stock 01 EKG Electrodes 02 Sterile gloves, 2 pairs each size - small, medium, and large 03 2 Masks with face shields or masks and eye protection 04 Scalpels with blades 05 Dressings Gauze 06 Sharp Box 07 ECG paper roll and Jelly Note Some Crash Cart has limited number of drawers. However, it could be arranged as per the number of drawers available and partition could be improvised. However, the Crash Cart should be maintained neat and tidy.

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ANNEXURE-M

LIST OF EXPERTS WHO VALIDATED THE PREPARED TOOL 1.Prof. Chandara Devadoss

Principal,

P.R College of Nursing

Bangalore

2. Prof.Shridhar K.V

Dept. of Medical Surgical Nursing

KIMS

Bangalore

3. Prof. N.N Yalayyaswamy

HOD of Medical Surgical Nursing

KIMS

Bangalore

4. Mrs. Suvarnalatha

Nursing Superintendent

Soubghya Hospital

Bangalore

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5. Mrs.Jancy

HOD of Medical Surgical Nursing

Govt.College of Nursing

Fort, Bangalore-2

6. Dr.Nagaraj V.S

Cardiologist

Soubghaya Hospital

Bangalore

7. Asso.Prof. H.S.Surendra

Dept. of Biostatistics,

GKVK Agricultural University,

Bangalore

Cart System Among Nurses In Selected Hospitals, Bangalore

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