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)
ii
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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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
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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
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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.
xiii
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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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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.
18
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
19
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
21
Problem Statement:
“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 ”.
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.
23
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
System Among Nurses In Selected Hospital, Bangalore; With A View To Develop
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
28
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.
30
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
34
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.
35
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
Low Practice Moderate Practice
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)
Low Practice Moderate Practice
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
(%)
Low Practice Moderate Practice
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:
1. To assess the practice of nurses regarding organized crash cart system.
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
Sarvodaya College Of Nursing
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
II Year Msc Nursing student
Sarvodaya College Of Nursing
#11/2, Magadi Main Road
Agrahara Dasarahalli,
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
II Year Msc Nursing student
Sarvodaya College Of Nursing
#11/2, Magadi Main Road
Agrahara Dasarahalli,
Bangalore-560079.
To,
The Medical Superintendent
Sarvodaya Hoapital
Bangalore
Through
The Principal
Sarvodaya College Of Nursing
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
II Year Msc Nursing student
Sarvodaya College Of Nursing
Agrahara Dasarahalli,
Bangalore -560079.
To, Through
The Principal
Sarvodaya College Of Nursing
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:
1. To assess the practice of nurses regarding organized crash cart system.
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.
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* 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 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