EMERGENCY EQUIPMENT TROLLEY DAILY SIGNATURE SHEET Please refer to the Emergency Equipment stock poster for detailed information Equipment must be checked daily and immediately following an emergency event by a qualified member of staff. Routine replenishment of equipment can be collected from the clinical skills centre between 0:0 0:0 weekdays (excluding bank holidays). ONLY following an emergency can ward staff attend clinical skills outside of these hours. The Hospital Clinical Coordinators can be contacted during out of hours, weekends & bank holidays to replenish equipment following an emergency - they should not be contacted for routine replacements. If the equipment is checked following an emergency, and the trolley has already been checked within that hr period, initial in the appropriate box to document that you have checked and replenished as required additionally to the routine inspection. All equipment expiry dates must be confirmed as part of the daily check. If the ward/unit is due to be closed and therefore the trolley not checked it must be clearly documented (on those dates) to demonstrate this has occurred. Each box on the checklist must be ticked or initialled (in the case of a recheck following an event). A signature and the printed name of the staff member must be documented on the end of the form. If there is a problem or deficit with any of the equipment this must be rectified immediately. Please report all problems to the Ward Sister / Shift Leader immediately. If there is equipment on the emergency arrest trolley that is not on the checklist please remove it. If it is not on the checklist there is no evidence that it is being checked therefore there is a risk of items becoming out of date and a risk. If a replacement battery for the AED (Automated External Defibrillator) is required during normal working hours contact EBME and arrange its immediate replacement. Out-of-hours contact Labour ward and M CGH and then on the next normal working day inform EBME as a matter of urgency. Please keep months of daily signature sheets for audit purposes.
0 0 0 Month - Year - Ensure Trolley, Defibrillator, Portable O & Portable Suction devices clean Oxygen cylinder and portable suction are located next to the Emergency Trolley Portable O cylinder at least ½ full with oxygen tubing attached Portable Suction is working with suction tubing & Yankauer Catheter connected and covered Top of Trolley Daily Check for Manual and AED Defibrillators - black flashing egg timer Manual Defib only - Once weekly (Monday) shock test Sticker on defibrillator where to find nearest pacing defibrillator Manual Defib only - monitoring dots available but not pre - connected to ECG leads
0 0 0 x Cardiac Arrest Audit Forms x Packs of Adult Defibrillator Pads - Sealed Airway Tray within expiry date and sealed First Drawer () x Stethoscope x Sachets of Lubricating / Water Soluble Gel Manual Defib only - x Spare roll of ECG paper Manual Defib only - x ETCO module Manual Defib only - x single use ETCO Airway Adapter set x Pocket Mask with One Way Valve x Spare One Way Valve x Anaesthetic face mask Size x Non-rebreather oxygen mask with reservoir x Adult Water Circuit
0 0 0 x Size C Batteries for Laryngoscope x Adult Magill s Forceps (each) x ET cuffed & uncut sizes.0 &.0 &.0 &.0 (each) x Oropharyngeal Airway sizes,,, (each) x Nasopharyngeal Airway sizes,, x Size 0 Scalpel with integral handle Second Drawer () x box of disposable tourniquets x Green Vacuette needles x Quick shield/safety Vacuette barrels x (each) Blood collection tubes (green, ochre, pink, grey, purple & blue) x Safety butterfly needles
0 0 0 x Vacuette barrels for connecting to cannula to take blood x Blue needles x Green needles x G Safety needles for injection x Blunt filter drawing up needles x Syringe ml, ml, ml x Syringe 0ml, 0ml, 0ml x Safety Cannula G (Orange) x Safety Cannula G (Grey) x Safety Cannula G (Green) x Safety Cannula 0G (Pink) x -Way Tap x Needle free connectors (bungs) x Gauze Swabs x IV dressing cannulation Packs
0 0 0 0 x skin wipes (0% v/v isopropyl alcohol & % w/v chlorhexidine gluconate) x Arterial Blood Gas (ABG) syringe x cm Bandages x Disposable prep Razor x Roll of surgical Tape x Disposable scissors Third Drawer () x Rapid Infusion Blood Giving Sets (wide bore) x Infusion Pump Giving sets x Box of medium gloves x Box of large gloves x Roll of Aprons x Eye Protection/Goggles x Yankauer suction catheter (each) x Suction catheter size 0 & &
0 0 0 0 0 0 Bottom of Trolley x Yellow Lid Sharps Container x Anaphylaxis Drug Case Tamper Seal intact & within expiry date. When expired, used or tampered with take to pharmacy for replacement Cardiac Arrest Drug Case Tamper seal is intact & within expiry date. When expired, used or tampered with take to pharmacy for replacement Hypoglycaemia Kit (Hypo Box) x Lucozade x GlucoGel x Emergency Lifting sheet Initial And Print Name Clearly