Code carts don’t save lives — well-trained clinicians do. But even well-trained clinicians may not be able to save lives if the supplies they need are not well organized and easily accessible in a properly operating code cart. Let’s look at three key factors in improving patient outcomes during a “Code Blue”.


Does it hold everything needed for your staff to treat your patients in a “Code Blue” event?

  • In order to ensure your clinicians can effectively treat their patients, it is important to make sure that all needed supplies are readily available on your code cart. This means that ALL vital supplies and equipment are securely stored within or on the code cart.
  • It is not recommended to have a separate cart for your defibrillator, oxygen, respiratory equipment, or medications as it requires additional staff to transport each of these life-saving measures to the patient’s location. Having everything stored in/on your code cart ensures that what your staff needs is accessible the very second the code cart arrives on scene.

Is it easy to identify as your “Code Blue” cart?

  • In order to improve both patient response times and outcomes, your code cart should stand out from other procedure carts in a unit or hallway. This can be accomplished easily by having the cart be ALL RED or ALL BLUE so from any vantage point, the code cart can rapidly be identified.

Is it easy to maneuver to the site of the “Code Blue” emergency?

  • Is it constructed of a lightweight and durable material (such as aluminum)?
  • Are the casters smooth rolling and in good working order?
  • Are the cart push handles ergonomic? Do they make the cart easier to maneuver?

Is it secure?

  • In regard to tamper evidence versus restricted access, you DO NOT want to restrict access to your code cart through use of a key lock or padlock. Doing so could delay treatment if a key or combination cannot be quickly found and brought to the cart’s (and, therefore, patient’s) location. This holdup in treatment can negatively impact patient outcomes.
  • Instead, your code cart should have the ability to be sealed with a plastic tamper evident seal, a visual indicator that the cart contents are secure and nothing is expired, without restricting access.
  • The best practice would be to check the plastic tamper evident seal at the start of each shift to ensure that cart contents are ready for use. The unique number on each can verify the seal used to secure the cart upon restocking is the same seal on the cart during each shift change, or indicate an issue that needs prompt addressing.

Does it offer ample work surface?

  • “Code Blue” events don’t always occur in a location that allows good access to work surfaces, as patients in stairwells, vestibules, hallways, public rest rooms, etc can find themselves in a life-threatening situation. Even though there is no convenient writing surface in these areas, copious notes still must be kept to document the “Code Blue”.
  • Having a code cart with additional pull-out work surfaces provides clinicians with a place to draw up medications, prepare supplies, and log code sheet information when needed.

Is your code cart in good working order?

  • Are there visible signs of damage that could impede its ability to be used in a code?
  • Are the casters in good working order and will they get you to the site of the code quickly?
  • Are the cart push handles in good working order or are they loose/missing, which makes transporting the cart more of a challenge.


Are they organized with rapid treatment in mind?

  • Medications in top drawer, easily accessible, and well organized?
    • Errors are a constant threat to patient safety, so it is important to ensure medications are easily accessible and organized.
  • Do the balance of the drawers follow the ABCs of ACLS treatment?
    • The best practice is to organize drawers in order and by their treatment type. Airway, Breathing, Circulation (ABCs).

Are they fully stocked?

  • Are any vital items missing?
  • Has anything been borrowed or pilfered from a drawer on a “Code Blue” cart that could impede patient treatment?
  • Are all the right sizes of equipment available to match the needs of your patient?
  • Do you have duplicates of commonly used items so you don’t have to run elsewhere for them if a necessary item is damaged or contaminated during use

Is anything outdated/expired?

  • Outdated or expired medications/equipment can negatively affect patient outcomes.
  • Both Pharmacy and the Central Supply Department in a hospital should have procedures in place to check for outdating or outdated medications/supplies.
  • A good practice is to list the next to expire item somewhere on the outside of the cart where a clinician can see it during their shift inspection.

Is equipment on the code cart in good working order?

  • Is the defibrillator fully charged and tested?
  • Is the portable suction fully charged and tested?
  • Are your oxygen tanks full?


Can they identify your code cart?

  • As mentioned previously, to improve both patient response times and outcomes, your code cart should stand out from other procedure carts in a unit or hallway. This can easily be accomplished by having the cart ALL RED or ALL BLUE ensuring that from any angle of view, the code cart can be identified swiftly. Is your staff trained to identify your code cart in an emergency?

Are your staff adequately trained to rapidly find items in the cart?

  • Hospitals should have regularly scheduled training on their code carts to familiarize clinicians on staff with where supplies, medication, and equipment are located.
  • Scheduling “Mock Codes” with nursing education is a great way to reinforce this training with your staff.
  • Nurse education should have a couple of training code carts that can be used for “Mock Codes” and other training. This keeps the regular fleet of code carts available for patient use.

Are they inspecting the code cart regularly to ensure it’s ready for use?

  • A common safety error that can impact patient safety are improperly inspected code carts that have outdated or missing supplies.
  • It is recommended that each shift check the code carts on their units to ensure the tamper evident seals are still intact on the cart and that all external supplies and equipment are accounted for and properly working.
  • Do staff members know who to contact in your hospital if their code cart inspection reveals that something is missing or needs to be addressed? Typically, this would be the Central Supply Department, but be sure to train staff on who to call for assistance with your facility’s code carts. Something as simple as putting a label on the cart with a contact number can be helpful.
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