/depts/,/depts/uwhealth/,/depts/uwhealth/ambulatory-education/,/depts/uwhealth/ambulatory-education/ambulatory-emergency/,/depts/uwhealth/ambulatory-education/ambulatory-emergency/resources/,

/depts/uwhealth/ambulatory-education/ambulatory-emergency/resources/UWHC-Code-Blue-Cart-Audit-Template-2017-vers-2.pdf

201711333

page

100

UWHC,UWMF,

Learning and Development,

Departments & Programs,UW Health,Ambulatory Education,Ambulatory Emergency,Resources

ACLS Cart Audit

ACLS Cart Audit - Departments & Programs, UW Health, Ambulatory Education, Ambulatory Emergency, Resources


UW Health Emergency Response Cart Audit ACLS Monthly Checks Intubation supply check: ______________(open cart – place one blade on each handle – check for light)
Month and Year: _______________________O2 tank check: _________________(replace to full cylinder) Defib Battery Expiration Date:______________ Unit: _____________
Day Time Emergency Cart Lock
Numbers

ACLS Supplies
Locks
Intact
CPR
Board
PPE
ACLS
Drawer
Expiration
Date
O2
Tank
EZ IO
Bags
Locked
x 2
Zoll
Defibrillator
30J Manual
Self-Test
EtCO2/NI
BP/EKG/
pulse ox
Plugged in
Defib Pads
Connected
to Defib
Suction
Present
&
Charging
Signature New Lock Number if Cart is
Open

ACLS Supplies
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
J:\CardAdmin\RRC\Code Blue Cart Audit Rev 5/20/17