Challenges Associated with Anesthesia Tray Fill and Crash Cart Fill

By Jessica Pyhtila, PharmD

February 04, 2022

Crash carts and anesthesia trays are vital components of inpatient pharmacy practice in a health system setting. Clinicians rely on them to be functional and fully stocked in life-threatening situations. However, ensuring that carts and trays are filled accurately, promptly, and safely can be challenging. This is especially true given rampant short-staffing during the COVID-19 pandemic.

Safety Issues

Known safety issues linked to carts and trays include:

Some health systems have successfully addressed these challenges in several ways, including using electronic monitoring and sealed carts/trays, standardizing cart/tray components, and incorporating staff training.

Electronic Monitoring of Crash Carts and Anesthesia Trays

Electronic monitoring, including web-based tracking systems, is available to help track crash carts and anesthesia trays. This can have several benefits, including:

Some health systems have moved a step further, into automated cart/tray management. For example, RFID tags can be applied to each item and medication. When the cart/tray returns to the pharmacy, it is placed at a scanning station. Each tag is then scanned, and a report is generated to inform the pharmacy of which items need to be replaced. Such systems can benefit the health system in several ways, such as:

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Staff Training for Crash Carts and Anesthesia Trays

Staff training is crucial for long-term success in addressing the challenges linked to crash carts and anesthesia trays. Without adequate training, it is difficult to implement and maintain process improvements in managing the filling process. Training should ideally take the form of continued education and may be included on staff competency assessments. Training may include:

Training and assigning a staff member as team lead for cart/tray filling can be an important factor in success. A pharmacy technician may be assigned to this role, and have responsibilities such as:

Similarly, on the floor, a nursing staff member may be assigned as team lead for visually inspecting the carts for integrity, keeping them in the proper location, and testing electronic components of the cart.

Standardizing Crash Carts and Anesthesia Trays

Hand-in-hand with training is the importance of equipment standardization and process simplification. This is especially true given the chronic staffing shortages in many hospitals, which leads to staff reassignment to practice areas with which they may not be familiar. By simplifying the filling and checking process, there is a better chance that new or temporary staff will be able to be quickly trained and comply with procedures.

Minimizing the number of items that need to be checked can also help improve the process. Crash carts are generally not standardized. Instead, health systems are given broad latitude in terms of items to include, with the requirement that carts contain the items required to respond to an emergency in each practice setting. Management can consider involving stakeholders from individual crash cart placement areas to give feedback on the items currently in the crash cart, and whether they are necessary.

Stakeholder input can also help optimize the placement of medications and supplies on the cart/tray. For example, the items on an anesthesia tray can be arranged in a linear way based on typical staff needs. Supplies needed at the beginning of the surgery may be placed on the left side of the tray, with a linear progression towards the right side of the tray which may hold supplies needed at the end of a procedure. In addition, the items on a crash cart can be organized by drawer, with medications, respiratory needs, fluids, and procedure supplies all occupying their own clearly-marked drawers.

Sealing Crash Carts and Anesthesia Trays

Sealing crash carts and anesthesia trays after filling can have benefits including:

Optimizing crash cart and anesthesia tray management can be challenging. However, by incorporating staff training, standardization, electronic monitoring, and sealing of trays and carts, it is possible to increase accuracy, reduce errors, and improve staff efficiency.

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The Joint Commission. “Crash-cart preparedness.” Quick Safety, April 2017, Issue 32. Retrieved from

Miller, Rachael Fleagle; March, Kristen E. “Automate OR Tray Management.” Pharmacy Purchasing & Products, May 2019. Retrieved from

Jessica Pyhtila, PharmD

Jessica Pyhtila is a Clinical Pharmacy Specialist practicing at the top of her license in primary and palliative care at the Department of Veterans Affairs. She is board-certified in geriatrics (BCGP) and pharmacotherapy (BCPS). She received her PharmD from the University of Maryland; PGY1 Pharmacy Practice and PGY2 Ambulatory Care trained at the VA Maryland Health Care System. She additionally writes and edits interdisciplinary continuing education presentations and medical content.