Life-Saving Workspace Organization

5S for Crash Carts

Lean’s “5S”—Sort, Set in order, Shine, Standarize, and Sustain—might seem like a fancy way of saying, “tidy up,” but Harjinder Sandhu, Pharmacy Supervisor with King County Jail Health Services, and the pharmacy technicians on his team recognize that good workspace organization is important.

Jail Heath pharmacy and nursing staff from both King County Correctional Facilities in Seattle and Regional Justice Center in Kent recently developed a thorough 5S system for their emergency crash carts. The 5S approach helped them solve a challenge they had faced in making sure that every crash cart was fully stocked. These crash carts are used whenever a medical code occurs anywhere within the King County jails.

As the pictures below detail, the newly 5S’d organization and order system help doctors and nurses access the crucial medicines and equipment quickly and ensure that pharmacy staff can fully replenish them once they’ve been used.

Most people’s workspaces do not serve the urgent, sometimes life-saving, purposes as these crash carts, but eliminating waiting and confusion by making sure that everything is stocked and in the right place could benefit every worker.

In the past, before the team’s 5S, medications were stored wherever there was space within the cart. Now, each medication is stored in a designated spot in the cart. This also prevents staff from adding additional unnecessary medications “just in case.”


The location of each medication is outlined and the name of the drug is labelled in the space so that if a medication is used, the space below will reveal which medication is missing. When medication is used, nurses are able to easily identify which and how much medication was used.

The pharmacy and nursing team also set a replenishment level for each medication to ensure there is adequate supply. The spots also indicate the “full” levels


In the past, there was no standard process to ensure that medications used during a code were replaced. After a code, nurses may not have readily known which medication had been used and there was no standard way to communicate with the Pharmacy to request medications be replaced.

Sandhu’s team created a standardized cart restocking process so that everyone involved could work together to ensure fully stocked crash carts. In order to help nurses organize and re-order medications after a code, there are easy-to-use reorder forms, along with color pictures of a fully stocked cart, at the locations where carts are stored. The order forms also show the location of medications and the full levels; all nurses have to do is compare the form to the cart and request the right amount to stock the cart.

Crash Cart reorder forms

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