In a 2022 report, the Joint Commission revealed a concerning trend: missing and expired items on crash or code carts ranked among the top 5 clinical problems found by surveyors. Shockingly, this isn’t a new issue. The Joint Commission highlighted similar concerns back in 2017, indicating that incomplete or improperly supplied emergency carts continue to pose significant risks to patient safety. Despite years of awareness, little progress has been made in addressing this critical issue.