Clab in the mainland
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CLAB In The Mainland. Overview. Christchurch ICU Where were we? Where are we now? Where are we going?. The Challenge. South Island 56% New Zealand 23% population 5 DHBs Culture Christchurch Single ICU All subspecialties except paeds cardiac and burns Population 550,000.

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CLAB In The Mainland

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Clab in the mainland

CLAB In The Mainland


Overview

Overview

  • Christchurch ICU

  • Where were we?

  • Where are we now?

  • Where are we going?


The challenge

The Challenge

  • South Island

    • 56% New Zealand

    • 23% population

    • 5 DHBs

    • Culture

  • Christchurch

    • Single ICU

      • All subspecialties except paeds cardiac and burns

    • Population 550,000


Christchurch icu

Christchurch ICU

  • Size of unit

    • Staffed 16 ICU bed equivalents

    • 120 nurses, 8 SMO and 18 registrars

    • 2.9 beds/100,000 (4.8 NZ average)

  • Interventions

    • 65% ventilation rate

    • Mean length of stay 3.5 days

  • Outcomes

    • Mortality 12%

    • Low SMR


Clab consideration

CLAB Consideration

  • History

    • Insertion process established 2009

  • Patients

    • 1250 admissions PA (70% CVC)

    • 350 cardiac patients

    • 120 LTM patients

  • Process

    • Antibiotic impregnated lines for high risk

    • PICC service for LTM lines

  • Observation

    • Average 300 line days per month


Quality healthcare in christchurch

Quality Healthcare in Christchurch


Historic chch clab data

Historic Chch CLAB Data


Clab results

CLAB Results

  • Structure

    • Team – Dr, nurses, educator, data, IPC + guest

      • Regular meetings

    • Goals

      • Simple -Awareness/Education

  • Process

    • Compliance – insertion/maintenance/cultures

      • Alliance and complement DHB processes

    • Robust data


Outcome

Outcome

  • CLAB rate 0/1000 line days

  • 352 CLAB free days

    • 10 CLAB avoided

    • 1-5 lives saved

    • Up to $500,000 saved

  • Endorsement CEO

  • Role out to NICU


Problems

Problems

  • Education

  • Data burden

    • E-database

    • Global IT issues

  • Compliance

    • Insertion – 80-100% (10/week)

    • Maintenance- 60-70% (150 episodes/week)

    • Blood culture- recent reduction in compliance


Key success

Key Success

  • CLAB rate

  • QI profile

  • MDT


Future

Future

  • Maintain high profile

  • Formalise competencies

  • Compliance improvement

  • Blood culture simplicity

  • Sustainability beyond April 2013


Key objectives

Key Objectives

  • Reduce the rate of CLAB in New Zealand ICUs towards zero (<1 per 1000 line days by 31 March 2013)

  • Share evidence based practices and provide leadership, coordination and data management that will lead to sustainable improvement and better patient safety outcomes

  • Establish a robust national measurement approach for CLAB

  • Spread the methodology to at least one other area


The region

The Region


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