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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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Presentation Transcript
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
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
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