1. CLAB In The Mainland

2. Overview Christchurch ICU Where were we? Where are we now? Where are we going?

3. 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

4. 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

5. 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

6. Quality Healthcare in Christchurch

7. Historic Chch CLAB Data

8. 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

9. 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

10. 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

11. Key Success CLAB rate QI profile MDT

12. Future Maintain high profile Formalise competencies Compliance improvement Blood culture simplicity Sustainability beyond April 2013

14. Key Objectives 1.Reduce the rate of CLAB in New Zealand ICUs towards zero (<1 per 1000 line days by 31 March 2013) 2.Share evidence based practices and provide leadership, coordination and data management that will lead to sustainable improvement and better patient safety outcomes 3.Establish a robust national measurement approach for CLAB 4.Spread the methodology to at least one other area

15. The Region CityPopulationDHB Christchurch380,900CDHB Dunedin117,700SDHH Nelson60,800NMDHB Invercargill49,200SDHB Blenheim30,300NMDHB Timaru27,700SCDHB Ashburton17,950CDHB Oamaru13,000SDHB Queenstown10,442SDHB Greymouth10,100WCDHB