Photo Gallery: The CLAB-ICU Project

The following photo gallery is an on-going collection of great innovative clinician ideas/strategies that promote easier, safer and more efficient CVC Line Insertions and support the initiatives of the CLAB-ICU Project and its implementation. The photos were captured on recent site visits to participating units.

We would like to promote the activities &/or the good ideas of your Unit and share them with the larger CLAB-ICU collaborative. To contact us &/or e-mail in the details +/- digital photo to the following address: Margherita.Murgo@cec.health.nsw.gov.au

Photos from recent site visits include:-

Albury Hospital

• "Six key elements for safe insertion of central lines" poster laminated and mounted on the wall at each bedside.
• All reports displayed on a staff noticeboard to illustrate progress.
• Considering rollout of project to the wider hospital starting with ED.
• View photos from Albury Hospital

Bathurst Base Hospital

• All procedural requirements packaged together for quick access.
• Hospital wide uptake of project- collaboration between: ICU/other educators across the hospital/ED/OT/X-ray department.
• Local resources developed to support staff completing data entry.
• Project team orientates all unit staff to project.
• View photos from Bathurst Base Hospital

Blacktown

• Computerised Information System (CIS) captures insertion procedural data.
• CIS captures clinician skill level for CVC insertion.
• Mobile trolley used to co-locate all necessary equipment.
• View photos from Blacktown ICU

Campbelltown Hospital

• Dedicated trolley.
• Procedure packs made internally.
• Keep log of all patients with a CVC.
• Assistant usually the bedside nurse.
• View photos from Campbelltown Hospital

Children's Hospital Westmead

• Team approach to the project for all levels in the unit.
• Liaison between ICU and infection control clear and evident.
• Countdown of time between infection on the staff room wall.
• Attempt to remove lines where possible prior to discharge from ICU.
• View photos from Children's Hospital Westmead

Coffs Harbour Hospital

• Equipment necessary to adhere to recommended technique sealed in storage boxes.
• Clear process for data entry requirements.
• Evidence of collaborative teamwork.
• View photos from Concord Hospital

Concord Hospital

• Multidisciplinary CLAB team meet 2nd weekly to plan Clinical Practice Improvement (CPI)
• Team work collaboratively to achieve CPI
• Process in place to ensure complete data capture through a data manager
• Process in place to supervise and record CVC insertions for junior staff
• Box sourced and stocked for emergency CVC insertions
• Key information and promotional material placed strategically around the ICU
• View photos from Concord Hospital

Dubbo Base Hospital

• Information for project easily visible on pin board in unit.
• Forms filled in by proceduralist or assistant for process indicators.
• View photos from Dubbo Base Hospital

Gosford Hospital ICU

• Conveniently located adjacent to ICU Staff Station.
• Guides staff through filling out the form correctly.
• Clarifies roles / responsibilities of staff and areas of the form which may seem a little ambiguous.
• CLAB Logo, brightly coloured backboard and coloured CLAB form draw attention. to CLAB and increase the profile of the project.
• Most items for CVC insertion conveniently pre-packed for staff to pick up and use.
• Form included as a prompter within the pack.
• Note: The CLAB form has been printed onto orange paper so it is easily identifiable to staff. [This strategy was also employed during the SSSL project]
• All items packaged into a single CVC Pack.
• Stored in one location and earning accessible to staff.
• View photos from Gosford hospital ICU

Hornsby Hospital ICU

• Collaborated with industry representative to develop a sterile drape prototype that complies with the Safe Insertion Guidelines. Soon to be commercially available.
• Strong support from infection control.
• Embedded practice change, in part due to previous collaboration with the SSSL project.
• Colocation of all procedural requirements for CVC insertion.
• View photos from Hornsby Hospital ICU

John Hunter Hospital ICU

• Slim-line trolley with eight wire baskets.
• All instrumentation and equipment required for central line insertion is labelled and stocked in baskets.
• Trolley is re-stocked from the main ICU storeroom on a daily basis.
• Trolley can be wheeled to any given bed-space for use.
• Wire baskets enable items to be readily identified.
• Clear labelling prompts staff around the equipment requirements for CVC insertion.
• All required times can be stored and transferred on one dedicated trolley.
• CVC stock-trolley has laminated CLAB information / procedure guides attached.
• Good prompters for staff to remember to include CLAB checklist in every CVC insertion procedure.
• Wire baskets enable items to be readily identified.
• Clear labelling prompts staff around the equipment requirements for CVC insertion.
• All required times can be stored and transferred on one dedicated trolley.
• The sticker template is readily accessible on the ICU staff computer and can be printed on regular 10cm x 14cm AVERY Labels in the ICU.
• Placed in patients’ notes and able to be modified in the future to include CLAB-specific information such as microbiology follow-up.
• View photos from John Hunter ICU

Lismore Hospital

• Embedded practice change with the philosophy that patient safety is everyone's job.
• Competency Assessment tool and Handbook available to staff.
• Lines tracked through a follow up program until removal.
• Data collection collated at an area level.
• View photos from Lismore Hospital

Liverpool Hospital

• Dedicated CVC Team run by ICU staff for ward patients.
• Dedicated trolley for service.
• Follow up of CVC Team inserted lines using a "tracking sticker".
• Standardised equipment and setup by CVC Team.
• Dedicated CVC trolley for CLAB ICU project.
• CLAB ICU Project officer for SSWAHS western zone.
• Ultrasound device available for use during CVC insertion.
• View photos from Liverpool Hospital

Manly Hospital

• Dedicated project officer 1 day/week to follow up data collection.
• Currently dedicated storage area for central line equipment and checklists.
• CLAB Posters displayed prominently close to dedicated storage.
• Plan to stock the deFries CVC pack tailored to local needs.
• Sourcing a dedicated trolley for CVC insertion.
• Folder listing requirements for CVC and arterial line insertion located within reach of stored equipment.
• View photos from Manly Hospital

Newcastle Mater Hospital

• This label has been adapted from the John Hunter ICU CVC label.
• A good example of standardisation of a process across an Area Health Service.
• View photos from Newcastle Mater Hospital

Orange Base Hospital

• Local tracking slip attached to form for follow-up.
• Planned duplicate form in development.
• Times of procedure also kept for local use.
• Dedicated vascular access storage area.
• View photos from Orange Base Hospital

Port MacQuarie Hospital

• Assistant wears hat and mask during procedure too.
• Folder for record keeping and batch tracking for data input.
• Clear follow up process.
• DeFries pack in use- often used for other similar procedures.
• Teleform software in use across area health service.
• View photos from Port MacQuarie Hospital

Prince of Wales Hospital

• Dedicated metro flex 6 drawer trolley for line insertion
• Industry source: Device Technologies
  Ph: 02) 9975 5755
• All bundle requirements co-located within the trolley
• CLAB ICU Teleform attached to each CVC Pack
• Teleform on yellow paper to "stand out"
• See contents clearly on packaging.
• Guidelines for the CLAB ICU project in the CVC drawer to support data collection.
• Forms kept at the bed side whilst patient in ICU and has a CVC.
• Pigeon hole for returned forms on discharge or after line removal in ICU.
• View photos from Prince of Wales Hospital

Sutherland Hospital

• Utilise a log sheet for all CVC insertions as a data quality measure
• Maintain a folder split by month of completion for all checklists submitted
• Acquired CVC insertion trolley to support the process
• Equipment coordinator aware of stock levels to estimate usage and compliance with checklists
• View photos from Sutherland Hospital

Sydney Children's Hospital

• CVC insertion within ICU exclusive to MO's- registrar and above.
• Dedicated Audit Officer follow up to checklist.
• Data capture adapted for paediatric and site specific use.
• View photos from Sydney Children's Hospital

Wollongong Hospital

• Assemble CVC packs at the hospital and store with all process requirements
• Place a central Venous Access Device Insertion sticker in the notes
• View photos from Wollongong Hospital