The Implementation of an ICU Intrahospital Transfer Checklist

Background and Aims

Transport of critically ill patients1 increases risk of adverse events

To minimize this risk and Improve the quality of care, an Intra-hospital Transfer Checklist was implemented using QI methodology

Methodology

Three Plan Do Study Act Cycles

Information gathering and first ICU intra-hospital transfer checklist draft

Tea Trolley Training2 and feedback forms collected for various MDT members

Finalized checklist piloted by SpR and ACCP and deemed practicable for use. Approved for use by clinical governance

“

100% of MDT members agreed that an ICU Intrahospital Transfer Checklist would improve patient safety ”

Results

Overall, 100% of responders agreed that an IHTC would: o Help prepare for a potential adverse event during transfer o Improve safety during transfer

Feedback identified that: o More IHT training for nursing staff was needed o The team should ensure suitable ventilator setup at destination

Neonatal Central Venous Catheters: A successful triad of a traffic light system, an education guide and a new X-Ray project

• Background:

The use of central venous catheters (CVCs) is essential part of neonatal care allowing delivery of intravenous fluids and medication However, their utilisation is associated with severe complications such as infection and extravasation to a body cavity, which is potentially fatal 1 Critical events associated with neonatal CVCs triggered a thorough review into local practice, with the aim to disseminate findings and ensure sustained improvements to patient care and safety.

• Aims:

Reduction of the number of incorrectly positioned lines, with the secondary aim of reducing complications through a prescript ive education package. We restructured the process for assessing CVC position, securing the device and created a robust system of ongoing monitoring. A collaborative ‘Central Line Quality Improvement Group’ was initiated to address all the project objectives.

• Initiated a quality improvement project with the radiology department

• Aim to re -evaluate the outcome 2 months post change

Cycle 5 Cycles 1 & 2 Cycle 3 Cycle 4

• Reviewed images of 50 babies for artefacts, collimation and the correct positioning.

• We found that poor quality X-Rays impacted on decision making

• Results:

 1st audit found 29.7% (28/94) lines were in an unintentionally suboptimal position (with 2 cardiac tamponades)

• 94 lines in 72 patients who had a CVC inserted on our unit were reviewed (01/09/2021-06/12/2021)

• Implemented changes

• Re-evaluated practice. Reaudit of 103 lines in 62 patients (01/03/202230/04/2022)

• Collated feedback and created education package

• Continuous education of the multidisciplinary team

Summary of changes

 Created a ‘traffic light system’ to assess and monitor CVCs

 Educated the team on optimal securing of catheters to avoid migration

 Developed an education guide distributed to every new rotation of doctors since 01/05/2022

 Designed posters on preparation for XRay, positioning and securing lines

 Liaised with radiographers

 Created new educational material

 1st re-audit revealed a reduction of ‘red lines’ to 17.4% (18/103)

 Review of X-Rays found suboptimal body and limb positioning in 45% of cases and artefacts in 55%

 2nd re-audit revealed a further reduction in ‘red lines’ to 13.1% (8/61)

• What’s next?

 Decide on implementation of Point of Care USS to check line position of to re -audit practice