National Donation Congress, March 2012 How to get your Emergency Department engaged in organ donation Francis Andrews Clinical Lead for Organ Donation St Helens & Knowsley NHS Trust

National Donation Congress, March 2012 Emergency departments are often best avoided if you have any sense! Target driven pressures are constant Yet staff very keen to take up new challenges They do need intensive support though to get goals realised Introduction Engagement Education The ideal policy ED donation: are departments willing to engage? Barriers

National Donation Congress, March 2012 Get this bit right and you have a very powerful driver for ED donation potential Make sure that all staff feel it is their responsibility to contact the SNOD, especially nurses Even if you cant get everything else in place immediately, then at least get this bit in place Get staff to know the SNOD Engagement Education The ideal policy The crucial bit is that someone in the ED needs to alert the SNOD Barriers

National Donation Congress, March 2012 Engagement with the ED –Who, how –Who is important and why Education –The role of the SNOD Barriers and how to overcome –The types of barriers –Potential solutions The ideal ED policy Outline Engagement Education The ideal policy ED donation: there are barriers to overcome Barriers Develop a ED policy Assemble core ED team Education programme Potential donation

National Donation Congress, March 2012 Representative project group Identify the ED role models Get them on the donation committee Use examples from other ED departments with successful donation track records On going engagement –Have examples of ICU patients who became donors soon after ED referral –Positive feedback/ achievements How to do it Engagement EducationThe ideal policy ED donation: Engagement Barriers

National Donation Congress, March 2012 ED consultant lead ED lead nurse Critical care lead consultant/matron Anaesthetics lead ODP lead Bed management team Coroner Donation committee chair Who is important Engagemen t EducationThe ideal policy ED donation: Engagement Barriers

National Donation Congress, March 2012 ED time constraints Poor attendance at teaching Poor understanding of potential for organ donation, especially in older patients Lack of understanding of role of SNOD Lack of confidence/experience in discussing organ donation with families Problems Engagement Education The ideal policy ED staff education Barriers

National Donation Congress, March 2012 Use whatever has been shown already to work for that particular department Consider one to one teaching on the shop floor Drop in sessions Keep going back The SNOD is the most effective teacher Reinforcement by CLOD Solutions Engagement Education The ideal policy ED staff education Barriers

National Donation Congress, March 2012 Unwilling ED staff, especially those with higher responsibility Anesthetist unable to stay in ED Refusal of recovery staff to help ICU consultant refusing to admit patient solely to die Bed managers unable to discharge ICU patients Nursing staff on ICU unable to form nursing relationship with patient People barriers Engagement EducationThe ideal policy ED Barriers and overcoming them Barriers

National Donation Congress, March 2012 Organizational –Priority Targets –Management support –culture Logistical –Place of withdrawal –Skill mix of staff –Facilities for relatives Legal/ethical –Police/coroner Other barriers… Engagement EducationThe ideal policy ED Barriers and overcoming them Barriers

National Donation Congress, March 2012 The way in which you overcome these barriers needs to be relevant to your hospital culture – there is no one-size fits all approach People: Someone needs to take the clinical lead and support all the staff involved. This can be from the ED/ICU/anaesthesia Organisational: The clinical lead/donation committee may need to engage directly with hospital management to overcome some of the organisational barriers Logistical: Flexible Collaborative approach between the ED, theatres and critical care to determine the most appropriate facility. Funded extra staff to assist this External: SNODs are experienced at dealing with the coroner and police. Senior ED and ICU staff need to have a good grasp of the mental capacity act and policies for treatment withdrawal

National Donation Congress, March 2012 Our experience is that the SNOD plays a crucial role in overcoming all these barriers They have to deal with them regularly and have developed a lot of expertise Some years ago, we managed an entire DBD in our Emergency Department. All the barriers discussed were there, and we overcame them Dont forget the SNOD… Engagement EducationThe ideal policy ED Barriers and overcoming them Barriers

National Donation Congress, March 2012 Call it an ED policy so the ED feels it belongs to them …and they might read it Ideally integrated as part of an ED withdrawal of treatment policy (UKDEC 2011) The policy needs to be easily accessible-paper and internet The ED policy EngagementEducationED Policy ED donation policy and pathways Barriers

National Donation Congress, March 2012 Early Identification criteria Life sustaining treatment & best interests Approach to family Consent End of life care plan Management of potential donor Advice on prognosis Who is responsible for what Where care should take place Diagnosis of death and retrieval Monitoring of compliance What should it contain? EngagementEducationED Policy ED donation policy and pathways Barriers

National Donation Congress, March 2012 There are ways of dealing with potential obstacles to ED organ donation... "We will either find a way, or make one." ~Hannibal~ "The way I see it, if you want the rainbow, you gotta put up with the rain." ~Dolly Parton~ 15