Cindy Kolzow, RN / Donation Liaison Ministry St. Joseph’s Hospital-Marshfield Doug Miller Symposium, April 25, 2013 Developing a Donor Resource Team

Ministry Life Gift Team Cindy Kolzow, RN Heather Schmidt, RN Jean LaMaide, MICU RN Lacie Pohl, SICU RN Libby Ferris, OR RN Alison Harycki, PICU RN Sara Strell, UW OTD Tracie Cook, UW OTD Rupal Shah, RT Jenny LaPoint, RT Dr. Jesse Corry, Neurointensivist Lindy Nelson, Chaplain

Vision MSJH will have a multidisciplinary patient- centered approach to the donation process involving spiritual services, nursing, and physician staff that will result in a well coordinated, seamless consent process benefiting families, patients, staff, and recipients.

Analysis 13 potential donors (non-donors) in 2011 Completed root cause gap analysis to determine the whys –MSJH has over 120 trained designated requestors across 3 critical care units –Few are confident in their knowledge of the donation process and approaching families about donation –Resulting in poor consent processes and decreased consent for donation Reviewed 2 recent cases that went well –Expert nurse coordinating the care –2:1 nurse ratio in caring for patient –Huddle process in place prior to consent discuss –Key MDs who understood donation process

Changes 1.Created multidisciplinary communication worksheet for organ referral patients 2.Development of donor resource team (DOT- Donor Organ Team)

Orange Communication Worksheet Tool to facilitate communication between providers and shifts –Initiated when patient meets clinical triggers –Updated with donation information as appropriate –Not permanent part of medical record but kept in front medical chart –Orange - you can’t miss it!

DOT (Donor Organ Team) Resource team with expertise in the donation process Role: –Coordinate huddle to best facilitate consent process with consistent, accurate donation information –Assist with resource management of the consent process

DOT - Where Did We Start? 1.Obtained administrative support for the project and potential on call schedule Modeled after the SANE program in the ER 2.Identified core team members with critical care background as members 3.Developed education for team

DOT Member Selection 12 RNs from the PICU, MICU, SICU, and management DOT members have: –Critical care experience –Vested interest in donation –Good communication skills (esp. EOL issues) –Varied work schedules for adequate coverage

Ministry St. Joseph’s DOT Members Cindy Kolzow, Donation Liaison Annette Hansen, MICU RN Tiffany King, MICU RN Heather Haun, Peds ICU RN Reesa Mitchell, Peds ICU RN Stacey Larson, House Sup RN Sherrie Lancour, MICU RN Jean LaMaide, MICU RN Lacie Pohl, SICU RN Greg Schield, SICU RN Heather Schmidt, MICU Mgr Thora Tollefson, SICU RN

When Is DOT Contacted? Family brings up donation A family conference is being planned for grave prognosis or withdrawal of care When the option to donate is in question

How Contacted? Critical care charge RNs and house supervisors have DOT members’ contact information –Assess 1 st in-house resources M-F days, management members available DOT working on unit and able to assist House supervisor to assess availability of DOT member in another unit –Otherwise, contact a member on the list at home

Call Schedule Have not put together a formal call schedule –We have solid weekend coverage and pm shift coverage –Considering a holiday call schedule Call pay

Expectation of DOT Member When One Receives a Call 1.Call unit to query where we are in the process of donation Is patient BD? Is there a plan to withdraw care? Any request/mention made by MD? Family questioning organ donation? Does patient have first person authorization? 2.Develop plan for next steps (come in, watch and wait, etc).

3.Initiate huddle - ensure all disciplines are aware of the donation process –Provide real-time education for nursing, MDs, spiritual care, etc. 4.Be the designator requestor

5.Assist with coordination of care beyond the consent process, if able –Serologies –Heart & lung procurement work-ups 6.Attend monthly meetings –Case review –Continuing education/process improvement

Education of DOT Members Survey to assess education gaps (Wide variation of knowledge!) One 8-hour training day –Roles and expectations –Consent process –Overall donation process –Effective requesting strategies Role playing Difficult situations

Key Learnings: Orange Sheet 1.Valued by staff – in patient’s paper chart so easy to update and maintain 2.Not part of the patient’s permanent medical chart 1.Roll-out to units was inconsistent so sheet is not always pulled 2.Sheet gives little instruction to bedside nurse on contacting DOT/next steps

Key Learnings: DOT Team 1.Little knowledge of DOT’s existence by MSJH at large. DOT not consistently notified. 2.Monthly DOT meetings are poorly attended – keeping the core team “connected” has been difficult 1.Improved year-over- year regulatory and true conversion rates and consent rate 2.DOT role focused on consent process -> serologies, not the whole case, so not a huge tax on the “system”

Next Steps Make MSJH aware of DOT team Ensure DOT members can attend monthly meetings and in-services Establish criteria for what is a “good no” for consent versus an opportunity to improve Revise orange sheet and internal website for donation info/resources

Questions?