1. Culture of Donation Doug Miller Symposium 2013 Gundersen Lutheran Medical Center LaCrosse, WI

3. Trust When cases go smoothly, both hospital staff and families TRUST that donation is a good thing Good organ donation experiences breed a hospital/staff culture that supports future investment in the donation program

4. Donor Resource Team In 2007 Gundersen trialed a donor resource team – 10 - 12 ICU nurses – Once verbal consent obtained, resource team RN contacted – Resource team RN dispatched to adult ICU/ER/peds ICU By 2009, resource team was deemed “successful”

5. 2013 Gundersen Donor Resource Team Melissa Revels, RN Donation Liaison Julie Gollnick, RN Team Leader Chrissy Tevis, RN Team Leader Rita Roberts, RN Jake Clements, RNErica Cook, RN Seth Barna, RN Tracy Quackenbush, RN Kristen Krueger, RN Becky Kiesau, RN Kathy Hageseth, RNAngie Haugen, RN

6. Resource Team Duties 1.Complete consent form Why? Re-do’s and have lost some donors due to the descriptions given How? Utilize cheat sheet 2.Prep family for med/soc interview 3.Discuss the donation process in-depth 4.Give family permission to leave “How would you like to say goodbye?” “I promise you we will take good care of Karen – she is comfortable, and you need not worry.” “We will call you with any updates.”

7. McDonald Room

8. Resource Team Duties (cont.) 5.Enlist pastoral care/social work per family needs – Offer spiritual support/listening – Contact clergy/arrange for rituals as able – SW: Insurance/FMLA, etc. 6.Assist bedside nurse with serologies and order sets 7.Present donation mementos to family

12. Forward Focus - 2012 to Present Problem: Data showed donation potential in non-realized DCD cases – Families were offered donation at point of withdrawal of ventilator…TOO LATE Plan: Get resource team members involved earlier – huddle/approach before family is “done” Strategy: Orange sheet communication tool for resource team members to stay abreast of open referrals –> initiate huddles/approaches sooner

13. Orange Sheet – Do/Study 1.Revised for more “free-writing,” increasing its value/use 2.Donation liaison used sheet to track where things were at on a given referral 3.Paper sheet not part of patient’s permanent medical chart 1.Decisions for resource team made by FF team 2.Paper worksheet inconsistent with GL’s paperless charting 3.Orange sheet did not fulfill goal to deploy resource team earlier on organ referrals

14. What We Learned: Act/Next Steps 1.Evaluate FF Team: Enlist resource team members to the FF committee Create new PDSA focus with resource team ownership 2.Consistency is Needed: New donation/bereavement liaison to actively follow all referrals -.5 FTE position 3.Ongoing Donation Awareness: Rapid recovery Invite PICU RN to join resource team

15. Next Steps (cont.) Resource team / MD connections Strengthen MD knowledge/commitment to donation program – Resident training – GL provider/UW OTD dinner – 11 providers – Reach out to cardiology MDs

16. Thank you!