2. Moderator: Janet Hewson, RN, Western Medical Center Santa Ana Presenters: Cynthia Jugo, RN; Georgi Collins, RN; Karina Kilian, RN; Jackie Leopard, RN, Riverside Community Hospital Breakout Session B: Doubling Donation Outcomes… What a Difference a Year Can Make

3. Doubling Donation Outcomes… What a Difference a Year Can Make: Riverside Community Hospital Moderator: Janet Hewson, RN Director of Trauma Services Western Medical Center-Santa Ana

4. Doubling Donation Outcomes… What a Difference a Year Can Make: Riverside Community Hospital Cynthia Jugo, BSN, CCRN, MBA, RN, Director Surgical ICU/CVU Georgi Collins, BSN, RN, Trauma Program Manager Karina Kilian, CEN, MICN, RN, ER Clinical Manager Jackie Leopard, MSN/ED, CNOR, RN, Perioperative Clinical Educator

5. “How to be…” Being in action! The answers are in the room “Report out” on Question to Run-on: – Scribe – Spokesperson All Teach / All Learn

6. Question to Run-On How will you bridge the donation process and your current practices to create a culture of donation?

7. Objectives By the end of this presentation, the attendee will be able to: 1.Learn the strategies needed to build an effective end of life team 2.Recognize the positive impact of standardized order sets for the management of catastrophic brain injury 3.Recognize barriers to donation embedded in current hospital culture

8. Riverside Community Hospital Founded in 1901, Riverside Community Hospital/RCH is a 373 licensed bed, acute care hospital in the heart of the Inland Empire. RCH houses the largest Emergency Room and Level II Trauma Center in the Inland Empire with 50 beds, a Heli-stop and a 40 bed ICU. RCH is one of the Riverside County’s STEMI receiving centers and is a fully accredited Chest Pain Center.

9. Riverside Community Hospital Centers of Excellence include: – HeartCare Institute – Urology/GYN da Vinci Program – Cancer Center – Level II Neonatal Intensive Care Unit. Transplant Program, Kidney and Pancreas Center since 1997 – 1 of 20 kidney centers; 1 of 16 kidney/pancreas centers in California

10. Need for Team Outcomes not meeting national standards Needed increased visibility and availability of OneLegacy staff Opportunity to improve communication between OneLegacy and ED, ICU, and OR

11. Need for Team RCH staff misunderstood the donation process Education on clinical triggers and consultation timeliness

12. Building the Foundation Customized Donation Program at RCH based on continuous staff feedback Modified clinical trigger card language – Referral to consultation In-serviced ICU, ED, and OR on the donation process (clinical triggers and consultation timeliness) Communication boards developed in ICU, ED and OR

15. Creating the Team Identified champions in ED/Trauma, ICU, RT, Social/Chaplain Services, OR and Marketing Created Monthly Donor Council meetings Mission: The Donor Council at RCH is a multi-disciplinary team dedicated to improving the overall health of our community by preserving the gift of life through organ, tissue, and eye donation.

16. Building the Team Provided hospital badge access and laptops to OneLegacy staff Electronic patient records access to OneLegacy staff

17. Building the Team Implemented Adult Catastrophic Brain Injury Support Guidelines and Physician orders – Good patient care is good donor care – Preventing secondary organ damage is crucial RCH CBIG 2011 08 NS4241 05 10 AdultCatasBrainInjury p1^FP P11.pdf

18. Building the Team On-going education with Trauma and Neuro Surgery physicians In-serviced at New Employee Orientations Rounds/Communication with champions and staff on every consult

20. Walking In-services…

21. Case Study 43 year old female head trauma; status post fall from horse. Arrival time 1027 Day 1:Timely consult from ED; Consult time 1039 » Patient was a Registered donor Day 4:Consult closed by OneLegacy as Not Brain Dead Day 8:Second consult made to OneLegacy

22. Gift of Life Day 8:Catastrophic Brain order set/CBIG implemented Day 9:Declared brain dead by 2 licensed physicians Outcome:5 organs recovered/4 lives saved

23. Gift of Life Liver/Left Kidney-55 Married, with 3 children, was on the waiting list for 13 days. He works as a branch manager at a pest control company. Lives in Ontario, CA, and enjoys fishing and travel. Double Lung-24 Single, no children, was on the waiting list for 22 days, lives in Las Vegas, NV. Heart-68 Married, was on the waiting list for 9 days, lives in California. Right Kidney-62 Married with 2 children, 2 grandchildren, was on the waiting list for 1, 191 days. Works in dental equipment repair and enjoys reading, talk radio and cooking.

24. Outcomes 2008 Pre-team 2009 Building… 2010 Post-team 2011 (YTD) Hardwired Consultations 45 115155186 Eligible Deaths 8 81410 Organ Donors 3 5108 Consent Not Recovered/CNR 0 310 Timeliness Goal 100% 54%86%97%98% Organs Transplanted per donor Goal 3.75% 3.672.803.802.5 Conversion rate Goal 75% 35%63%71%80% Lives saved 11143820

25. Tree of Life

26. The Courage of One Called from this world by God’s hand, we mourn the loss of a loved one. But a legacy was left behind; sight to a blind man, a new heartbeat for one whose broken heart can beat no more, breath for one who had drawn near to her last, a second chance to live a life forsaken. A hero’s welcome awaits their arrival, for a courageous act was their last. Giving their last breath, the last beat of their heart, the very sight from their eyes, to those who needed it most. A living legacy to fallen heroes, who gave all they had to give, as God called them home, to a hero’s welcome.

27. Bobby D. Collins

28. Riverside: Hospital Honors Organ Donors Rich Linton / Special to The Press-Enterprise A Tree of Life memorial was recently unveiled at Riverside Community Hospital honoring organ donors. A permanent marble monument will be added later and erected in the entry hallway.

29. 2011 Initiatives OneLegacy presents at monthly ED, ICU, RT and OR staff meetings. OneLegacy activities/updates are included in the hospital newsletter. OneLegacy participates in: – General New Employee Orientation – ICU clinical practice – Intro to Trauma classes – Trauma Rounds

30. 2011 Initiatives RCH ecampaign on the RCH website http://riversidecommunityhospital.com/service/t ransplant-services http://riversidecommunityhospital.com/service/t ransplant-services Adult Brain Death examination forms RCH Determination of Brain Death Exam Form Revise 6 10 2011 gc (2).docxRCH Determination of Brain Death Exam Form Revise 6 10 2011 gc (2).docx Identify Donation After Cardiac Death opportunities

33. Question to Run-On How will you bridge the donation process and your current practices to create a culture of donation?

34. Transition to Lunch Lunch is from 12:10 – 1:10 In the Main Ballroom Open seating Bon Appétit!