All abstracts are organized by track and listed in alphabetical order by title.
A Multimodal Process for Confirming Minimal Orientee Authorization Competency
Patricia Mulvania, Senior Clinical Staff Educator, Gift of Life Donor Program
Christina Ryan, Manager, Transplant Coordinator Services, Gift of Life Donor Program
Andrea M. Reynolds, Clinical Staff Educator I, Gift of Life Donor Program
Purpose: Develop and implement a structured process to objectively assess and measure orientee skill and competency prior to their approval to independently lead family donation conversations (FDCs).
Methods: In July 2017 this OPO identified gaps in authorization training final assessment and sign-off process for new orientees responsible for leading FDCs. Recognizing the vital importance of this skill set, the OPO developed and implemented a new structured, multimodal process for assessing orientees’ FDC skills. This stepwise process is based on staff’s ability to effectively operationalize the OPO’s standard of practice, combining the OPO’s unique FDC model and its specific goal-oriented triggers for initiating a FDC. A distinct focus was placed on OPO request. Classes were enhanced to ensure continuity with expectations. Trainers were limited to a high-performing group tasked with conveying consistent messages. The process was introduced to orientees during their second of four skills-based family communication didactic classes. By class three, if there were concerns regarding an orientee’s skill set, the direct supervisor was informed and additional training was implemented via a pre-determined, customizable development plan. A three-part, multimodal sign off process was developed inclusive of: a) a web-based donation conversation coached and scored by a FDC expert from an internationally known training institute; b) three in person, FDC simulations representing critical OPO triggers, coached by OPO in-house experts and recorded for orientee self-assessment and review with coach; and c) a designated OPO leader performing a real-time on-site assessment of orientee’s ability to effectively lead a FDC. A standardized scoring tool was used for all conversations, regardless of the assessment mode. A minimally competent score was identified. Staff, who did not achieve this score, required additional training until they met the necessary standards.
Results:We compared the one year post-orientation authorization rates of twelve staff (test group) that had completed the new sign-off process to a control group of 12 staff who had not completed the same process. Results are illustrated in Table 1.
Conclusion: The multimodal authorization sign off process in tandem with enhanced training and a well-defined skill improvement process has resulted in increased year one authorization rates for new staff. Staff as well as leadership is more confident in their abilities to effectively lead FDCs. The OPO continues to gather data to assess performance of incoming new staff, impact on longer term authorization rates and number of lives saved.
Bridging Language: An Educational Partnership Between an OPO and a Children’s Hospital
Brian Leland, MD, Assistant Professor of Pediatrics, Division of Pediatric Critical Care, Riley Hospital for Children at Indiana University Health
Christy Cannon, Hospital Liaison, Indiana Donor Network
Purpose: To determine if bridging language, used by a physician, can increase organ donation consent rates while improving families' overall experience surrounding donation.
Methods: Traditionally, members of the healthcare team do not mention donation, as historical consent rates are higher if donation is first mentioned by a trained non-healthcare provider. However, the connection between the PICU medical team caring for the patient and the family is a unique relationship that may lend itself to improving the family's overall experience surrounding organ donation. For this study, the topic of donation is introduced in an appropriate manner by a formally trained PICU/CVICU attending physician or fellow and OPO staff is then introduced.
Results: The study was completed in late 2019. Results are in progress and will be available in January 2020. The learner will be able to understand results from this study and potentially implement it at their institutions.
Conclusion: Preliminary conclusions indicate that this practice is providing better continuity of care for families and the perception of more transparency.
Donor Family Legacy Opportunities
Katie Mckee, Partner Relations and Family Aftercare Manager, LifeSource
Jill Halimi, Donor Family Advocate, LifeSource
Purpose: I treasure the chance to say my loved one’s name and celebrate his legacy, Donor Family Member. The purpose of the legacy and connection opportunities is to offer a strong variety of options for donor families to engage with our OPO and a community of families in ways that meet their unique desires for healing, hope, and remembering.
Methods: With the premise that families approach donation, grief, and engagement from very different perspectives, the LifeSource Donor Family Aftercare Team has expanded opportunities offered to include: Connection: Annual Donor Family Gatherings, Healing Garden Event, Private Donor Family Facebook page Legacy: Electronic Tribute Forum Gallery of Hope, Donor Quilts, Memorial Wall and Memorial Benches in a Healing Garden that was designed to serve as a “home for donation” and gathering space for families to remember and reflect, Donor Recognition Ceremonies with the Governor of each state.
Results: We engaged with RPG to conduct a Donor Family Satisfaction survey. Legacy and connection opportunities drove specific questions. 88% of families surveyed expressed a high level of satisfaction with the services and support provided by our teams. These results were the highest ever baseline satisfaction results RPG has seen.
Conclusion: Our legacy and connection opportunities are meeting the variety of preferences and needs of the >12,000 families we actively serve. We will continue to seek feedback to modify these opportunities in support of families
Honoring the Gift: Overcoming Dissent for First Person Authorized Donation after Circulatory Death
Joel Baucom, Manager of Family Services, Carolina Donor Services
Rodney Pilson, Family Support Coordinator, Carolina Donor Services
Dannesia Ragland, Hospital Development Specialist, Carolina Donor Services
Julie Landon, Organ Administrator on Call, Carolina Donor Services
Melanie Combs, Organ Donation Coordinator, Carolina Donor Services
Purpose: Donation after Circulatory Death (DCD) presents unique challenges for donor families, the hospital care team, and the Organ Procurement Organization (OPO) staff. In this OPO’s service area, dissent of First Person Authorization (FPA) for potential DCD donors occurs at a higher rate than FPA dissent for potential donors who have been declared brain dead (BD). FPA has been routinely accepted for donors who have been declared BD and this OPO moves forward to honor the registered donor's decision. However, prior to this study, this OPO had not been as assertive with the families of donors who had not been declared BD. Thus, when the family dissented FPA for patients who met DCD Criteria, the OPO was unable to recover organs from patients who had already made their own decisions to be donors. In January through June of 2019, 28% of the 46 approaches for FPA DCD resulted in decline
Methods: The action plan included three strategies: 1) Ensuring that this OPO's culture around FPA and DCD was aligned with honoring FPA for ALL donors (BD and DCD), 2) Education for OPO and hospital staff, and 3) Adapting the approach process to allow for more timely conversations with families of FPA donors. Beginning 7/1/2019, dissent of FPA for DCD donation resulted in a multi-disciplinary meeting to develop strategies to overcome the challenges in real-time. Additionally, Family Support Coordinators (FSC) used specific language (referring to the donor’s “decision” rather than “wish”) to communicate the legality of an FPA donor’s decision with both donor families and hospital staff.
Results: This intervention resulted in a 19% decrease of FPA dissent for DCD. In Q32019 9% of the 22 approaches for FPA DCD resulted in a decline. During this time period there were 21 DCD donors, 39 organs transplanted, and 14 organs placed for research. In the quarter prior there were 12 DCD donors, 19 organs transplanted, and 14 organs placed for research.
Conclusion: The utilization of strategic language (“decision” vs. “wish”) with donor families and hospital staff proved effective in reducing the occurrences of FPA DCD dissent, along with a clear process multi-disciplinary team approach to assist during occurrences of FPA dissent. Efforts to increase the overall timeliness of the donation conversation with families of FPA donors likely also affected the positive results; however, this was not measured.
Increasing Organ Authorization Rates through Adoption of a Dual Advocacy Model
Andrew Sigond, Director of HD and DFS - Center for Donation and Transplant
Karin Rebehn, Director of Quality - Center for Donation and Transplant
Daniel DiSante, Director of Clinical - Center for Donation and Transplant
Michael Thibault, Executive Director - Center for Donation and Transplant
Purpose: To improve organ authorization rates by shifting to the Dual Advocacy approach model.
Methods: • Consulted with an industry expert in theory and application of Dual Advocacy approach model • Collaborated to provide virtual and onsite training programs • Developed internal mechanisms to report and increase focus on performance
Results: Virtual and onsite training programs were completed in Q3 and Q4 of 2018. Total organ authorization rate increased from 42% in all of 2018 (N- 179 approaches) to 59% from 1/1/2019 – 10/31/2019 (N- 157). Number of consents increased from 75 (in all of 2018) to 92 (1/1/2019-10/31/2019). Monthly authorization rate ranged from 38% to 50% in 2018. In 2019, the range was 47%-64% with nine out of 10 months above 50% (vs. only one month above 50% in 2018).
Conclusion: Our OPO’s approach practice has shifted from a traditional to a Dual Advocacy model through commitment to the concept, ongoing staff training, and continual performance measurement. This has resulted in significantly improved authorization rates and has been a key driver of sustained organizational growth.
Standard Approach for Tissue Donation
Jonathan Coleman, Tissue Manager, CORE
Purpose: To improve non-designated authorization rate
Methods: We looked at or ND rate over the past 2 years and brainstormed different ways to increase the ND rate
Results: In 2018, our ND rate was less than 31%
Conclusion: We tracked daily authorization rates and held weekly meetings with tissue coordinators to develop a standard approach for all to use when approaching. We increased our ND rate to 40% in 2019.
Unlearning Cultural Competence “A Modern Approach to Cultural Competence Training”
R. David Robles, LCSW, Director, Donor Family Services, Donor Connect
Yvette Melby, LCSW Family Support Coordinator, Donor Connect
Purpose: Historically, Cultural Competence trainings tend to fall short of what they are intended to do and end up reinforcing stereotypes and bias. Participants often report these trainings to be ineffective and boring. Our modern approach to training on this subject educates in a manner which is enjoyable, engaging and provides the learner with more useful and applicable information.
Methods: We provided 24 learners consisting of family support coordinators, hospital services department members, and organ donation coordinators at our OPO with our “Unlearning Cultural Competence” training. Training includes: Updated definitions of current terminology, education regarding personal identity, overgeneralization and microaggressions, introspective activity, psychoeducation regarding human behavior, comical but applicable video clips, educational video clip regarding implicit bias from leading researcher, practical application of how bias comes into play while at the hospital with hospital staff, OPO staff and potential donor families, education regarding cultural humility.
Results:After having completed the training participants were surveyed via an online form. Learners were asked to rate the training. 100% of participants indicated a positive learning experience (Good or Excellent) 71% of participants indicated having an excellent learning experience (Excellent)
Conclusion: Our modern approach to Cultural Competence training, “Unlearning Cultural Competence” is more beneficial for learners than the traditional Cultural Competence trainings. This training, or similar approaches would be more beneficial to those who are to participate in such trainings.