5

All abstracts are organized by track and listed in alphabetical order by title.

Benefits of Research Specific Staff

AZOB

Author: 

Kayla Gray, Research Projects Coordinator, Donor Network of Arizona

Purpose: With 3.5 organs transplanted per donor on average, there was a need to ensure that the donor’s gift of donation is pursued to the fullest. As well, CMS guidelines encourage OPOs to participate in placing organs for research. With a person dedicated to ensuring that both of these are met, it also allows for success both within the individual OPO and within the scientific community.

Methods: The position of a full-time research projects coordinator was created in 2018 to focus on all clinical research initiatives within the organization. In the year following the hiring that individual, research recoveries, organs placed for research, research organs per donor, the number of research partners, and participation in clinical research initiatives were examined in addition to the workload on other staff.

Results: In the year since the hiring that individual, research recoveries reached an organizational record, placement nearly double which translated to 0.40* research organs per donor as compared to 0.26 from the previous year. Research partnerships and participation in clinical research initiatives without significant additional workload on existing clinical staff increased exponentially.

Conclusion: The data shows that an individual focused on this work, directly correlates to more significant data and more involvement in the research, clinical, and hospital partnerships. In addition, focusing on research in this manner can contribute an overall benefit to the transplant and scientific communities.

Building Relationships That Lead to Superimposing Life Using Technology in the Real World.

STA Featured Image

Author: 

Damian Jackson, Medical Examiner Liaison, Southwest Transplant Alliance

Co-Author: 

Yvette Chapman, Director, Transplant Center Development, Southwest Transplant Alliance

Purpose: If we build quality relationships, then it is possible to have positive & successful outcomes; seeking every interaction as an opportunity to learn and grow. What if you were able to visualize an organ recovery in Midland, Texas from your office in Fort Worth, Texas?

Methods: Through proper leadership, this accomplishment began by creating a role "Medical Examiner Liaison". We are proposing that treating people like they matter is the foundation. Not just what can you do for me. At the genesis, it is an acknowledgment of importance that gives validation. We set out to have a consistent method of building quality experiences. Building trust, having respect, being mindful of others' time & responsibility, welcoming the differences of opinion & most of all open communication.

Results: The findings were extremely noticeable. We were able to survey all of our partners and have real conversations face to face which in turn allowed us to accept some misinterpretations along with mistakes made. When we owned them and made plans for corrective action/ performance improvement, it changed the relationship. It strengthened it. We have seen where trust is the foundation growth.

Conclusion: The solutions are still blossoming; As we are able to share the impact of donation through the tissue, eye & organ authorization granted by our partners were are able to explore some new concepts. Being a visionary has a great responsibility. I can share with you that utilizing augmented reality combined with virtual reality will be the next step in our quest to maximize the gift. As we look to have our own facility that is able to be the hub for excellence through proper, training, education & research.

Development of a Pulmonary Workshop for Organ Recovery Coordinators' Continuing Medical Education

logo-without-tagline
TOSA Featimg

Author: 

Nicholas R Henry, MS, RRT-ACCS, RRT-NPS, AE-C, Associate Professor and Per Diem Organ Recovery Coordinator, Texas State University and Texas Organ Sharing Alliance

Co-Authors: 

Donna D. Gardner, Dr.PH., RRT-NPS, FAARC, FCCP

Nathan Rodriguez, MSIS, RRT-NPS, RRT-SDS, EMT-B

Purpose: Organ recovery coordinators (ORCs) have varied professional education backgrounds; however, based on their specialized education, their training may not have included in-depth mechanical ventilation and pulmonary management. The purpose of this study is to describe a designed pulmonary workshop to act as a model for future continuing education of ORCs and to evaluate the results of the continuing education program. The workshop focused on pulmonary management topics/skills such as pathophysiology, mechanical ventilation settings (volume control and pressure control breath types), chest radiography interpretation, pediatric organ donor management, the San Antonio Lung Transplant (SALT) protocol, ventilator troubleshooting, and arterial blood gas interpretation.

Methods: This project was considered exempt from IRB oversight. An 8 – hour pulmonary workshop was developed and provided to ORCs as a collaboration between a local organ procurement organization (OPO) and a University-based Respiratory Care (RC) program. The workshop was held in the RC Advanced Instrumentation Lab on the University campus. Didactic lecture of material was provided by OPO staff and a University RC faculty member. The pulmonary workshop also consisted of hands-on laboratory exercises using five mechanical ventilators found within the OPO service area. During the hands-on practice activities, participants were provided instructional handouts, which assisted participants with self-directed learning activities with the most common ventilators in their service area. A program assessment questionnaire was completed by participants before and after the workshop, which requested their self-reported comfort/familiarity with pulmonary management skills on a 5-point Likert scale. The paired t-test was used to analyze the ORCs’ self-reported comfort/familiarity of pulmonary management skills before and after the workshop at an alpha level of 0.05.

Results: Eighteen ORCs completed the program assessment questionnaire with professional backgrounds as nurses (n=13), paramedics (n=3), a respiratory therapist (n=1), and a participant with background in tissue recovery (n=1). Following the pulmonary workshop, the mean ORC comfort/familiarity for all pulmonary management skills increased significantly (p<0.01). Written feedback from ORCs were consistently positive following the pulmonary workshop.

Conclusion: This program suggests ORCs can develop a greater awareness and comfort with pulmonary management by participating in a continuing education pulmonary workshop. Participants’ self-reported comfort and familiarity improved for all items on the questionnaire. Continuing education initiatives focused on pulmonary management of donor patients using hands-on competencies should be part of the ORCs practice improvement efforts.

Early Onsite Process Connection

MNOP

Author: 

Katie McKee, Hospital Development Manager, LifeSource

Co-Author: 

Susan Mau Larson, Director, Partner & Community Relations, LifeSource

Purpose: Authorization rates for organ donation were not meeting organizational #1 strategic goal as of midyear 2019. Early onsite process connection was identified as a priority intervention. The early onsite process connection was developed to contribute to increased organ authorization rates through: 1. More proactive, collaborative connection with care teams 2. More planful donation discussions with families 3. Decreased “family is ready to withdraw” notifications resulting in rushed donation discussions or missed opportunities for donation discussions 4. Targeted hospital engagement An anticipated secondary benefit was improved process efficiency.

Methods: The process followed this algorithm (see attached diagram) Resources to guide the connection process include an Early Onsite Process Connection “leave-behind” resource and LifeSource electronic records (TrueNorth) documentation templates for internal communication and next steps planning.

Results: The early onsite process connection has been fully adopted by the LifeSource Hospital Development team. Of the 2000 vented referrals assessed, 26% met indications for early onsite process connection. Connection compliance was 95%. Initial results show that the early onsite process connection contributes to an increased authorization rate. There are multiple initiatives, including the early onsite process connection, that have contributed to a four-point increase in authorization in the second half of 2019.

Conclusion: Consistent, process-driven early onsite process connection contributes to increased authorization for donation and streamlined support processes. By the annual meeting, we will have a full year of data to present.

HD Division Structure Leads To Improved Referral Recognition Behavior From Hospital Practitioners

WRTC-2c-V_10-12.eps

Author: 

Michele Foxx, Manager of Hospital Services and Professional Education, Washington Regional Transplant Community

Co-Author:

Nena Abernathy, Washington Regional Transplant Community

Purpose: Identify OPO roles and responsibilities needed to deliver comprehensive support to CMS designated hospitals and identify and realize all potential donors

Methods: The basic design of the department is multi-pronged: to simplify and create consistency with medical record review (MRR) and electronic medical record (EMR) access by creating specific positions to cover these roles; to provide dedicated continuing education support; to provide real-time process expertise for recovery staff during donation activity, and to provide an in-house donation coordinator (IHDC) role to reduce response times at high volume donor hospital while strengthening our relationships.

Results: Having the same person perform medical record review (MRR) allows for the data turnaround time and accuracy to be consistent. Having one point of contact for the hospital and reliable subsequent follow up improves referral recognition and partner relationship. From June 2018 to November 2019, 86% of our donors were in a hospital in which we have EMR access. Previously, January 2017 to May 2018, that number was 75%. These numbers justify the necessity of a dedicated person to improve electronic medical record access for clinical, MRR, and QA staff as well as being the point of contact for the hospital. We have offered more donation resource specialist (DRS) training classes each year with a total number of 1,062 attendees and have 12,015 total number of available continuing education units (CEUs) from 2013 to the present. One of the results is a decreasing trend in missed clinical indicators from 2013 to 2018 at MDSG and DCGU, where we have held our educational programs. Missed indicators have decreased from 36 in 2013 to 8 in 2018 and 42 in 2013 to 25 in 2018 respectively representing improved referral recognition. WRTC also has a specialized role called hospital services real-time (HSRT) that allows for 24-hour service to support our recovery staff during a donation event. This has proven to be very valuable in donation outcomes and relationship building. Our IHDC role at our busiest hospital decreases the response times to referrals and hospital needs.

Conclusion: These roles optimize HD function. By contributing to accurate and actionable data during MRR, improving the EMR process, offering CEUs and improving the donation process in real-time as well as decreasing response times at one of our busiest hospitals, leads to improved referral recognition behavior from hospital practitioners.

Improving Effectiveness of Clinical Orientation Training Utilizing Learner Needs, Expectations and Experience Assessment

Gift of Life Donor Program Feat Img

Author: 

Patricia Mulvania, Senior Clinical Staff Educator, Gift of Life Donor Program

Co-Authors: 

Andrea Reynolds, Clinical Staff Educator I, Gift of Life Donor Program

Richard Hasz, Vice President, Clinical Services, Gift of Life Donor Program

Howard Nathan, President & CEO, Gift of Life Donor Program

Purpose: Initiate a pre-post orientation didactic survey to evaluate needs, expectations, and experiences of OPO clinical orientees as part of ongoing efforts to improve efficacy of orientation training processes.

Methods: In March 2017 this OPO implemented a pre-post orientation didactic survey process. Utilizing a web-based application, SurveyMonkey, new orientees were surveyed prior to beginning orientation didactics and completed a post-survey at conclusion of didactic training. Using a Likert scale, pre-survey questions included asking orientees about different learning modalities they believed would work best for them (Table 1) and asked them to anticipate areas in which they needed the most training (Table 2). Using the same questions/scale, post-survey questions asked participants to respond based on their actual experience after completing didactics. Surveys provided space for and prompted participants to add additional narrative comment enhancing the OPO’s ability to utilize results to improve training effectiveness and reduce time that did not result in learning transfer.

Results: Through August 2019, 65 pre- and 58 post-didactic surveys were completed for eight separate training rounds. 55% (38) of respondents held the OPO position responsible for all aspects of organ coordination, inclusive of authorization and all case aspects from organ referral through recovery. These respondents comprised the target group for which training had been designed. Additional feedback included that while 98.3% (58) felt didactics provided core knowledge/skills necessary to be successful, 34.5% wanted more time to observe before starting classes, 32.8% wanted more OTJ experience between classes and 41.4% wanted scheduled time to complete class pre-work.

Conclusion: Surveys revealed that participants recognized an increased value of role-playing, followed by instructor interaction, self-study used for class prep and skills-based simulation (Table 1). Two of the original top three areas in which respondents identified needing more training, allocation and organ recovery persisted, while donor management replaced family communication in the post-training top three (Table 2). Curriculum was redesigned as follows; a) didactic classes were given on weeks alternating with OTJ training, b) one class day per week was dedicated to pre-work, c) classes are undergoing redesign to utilize Flipped Learning instructional strategy and d) class sequence and skills practice depth was adapted to facilitate building knowledge and skills in a cogent, meaningful sequence. Total weeks dedicated to orientation didactic was reduced from 8 to 7, learner and leadership feedback regarding effectiveness of orientation training has improved significantly and orientees have been ready to move onto the call schedule in 4 months.

Investigate, Before You Extubate

KODA

Author: 

Brittyne Dunn, MD, Client Services Coordinator, KODA

Co-Author: 

Tammy Thompson, Client Services Coordinator, KODA

Purpose: Utilize Respiratory Therapy staff to decrease untimely terminal extubations, and work to increase their understanding of the organ donation process.

Methods: Two hospitals were asked to participate in a PDSA. One was a Level I Trauma Center, the other was a stand-alone multi-service hospital within a large healthcare system. We started by identifying the appropriate RT leadership to engage in the PDSA. We then provided mandatory in-services during staff meetings. We looked into the hospital withdrawal of treatment/comfort care policy to make sure calling the OPO was a high priority on the list. During the in-service we focused special attention on training the RTs to ask the bedside nurse "did you call the OPO and what did the OPO say?". For all new RTs that are hired, the preceptor is reviewing an education slideshow during their orientation process. The Hospital Development Coordinator rounded regularly in the RT department to review the new process and address any questions. For all terminal extubations, the unit manager and the RT manager was contacted and asked to look into the variance and educate the staff involved.

Results: The PDSA was performed over a six month period. The trauma center showed improvement in the decrease of terminal extubations. For January-June of 2018 there were 11 untimely terminal extubations, for the same time period for 2019 there were only 7 untimely extubations. For the other hospital, from January-June 2018 there were 4 untimely terminal extubations, it increased to six untimely extubations for the same time period in 2019. However, the investigation into why, showed some extubations are being performed by the physician without nursing staff knowledge. The realization that untimely extubations are not only coming from the nursing staff but sometimes other members of the healthcare team. Due to these results, our OPO's Hospital Development Department is developing a Respiratory Therapy Champion Training program for 2020.

Conclusion: We received significantly more buy-in with Respiratory Therapists. Some untimely extubations were being self-reported by the RT Director. For both hospitals, all untimely extubations were investigated through a multi-disciplinary approach. All RT staff are now aware of the process, and actively participate more in organ cases. RT Directors are more actively participating in hospital Donation Committee meetings, taking responsibility in the education and actions of their departments, and having more dialogue with the Hospital Development Coordinators regarding issues and challenges the respiratory therapy department faces. Three RTs and one RT Director attended OPO Champion Training. They were then able to take that additional knowledge back to their departments to provide more in-depth training. Due to these positive results, this PDSA has been turned into a formalized Respiratory Care Program to be rolled out to all organ potential hospitals within our DSA. This new program will address training for current and new hire Respiratory Therapists. To help RTs remember the process and actively engage in organ donation, we have developed RT badge cards as reminders.

Life² Honoring Birth and Donation

FLUF

Author: 

Jonathan Carrier, MBA, CPTC, Assoc. Director of Clinical Operations, Manager of Family Advocates, LifeQuest Organ Recovery Services

Co-Authors: 

Kathleen Giery, APR, Director of Donor Program Development LifeQuest Organ Recovery Services

Harvey Norton Jr., MSN RN CCRN-K, MICU Unit Manager, UF Health Shands

Hiren Mehta, MD Associate Professor of Medicine, Program Director, Interventional Pulmonology Fellowship Program, UF Health Shands

Purpose: The purpose of the abstract is to share the success of organ donation following delivery of a donor’s baby close to three months following declaration of death by neurological criteria. The presenters will provide a case study of a female who was in her 30s, was pregnant, suffered an ICH, was declared and medically managed by the hospital's critical care team for close to three months to allow the patient’s unborn child to be delivered close to term where organ donation followed.

Methods: The investigation for outcomes was observed through an actual case observed in the presenting OPO’s DSA.

Results: The presenting OPO will share that not only was patient able to carry her unborn child closer to term thus allowing less neonatal complications, the patient was also able to donate liver and kidney(s).

Conclusion: Based on strong clinical management provided by the donor hospitals critical care team, both wishes for delivery of a healthy baby and organ donation were honored.

Love and Compassion

KODA

Author: 

Kimberly Wardlow, Hospital Development Coordinator, Kentucky Organ Donor Affiliates

Purpose: Families and staff that are provided true love and compassion; regardless of the outcome has an impact on the culture of donation.

Methods: Families are always given love and compassion, however what about the nurses, environmental services, respiratory therapists, lab, radiology; the list goes on and on. All staff truly are needed and knowing their concerns as it related to the process of donation; truly is beneficial and priceless.

Results: When people feel a part of a process, it builds investment and ownership of a process.

Conclusion: Regardless if a family says yes or no to the Gift of Life, the culture of those feeling invested in the process and staying invested; and making the family feel special is unforgettable.

Navigating a Court Authorization of John Doe Over Hospital Opposition

TXGC

Author: 

Shante' Wells, Director of Donation Systems, LifeGift

Co-Author: 

Tim Dean, Donation Systems Specialists, LifeGift

Purpose: To explore the authorization process on John Doe donors with no known next-of-kin when a Level 1 trauma hospital and transplant center refuse to support an anatomical gift despite UAGA provisions.

Methods: An unidentified male believed to be homeless was admitted to the hospital as a Level 1 trauma assault on 10/3/19 at 0824; patient was referred to LifeGift on 10/3/19 at 0847. Social work fingerprinted to identify patient and locate next-of-kin on 10/4/19 at 1328, and patient was declared brain dead on 10/4/19 at 1617. OPO planned to pursue authorization for donation. The attending physician decided to withdraw support four hours after brain death declaration, but OPO secured a delay in withdrawal until 10/5/19 at 0900. OPO leadership contacted the hospital administrator on-call who declined authorization, citing hospital policy which did not allow hospital administration to authorize donation when a patient was not identified and/or did not have legal next-of-kin. OPO engaged legal counsel with the intent to file an emergency legal injunction against the hospital to maintain physiological and ventilatory support. The hospital’s risk department became involved and delayed the withdrawal of support to 10/5/19 at 1200. A court order was filed and OPO was approved to act in accordance with the State Anatomical Gift Act, with 10 days to identify and find legal next-of-kin. Fingerprinting returned no local results from the Sheriff’s Office or Police Department. OPO inquired with the Fire Department/EMS, but no further information was available. A special request was made through a contact at the Sheriff’s department to have the fingerprints ran nationally through the FBI’s database, which resulted in identification. Patient was identified in under 12 hours and OPO’s team worked to identify relations via phone calls and internet searches, including Google, White Pages, Facebook, Instagram, and the donor registries of 6 states. With no success in identifying potential next-of-kin, OPO and legal counsel proceeded with obtaining a court order granting anatomical gift.

Results: A court order was issued for the anatomical gift of whole body and organs, which resulted in two kidneys being transplanted.

Conclusion: This case provided opportunities to examine pathways for pursuing identification of unknown patients as well as the legal processes surrounding John Doe authorizations. The case highlights that thorough investigation for identification and involvement of multiple stakeholders is imperative to the authorization and donation process.

Referral Non-Compliance Causal Analytics

PATF

Author: 

Christie Ryan, Director of Professional Services and Regulatory Affairs, Center for Organ Recovery and Education

Co-Author: 

Nick Yakubisin, Program Manager of Performance Improvement, CORE

Purpose: Reduce the rate of non-compliance related to "No Call Prior to Extubation" occurrences while enabling future improvement efforts.

Methods: The DMAIC process was utilized in conjunction with Root Cause Analysis (RCA) and human performance evaluation techniques.

Results: Development and validation of a data rich measurement system that blends referral, non-conformance, and causal data. A process for identifying human performance factors and the systemic causes that led to the referral non-conformance were implemented.

Conclusion: Variation in the defense structure across hospitals within the DSA was identified. This resulted in the development of hospital maturity assessment strategy to identify high impact opportunities for improvement and leverage best practices.

The Making of Donation Champions; Donation Resource Specialist Training (DRS)

WRTC-2c-V_10-12.eps

Author: 

David Lee, MHA, FACHE, Hospital Services and Professional Education Specialist, Washington Regional Transplant Community

Co-Author:

Patricia Murphy, MS, Hospital Services & Professional Education Specialist II, Washington Regional Transplant Community

Purpose: To provide trained and vested medical professionals at DSA hospitals to act as liaisons (donation champions), provide peer-to-peer training and be a resource during organ donation activities. Provide this education free of charge to attendees with 7.5 CEs for nurses and physicians; 7.0 CEs for social workers.

Methods: Provide an in-depth all-day training with modules that cover the entirety of the organ donation process, from the initial referral phone call to the OR recovery (donor evaluation, donor management, allocation and recovery in the OR). Attendees are connected to the purpose at the start of the program with a donor family member sharing their experience through their eyes. Conclude the program with both organ and tissue recipient speakers. Physician faculty is used to facilitate brain death and DCD presentations. A mock family approach for a donation decision with attendee participation provided. Also include segments on tissue recovery and applications; donor family support post donation and community outreach. Break during program for table discussions on what works well and doesn’t work at their hospitals. Conclude program with “if … then” statements from participants, which assesses the attendees’ receipt of the best practices in which they can implement changes and/or improvements on their units.

Results: DRS graduates serve as invaluable assets for their units and for the OPO during donation cases. The DRS program has improved our DSA hospitals’ referral compliance through the recognition of the clinical triggers, resulting in the increase of potential organ and tissue donors. Level C & D hospitals with little or no organ donation potential had an increase in their ability to recognize clinical triggers. OPO tracks and reports missed clinical triggers and through DRS education, we have seen a significant decrease in the amount of missed clinical triggers. This has led to increased number of organ and tissue donors. Upon completion of the program, our hospital partners apply advanced knowledge of donor management in a critical care setting, perform the duties of a critical care nurse in the donation process and partner with OPO in the OR for organ recovery. Many attendees have also encouraged their co-workers to attend, resulting in over 1,000 participants to date and over 7500 continuing education credits to physicians, nurses and social workers.

Conclusion: The DRS training program gives us an opportunity to provide in depth education on this complex, but infrequent event to the Level C & D hospital staffs that are directly involved in the process. It allows us to answer in detail various questions such as: why the process takes so long, why we want to be onsite for brain death testing, why we draw so much blood, and what really goes on when you talk to a family about donation? In our DSA, some hospitals now make it mandatory for their newly hired ICU RNs to attend DRS. Demand has required us to schedule one and sometimes two classes a month. Through our collaborative partnership, OPO provides DRS at our DSA hospitals. The DRS program has educated over 1,000 participants to date resulting in a multitude of donation champions connecting them to the purpose of saving lives through donation.

Utilizing the EMR to Increase Organ Donation Outcomes

PATF

Author: 

Kayla Gray, Professional Services Liaison/Donor Family Support Coordinator, Center for Organ Recovery and Education

Co-Author: 

Jennifer Shrader, Quality Nurse Specialist, WVU Medicine Ruby Memorial Hospital

Purpose: Implement strategies to increase organ donors within the hospital. Increase the number of lives saved by utilizing functions embedded in EMR.

Methods: Investigated/research on current methods of CORE referral/organ donation process. During the investigation process, discovered there were processes that could be restructured to better support the clinical team in the referral process. If the referral processes were executed successfully, it was believed an increase in organ donors and therefore, lives saved. The changes were strategic and therefore significant. The CMO order sets utilized for CORE referrals/organ donation were in need of a revision. Prior to the revision, there were three order sets to select, of which only one had within the order set to make referral to CORE prior to CMO. This caused confusion and led to not being as successful as we could have been with our referrals made in a timely fashion to CORE. We decided to have one CMO set with the addition of orders included for Respiratory Therapy. Our intended goal with adding Respiratory Therapy was to decrease extubations. We also instituted a new process, which was our CORE BPA (best practice alert). The goal of the BPA was to aid the healthcare providers to make a more timely/ efficient referrals to CORE. The BPA criteria was built within the EMR and will trigger an alert to staff based off documentation from the assessment of the GSC. We were successful with this new BPA process. Increased referrals from implementation in 2018 __524__ to _556 _to date in 2019.

Results: In 2018, we had a total number of 524 timely organ referrals with a total of 29 organ donors saving the lives of 86 people. Through November 2019, we have had 542 timely organ referrals for a total of 35 organ donors saving the lives of 111 people. From 2018 to 2019, extubations were decreased and timely organ referrals through November are at a 99% referral compliance rate.

Conclusion: We were able to demonstrate through increased staff education and staff participation with the CMO order set revision process, and the CORE BPA implementation, that our early referrals and lives saved were significantly improved.