Culture of Donation

Doug Miller Symposium 2013Gundersen Lutheran

Medical CenterLaCrosse, WI

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

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”

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, RN Erica Cook, RN

Seth Barna, RN

Tracy Quackenbush, RN

Kristen Krueger, RNBecky Kiesau, RN

Kathy Hageseth, RN Angie Haugen, RN

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 interview3. Discuss the donation process in-depth4. 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.”

McDonald Room

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

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

Orange Sheet – Do/Study1. 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

What We Learned: Act/Next Steps1. 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 position3. Ongoing Donation Awareness:

• Rapid recovery• Invite PICU RN to join resource team

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

Thank you!