National Donation Congress, March 2012 How to get your Emergency Department engaged in organ donation Francis Andrews Clinical Lead for Organ Donation

National Donation Congress, March 2012

How to get your Emergency Department engaged in organ donation

Francis Andrews

Clinical Lead for Organ Donation

St Helens & Knowsley NHS Trust


• Emergency departments are often best avoided if you have any sense!

• Target driven pressures are constant

• Yet staff very keen to take up new challenges

• They do need intensive support though to get goals realised

Introduction

Engagement Education The ideal policy

ED donation: are departments willing to engage?

Barriers


• Get this bit right and you have a very powerful driver for ED donation potential

• Make sure that all staff feel it is their responsibility to contact the SNOD, especially nurses

• Even if you can’t get everything else in place immediately, then at least get this bit in place

Get staff to know the SNOD


The crucial bit is that someone in the ED needs to alert the SNOD

Barriers


• Engagement with the ED– Who, how

– Who is important and why

• Education– The role of the SNOD

• Barriers and how to overcome– The types of barriers

– Potential solutions

• The ideal ED policy

Outline


ED donation: there are barriers to overcome

Barriers

Develop a ED policy

Assemble core ED team

Education programme

Potential donation


• Representative project group

• Identify the ED role models

• Get them on the donation committee

• Use examples from other ED departments with successful donation track records

• On going engagement

– Have examples of ICU patients who became donors soon after ED referral

– Positive feedback/ achievements

How to do it


ED donation: Engagement

Barriers


• ED consultant lead

• ED lead nurse

• Critical care lead consultant/matron

• Anaesthetics lead

• ODP lead

• Bed management team

• Coroner

• Donation committee chair

Who is important


ED donation: Engagement

Barriers


• ED time constraints

• Poor attendance at teaching

• Poor understanding of potential for organ donation, especially in older patients

• Lack of understanding of role of SNOD

• Lack of confidence/experience in discussing organ donation with families

Problems


ED staff education

Barriers


• Use whatever has been shown already to work for that particular department

• Consider one to one teaching on the shop floor

• Drop in sessions

• Keep going back

• The SNOD is the most effective teacher

• Reinforcement by CLOD

Solutions


ED staff education

Barriers


• Unwilling ED staff, especially those with higher responsibility

• Anesthetist unable to stay in ED

• Refusal of recovery staff to help

• ICU consultant refusing to admit patient ‘solely to die’

• Bed managers unable to discharge ICU patients

• Nursing staff on ICU unable to form nursing relationship with patient

People barriers


ED Barriers and overcoming them

Barriers


• Organizational– Priority Targets

– Management support

– culture

• Logistical– Place of withdrawal

– Skill mix of staff

– Facilities for relatives

• Legal/ethical– Police/coroner

Other barriers…



Barriers


The way in which you overcome these barriers needs to be relevant to your hospital culture – there is no “one-size fits all” approach

People:

Someone needs to take the clinical

lead and support all the staff involved.

This can be from the

ED/ICU/anaesthesia

Organisational:

The clinical lead/donation committee

may need to engage directly with

hospital management to overcome

some of the organisational barriers

Logistical:

Flexible Collaborative approach

between the ED, theatres and critical

care to determine the most appropriate

facility. Funded extra staff to assist this

External:

SNODs are experienced at dealing

with the coroner and police.

Senior ED and ICU staff need to have

a good grasp of the mental capacity

act and policies for treatment

withdrawal


• Our experience is that the SNOD plays a crucial role in overcoming all these barriers

• They have to deal with them regularly and have developed a lot of expertise

• Some years ago, we managed an entire DBD in our Emergency Department. All the barriers discussed were there, and we

overcame them

Don’t forget the SNOD…



Barriers


• Call it an ED policy so the ED feels it belongs to them

• …and they might read it

• Ideally integrated as part of an ED withdrawal of treatment policy (UKDEC 2011)

• The policy needs to be easily accessible-paper and internet

The ED policy

Engagement Education ED Policy

ED donation policy and pathways

Barriers


• Early Identification criteria

• Life sustaining treatment & best interests

• Approach to family

• Consent

• End of life care plan

• Management of potential donor

• Advice on prognosis

• Who is responsible for what

• Where care should take place

• Diagnosis of death and retrieval

• Monitoring of compliance

What should it contain?

Engagement Education ED Policy

ED donation policy and pathways

Barriers


There are ways of dealing with potential obstacles to ED organ donation...

"We will either find a way, or make one." ~Hannibal~

"The way I see it, if you want the rainbow, you gotta put up with the rain." ~Dolly Parton~

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Documents

National Donation Congress, March 2012 How to get your Emergency Department engaged in organ donation Francis Andrews Clinical Lead for Organ Donation