national donation congress, march 2012 how to get your emergency department engaged in organ...
TRANSCRIPT
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
National Donation Congress, March 2012
• 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
National Donation Congress, March 2012
• 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
Engagement Education The ideal policy
The crucial bit is that someone in the ED needs to alert the SNOD
Barriers
National Donation Congress, March 2012
• 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
Engagement Education The ideal policy
ED donation: there are barriers to overcome
Barriers
Develop a ED policy
Assemble core ED team
Education programme
Potential donation
National Donation Congress, March 2012
• 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
Engagement Education The ideal policy
ED donation: Engagement
Barriers
National Donation Congress, March 2012
• 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
Engagement Education The ideal policy
ED donation: Engagement
Barriers
National Donation Congress, March 2012
• 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
Engagement Education The ideal policy
ED staff education
Barriers
National Donation Congress, March 2012
• 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
Engagement Education The ideal policy
ED staff education
Barriers
National Donation Congress, March 2012
• 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
Engagement Education The ideal policy
ED Barriers and overcoming them
Barriers
National Donation Congress, March 2012
• Organizational– Priority Targets
– Management support
– culture
• Logistical– Place of withdrawal
– Skill mix of staff
– Facilities for relatives
• Legal/ethical– Police/coroner
Other barriers…
Engagement Education The ideal policy
ED Barriers and overcoming them
Barriers
National Donation Congress, March 2012
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
National Donation Congress, March 2012
• 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…
Engagement Education The ideal policy
ED Barriers and overcoming them
Barriers
National Donation Congress, March 2012
• 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
National Donation Congress, March 2012
• 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
National Donation Congress, March 2012
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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