Developing a
Donor Resource Team
Cindy Kolzow, RN / Donation Liaison
Ministry St. Joseph’s Hospital-Marshfield
Doug Miller Symposium, April 25, 2013
Ministry Life Gift Team
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Cindy Kolzow, RN
Heather Schmidt, RN
Jean LaMaide, MICU RN
Lacie Pohl, SICU RN
Libby Ferris, OR RN
Alison Harycki, PICU RN
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Sara Strell, UW OTD
Tracie Cook, UW OTD
Rupal Shah, RT
Jenny LaPoint, RT
Dr. Jesse Corry,
Neurointensivist
• Lindy Nelson, Chaplain
Vision
MSJH will have a multidisciplinary patientcentered approach to the donation process
involving spiritual services, nursing, and
physician staff that will result in a well
coordinated, seamless consent process
benefiting families, patients, staff, and
recipients.
Analysis
• 13 potential donors (non-donors) in 2011
• Completed root cause gap analysis to determine the whys
– MSJH has over 120 trained designated requestors across 3
critical care units
– Few are confident in their knowledge of the donation
process and approaching families about donation
– Resulting in poor consent processes and decreased
consent for donation
• Reviewed 2 recent cases that went well
– Expert nurse coordinating the care
– 2:1 nurse ratio in caring for patient
– Huddle process in place prior to consent discuss
– Key MDs who understood donation process
Changes
1.
2.
Created multidisciplinary communication
worksheet for organ referral patients
Development of donor resource team
(DOT- Donor Organ Team)
Orange Communication
Worksheet
Tool to facilitate communication between providers and
shifts
– Initiated when patient meets clinical triggers
– Updated with donation information as appropriate
– Not permanent part of medical record but kept in front
medical chart
– Orange  - you can’t miss it!
DOT (Donor Organ Team)
• Resource team with expertise in the donation
process
• Role:
– Coordinate huddle to best facilitate consent
process with consistent, accurate donation
information
– Assist with resource management of the consent
process
DOT - Where Did We Start?
1.
Obtained administrative support for the project and
potential on call schedule
• Modeled after the SANE program in the ER
2.
Identified core team members with critical care
background as members
3.
Developed education for team
DOT Member Selection
• 12 RNs from the PICU, MICU, SICU, and management
• DOT members have:
– Critical care experience
– Vested interest in donation
– Good communication skills (esp. EOL issues)
– Varied work schedules for adequate coverage
Ministry St. Joseph’s
DOT Members
Cindy Kolzow,
Donation Liaison
Jean LaMaide,
MICU RN
Lacie Pohl,
SICU RN
Annette Hansen,
MICU RN
Heather Haun,
Peds ICU RN
Tiffany King,
MICU RN
Sherrie Lancour,
MICU RN
Stacey Larson,
House Sup RN
Reesa Mitchell,
Peds ICU RN
Greg Schield,
SICU RN
Heather Schmidt,
MICU Mgr
Thora Tollefson,
SICU RN
When Is DOT Contacted?
• Family brings up donation
• A family conference is being planned for grave
prognosis or withdrawal of care
• When the option to donate is in question
How Contacted?
• Critical care charge RNs and house supervisors
have DOT members’ contact information
– Assess 1st in-house resources
• M-F days, management members available
• DOT working on unit and able to assist
• House supervisor to assess availability of
DOT member in another unit
– Otherwise, contact a member on the list at home
Expectation of DOT Member
When One Receives a Call
1.
Call unit to query where we are in the process of
donation
• Is patient BD?
• Is there a plan to withdraw care?
• Any request/mention made by MD?
• Family questioning organ donation?
• Does patient have first person authorization?
2.
Develop plan for next steps (come in, watch and
wait, etc).
3.
4.
Initiate huddle - ensure all disciplines are aware of
the donation process
– Provide real-time education for nursing, MDs,
spiritual care, etc.
Be the designator requestor
5.
Assist with coordination of care beyond the consent
process, if able
– Serologies
– Heart & lung procurement work-ups
6.
Attend monthly meetings
– Case review
– Continuing education/process improvement
Education of DOT Members
• Survey to assess education gaps (Wide variation of
knowledge!)
• One 8-hour training day
– Roles and expectations
– Consent process
– Overall donation process
– Effective requesting strategies
• Role playing
• Difficult situations
Key Learnings: Orange Sheet
1. Valued by staff – in
patient’s paper chart
so easy to update and
maintain
2. Not part of the
patient’s permanent
medical chart
1. Roll-out to units was
inconsistent so sheet is
not always pulled
2. Sheet gives little
instruction to bedside
nurse on contacting
DOT/next steps
Key Learnings: DOT Team
1. Improved year-over- 1. Little knowledge of
year regulatory and
DOT’s existence by
true conversion rates
MSJH at large. DOT not
and consent rate
consistently notified.
2. DOT role focused on 2. Monthly DOT meetings
are poorly attended –
consent process ->
keeping the core team
serologies, not the
“connected” has been
whole case, so not a
difficult
huge tax on the
“system”
Next Steps
• Make MSJH aware of DOT team
• Ensure DOT members can attend monthly meetings
and in-services
• Establish criteria for what is a “good no” for consent
versus an opportunity to improve
• Revise orange sheet and internal website for
donation info/resources
Questions?