This project developed a number of tools and guides to help staff collect data and enter it into the electronic donor record (EDR) more efficiently.
Aim
To reduce the median time taken to complete the EDR, to eight hours by 31 March 2018 and six hours by 30 June 2018.
Benefits
- Reduces waiting time for organ and tissue donations.
- Increases the quality of organ and tissue donations.
- Improves the experience of donor families and carers.
- Increases bed availability in intensive care units.
- Reduces clinical resources in intensive care units.
- Reduces donation specialist fatigue and overtime.
Background
In 2014, The Organ and Tissue Donation Authority launched the EDR, which is an online medical record platform that is used to collect and document information about a potential organ and tissue donor. Once this information is collected, referrals to transplant centres can be made, potential donor recipients identified and retrieval surgeries planned. Prior to 2014, information was collected on handwritten paper documents, with a verbal handover process. This was usually completed within 4-6 hours of getting verbal consent from the senior available next of kin.
Since the implementation of the EDR, anecdotal feedback from staff suggested referral times were increasing. A retrospective review was performed on organ donor cases from January to June 2017, which found the median time to complete the EDR was 9.7 hours. Initially, it was thought that the increase in time to complete the EDR was due to staff getting accustomed to using the new platform. However, the ongoing increase suggested there were opportunities to improve the process.
The National Study of Family Experiences of Organ and Tissue Donation 2010-2011 found that four per cent (N=97) of families struggled with the lengthy process associated with waiting until the time of donation.1 Staff working in intensive care units also suggested in governance meetings that caring for these patients takes up valuable resources. The increase in time also impacts overtime costs, as donation specialists remain with the patient until they are in surgery.
Implementation
- A project group was established, comprising NSW Organ and Tissue Donation Service Management, education staff, donation specialist nurses, donation specialist coordinators and quality managers.
- A Potential Donor Screening Form was developed, to collect current and past medical history information from the donor’s next of kin. This determines medical suitability for donation and aligns with information required as part of the EDR. When verbal consent is obtained from the senior available next of kin, the information collected is transferred to the EDR. A guide on how to complete the form was created and an email sent to all donation specialist staff in December 2017. The tool has been in use since January 2018.
- A Bedside Guide for Organ Donation was created for medical and nursing management, to guide the care plan of the potential organ recipient. The guide outlines the frequency of tests and investigations required. It also outlines tasks hospital staff can perform, to help donation specialists.
- A Donor Management Guide was created for medical and nursing management, to guide the care plan of the organ donor. It outlines medical parameters to maintain adequate oxygenation and perfusion of organs. This tool was released to donation specialist staff in February 2018.
- A Prioritisation Tool for Donation Specialists was developed to help staff prioritise the collection of data and tests required to complete a donor referral as soon as is practical. The document was sent to donation staff in February 2018.
Status
Implementation – The project is ready for is currently being implemented.
Dates
- August 2017: Project start
- October 2017: Change concepts decided
- November 2017: Review of existing documentation
- January 2018: Potential Donor Screening Tool and Guide implemented
- February 2018: Bedside Guide for Organ Donation, Donor Management Guide and Prioritisation Tool for Donation Specialists implemented
- February 2018: Staff survey distributed
- July 2018: Project evaluation
Implementation site
NSW Organ and Tissue Donation Service
Partnerships
Clinical Excellence Commission Clinical Leadership Program
Evaluation
The project will be evaluated in July 2018, measuring the median time frame to complete the EDR, as well as donation staff satisfaction with tools and guides implemented.
Lessons learnt
- It is important to keep the project team engaged throughout the project.
- Try to delegate tasks to keep the project moving when the project leader is unable to lead.
- Explain reasons behind the change in process, to bring staff along on the journey.
References
- Proof Research Pty Ltd. National Study of Family Experiences of Organ and Tissue Donation: Wave 1 - 2010 and 2011. Canberra ACT: Organ and Tissue Authority; 2014.
Contact
Nicola Seifert
Clinical Nurse Consultant
NSW Organ and Tissue Donation Service
Phone: 02 8566 1711 / 0407 254 641
nicola.seifert@health.nsw.gov.au
