How to get your Emergency Department engaged in organ donation

1. 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

2. ED donation: are departments willing to engage? Introduction • 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 Engagement The ideal policy Education Barriers National Donation Congress, March 2012

3. The crucial bit is that someone in the ED needs to alert the SNOD Get staff to know the SNOD • 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 Engagement The ideal policy Education Barriers National Donation Congress, March 2012

4. ED donation: there are barriers to overcome Outline • 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 Assemble core ED team Develop a ED policy Education programme Potential donation Engagement The ideal policy Education Barriers National Donation Congress, March 2012

5. ED donation: Engagement How to do it • 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 Engagement Education Barriers The ideal policy National Donation Congress, March 2012

6. ED donation: Engagement Who is important • ED consultant lead • ED lead nurse • Critical care lead consultant/matron • Anaesthetics lead • ODP lead • Bed management team • Coroner • Donation committee chair Engagement Education Barriers The ideal policy National Donation Congress, March 2012

7. ED staff education Problems • 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 Education Engagement Barriers The ideal policy National Donation Congress, March 2012

8. ED staff education Solutions • 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 Education Engagement Barriers The ideal policy National Donation Congress, March 2012

9. ED Barriers and overcoming them People 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 Barriers Engagement Education The ideal policy National Donation Congress, March 2012

10. ED Barriers and overcoming them Other barriers… • Organizational • Priority Targets • Management support • culture • Logistical • Place of withdrawal • Skill mix of staff • Facilities for relatives • Legal/ethical • Police/coroner Barriers Engagement Education The ideal policy National Donation Congress, March 2012

11. The way in which you overcome these barriers needs to be relevant to your hospital culture – there is no “one-size fits all” approach National Donation Congress, March 2012

12. ED Barriers and overcoming them Don’t forget the SNOD… • 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 Barriers Engagement Education The ideal policy National Donation Congress, March 2012

13. ED donation policy and pathways The ED policy • 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 Engagement Education Barriers ED Policy National Donation Congress, March 2012

14. ED donation policy and pathways What should it contain? • 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 Engagement Education Barriers ED Policy National Donation Congress, March 2012

15. 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~ National Donation Congress, March 2012 15