The Continuum of Organ Donation: A Panel … for Transplant •Specialty transplant floors that care...

The Continuum of

Organ Donation:

A Panel Discussion

Nebraska Medicine

Omaha, Nebraska

Panel Members

• Lisa Butler-Walker, TFC

• Kyle Dorn, RN

• Megan Gregory, BSN, RN

• Leigh Lindner, BSN, RN, CMSRN

• Amber Saltsgaver, BSN, RN

• Amy Schurke, BSN, RN, CCTC

• Karen Townsley, BSN, RN, CCTN

The Process of How a

Patient Gets Listed for

Transplant: Duties of the

Pre-Transplant Team

Leigh Lindner, BSN, RN, CMSRN

Transplant Coordinator

How Patients Get to Nebraska Medicine

• Referral from their local MD

• Self-referral

• Inpatient at Nebraska Medicine

• Providers within the transplant teams

• Insurance Companies

We are a Center of Excellence

• Dialysis Centers

After Referral

• Coordinator calls

Educate them about our program and the evaluation process

Review their PMH

Collect insurance information

o Financial Counselors obtain insurance auth

Request outside records from all providers

**Once Obtained: Clerical Staff Schedules the Evaluation**

Evaluation

• 2-5 Consecutive days of Outpatient testing

Labs - Social Work

Imaging/Procedures - Psychology

o Abd US, Cxray, EKG, ECHO, - Psychiatry (if needed)

DSE, Mammo, PFTs

Cardiology - Financial Counselor

Individual Organ Specialty - H&P

o Hepatology, Nephrology - Pharmacy Financial

Counselor

o Pulmonology, Cardiology - Nutritionist

Transplant Coordinator - Other services and testing

Transplant Surgeon

**Testing is based on each individual person**

Patient Selection Committee

• Every organ team meets weekly

Each member of the team presents the info they gathered

We make a TEAM DECISION

o Further testing

o Too early

o Compliance

– Medical, psychosocial, drug/ETOH

o Does not meet criteria for listing (not approved)

o List for transplant

Listed Patients

• To List:

Transportation needs to be arranged

Financial Counselors get clearance from

insurance companies

Each organ submits specific information to Donate

Life Services (DLS)

o DLS submits listing to United Network of Organ

Sharing (UNOS)

Listed Patients

• While patients are Listed:

Monitor/Submit labs to DLS as appropriate

Maintain communication with patients

Schedule/Review any necessary testing – organ

specific

Maintain the requirements of listing

Annual/Bi-annual reviews

What Does This Have to Do With BURNOUT?

• There can be frustration when a patient really needs a transplant evaluation and insurance denies them to come to Nebraska Medicine

• Obtaining records

• Compliance

• Telling people they are not a candidate for transplant

• We get to know some of our patients really well since we follow them closely; it can be hard when they die while waiting for transplant

• We often take on other workload/tasks

• On call

Financial Aspects

of Transplant

Lisa Butler WalkerTransplant Financial Counselor

Transplants

• Necessary

• Important

• Expensive

Milliman Report 2017

Hospital Transplant Admission:

• Bone Marrow Allogenic $465,200.00

• Bone Marrow Autologous $226,300.00

• Heart $887,400.00

• Kidney $159,400.00

• Liver $463,200.00

• Lung (single) $475,000.00

• Lung (double) $679,100.00

Transplant Financial Counselors

• Verify patient’s insurance

• Provide financial information to the patient as well as

the patient’s family

• Ensure we provide the correct financial to the

physician as well as the facility we work for

How Patients are Referred

• Current patient

• Referred from another doctor or facility

• Current inpatient referral

• Globally

• Self referral

Candidate Transplant Process

• Consult, inpatient, physician referral

• Verify insurance

• Transplant coordinator / physician discussion

• Authorization for evaluation

• Evaluation

• Patient Selection Committee

Transplant Financial Counselor Burn Out

• Patient’s insurance won’t pay for a transplant at our

facility

• Patient dies before transplant

• Emotional connection with a patient that has passed

away

• Patient does not qualify for a transplant

• Workload

• Denial

The need for donors

118,000+

waiting list––––––

22 die each day

+ 1 every 10 minutes

––––––

Nebraska Organ Recovery (NORS)

• Established in 1977

• Federally designated Organ Procurement Organization (OPO) serving Nebraska and Pottawattamie County in Iowa

• Non-profit

• Independent of all hospitals and transplant centers

• Cadaveric organ and tissue procurement

Organ Donor Criteria

1. Patient must be ventilated in a hospital2. Patient must have a devastating injury or illness3. Patient must be declared brain dead based on

hospital protocol, or meet Donation after Circulatory Death (DCD) protocol

• Additional criteria• No age restrictions (brain dead only)• Very few medical rule outs• Organ function is important

Medical Management

• 24-72 hours in the ICU• Blood draw

• Hospital labs, serology testing, HLA

• Evaluate and optimize organ function• Echo, EKG, heart cath, bronch, CT

• Organ allocation– Facilitated through UNOS– Recipient list by organ

• Blood type, tissue type, recipient condition, donor condition, size, weight

• Transport to OR

Donate Life

Services:Our Part in the BIG Picture

Megan Gregory, BSN, RN

Nurse Coordinator

The Offer

Donor Match RUN

• Blood type• Height and weight• Status (medical urgency)• HLA matching for Heart, Lungs, Pancreas and Kidneys• Length of time on list• Geography (Local, Regional, National, Canada)

Donor Summary

Accepting an Organ

• Surgeon: Case details

• Organ Coordinator: Get recipient moving

• Transportation: Commercial/Charter

• Recipient OR: Schedule the case

• Pharmacy: Any medication supplies

• OPO: Set up details (OR time, extra

specimens, a ride)

Road Trip

Taking Off

In-Flight Details

Donor Hospital

Packing Up

Optimal Preservation Times

• Heart 4 Hours

• Lung 4-6 Hours

• Pancreas 12-18 Hours

• Liver6-8 Hours

• Kidney 24-48 Hours

• Intestine 6-12 Hours

Before Out With the Old, In With the New… Safety is Key!!

Burn Out

• Long and irregular hours

• Sleep deprivation (24-hour+ shifts)

• On call commitments (24/7/365)

• Poor quality of “off” call time

• Insufficient resources

• Excessive workloads

• Lack of family time

Solid Organ

Transplant Unit –Inpatient Aspect

Karen Townsley, BSN, RN, CCTN

Clinical Education Coordinator for SOTU

Admission for Transplant

• Specialty transplant floors that care for patients pre-transplant, during the transplant phase, and post-transplant:

Solid Organ Transplant Unit (SOTU) for abdominal organs

Cardiac Progressive Care Unit (CPCU) for thoracic organs

• Patient may already be in hospital

• If patient not in hospital, they are admitted preferably to specialized transplant floor or possibly go to Pre-op directly

• Hibiclens (Chlorahexadine – CHG) pre-op:

o Planned surgeries – living donors encouraged to CHG bath/shower at home

o Part of the admission order set to be done prior to pre-op

• Transfer to Pre-op for surgery

After Transplant Surgery

• Kidney and Pancreas transplant recipients return to

SOTU from PACU when stable after being extubated

and discharge from SOTU

• All other transplant recipients transfer to the specialty

ICU for cares post-op up to 24-48 hours then return

to specialty transplant floor (SOTU or CPCU) when

stable after being extubated until discharge:

Surgical Intensive Care Unit (SICU) for abdominal

organs

Cardiovascular Intensive Care Unit (CVICU) for

thoracic organs

Kidney Transplant Recipient Clinical Pathways

Kidney Transplant Plan of Care

Transplant Day

Date ________________

Post-Op Day #1

Date ________________

Pre-op Hibiclens (CHG) bath

Wear leg compression devices while in room

Incentive spirometer 10 times per hour while awake

Communicate with nurse regarding pain needs/control

Pain management as ordered

Hourly monitoring (vitals, urine, IV, etc.)

Nothing by mouth until awake, then clear liquids; advance as tolerated

Dangle legs bedside

Sit up in chair for 1 hour

Walk as able

Care Partner present and participating in care

Plan for discharge:

o Home care plan

o Transplant Education

Daily weight (between 4a – 6a)

Labs drawn

Hibiclens (CHG) bath


Ultrasound of kidney


Incentive spirometer 10 times per hour while awake: (mark each hour off as you complete)

7a 8a 9a 10a 11a 12p 1p

2p 3p 4p 5p 6p 7p 8p 9p 10p

Sit up in chair x 3:

_____ _____ _____

Walk the hall x 3:

____ ____ ____

Advance diet as tolerated

Care Partner present and participating in care

Begin reading transplant education manual

Discharge planning on track:

o Home care plan / Home Health

o Lab schedule

o Follow-up appointments

o Medications

o Reinforce transplant education

Kidney Transplant Clinical Pathway Checklist

Expected Length of Stay: 3-4 Days

Transplant Day Date ___________

Post-Op Day #1 Date ____________

Post-Op Day #2 Date ____________

Post-Op Day #3/4 Date ____________

Interdisciplinary Care Team

Consults made to: Social Work Nutrition Pharmacy Pharmacy Financial Counselor Diabetic Educator (If diabetic) Other: __________________

Patient seen by: Social Work Nutrition Pharmacy Pharmacy Financial Counselor Diabetic Educator Referral to Home Health agency Other: __________________

Coordinate diabetic DC scripts If not ambulating, consider PT

eval Assess for outpatient dialysis

needs

Outpatient visits/appointments Local lodging, if needed

Teaching Needs

(Inpatient Coordinator and Nursing)

Pain management & communication

Foley catheter Central line/ hemodynamic

monitoring Care Partner responsibility /

participation Surgical dressing/wound

healing Incentive spirometer w/ return

demo Drain management

Receive discharge education binder

Care Partner responsibility / participation

Medication teaching with each dose administered including indication and side effects

Lab results/schedule

Medication teaching with each dose administered including indications & side effects

Care Partner responsibility / participation

Discharge education binder reviewed

Medication teaching with each dose administered including indications & side effects

Coordinator Discharge teaching Urinal / hat for home Specimen cup for drain/urine if

needed Pillbox Final discharge teaching AVS

w/ Staff RN

Care Considerations

(Nursing)

Complete Daily at End of Day Shift

Patient functional pain goal: ________________________

Hibiclens(CHG) Bath Pre-Op Standing weight Pain management Control nausea/vomiting 2:1 nursing care Assess fall risk; implement fall

precautions Braden scale/implement skin

protection interventions Oxygen per protocol Incentive spirometer x 10/hour

while awake Oximeter Hourly I&Os IV fluid replacements Drain management Foley cares BID 1000 & 2200

Patient functional pain goal: ________________________

Standing weight 0400-0600 Hibiclens(CHG) Bath Pain management Off 2:1 care, to normal staffing

in the 12-24 hrs post-op period Assess fall risk; implement fall


protection interventions Wean from oxygen if applicable Discontinue oximeter when

oxygen and PCA discontinued Incentive spirometer x 10/hour

while awake Foley cares BID 1000 & 2200 I&O every 4 hours IV fluid maintenance SCD to legs while in room Notify DEM of diet changes Encourage pt to achieve chair

and ambulation goals

Patient functional pain goal: _____________________

Standing weight 0400-0600 Hibiclens(CHG) Bath Pain management Assess fall risk; implement


protection interventions Assess bowel function;

encourage ambulation Notify primary team if continued

need for supplemental oxygen Incentive spirometer x 10/hour

while awake Foley cares BID 1000 & 2200 Discontinue SCD when

ambulating 4 x/day I&O every 4 hours Standing weight 0400-0600 Notify DEM of diet changes Encourage pt to achieve chair

and ambulation goals

Patient functional pain goal: _____________________

Standing weight 0400-0600 Hibiclens(CHG) Bath Consider at-home pain

management needs Assess fall risk; implement


protection interventions Change HD catheter dressing

prior to discharge (if appropriate) Assess bowel function, if no

BM, contact MD for further intervention

Remove Foley – patient to void every 2 hours while awake and every 4 hours while asleep

PVR after 1st 2 voids and call if greater than 150mLs

If patient unable to void 4 hrs after foley removal, notify team

Discontinue central line after Simulect dose

Notify DEM of diet changes

Pharmacist

Review post-op orders Collaborate w/ APP to resume home meds as appropriate

Collaborate with APP to initiate DC med reconciliation

Final DC med reconciliation. Discharge medication teaching New transplant duffle bag Pillbox provided

M.D. / A.P.P. / Fellow

Verify consent complete/correct Monitor I&Os Initiation of immunosuppression Verify Orders SCIP Protocol Post-Op assessment

Kidney ultrasound Resume home meds as

appropriate Blood pressure management

Initiate discharge medication reconciliation

Discuss DC planning w/ DEM

Order discharge medications Simulect POD #3 (if applicable)

Orders to dialysis (from NephMD) Neph communicate w/Ref Neph Neph order HD line dressing

change if needed

Blood Glucose Management

DEM consult if diabetic Diabetic Educator consult if

diabetic

IP Coord to fwd drug coverage info DEM educator (if applicable)

Diabetic education assessment Education plan initiated

Write diabetic discharge scripts Diabetic education Education plan continued

Make sure drugs affordable Diabetic follow-up Sign own discharge orders Discharge Note Diabetic education

reinforcement

Social Work Assessment and note Consult

Collaborate with inpatient coordinator on discharge planning needs & Home Health

Collaborate with inpatient coordinator on discharge planning needs & Home Health

Final discharge planning / note Complete note & send OTTR Complete discharge checklist

Nutrition NPO until awake then clear

liquids as tolerated Consult Advance diet as tolerated

Diet as tolerated Discharge note

Daily Goals/ Outcomes Achieved

Hibiclens (CHG) Bath Stable respiratory status Pain controlled at functional

goal Fluid/electrolytes status stable Free from injury Discharge planning initiated Care Partner participation

Stable respiratory status Pain controlled functional goal IV pain control discontinued Fluid/electrolytes stable Free from injury Diet as tolerated Discharge planning on track Care Partner participation

IV pain control discontinued Free from injury Free from S/S infection Discharge planning on track Care Partner participation

Discharge education completed Patient will state:

o Anti-rejection medications and

lab schedule, f/u appts

o Diabetic management plan

o Quiz answers

Foley removed POD #3 Free from injury Care Partner participation

Kidney Donor Clinical Pathway

Kidney Donor Plan of Care

Donation Day Date _____________

Post-Op Day #1 Date ________________

Post-Op Day #2 Date ________________

Discharge Needs

Patient Goals/

Expectations

Pre-Op Hibiclens (CHG) Bath


Communicate with Nurse regarding pain needs/control


Dangle legs bedside

Sit up in chair for 1 hour

Incentive spirometer 10 times per hour while awake

Nothing by mouth until awake, then clear liquids; advance as tolerated

Daily Weight (btwn 4a – 6a)

Labs drawn

Hibiclens (CHG) Bath

Sit up in chair x 3

_____ _____ _____

Walk the hall x 3

_____ _____ _____

Incentive spirometer 10 times per hour while awake (mark each hour off as you complete)

7a 8a 9a 10a 11a 12p 1p

2p 3p 4p 5p 6p 7p 8p 9p 10p

Foley catheter removal; Try to void every 2 hours after catheter removed

Bladder scan for post-void residual with first urination after catheter removed

Advance diet as tolerated

Wear leg compression devices when in room

Pain Management as ordered, Begin oral medication by mouth


o Home care plan

o Medications

o Reinforce Post-Op Education

Daily Weight (btwn 4a – 6a)

Labs drawn (including urine)

Hibiclens (CHG) Bath

Sit up in chair x 3

_____ _____ _____

Walk the hall x4

_____ _____ _____ _____

Incentive spirometer 10 times per hour while awake (mark each hour off as complete)

7a 8a 9a 10a 11a 12p 1p

2p 3p 4p 5p 6p 7p 8p 9p 10p

Full diet as ordered


Review Donor Discharge Instructions


o Home care plan

o Medications

o Reinforce Post-Op Education

o Lab Schedule

o Follow-up appt scheduled

o Follow-up 6 months with PCP

Plan to discharge on Post-Op Day 2

Ensure required labs done

Home care plan

Medications

Lab schedule

Follow-up appointments

Reinforce Donor Education

Follow-up requirements

Liver Transplant Recipient Clinical Pathway Liver Transplant Clinical Pathway Checklist

STAFF CHECKLIST

Expected Length of Stay: 7-8 Days

Transplant Day

Date ___________ Post-Op Day #1

Date ____________ Post-Op Day #2

Date ____________ Post-Op Day #3

Date ____________

Interdisciplinary Care Team

Consults made to: Critical Care Surgery Hepatology Social Work Nutrition Pharmacy Pharmacy Financial Counselor Diabetic Educator (if diabetic) PT/OT Other:

Patient seen by: Social Work Nutrition Pharmacy Pharmacy Financial Counselor Diabetic Educator (if diabetic) PT/OT Other:

Teaching Needs (Inpatient

Coordinator and Nursing)

Pain management and communication

Restraints Hemodynamic monitoring/central

line Frequent lab work (every 6 x 24

hours) Care Partner responsibility/

participation Medication teaching with each

dose administered including indication and side effects

Surgical dressing/ wound healing Incentive spirometer w/ return

demo (T, C, DB) Drain management Foley Activity

Receive discharge education binder

SOTU expectations (quiet time, involved in plan of care, infection control)


Care Partner responsibility/ participation

Medication teaching with each dose administered including indication and side effects

Infection control Fluid changes (daily standing

weight) Foley – remove Activity

Medication teaching with each dose administered including indications and side effects



Discharge education binder initiated

Incisional care – staples Infection control Activity Blood glucose management

Medication teaching with each dose administered including indications and side effects



Rejection Infection control Nutrition Activity Blood glucose management

Care Considerations

(Nursing)

Complete Daily at End-of-Day Shift

Patient functional pain goal: Hibiclens(CHG) treatment pre-op Weight Pain management Control nausea/vomiting Hemodynamic monitoring Remove arterial lines Change over central line Assess fall risk; implement fall


protection interventions Oxygen per protocol Incentive spirometer x 10/hour

while awake Turn, cough, deep breathe every

2 hours Continuous pulse-ox Hourly I&Os IV fluid replacements – patient is

NPO Drain management Foley cares per P/P HOB 30 degrees Encourage activity Prepare for SOTU transfer –

discuss staffing ratios

Patient functional pain goal: Hibiclens (CHG) treatment Standing weight 0400-0600 Pain management Central line cares Assess fall risk; implement fall


protection interventions Wean from oxygen if applicable Discontinue continuous pulse-ox

when oxygen and PCA discontinued

Incentive spirometer x 10/hour while awake

Remove Foley I&O every 8 hours IV fluid maintenance Drain management SCD to legs while in room Encourage patient to achieve

chair and ambulation goals

Patient functional pain goal: Hibiclens (CHG) treatment Standing weight 0400-0600;

assess fluid status Pain management Central line cares Assess fall risk; implement


protection interventions Assess bowel function;

encourage ambulation Notify primary team if continued

need for supplemental oxygen Incentive spirometer x 10/hour

while awake SCD to legs while in room Encourage patient to achieve


Patient functional pain goal: Hibiclens (CHG) treatment Standing weight 0400-0600 Pain management Central line cares Assess fall risk; implement


protection interventions Assess bowel function; if no BM,

contact MD for further intervention

Incentive spirometer x 10/hour while awake

SCD to legs while in room Encourage patient to achieve


Pharmacist

Review post-op orders Collaborate w/APP to resume

home meds as appropriate

Collaborate w/APP to resume home meds as appropriate

Review transfer orders

MD/APP/Fellow

Verify Transplant, Blood, and Surgical consents are complete/correct

Pre-op assessment Monitor I&Os Initiation of immunosuppression Verify orders Core measure protocols Post-op assessment Liver ultrasound, EKG, CXR

Resume home meds as appropriate

Blood Glucose Management

Glucose checks Glucose management Diabetic Educator consult if

diabetic

Diabetic education assessment Education plan initiated

Diabetic education Diabetic education reinforcement

Social Work

Assessment and note Consult

Collaborate with inpatient coordinator on discharge planning needs and Home Health

Collaborate with inpatient coordinator on discharge planning needs and Home Health

Advanced Transplant Nursing Care Team

• At least 1 year of nursing experience on

specialty transplant floor

• Specialized Cardiology and Transplant

Fellowship classes

• Encourage Transplant Certification within

division:

CEPTC offerings throughout the year to prepare

for and maintain certification (CCTC, CPTC,

CCTN)

Inpatient Nursing Fellowship Classes

CPCU (Cardiology Fellowship)

• Immunosuppression• Surgical procedure and

considerations: Heart• Immediate post-operative care• Nursing care and patient

education• Surgical procedure and

considerations: Lung• Post-operative care and patient

education• LVAD, acute coronary syndrome,

heart failure and electrophysiology

SOTU (Transplant Fellowship)

• Transplant overview• Introduction to kidney and

pancreas transplantation• Transplant pharmacology and

infectious complications• Liver transplantation• Intestinal transplantation• Advanced kidney and pancreas

transplantation• Continuous bladder irrigation,

central venous pressure and arterial lines

Inpatient Hospitalizations

• Pre-Transplant patients can be admitted to

specialized transplant floors prior to evaluation,

during the evaluation process, and while waiting on

the list for transplant for any medical-surgical reason

• Post-Transplant patients can be (and likely are)

admitted to specialized transplant floors for any

reason, but especially anything related to the

transplant surgery or transplanted organ

Transplant Nurse Burnout

According to Progress in Transplantation, “To date,

only a handful of studies have specifically addressed

the experience of organ transplant nurses. Qualitative

data show that transplant nurses are driven by

altruistic motivations and are highly engaged in their

work, even to their own detriment, as they also often

report high levels of stress in their roles.”

Jesse M, Abouljoud Marwan, Hogan K, Eshelman A. Burnout in Transplant Nurses. Progress in Transplantation. 2015; 25(3):196-202

SOTU Bedside RN Struggles

• Bedside nursing is HARD WORK

Managing end-stage organ disease prior to transplant and

continuing with a “Chronic Medical Condition” after transplant

• Transplant patients don’t always have a smooth journey

Medications to manage this “Chronic Condition” makes the

patients susceptible to other disease processes – rejection,

infection, cancer, etc.

• SOTU RNs often form close relationships with the patients that

have frequent inpatient hospitalizations

• Bedside nurses experience the joy and frustration of the transplant

journey with their patients and the families

• SOTU is a hard floor – sick patients, emotional variability with

patients and care givers, huge learning curve and high

expectations

RNs take their knowledge and skills learned to other areas

(ICUs, ED, Float Pool) when they are ready to move on

Nebraska Medicine

Center of Excellence

Amber Saltsgaver, BSN, RN

Staff Lead RN, Quality Champion for

SOTU

Quality Champion

• An RN on each specific unit is designated to lead

quality change to increase patient safety

• Leads monthly performance unit meeting to discuss

areas of performance improvement in regards to

Nursing Quality Indicators and unit initiatives

• Member of the Quality and Innovation Council

within Nebraska Medicine that meets monthly to

discuss quality and safety initiatives and outcomes

throughout the organization

Nursing Quality Indicators

• CAUTI (Catheter Associated Urinary Tract Infection)

• CLABSI (Central Line-Associated Blood Stream

Infection)

• HAPU (Hospital-Acquired Pressure Ulcers)

• Falls – both Injury and Non-injury falls

• VAP (Ventilator-Associated Pneumonia) in the ICU

Settings

Quality Initiatives

• House-wide education and competencies for CAUTI reduction

• House-wide education and competencies for CLABSI reduction:

CVICU Unit Based Council initiative was shared house-wide for

Second Nurse observation for all central line dressing changes

Collaboration with the PICC team on central line dressing

changes on SOTU (pilot starting to expand to other units)

• Collaboration with the PICC team on central line cares on

SOTU

• Purposeful hourly rounding to aid with fall reduction

• Collaboration with wound nurse to reduce pressure

injuries within unit

Patient Satisfaction and Experience

Information is shared with the staff on the inpatient units

and at the Transplant Quality Assessment Performance

Improvement meeting for continuous improvement

ideas/opportunities:

• HCAHPS -

Nurses listen carefully to you

Nurses explain in a way you understand

Nurses treat you with courtesy and respect

Nurse Call Light responsiveness

Hospital rating (0-10)

• Press Ganey

• Patient rounding and discharge follow-up phone calls

High Expectations at all Times

• With the immunocompromised status of our patients, we have to be perfect all of the time

• Sometimes you can do everything correctly and have every intervention in place and still have problems

Patients may be weaker than they anticipate

Central line placement – IJs dressings stick to hair or beards instead of occlusive on the skin

Patients need extra encouragement to eat, bathe, be active

• Surveys are subjective based upon patient’s perception:

One negative experience in one moment of time – not happy with food, test took to long, pain level not at zero, etc., is what the patient remembers and responds to survey with that in mind

Post Transplant

Amy Schurke, BSN, RN, CCTC

Transplant Coordinator

Compliance

• Medications:

Antirejection meds need to be taken 12 hours apart -

o Timing of meds is very important

• Labs:

Timing importance -

o Needs to be 30-45 minutes before IS meds taken

o Should be at same time with each draw; patients should be consistent with what they do before each draw

o Should be fasting

Follow-up

• All team members of the multidisciplinary

team are involved in the patient’s care

• Clinic visits are in their organ specific clinic:

Pretty frequent visits right after transplant

Further out the less they are seen

• In general patients are followed by the

transplant team indefinitely (or the lifetime of

their transplant)

Lifetime Follow-up

• Once a patient is a transplant patient, they will

always be the transplant team’s patient

• The transplant team is available to follow any

medical needs:

Rejection

Graft loss

Hernia repair

Any other concerns

After Hours

• There is a nurse coordinator on call 24/7 for

emergencies:

Call the main office number to reach on call

coordinator after hours

• Transplant Physician and Transplant Surgeon are

also on call for MD-to-MD phone calls

Outcomes

• All outcomes for each transplant center for all

organs is public:

Website: www.srtr.org

Updated outcomes twice a year, usually

December and June

http://www.srtr.org/

Post-transplant Coordinator Burnout

• Follow same patients through the entirety:

Patients are not always fully honest

Work short staffed due to vacations or illness

Patient load 180-200 patients each

Cumbersome/difficult patients

• On call demands

• Ever changing processes within the transplant realm:

CMS requirements

UNOS requirements

Other Governing bodies

o HIPPA requirements

Post-transplant Coordinator Burnout

• Completing non-nurse tasks:

Takes away from patient care

• Coordinators work Monday-Friday:

May not be as flexible as staff nurses’ 12-hour/

3 days a week schedule

• Patient follow-up:

Non-compliant patients

Compliant patients with bad outcomes

Graft failure, rejection, or infection

• Care partner burnout

Coping with Burnout

• Employee Assistance Programs

• Friends with coworkers

Food days at work

o Past patients send goodies over the holidays

Gatherings outside of work

o Celebrating wine/beer/margarita days responsibly

• Time away from work

Vacations, days off

• Remembering patients

Donor ceremony

Celebrating successes either in media or when patient’s visit

Coping with Burnout

• Self-Care

Exercise, massage, pedicure

• Getting away from desk

Lunch

Walking breaks

• We are a TEAM and it takes a TEAM to get through it

all

Heart Lung Transplant

• https://www.youtube.com/watch?v=WbemBjviJ7I

The Continuum of Organ Donation: A Panel … for Transplant •Specialty transplant floors that care...

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