Welcome to Your DSA Action Team Meeting. February 29, 2012

Transcription

1 Welcome to Your DSA Action Team Meeting February 29, 2012

2 Who s on the Call?

3 Questions??? Use the Q & A panel displayed on your screen Type your question in at the very bottom portion of the Q & A panel. Time permitting, questions will be repeated and answered at the end of the hour.

4 My Donation Resource Visit to see slides from today s webinar and to review any remaining questions.

5 DSA Action Team: Together We Make a Difference Create a robust and efficient group to be in action for making changes that will result in improvements in organ, tissue and eye donation and transplantation.

6 Agenda Our DSA Data *** Electronic Medical Records - Providing Access to LifeSource - Documenting Brain Death Notes *** How Successful is a Kidney Transplant? *** I Want to Hear from My Loved One s Recipients *** Connect to Purpose *** Your Input/Q & A/Wrap Up

7 A Year in Review: Our DSA Data Ann Gihl, LifeSource Organ Procurement Manager

8 2011: Offering Hope and Healing LifeSource DSA Activity Dashboard GROWTH PILLAR Measurement Targets Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YTD # Organs Transplanted (from deceased local donors) # Organ Donors (all) # Donation after Circulatory Death (DCD) Conversion Rate (all organ donors/possible organ donors) 80% 100% 67% 68% 86% 85% 80% 61% 83% 100% 90% 80% 90% 80% Organs Transplanted Per Donor (overall) Timely Vented Referral Rate (within one hour of meeting triggers) 90% 68% 66% 72% 84% 86% 69% 75% 73% 66% 65% 63% 57% 70% # Tissue Donors # DD Increases in DSA 50,000 8,731 25,015 29,174 27,667 90,587 Green = Goal Met; Yellow = Nearing Goal; Red = Improvement Needed

9 2012 Goals Organs transplanted from local donors Donation after circulatory death donors Organ conversion rate 80% 80% Timely vented referral rate 90% 90% Total tissue donors DSA donor designation increases 80,000 50,000

10 My Donation Resource Reminder! Recordings of our webinars are posted on

11 Benefits of Electronic Medical Records Providing Access to LifeSource Documenting Brain Death Notes Glenn Galloway, LifeSource Joe Ackert, Children s Hospitals and Clinics of Minnesota Lori Wildman, North Memorial

12 Rationale LifeSource Access to Medical Records: Per CMS Conditions of Participation for Hospitals ensure that the hospital works cooperatively with the designated OPO in reviewing death records to improve identification of potential donors, and maintaining potential donors

13 Rationale cont. LifeSource Access to Medical Records: Per Organ Recovery Agreement Responsibilities of Hospital Make the potential donor s medical records available to LifeSource to determine the medical suitability...

14 Benefits of Remote Access to EMR More time for patient care with less time on phone Direct access minimizes errors Rapid turn around time Frequent status updates - at any time - without interrupting patient care Better coordination of care

15 EMR Process and Experience What is the process for remote access for LifeSource? Have there been challenges? If yes, how are they addressed? What checks and balances are in place? Any advice?

16 Partnering for Remote Access Joe Ackert Remote Access Coordinator

17 Electronic Brain Death Documentation

18 Before.

19 Change needed Decided at Gift of Life Committee that we needed to get our paper form into an electronic form. Criteria- EASY for staff to find EASY to understand and complete All inclusive

20 The Process Subcommittee to develop form * Nursing, IT, Life Source Form sent to Critical Care, Neurosurgery, Neurology, & Trauma for input and acceptance. Revisions made Back to Gift of Life Committee for final approval Added to Epic.

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22 Contacts Glenn Galloway Joe Ackert Lori Wildman

23 My Donation Resource For online donation resources, go to

24 How Successful is a Kidney Transplant Glen Geditz Quality Manager February 29, 2012

25 Transplants from Deceased Donors in 2011 Region 7 United States (SD, ND, MN, WI, IL) Kidney ,185 Kidney/Pancreas Pancreas Alone Liver 506 5,614 Heart 219 2,151 Lung 117 1,682 Heart/Lung 1 24 Intestine Organ Procurement and Transplantation Network (OPTN) Website

26 Getting on the Kidney Transplant List Pre-Transplant Phases 1. Referral Phase Referral originates from the nephrologist, dialysis unit, or patient self-refers. 2. Evaluation Phase Patient receives a multidisciplinary evaluation to include intense education about the transplant process with some elements prescribed by CMS CoPs, UNOS bylaws. 3. Listing Phase Case presentation at Selection Committee and candidacy is approved or denied based on the individual center s selection criteria..

27 Waiting for a Kidney Transplant 1. Patients selected as kidney transplant candidates at selection committee have their medical profile entered into the UNOS database for matching when a deceased organ becomes available. 2. Once on the list, transplant candidates are evaluated at least annually. 3. Transplant coordinator stays in contact with transplant candidates ( waitlist management ) to ensure center is up to date with any health or financial status changes.

28 Matching of Donors and Recipients Recipient information is routinely updated in the database. Recipients are NOT placed on a ranked list at the time their medical profile is entered into the UNOS database. When a kidney becomes available, the OPO will enter the donors information into the UNOS database. This donor is then matched with transplant candidates and a ranked list is generated based on the OPTN organ allocation policies.

29 Matching of Donors and Recipients cont In general, the kidney is offered to the first candidate on the ranked list who is listed within our Donor Service Area (DSA). Many times the organ is not accepted by the first person on the list and the offer then goes to the next person on the list. This continues until the organ is accepted for a candidate within our DSA.

30 Matching of Donors and Recipients cont If the kidney is not accepted for a candidate listed within our DSA, then it is offered out regionally, then nationally until the kidney is accepted for a recipient or the list is exhausted. Recipients listed outside our DSA may take priority in cases when there is a zero mismatch with the donor kidney. The kidney may be offered to recipients who are a zero mismatch with the donor regardless of which DSA or Region they are listed.

31 Factors Affecting Waitlist Time 1. Days on list transplant candidates receive more points as they wait on the list. 2. Blood Group statistically blood group O recipients wait the longest. 3. Preformed Antibodies (PRA) Level candidates with high antibody levels are often incompatible with donor organs.

32 Factors Affecting Waitlist Time cont 4. Standard Criteria Donors/Expanded Criteria Donors accepting expanded criteria donors can expand the donor pool for recipients who consent to ECD donors. 5. On average a recipient may wait 2-5 years before receiving a kidney transplant from a deceased donor depending on the factors just reviewed.

33 Back Up Recipients There are times when a back up recipient may be required based on the recipients immunologic profile. If the local transplant center feels a back up is needed, they will notify LifeSource of the need to identify a backup recipient. Recipients will be backed up in sequence order by the match results when the donor kidney is procured locally.

34 What Happens When a Kidney is Provisionally Accepted for a Recipient 1. The final crossmatch is started. 2. The recipient is notified and interviewed by our transplant coordinator to screen for acute health changes. 3. The potential recipient is instructed to come to Avera for kidney transplant - some potential recipients may live 5-7 hours away from Avera. 4. The organ is shipped by the OPO and transportation logistics are communicated to our on call transplant coordinator.

35 What Happens When a Kidney is Provisionally Accepted for a Recipient 5. The kidney may be placed and transported on a circulation pump. 6. When the kidney arrives the surgeon prepares it for transplantation into the recipient.

36 Post Transplant 1. Inpatient stay 2-5 days 2. Immediate clinic visits labs are completed and patients are seen in post transplant clinic twice weekly by the transplant team. 3. Labs and clinic visits decrease in frequency as the patient condition demonstrates stability. 4. Transplant recipients will be on immunosupressive medications for the life of the organ.

37 Important Long-Term Issues 1. Take your medications failure to take the immunosupression medications as prescribed is the second leading cause of losing transplant function 2. Know your blood pressure goal is below 130/80 3. Know your cholesterol goal of LDL less than 100mg/dl 4. Bone disease annual DEXA scan for recipients taking steroids 5. Cancer risk increased risk for skin cancer. (Cover up when out in the sun: long sleeves and hats with protective brims. Sunscreen protection from UVA and UVB.) 6. Immunizations influenza vaccination each year, pneumovax every 5 years, twice in your lifetime, 5 years apart (only 2 doses)

38 Important Long-Term Issues 7. Obesity low calorie, heart healthy diet. Encourage exercise, walking. 8. Infection risk wash fruits and vegetables before eating, wear gloves when gardening, wash your hands, avoid areas where old carpet is being pulled up. Use insect repellent containing DEET during mosquito season to decrease risk of West Nile Virus. Antibiotics before procedures. 9. Kidney toxic medications ibuprofen, naproxyn, some Chinese herbs, etc. 10. Pregnancy avoid unplanned pregnancy. Pregnancy in transplant patients is possible but considered high risk. Some medications must be changed due to risk of pregnancy loss and fetal defects.

39 Success Rate of Kidney Transplant at Avera Transplant Institute (Kidneys from Deceased Donors Only) Graft Survival 1 month 98.36% 1 year 93.18% 3 years 83.05% Patient Survival 1 month 100% 1 year 96.36% 3 years 94.34% Most recent data from SRTR Report

40 Thank You