Strategies for Improving Organ Donation Catherine Stephens MSN, RN, NEA-BC, CNRN, SCRN Associate Director of Nursing Upstate Medical University

Upstate Medical University Academic Medical Center located in Syracuse Downtown Campus – 425 beds Community Campus – 306 beds

Downtown Main Campus Level 1 Trauma Center – 17 counties Level 1 DNV certified Comprehensive Stroke Center – 17 counties Clark Burn Center – 17 counties Poison Control Center – 54 counties Upstate Golisano Children’s Hospital Cancer Center

Organ Donation at Upstate 2007 – Identified need for a cohesive approach to Organ Donation and a strong council to lead this Linda McAleer Director Golisano Children’s Hospital Bill Sainsbury RN FLDRN

Challenges New OPO leadership Lack of knowledge regarding donation and Fledgling council New OPO leadership Lack of knowledge regarding donation and perhaps biases against Lack of support from physician groups & staff Lack of physician champion Inconsistencies in policy Lack of consistent data reporting Computer Order Entry

Goals/Strategies - Building Infrastructure Council structure and meetings – consistent data to review by unit Subcommittees focused on DCD, creation of a Clinician Guide, CPOE Education at every council meeting Lunch provided! Policies/procedures creation and revision Identification of Administrator and Physician champion – vital step

Strategy - Building Infrastructure Development of education and information needed for all staff Referral process Brain Death Criteria DCD Designated Requestor After Action Reviews at Council and in units Donor Collaboration Meeting area hospitals

Continued growth Identification and education of clinical triggers to increase referrals Declaration of Death by Neurologic Criteria education and certification for physicians Continued education for critical care & ED nursing Unit based education and follow up Public awareness campaigns and celebration of donation – registration campaigns Independent order entry for OPO staff – this was done twice!

Donor Totals 2006 - 2017

Traditional Donors

DCD Totals by Year

Organ Donation Council – both campuses Co-chairs – Administrator and Physician Finger Lakes Donor Recovery Network Musculoskeletal Transplant Foundation Central New York Eye and Tissue Bank Rome Memorial Hospital Clinical Education Admitting/Registration Transplant Recipients Transplant Program Department of Bioethics Nursing Staff and Managers EDs – pediatric and adult Pediatric ICU Neuroscience ICU and Intermediate Care Units MICUs, SICU, CPICU, Burn ICU, Community Campus ICU ORs – Adult and Pediatric from our 8 ICUs, Pediatric and Adult EDs, DT ORs, Medicine and Surgical Units Palliative Care Spiritual Care Interested staff throughout both campuses Affiliated with St. Joseph’s Hospital Organ Donation Council

Partnerships Upstate Medical University Donor Council and the Donor Councils at St. Joseph’s, and Rome Memorial Hospital, Upstate Advocates, Finger Lakes Donor Recovery Network, Musculoskeletal Transplant Foundation and CNY Eye and Tissue Bank The purpose of this partnership was to increase Onondaga County’s enrollment percentages in the donor registry through a campaign of public awareness of the importance of organ donation and how to become a registered donor.

Community Outreach Activities Donate Life Baseball Game Great New York State Fair Hockey Games with the Crunch Health Link Events/Lectures Lobbying Efforts in Albany Donor Appreciation Luncheon Rose Event – held at St Joseph’s Donate Life Month Events in April Donate Life Celebration with Press Conference Flags placed in businesses around Syracuse and Rome Radio PSAs

NY state 2016 donor registration rates: National average = 54% New York State Average = 28.3% Onondaga County = 37.6%

Onondaga County Registration Percentage by Year

Goals/Strategies for 2018 Increasing potential for DCD donations Increasing our post-extubation time for declaration of death from 60 minutes to 90 minutes. Adding an additional 10 minutes based on team decision Decreasing our untimely notifications – partnering with St Joseph’s Reinvigorating clinical trigger information

Goals/Strategies for 2018 3. Increasing potential for tissue donations Secondary Tissue Agency 4. Formalizing Sub-Committees Policy/Procedure, Process Improvement, Education, Outreach Events 5. Streamlining donor management practices 6. Celebration of donation in real time 7. Succession planning

Thank you R. Scott Stephens Craig D Stephens