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End Stage Renal Disease(ESRD) Network Learning and Action Network (LAN) Series:
TransplantQuality Improvement Activity
February 20, 2018
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Welcome
Learning and Action Networks (LANs) bring people together around a shared idea, opportunity, or challenge to offer and request information and experiences to improve the identified topic of discussion.
As a participant in today’s LAN activity we encourage you to:
• Engage in the chat box. Share your approaches and experiences related to the information being shared and ask questions.
• Apply the information and knowledge being shared to your own facilities and practices to improve transplant referrals.
What you will hear from our presenters
• A transplant center’s approach to increase patient and staff engagement in the kidney transplant process
• The key responsibilities of a transplant surgeon designee
• The evolution of the transplant surgeon designee program created and developed by Saint Barnabas Medical Center
What is the intent of this LAN Activity?
• To understand strategies to creating a successful transplant outreach program.
• To recognize the value of communication and relationship-centered care in patient engagement.
Questions to run on…
• What can I take from this presentation and adapt in my facility or Network?
• What ideas do I have that are replicable and measurable to meet the national goal of increasing the number of patients on the transplant wait list by 30% by 2023?
Transplant Wait List
0 5 10 15 20 25 30
2016 National Average
2023 National Goal
2016 National Average 2023 National Goal
CE Credit Process: Certificate
Creating a Successful Transplant Outreach Program
Christina Psathas, MA
Transplant Outreach Coordinator
The Renal and Pancreas Transplant Division
Saint Barnabas Medical Center
973.322.2285christina.psathas@rwjbh.org
Objectives
Describe the Transplant Center’s approach to
increase patient and staff engagement in the
kidney transplant process
Discuss the evolution of the Transplant
Surgeon Designee Program created and
developed by Saint Barnabas Medical Center
Identify the key responsibilities of a transplant
surgeon designee
Saint Barnabas Medical Center
Livingston, New Jersey
•Kidney
•Pancreas
•Pediatric Kidney
•Living Donor • Altruistic Donation
• Kidney Paired Donation
• Incompatible Transplant
• Compatible Share
•NJ Satellite Sites:• Newark
• Edison
• Rutherford• Jersey Shore (2018)
Transplant Division
Our Success
• 341 kidney or pancreas transplants, exceeding the 304
transplants that Saint Barnabas performed in 2016
- 337 Kidney Transplants
- 4 Simultaneous Kidney/Pancreas Transplants
- 3rd largest program in US
• 162 living donor kidney transplants, including 45
kidney paired exchanges, making Saint Barnabas the
largest living donor kidney transplant program in the
United States
We could not have achieved these milestones
without your support!
Saint Barnabas Medical Center
Candidate Referrals
1687
1175
14601596
11321317
0
300
600
900
1200
1500
1800
2012 2013 2014 2015 2016 2017
February 27, 2018
Saint Barnabas Medical Center
New Candidate Evaluations
1373
10561112
1180
9791101
0
200
400
600
800
1000
1200
1400
2012 2013 2014 2015 2016 2017
How Do We Engage Patients &
Staff in the Transplant Process?
• Develop relationships with dialysis
staff
• Dialysis Site Visits
• Communicate with the dialysis
team
• Created dedicated outreach
position
Who is on the Outreach
Team?
• Outreach Coordinator
• Transplant Nephrologists (8)
• Pre- Transplant Coordinators (6)
• Outreach Assistant
Outreach Coordinator
• Reports to Chief of Transplant
• Organizes all aspects of outreach program
• Coordinates dialysis site visits
• Schedules & attends meetings with
community nephrologists
• Organizes conferences & special programs
(designee program, living donor
celebrations, etc.)
• Point of contact for dialysis staff
• Designs & creates marketing materials for
transplant division
What We Do
Dialysis Site Visits
• Patient Lobby Days
• Staff In Services
• Address the transplant-related needs of each
unit
• Provide updates to dialysis team
Physician Visits
• Assigned territories
• Transplant MDs visit Community Nephrologists
• Conduct education at dialysis units in their
territories
Special Programs
• Yearly Designee Program
• RN / Social Worker Symposia
Dialysis Site Visits
• Address Unit’s Transplant Needs✓ In Service Staff
✓ Patient lobby visit
• Review Transplant Report
• Provide updates on patients
• Review binder
• Provide supplies ✓ FedEx Mailers / Labels
✓ Brochures
✓ Satellite Flyers
✓ Referral Flyers
Referral Tools
New Online Referral Form
www.rwjbh.org/KidneyTransplantReferralForm
• Replaces referral forms units
currently fax to us
• Transplant team receives the
referral via email upon submission
• Allows transplant team to schedule
referrals quickly
• Transplant team can track referrals
by patient & unit
• New form is live now!
Online Referral Flyer
Distribute to
patients
Has main
transplant
telephone #
Online referral link
Transplant team
contacts patients
within 48-72 hours
New Online Referral Form
www.rwjbh.org/KidneyTransplantReferralForm
• After March 15, 2018, transplant
team will not accept referrals via
fax
• All referrals should be submitted
online
Evolution of the Transplant
Designee Program
First designee
course was in 1990
Created by Sham
Mulgaonkar, MD
Goal was to provide
transplant-related
education to
dialysis RNs
Dialysis RNs are
lifeline to patients
Transplant Designee Program
Initial courses were 3-4 hours long & held at
SBMC
Courses were voluntary – no incentive to
attend
Dr. Mulgaonkar felt that regular certification
for RNs was an important part of CKD care
Worked with QIRN3 (formerly TARC) to create
a certification program
Transplant Designee Program
Yearly initial &
recertification is
required for all
designees
Outgrew space at
Saint Barnabas
Full day program
Moved conferences
to outside venue
Who Attends?
Dialysis RNs
Dialysis Social
Workers
PCTs
Dietitians
Breakout sessions
Contact hours for all
disciplines offered
Transplant Designee Program
Largest designee
course in New
Jersey
Average 420-490
attendees each
year
28th Annual
Designee Program
will be held 4/26/18
at Pines Manor,
Edison NJ
Who Can Be a Designee?
• Licensed registered nurse
• Immediate dialysis experience of at least
one (1) year in direct clinical ESRD
practice
• Completion of educational program for
transplant designee (initial and
recertification program)
What are the Regulations? Federal: Part 494 Conditions for Coverage for
ESRD Facilities
Evaluate transplant suitability for
referral based on selection criteria
Develop Plan of Care for patient
✓Track Transplantation Status of
each patient
✓Document!!
Track results of transplant referrals
Key Responsibilities of a
Transplant Surgeon Designee
Evaluate all Chronic Kidney Disease patients in
your unit for kidney transplant suitability
Refer patients to a transplant center and assist
patient in scheduling appointment (online
referral form)
Coordinate with other team members and
ensure that patients required testing is
completed and faxed to the transplant center
Key Responsibilities
Communicate with the transplant center any
change in patient’s medical status
Use a binder to track your patients on the kidney
transplant list
Add any documentation from transplant center
to binder (letters from transplant center)
Act as a resource person in your dialysis unit
Know who is on your list!!
Key Responsibilities (continued)
MONTHLY SPECIMENS
Coordinate and ensure that monthly blood
specimen is sent to the Sharing Network before
the 10th of each month
Only ACTIVE patients need specimens
LISTED INACTIVE – STATUS 7 patients do not
need specimens
Monthly Blood Specimen - What’s
it For?
Tests are conducted to determine whether the potential recipient has developed antibodies
This information, along with serum sample, is stored at the NJ Sharing Network.
The sample will be used for cross matching when a kidney becomes available
Why do you need to send the blood
monthly?
While patient is waiting for a kidney, their health status may change
Patient can develop antibodies against a possible donor (from blood transfusion, pregnancy, previous tx)
Blood samples are tested periodically for these antibodies
Ideally, sample should be no more than a month old for cross matching
Monthly Blood Specimen Protocol
10 cc red top tube of blood per patient
Include the following information on Label
NO longer use full SS# an identifier on the Label
Name: ____________________
DOB: _____________________
SS: XXX-XX-1234
Specimen Date :____________
Drawn By : ________________
Monthly Blood Specimen Protocol
If any information is missing or incorrect, the
specimen will be discarded
No need to refrigerate the specimen
Send specimen within 24 hours of being drawn
So what if the blood isn’t current?
Would prefer if sample is no more than 1
month old
The antibodies can change at any time
Not safe to attempt transplant on a patient if
blood specimen is not current
Recipient loses an opportunity for a transplant
Managing Wait Listed Patients –
Transplant Designee's Role
Provide ongoing patient education
Communication with Transplant Center
Change in demographics
Change in insurance
Change in medical condition
Psychosocial issues
Change in dialysis unit
Conclusion Transplant Designee is a “life line” between
the patient and transplant center
You are your patients advocate for transplant
Patient assumes you will keep in contact with
transplant center
Call us anytime and let us know how we can
help “our patients.”
We want a safe and successful transplant for
our patients
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