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