Nancy Corbridge is manager of critical care at Overlake Hospital See also: Recommendations for an Effective Donation Program

“We’re all very passionate about donation,” explains Stephanie Crow, who is in charge of Clinical Effectiveness in the Quality Assurance department at Overlake Hospital in Bellevue, Washington. Before she and colleagues from several departments formed the Organ and Tissue Donation Committee in July 2002, “we really didn’t have any kind of protocol for tracking, trending, or improving the process of donation.” Crow was also motivated to improve the process in order to meet the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements for timely referrals of patient deaths.

In less than a year, Overlake more than tripled the number of tissue donors, thanks to the new protocols and added emphasis on staff education. In 2001, the Northwest Tissue Services had only three tissue donors from Overlake. But in 2002, that number jumped to ten. In 2003, there were 8 donors from Overlake. Gifts from these donors resulted in more than 400 life-saving and life-enhancing transplants of bone, tendon, skin, veins, and heart valves, helping patients with severe burns, debilitating degenerative diseases and painful orthopedic conditions and injuries.

“Overlake Hospital’s increasing
commitment to donation has
been a huge success story,” says
Candy Wells, the Tissue Services’s
hospital services supervisor.

Overlake also improved its donations of organs and corneas. In 2003, Overlake had 4 organ donors, resulting in 13 organ transplants, and 26 cornea donors, from whom 52 individuals received the gift of sight.

“Speaking for myself, caring for critically ill patients is often very stressful, very tragic. Donation makes us all feel like we’ve brought a positive outcome. It allows the family some dignity, some choice at a very difficult time,” explains Nancy Corbridge, Overlake’s manager of critical care.

Perhaps the most important step in the process has been the shift to the “team approach.” Protocols are now in place to ensure that referrals are made in a timely way and involve the donation agencies from the very first steps. The donation coordinator “teams” with hospital staff to support the family, facilitate family approach and offer donation options.

When there is a patient death or imminent death, Overlake staff contacts the donation agency. After the donation coordinator determines medical suitability, verifying whether and what the patient is eligible to donate, hospital staff introduces the topic of donation to the potential donor family and connects the family with the donor coordinator over the phone.

The coordinator is then responsible for providing the family with information about the options and the process, answering questions, and seeking consent if the family wishes to donate.

“Overlake Hospital’s increasing commitment to donation has been a huge success story,” says Candy Wells, the Tissue Services’s hospital services supervisor. “Because of their dedication to the community and their patients, they have partnered with our organizations to enhance the services they provide. They ensure that when there are donation options families have the opportunity to consider them and make informed choices.

“They have gone right to the intent of the JCAHO to raise awareness of donation’s importance throughout the hospital, and they have done so in ways that supports staff, families and patients at Overlake. They have also set an example for other hospitals, especially in their understanding of how to implement a more effective and caring team approach,” says Wells.

For Corbridge, the commitment to donation goes beyond a professional obligation. Last year, her brother died while waiting for a liver transplant. “Part of what I do is to help make sure others know that there is an option to help other people at this tragic moment in their lives,” she explains.

One major change relating to the team approach was a revision of the hospital’s after-death checklist. Says Corbridge, “We moved the donation information to the top of the checklist. When we have a patient whose death is imminent, we put the checklist in the chart and document the call to the donation agency, so the next staff member to care for the patient knows the call has been made.

“As we’ve been working with the team approach we’ve gotten the message out that an early phone call is best. It takes the stress off the person caring for the patient to know that the agency is offering the family the information about donation.”

Staff members from Critical Care, Oncology, Clinical Education, Administration, Quality Assurance and sometimes other departments too are involved in the committee, which meets quarterly. Representatives from the Northwest Tissue Services, the Northwest Lions Eye Bank and LifeCenter Northwest participate as well.

“Frequent education is really the key,” says Corbridge. “When we started the team approach, the donation agencies came to our clinical congress. They gave a talk on donation, and they had a donor family come to speak. We had the agencies come to CCU staff meetings, and they attended staff meetings throughout the house. Of course departments like the ICU and the CCU are a little more familiar with the process. For the floors that don’t have a lot of deaths, education three or four times a year really helps.

“I really appreciate that everyone from the agencies is so free with their time to help us educate our staff. It’s so important.”

“The donation agencies speak at orientation,” says Crow, the clinical effectiveness staff member. “We’ve included information in the annual review.”

Crow points out that she can now document that the referral rate is 100 percent, which was her goal. “In an effort to meet requirements in an ongoing way, we’ve made the process simpler. Now we have more expertise. All of these things add up. We keep donation in front of people; we’re continually working to improve.”

In July 2003, when Rodney Fiddamin’s wife Doris Turner suffered a devastating brain aneurysm, she was rushed to the CCU at Overlake Hospital. Fiddamin and his stepson had discussed organ donation with Doris and knew that she wanted to be an organ donor if her medical condition were ever so grave there was no hope for recovery.

Overlake’s efforts to improve their protocol to refer potential tissue, cornea and organ donors to donation agencies had been underway for almost a year. Turner was able to donate heart valves and kidneys. Two Washington men received her kidneys.

“We were able to help the family at a critical moment so that they could go on with the grief process at her bedside,” explains Corbridge. “They told family stories, there was some humor amidst the tragedy. They were able to grieve appropriately for her loss, while knowing that they would be helping other people through her death,”

Fiddamin later spoke of his positive experience with donation at the Northwest Tissue Services and Northwest Lions Eye Bank’s Donor Family Ceremony (see related story “Donor family ceremonies are rich in remembrance,”).

When asked about the nursing staff at Overlake during this harrowing period, Fiddamin replies: “Brilliant. They were always there to answer questions. As a nurse herself, Doris would have been proud of the care she received.”

Recommendations for an effective donation program   Stephanie Crow is in charge of Clinical Effectiveness at Overlake Hospital Dedicated staff at Overlake Hospital improved donation rates dramatically. Here are some important features of their plan, which can serve as a model for other hospitals. Partner with the donation agencies to specifically address the hospital’s individual needs and issues. Develop and implement a plan to insure referral calls are placed before the family is approached. Ensure that only donation agency coordinators or trained designated requestors approach families for tissue donation. Review policy and procedures annually for compliance with donation protocols. Verify that COP and JCAHO standards are met. Educate hospital staff regularly. Include COP, referral, donation process, and donor registry information. Make sure that any annual updates such as physician/resident training, new nurse orientation, skills review, staff meetings and self-study modules include information about donation protocols. Utilize Tissue Donation Summary reports. Provide these to hospital administration, nursing management and physician staff to show the donation program’s success. Use them to identify desired outcomes and to continuously improve quality practices.