Breakout Session B: The Donation Process – The Continuum of...
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Moderator:• Cristian Nunez, OneLegacy Presenters:• Marcia Penido, LCSW, Huntington Hospital• Robert Coppel, OneLegacy• Michelle Post, LMFT, OneLegacy
Breakout Session B:The Donation Process –
The Continuum of Care
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Questions to Run On
How can the hospital’s family support staff help guide
the donation process?
How can you help ensure a family is approached
effectively and appropriately?
What happens with a donor family AFTER an organ or
tissue donation?
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But How Does this Relate to My Job?
A Guide for the Hospital Social Worker & Chaplain
Marcia Penido, LCSW, MPHCo-Chair, Organ & Tissue Donation
CommitteeHuntington Hospital
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ObjectivesAt the end of this presentation, the participant will be able to:1. Understand their hospital’s
donation policy (timely referrals, diligent search, administrative consent).
2. Understand how they can impact the momentum of a referral/donor case.
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Prompt the Referral Know the clinical triggers for referring
patients: Loss of >1 brainstem reflex
&/or DNR & terminal extubation being considered
Ensure referral is on the radar of the MD/RN Follow-up until referral is made
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Trigger Card
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Identify Patient/N.O.K.
Do you have a diligent search protocol? Have you thought of everything? Do you have a time limit set? Legally-recognized decision-maker vs
N.O.K. Does your hospital allow administrative
consent?
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Support the Support System
Prepare them for MD’s dx/px Attend care conference(s) if possible Validate their grief Reinforce medical info, if needed Assist with concrete issues/answers Get spiritual care provider, if needed Offset anger directed at hospital/healthcare
team Run interference vs. withdraw into the
background
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Follow the Referral Is the patient ruled in or out?
What did OL write? What does the MD/RN know? Does OL’s understanding match the MD’s?
DCD vs BD? Map out the process for what will happen Ensure unit staff understand &
communicate in shift report
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Pave the Way for Approach N.O.K. Decision-maker(s) Influencers Saboteurs MIAs Careful responses if donation questions are
asked Observe/listen for family dynamics Ask about documents/listen for clues as to
patient’s wishes
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Huddle with the Team Have a Team Huddle Worksheet on which to
document collaboration/plan Part of Medical Record
Huddle upon OL’s arrival Huddle upon FCS’s arrival Huddle prior to approach Huddle whenever helpful
(Did I mention you should huddle?)
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Follow after the Approach Support family regardless of decision
Ensure they know their decision is not judged or rewarded
Answer questions Provide referrals Run interference with potential saboteurs Observe/listen for information helpful to
After Action Review & pass it onto Donor Council
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Learn, Learn, Learn Review every case Celebrate perfect collaboration Learn from challenges & declines Success is
an effective request what the patient would have wanted or the
N.O.K. needed to do
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Wait! There’s More for You to Do!
Do you have a Donor Council/Donation Committee?
Is your discipline/department represented? Is the nursing unit where donors are
referred represented? Do you have a method for giving feedback
after cases are identified? Do you receive recognition when there’s a
success or challenging case? Do you celebrate donor families?
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Maximizing Outcomes… Support….the family/support system Diffuse…any distrust, misunderstandings,
misperceptions, dissatisfaction Follow closely…the process so that all
policies are followed & opportunity for donation is being protected
Liaison…between medical staff & OL, ensuring collaboration
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What Factors Can Affect an
Approach?
Robert CoppelFamily Care Specialist
OneLegacy
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Objectives
At the end of this presentation, the participant will be
able to:
1. Understand what constitutes an effective or
ineffective approach.
2. Understand of what a OneLegacy family approach
consists.
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Why Huddle?
• Collaboration• Fact finding
– First Person Consent / Advance Directives– Identify LNOK, Family Support System– Understanding family dynamics, key decision-makers– Spiritual and Cultural needs of each family
• Establishing Hospital family support system: – SW, Pastoral, etc.
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Negative Factors Affecting Consent
• Inappropriate mention of donation registered or
otherwise
• Inadequate explanation of grave prognosis
• Inaccurate assessment of family
• Timing
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• Hospital supports organ donation
• Team huddles
• Appropriate requestor
• Family satisfied with quality of care and
communication
Positive Factors Affecting Consent
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• Reasonable time allowed with loved one
• Understanding of brain death
• MD coordinates end-of-life discussion
Positive Factors Affecting Consent
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• Has the doctor talked with you?
• What did he/she tell you?
• What does that mean to you?
What Happens Behind Closed Doors?
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• Explain brain death, even if family understands.
Keep in simple terms.
• Discuss funeral arrangements.
• Discuss coroner’s case and possible autopsy.
What Happens Behind Closed Doors?
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Thank You
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AFTERcare
Continuum of Care….What Happens Next?
Michelle Post, MA, LMFTOneLegacy Clinical Aftercare Specialist
Chair of AOPO Donor Family Service [email protected]
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Objectives
At the end of this presentation, the participant will be able to:
1. Recognize how OneLegacy’s Aftercare Department
supports donor families.
2. Verbalize which aftercare programs, events, and
correspondence is available to donor families.
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Our Philosophy
• AFTERcare = “Companioning” a bereaved
family (Alan Wolfelt, Ph.D.)
– Not experts on grief; take cues & offer support…
Do not lead~ Walk WITH
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Our Philosophy
• AFTERcare = Consistency
– After a family consents to donation, regardless of
medically closing the case and not transplant…
– Minimum of 2 years of support from OneLegacy
Aftercare Department
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Who Supports the Family?
OneLegacy Aftercare Staff & Interns =Interdisciplinary team: RN, LCSW, LMFT, MSW,
Chaplain
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Aftercare Program ~ 2 yrs Sympathy Card
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Aftercare Program ~ 2 yrs
Anniversary Card on One Year Anniversary of Loved One’s Death
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Aftercare Program ~ 2 yrs
• Letters of Support
• Grief literature
• Timed intervals from
the death through
2 yrs
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“The Companion”, a Donor Family Newsletter
• 3 times a year for as
long as they want to
continue to be on our
mailing list
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Aftercare Program
• Phone calls
of support
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Monthly Grief Groups
• Saturday Mornings ~
– Downtown LA – Kids, Teens, Adults (Span & Eng)
– Redlands (Spanish – hope to start Eng)
– O.C. (Hope to start Eng, Fall)
Building Hope Through Companioning
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Day of the Dead Craft Day & Cultural Diversity in Grief Wrkshp
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Surviving the Holidays Workshop
• Frames,
Ornaments, Plates
in memory of donors
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Aftercare Intern Program
Short-Term Grief Support Services
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ON-LINE
Private Facebook
Group for
Donor
Families
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“Fields of Gold” Donor Remembrance Ceremonies
Each family receives a Life Bridges Donor
Pin & Pendant set
Hundreds of donor family members gather at three annual events
Terry Harrington, heart recipient and the ‘voice’ of Lisa’s sax on the “Simpsons,” performs
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Donate Life Rose Parade Float Decorating Days & Family Circle Rose Dedication
A donor family gathers to decorate in
honor of their loved one
Donor parents dedicating a rose
Donor Sister works on the Donate Life Float
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Donate Life Run/Walk
Donor families formed teams of all sizes and walked in honor of their loved ones.
T-shirts personalized with each donor’s picture &
Family Circle Garden Posters
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Bridging Lives Quilt
Donor families can create a quilt block which becomes a community based quilt Kern County Bridging
Lives Quilt with project leader Becky Pitre
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• Organ Recipient Medical Updates
• Tissue Disposition updates
• Donor Family and Recipient
Meetings
Other Aftercare Services
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Long after the donation is complete...AFTERcare is available
Michelle Post, MA, LMFTOneLegacy Clinical Aftercare Specialist
Chair of AOPO Donor Family Service [email protected]
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Questions to Run On
How can the hospital’s family support staff help guide
the donation process?
How can you help ensure a family is approached
effectively and appropriately?
What happens with a donor family AFTER an organ or
tissue donation?