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DCD: Identification – Who Qualifies and When is it the Right Time to Make that Referral? . 2013 National Donor Management Summit Los Angeles, California September 25, 2013. Speakers:. Marwa Kilani , MD Providence Holy Cross, Mission Hills Marcia Penido , LCSW, MPH, ACM

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Dcd identification who qualifies and when is it the right time to make that referral

DCD: Identification – Who Qualifies and When is it the Right Time to Make that Referral?

2013 National Donor Management SummitLos Angeles, California

September 25, 2013


Speakers
Speakers: Right Time to Make that Referral?

  • MarwaKilani, MD

    Providence Holy Cross, Mission Hills

  • Marcia Penido, LCSW, MPH, ACM

    Huntington Hospital, Pasadena

  • Robert Coppel, Family Care Specialist

    OneLegacy, Los Angeles


Question to run on
Question to Run On: Right Time to Make that Referral?

  • How do we safeguard this (DCD) opportunity for all potential donors and their families?


Dcd referral approach
DCD: Referral / Approach Right Time to Make that Referral?

  • Providence Holy Cross Medical Center

  • 6/10/13 - 38yr old female admitted - ALOC & Respiratory Distress / Hospitalist Attending

  • 6/12/13 – Referral to OneLegacy

  • 6/16/13 – Referral closed / NBD/WNP

  • 6/21/13 – Re-Referral / Compassionate Extubation under discussion

  • 6/25/13 – Referral closed again


Palliative care
Palliative Care Right Time to Make that Referral?

“The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies… Palliative care affirms life by supporting the patient and family’s goals for the future, including their hopes for cure or life-prolongation, as well as their hopes for peace and dignity throughout the course of illness, the dying process and death.”

Excerpted from Clinical Practice Guidelines for Quality Palliative Care, AAHPM


Palliative care1
Palliative Care Right Time to Make that Referral?


Palliative care2
Palliative Care Right Time to Make that Referral?

Provided by a Team: MD, RN, MSW, Chaplain

  • Experts at Communication

  • Specialized Pain and Symptom Management

  • Guidance with Options for Medical Treatment

  • Help Navigate the Complex Healthcare System

  • Provide Spiritual and Emotional Support


Palliative care3
Palliative Care Right Time to Make that Referral?


Dcd referral approach1
DCD: Referral / Approach Right Time to Make that Referral?

  • PHCMC – Palliative Care

  • 6/15/13 – Palliative Care Consult

  • 6/20/13 – 1st Family Conference

  • 7/3/13 – 2nd Family Conference

  • 7/3/13 – Re-Referral to OneLegacy

  • 7/3/13 - Approach / Authorization for DCD


Huddle with opo
Huddle with OPO Right Time to Make that Referral?


Assessing medical suitability
Assessing Medical Suitability: Right Time to Make that Referral?

HUDDLE and DETERMINE:

  • What is the family planning?

  • Patient profile (contraindications)

  • Respiratory Effort

  • Neurological profile (imminent BD)

  • What is the probability that this patient will expire in the 60 minutes?


Suitability determined
Suitability determined… Right Time to Make that Referral?

Now how do you determine the “right time to provide this family with their opportunity/option to donate.


Huddle with care team
Huddle with Care Team: Right Time to Make that Referral?


Elements of an approach
Elements of An Approach: Right Time to Make that Referral?

  • Is the Family Ready

  • Who do we include and why

  • When is the best time for this family

  • Where is a quiet, private setting


Timing elements
Timing Elements: Right Time to Make that Referral?

  • Family Considerations

  • Hospital policy

  • Pre-Approach Huddle


Timing of the approach
Timing of the Approach Right Time to Make that Referral?

The Institute of Medicine (IOM) recommends that the decision to withdraw life-sustaining treatment should be made independently of and prior to any staff-initiated discussion of organ and tissue.

“Would this patient be removed from life-sustaining treatment whether OneLegacywas there or not?”


Pre approach enactment
Pre-Approach Enactment: Right Time to Make that Referral?


Summary
Summary: Right Time to Make that Referral?

Who Qualifies?

When Is the Right Time to Make the Referral?


Question to run on1
Question to Run On: Right Time to Make that Referral?

  • How do we safeguard this (DCD) opportunity for all potential donors and their families?


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