Donor Care Physiologist DCP annmarieglepapworth.nhs.uk

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The Modernisation Agenda

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Donor Care Physiologist DCP annmarieglepapworth.nhs.uk

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1. Donor Care Physiologist DCP [email protected]

2. The Modernisation Agenda & its Major Initiatives Changing the workforce programme. Agenda for change. New consultant contract. European working time directive. Modernising medical careers. Modernising nursing careers.

3. New Ways of Working Four main types of changes: Moving a task up or down a traditional uni-disciplinary ladder (Consultant to Junior Doctor). Expanding the breadth of a job (CNO’s 10 roles). Increasing the depth of a job – nurse/therapy consultants. New jobs – combining tasks differently.

4. What’s Been Happening at Papworth Surgery & Anaesthetics: Surgical Care Practitioners – 1994 Critical Care Practitioners – 1995 Donor Care Physiologists – 2003 Assistant Theatre Practitioners - 2006 Cardiology: Pre-admission service. Senior Assistant Technical Officers Assistant Technical Officers

5. Pharmacy: Pharmacy Technicians and Medicines Management Radiology: Catheter Laboratory Assistants – 2005 Generic Catheter Laboratory workers TCCU: Workforce redesign

6. Chest Medicine: Nurse Consultant in Respiratory Medicine Nurse Consultant in Oncology – 2006 CPAP Practitioners Nurse clerking

7. Background to the development of the role Papworth protocol for donor management (1990) sets out the way to optimise available donor organs Hormone replacement Infection control Ventilation Haemodynamic and fluid management

8. Facilitated by a mobile donor management team Surgical fellow Anaesthetic SpR Perfusionist Theatre nurse Research fellow Observers / visitors

9. The need to review Question of training value of donor runs for Anaesthetists by RCA led to early stimulus for exploring new roles Pressure of WTD. Anaesthetic time needed on donor run unsustainable History of practitioner roles.

10. Donor Care Physiologists Re-engineering the skill mix Aim To develop a non-medical practitioner who could substitute an anaesthetist and successfully manage a donor in relation to respiratory and circulatory support during a cardiothoracic retrieval event.

11. The Pilot DOH funding February 03 Steering group established March 03 Support from UKT Job description and in-service training programme agreed June 03 70 applicants Short listed 25 Appointed 5 DCPs September 03

12. Training Programme One year long in house study days and practice placements in theatres & critical care at:- Papworth Leicester and Bedford Linked with local HEI in May 04 and programme developed to Diploma in Donor Management

13. DCP Competencies Demonstrate the ability to:- perform anaesthetic safety checks.  check and interpret relevant documentation in relation to brain stem death.  transfer the donor to the operating theatre   

14. Demonstrate thorough knowledge of:- the insertion and management of a central venous pressure line. the insertion and management of a pulmonary artery flotation catheter. the insertion and management of an arterial line.

15. Knowledge of:- cardiovascular physiology, haemodynamics and haemodynamic monitoring equipment. pharmacology of inotropic and vasoactive drugs respiratory mechanics, gas exchange, blood gas analysis.

16. Demonstrate airway management  understanding of the Papworth retrieval protocol. ability to liaise with the donor hospital anaesthetist and demonstrate a professional and efficient approach to colleagues at Papworth and donor hospitals.

17. Progress All DCPs successful in training program. DCP role substituted anaesthetic SpR from September 2004 When not on donor runs involved in theatres, transplant research / audit and education programmes across the hospital. New cohort April 06

18. Common Themes in Role Development Recruitment to new roles (robbing Peter to pay Paul) Understanding the local market Developing internal staff – back filling junior roles Professional regulation and accountability Managing resistance to change

19. Audited Outcomes Sept 04-Sept 06 The first 144donor runs: at least 1 organ retrieved in 65% 63% of hearts, 36% of lungs viewed were retrieved main reasons for not accepting organs: hearts - no recipient, CAD, persistent high PCWP lungs - secretions, aspiration, infection, ABG?

20. Timings: arrival at donor hospital - donor ready for transfer to theatre: Median 30min (target 30 mins) donor arrives in theatre - KTS: Median 65 mins (target 70min) insertion of arterial line: 15min insertion of central lines: 15min floating PA catheter: 8min

21. Marginal Organs 27 runs to assess marginal organs 7x hearts, 19x hearts and lungs, 1x single lung retrieved after resuscitation: 6x H/L block, 11x hearts, 1x double lung successful retrieval in 66%

22. The Future Evaluation of the role (DOH, UKT Donor Hospitals) Extend programme to 15mths to include abdominal harvesting mgt. Role out to other transplant centres. Expansion of DCP role

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