The Modernisation Agenda
Donor Care Physiologist
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
Senior Assistant Technical Officers
Assistant Technical Officers
Pharmacy Technicians and Medicines Management
Catheter Laboratory Assistants – 2005
Generic Catheter Laboratory workers
6. Chest Medicine:
Nurse Consultant in Respiratory Medicine
Nurse Consultant in Oncology – 2006
7. Background to the development of the role Papworth protocol for donor management (1990) sets out the way to optimise available donor organs
Haemodynamic and fluid management
8. Facilitated by a mobile donor management team Surgical 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
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
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?
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