ACCORD

1. ACCORD Mark Roberts ACCORD Business Lead

2. Achieving Comprehensive Coordination in ORgan Donation EU funded Joint Action Joint Action led and coordinated by ONT 6 work packages NHSBT lead on Work Package 5 15 EU countries participating in WP5 3 Year project

3. Work Package 5 ‘strengthen the relationship between intensive care units and donor co-ordinators for the purpose of reaching the full potential of deceased donation in each participating Member State’

4. Aims Analyse end of life practices for patients with a devastating head injury across Europe and the impact on organ donation Provide a improvement methodology toolkit for strengthening co-operation between ICUs and DTC

5. Deliverables Establish a Clinical Reference Group Report on the study of the variations in end of life care pathways for patients with devastating brain injury in Europe

6. Deliverables Recommendations to achieve improvements in end of life care pathways to promote organ donation Report on the effectiveness of the improvement methodologies in achieving increases in organ donation

7. Methodology Each MS has appointed 2 hospitals to participate in the project Stage 1 – Variations in end of life care Country Questionnaire Hospital Questionnaire Patient Questionnaire

8. Methodology Stage 1 – Variation in care pathways Data is analysed by WP5 team to develop a report showing variation in practice Stage 2 - Evaluation Identification of potential barriers to donation

9. Methodology Stage 3 – Improvement Model implementation Training an expert in each participating MS in the improvement methodology (PDSA cycles) Each hospital undertakes a short project Collect further data to monitor

10. Methodology Stage 4 – final report Data from study and learning from PDSA cycles will be collated and reported

11. Questionnaires 6 Months data collection (Mar 13-Aug13) 67 hospital questionnaires submitted 66 hospitals submitted patient data 1670 patient questionnaires submitted 513 from UK hospitals

12. Country Questionnaire

13. National indicators for organ donation • A legal definition for brain death/cardio-respiratory death • Professional guidance/standards/codes of practice • National independent ethical codes of practice • Guidance on the withdrawal or limitation of treatment • Training for healthcare professionals • A national organisation responsible for organ donation • A regulatory body that has oversight of organ donation

15. Hospital Questionnaire 1. Number of staffed beds in your hospital where you can mechanically ventilate a critically ill patient. 2. Does your hospital have neurosurgical facilities on site? 3. Does your hospital have interventional neuroradiology facilities on site? 4. Does your hospital perform solid organ transplants? 5. Is your hospital a designated trauma centre? 6. Number of actual organ donors in your hospital in 2011 7. What is the availability of the Key Donation Person within your hospital?

16. Hospital Questionnaire 8. What is the clinical background of your hospital's Key Donation Person or if you have a team what is the clinical background of the Team Leader? 9. Does your hospital have a written local policy/guideline/protocol for managing the organ donation process? 10. Does your hospital have written criteria of when to alert the key donation person of a potential organ donor? 11. Does your hospital have the ability to facilitate organ donation 24 hours a day with regards to the following resources? Resources: CT Scanner/ MRI Scanner/ HLA and virology testing/  Trans-Cranial Doppler/ EEG/ Cerebral angiography

17. Patient Questionnaire

18. Patient Questionnaire Design STOP Q1, Q2 & Q3 General Qs….. Q4 Intubated & Ventilated Q5 ? preconditions Q13. Did donation happen? Q10: ? Family approached Q11: Who approached family? Q8: ? Donation after Circulatory Death Q6 ? tested Q9: ?referred to Key Donation Person Q7 ? Brain dead

19. Number of patients audited by country

20. DBD pathway for ALL audited patients (n=1670)

21. DCD pathway for ALL audited patients (n=1670)

22. Care of the patient

23. DCD donation

24. Improvement Model

25. Act Plan Study Do Understanding the problem. Knowing what you’re trying to do - clear and desirable aims and objectives The Improvement Model Model for Improvement What are we trying to accomplish? How will we know that a Measuring processes and outcomes change is an improvement? What change can we makethat What have others done? What ideas do we have? What can we learn as we go along? will result in improvement? Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L, (2009), The Improvement Guide: a practical approach to enhancing organizational performance (2nd ed), Josses Bass Publishers, San Francisco

26. The PDSA Improvement Model Make change on a small scale Ensure it is - modifiable - realistic - measurable Engage with key stakeholders

27. The PDSA Improvement Model 66 participants from across Europe attended one of three training days held in London on the Improvement Model. WP5 Project Team have reviewed all the plans and reports PDSA cycles ran from November 2013 to April 2014 52 reports from 55 plans

28. Hospital PDSA Plans

29. Sustainability Develop a toolkit for use by other hospitals Widely disseminate Final Report and Toolkit Publish findings Present at EDTCO and NHSBT congress

30. Thank You