Solid Organ Transplant Management Janet Drelicharz, RN, MSN, CCTC

1. Solid Organ Transplant Management Janet Drelicharz, RN, MSN, CCTC September 24, 2014

2. DATA, DATA, DATA

3. Clinical/QA Analysis akaTransplant Nurse Coordinator Specialist

4. Did I Miss Anything

5. Is There A Difference EMR

6. TRANSPLANTATION – 101

7. TRANSPLANTATION – 101

8. Overview of Four of the Stages

9. Candidate Listing • Meeting regulatory requirements – high concern • Features that allow users the ability to confirm the patient is ready to list • Action Macros such as an Order Set - List for Transplant Checklists. This includes: Blood Type Verification 2 ABO Verification in UNOS Send for Insurance Authorization Verify Demographics for Listing Register Patient in UNOS Send Listing Notification Letter to Patient, to MD Complete TCR Form Schedule Clinic Appointment Organ Specific Labs Listing Exceptions

10. Listing Checklist

11. Task Lists, To Do Lists, Sticky Notes

12. Actions

13. Staying on Top of Patient Care

14. Electronic  No Phone calls, No emails, No Paper Labs Awaiting Coordinator Review Track Overdue Labs and Clinic Appts. Complete Actions Call Patient Nurse Coordinator

15. Physician: What Needs Done?

16. Keeping Track

17. Candidate Listing Complete the Candidate Listing form in OTTR prior to listing the patient with UNOS • Red Asterisks on all required fields for Transplant Candidate Record (TCR) completion • Create lists, reports and letters based on information entered • Ability to track and research precise data

18. Candidate Listing – Listing Tab

19. Information at Listing Time

20. Letters • UNOS • Accept Selection Committee Decision Letter • Annual Patient Letter • Reject Selection Committee Decision Letter • Transplant evaluation Initiation Letter • UNOS Delisted Waitlist Listing Letter • Waitlist Status Change Letter • UNOS Delisted Letter

21. Letters

22. Listing Letter

23. Listed Patients

24. Waitlist Management Waitlist Management – All centers require diligent supervision of their waitlisted patients. High priorities include: • Listing criteria continues to be met • Health maintenance while on the list • Management of Status 7 list • Up-to-date On-call List for Organ offers

25. Does Patient Continue to Qualify for Transplant? • Examples for Heart Transplant • An estimated life expectancy of less than one year without transplant • Inoperable coronary artery disease with congestive heart failure • Strong family support to help the patient emotionally before and after the surgery • Age of more than 65 years • Development of severe irreversible high pressure in the lung arteries • Development of irreversible kidney or liver dysfunction not explained by heart failure • Development of severe chronic lung disease • Development of active infection

26. Not Falling Through the Cracks

27. Tracking the Patient’s Listing

28. Management of Status 7 Patients

29. Transplant Record Center’s ability to stay CMS certified and continue to meet UNOS Conditions of Participation depends on the center’s transplant outcomes Detailed documentation of the transplant will assist centers to track, analyze and research such records Recommendations include: • Entering data used for Scientific Registry of Transplant Recipients • Entering data helpful for Morbidity and Mortality Reports • Entering data useful if a transplant death occurs

30. Scientific Registry of Transplant RecipientsSRTR Data

31. Information Found Through The EMR

32. Not In The EMR

33. One Report

34. Monitor, Research, Analysis

35. Post-Transplant Management

36. Scientific Registry of Transplant RecipientsSRTR Data

37. UNOS Transplant Recipient Follow Up

38. Post Transplant Follow Up

39. Patient Reports • Detailed Phase Reports • Referral • Evaluation • Listing • Transplant

40. Evaluation Summary – Tests & Consults

41. Evaluation Summary – Documentation

42. Evaluation Report – Committee Assessments

43. Evaluation Summary - Outcome

44. Auto-Capture

45. Data . . . . Data . . . . And  More Data

46. Referring Physicians

47. Dialysis Reports

48. Detailed Death Data

49. Statistics

50. Statistics