Leading change

Specialist nurses for Organ Donation at NHS Blood and Transplant led on the implementation of a digital Application (App) programme for organ donation, for use by specialist nurses nationally. The programme has significantly improved the safety of organ recipients, patient and staff experience and released staff resources to spend more time with patients.

Where to look

NHS Blood and Transplant reports identify that over 6000 people in the UK are waiting for an organ transplant, with three people dying every day in need of a transplant, in part due to a shortage of organ donors. Organ donation is giving an organ to someone else who needs a transplant, saving thousands of lives in the UK every year. However, this relies on donors and their families agreeing to donate (NHS Blood and Transplant). The organisation is continually striving to modernise the digital services to transform outcomes for patients and donors to streamline the process of organ donation for all patients, donors and families.

Specialist Nurses for Organ Donation reported to their nursing management team that the bulky paper-based organ donation system was outdated and hindered the provision of offering optimal care to donors and families. The nurses identified that there was a chance of unwarranted variation as the process risked the safety of organ recipients, prevented the gift of donation by the donor and may not appropriately support their families by the safest processes available. This prompted the Senior Nurse to lead a project to identify a new system for organ donation.

What to change

Before the change, specialist nurses attending the bedside of a potential organ donating patient were required to manually complete over 60 different paper forms capturing vital information ensuring donor suitability and recipient safety. The process was cumbersome and required frequent repetition of vital information such as the unique ‘Organ Donor Number’ through which organ transplants, outcomes and follow-ups would be tracked as well as other forms of patient identifiable data. Any error whilst repeating these details risked the safety of any patient receiving an organ for transplant, which was mismatched to incorrect donor data. Even with thorough specialist training, incidences of error still occurred and the potential for further incidents remained.  The manual process meant nurses were away from the bedside completing paperwork and this time could be better spent providing frontline care to the patient and family. Nurse feedback when considered alongside previous transcription errors identified a clear need to transfer the process to a digital system in order to minimise repetition and maximise resources the nurse had, through the use of algorithms and intelligent systems, so that they could focus on providing high quality care to their patients, their families and carers.

How to change

The Multi-disciplinary team led on an extensive review of current practice, including whether the documentation used was relevant and needed, and where improvements could be made to simplify the system using a digital solution. Colleagues in Transplantation Medicine were asked what information they required from an optimal new system and administrative colleagues were asked how a system could better support their work. A nurse-led project team also consulted with international colleagues to learn how electronic systems (e-systems) can improve efficiency.

An e-system was designed with considerable frontline nursing involvement to support and improve the UK Organ Donation processes. This is in the form of an App, which works optimally across electronic devices used within the Trust.

The App allows the specialist nurses to identify information needed from patients and other services, share data with other healthcare professionals in real time and use intelligent algorithms to auto-populate fields such as donor number.

Adding value

Better outcomes – This has transformed the experience of those caring for both donors and recipients by allowing accurate patient data to be recorded accurately and shared. The donation process is now entirely paperless and streamlined. There is no longer a need for repetitious paper documentation, reducing transcription errors and improving donor and recipient safety. The year since introducing the App saw record levels of organ donation in the UK, with 1575 organ donors, allowing 4035 lifesaving transplants to take place. This would have been more difficult to achieve using the previous paper system. The safety of potential organ recipients has improved as repetitious form completion no longer takes place, eliminating the possibility of transcription errors.

Better experience – The use of the App on mobile devices allows documents to be completed at the bedside, rather than via a paper file in an office, which supports a more personalised approach for the potential donor and their family. Staff and patients report that this has created a better end of life care experience, with the nurse able to concentrate on the clinical care of the donor and the pastoral needs of their family. Regular family feedback is sought from donor families and ever increasing positive comments are received on the specialist nurses and their care for families. This showcases the patient experience benefit of the introduction of the App.

The App has allowed real-time sharing of information across centres caring for potential organ recipients, allowing better decision making around whether to accept or reject an organ for transplant. This has improved the experience for healthcare colleagues and administrative staff who have immediate access to important information to support decision making.

Nurses no longer need to carry the paper file ‘Organ Donor Packs’ with them to donor referrals. Survey results from nurses using the App indicates high satisfaction.

Better use of resources – The timeframe of over 3 hours for document completion has now reduced to 1 hour, saving 766 hours of nursing time per year on paperwork. Highly trained specialist nurses can now spend more time providing care to potential donors and their families, enhancing their carer experience and ensuring donor and family care remains of a high quality, which can improve an end of life experience. Administrative staff no longer need to spend significant amounts of time printing and compiling donor packs and this time saved has been used to provide greater family care including the introduction of a Gold Heart Donor Family Pin, which is presented to the families of those who save lives through organ donation. The team won the ‘Best use of technology to improve the working environment’ award at the Nursing Times Workforce Awards 2018.

Challenges and lessons learnt for implementation

Early and continuous consultative processes are vital for a successful outcome. Input from colleagues outside the specialist nursing workforce, such as Transplant teams and administrative colleagues need to be built in early in a project such as this, to ensure a broader understanding of requirements from the system and the best possible outcomes.

Create an initial business case that incorporates as wide a scope of colleague involvement as possible – through socialising and engaging with nurses directly impacted by the proposal and those who will be recipients of the system created, it should be possible to fully understand the implications of change and build a detailed picture of what is required to succeed.

Find out more

For more information contact:

• Anthony Clarkson, Chief Nurse – Organ Donation and Transplantation, NHS Blood and Transplant, anthony.clarkson@nhsbt.nhs.uk