Joshua Medow MD, MS Christopher Nickele MD, Christy Hunter,RN,CCRN, Patricia Chesmore,RN,CCRN, Tammy Kundinger,RT, William Tanke,PharmD, Gabriel Norgaard,BS, Tony Frey,BS Doug Miller Symposium April 25, 2013 USING THE ELECTRONIC MEDICAL RECORD TO MAXIMIZE PRACTICE EFFICIENCY IN ORGAN DONATION
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Joshua Medow MD, MS Christopher Nickele MD, Christy Hunter,RN,CCRN, Patricia Chesmore,RN,CCRN, Tammy Kundinger,RT, William Tanke,PharmD, Gabriel Norgaard,BS,
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Joshua Medow MD, MS Christopher Nickele MD, Christy Hunter,RN,CCRN, Patricia Chesmore,RN,CCRN, Tammy Kundinger,RT,
William Tanke,PharmD, Gabriel Norgaard,BS, Tony Frey,BS
Doug Miller Symposium
April 25, 2013
USING THE ELECTRONIC MEDICAL RECORD TO MAXIMIZE PRACTICE EFFICIENCY IN
ORGAN DONATION
DISCLOSURE
• The authors of this presentation have no financial or ethical conflicts to disclose
OUTLINE
• Efficiency
• The use of protocols
• Abilities of the EMR
• Order sets to increase efficiency
• Other avenues to increase efficiency
DEMANDS ON TIME
OR ER
ICU
Documentation
Outpatient Calls
General Care
PROTOCOLS
• Nursing care
• Physician input up front
• Triggers for call to physician
• Requires nursing to implement
• Computerized protocols versus paper1
1. J Burn Care Res. 2011 ; 32(2): 246–255. doi:10.1097/BCR.0b013e31820aaebf
THE TEAM
• Neurocritical Care
• Physician
• Nursing
• Respiratory Care
• Pharmacy
• Hospital IT
BRAIN DEAD DONOR (BDD)
• Optimizing care
• Critical care team efficiency
• Managing parameters / metric driven
DONATION AFTER CARDIAC DEATH (DCD) DONOR
• Donor comfort
• Optimizing care
• Critical care team efficiency
• Managing parameters/metric driven
PROTOCOLS – BDD LUNG PROTECTIVE
PROTOCOLS – DCD LUNG PROTECTIVE
PROTOCOLS – VASOACTIVE ALGORITHM
PROTOCOLS – VASCULAR VOLUME MAINTENANCE1. Obtain weight in kg
2. If weight is > 20 kg skip to step 5
3. If weight is > 10 kg skip to step 7
4. Multiply weight by 4 and skip to step 10
5. Subtract 20 from weight
6. Add 60 to result and skip to step 10
7. Subtract 10 from weight
8. Multiply result by 2
9. Add 40
10. This is the rate to maintenance (.9ns+20k.) IVF at
PROTOCOLS – VASCULAR VOLUME MANAGEMENT1. Obtain CVP every 2 hours
2. If CVP > 6 go to step 8
3. Multiply (7 – CVP) by 5
4. Multiply the value in step three by the weight in Kg
5. Round up to nearest 10 ml. Do not exceed 2000 mL
6. Give .9 NS at 1000 mL/hr until calculated volume is reached
7. Go to step 1
8. If CVP is < 13 go to 1
9. Give lasix 40 mg every 6 hours prn for CVP > 12
10. Go to step 1
PROTOCOLS – FREE WATER DEFICIT CORRECTION1. Obtain serum sodium.