A federal requirement enacted in 1998 requires facilities to report deaths to the regional organ procurement organization (OPO). This regulation was enacted so that no potential donor would be missed. The regulation ensures that the family of every potential donor will understand the option to donate.
Collection of most organs, including the heart, liver, kidney, and pancreas, requires that the patient be pronounced brain dead but kept physically alive until the organs are harvested. Tissue, such as eyes, skin, bone, and heart valves, may be taken after death.
The nurse should follow the facility’s policy for identifying and reporting a potential organ donor. Contact the local or regional OPO when a potential donor is identified. Typically, a specially trained person from the regional OPO will speak with the family about organ donation. The OPO coordinates the donation process after a family consents to donation.
Essential Documentation
Documentation will vary depending on the role of the nurse and the stage of the organ donation process. Separate documentation for each stage must be done. The date and time of each note must be recorded. The date and time that the patient is pronounced brain dead and the health care provider’s discussions with the family about the prognosis must be included in the documentation. (See “Brain death”, pages 49 to 51.) If the patient’s driver’s license or other documents indicate the patient’s wish to donate organs, the nurse must place copies in the medical record and document that it was done. The individual who contacts the regional OPO must document the conversation, including the date and time, the name of the person contacted, and instructions given. If the bedside nurse was part of the discussion about organ donation with the family, the nurse documents who was present, what the family was told and by whom, and their response. Document the nursing care of the donor until the time of transfer to the operating room for organ procurement. Document teaching, explanations, and emotional support given to the family.
Organ Donation
11/12/2019
0900
PATIENT TEACHING: At 0815. Dr. A. Silverstone explained to the family of Peter Hubbard that the patient was brain dead and the prognosis. Mary Hubbard, wife; Ron Hubbard, son; Mary Rundell, daughter; and Patty Fisher, RN, bedside nurse, were present. Family asked about organ donation. Wife stated, “My husband has spoken about donating his organs if this type of situation ever occurred.” Patient’s driver’s license confirms patient’s request for organ donation. Copy of license placed in Peter Hubbard’s medical record. Dr. Silverstone explained the criteria for organ donation and the process to the family. Mrs. Hubbard stated “she would like more information from the regional organ procurement organization (OPO).” OPO was contacted by Patty Fisher, RN, at 0830, and the intake information was taken by Rhonda Tierney, RN. ________________________________________________
NURSING INTERVENTION: Appointment made for today at 1000 for OPO coordinator to meet with family in conference room on nursing unit.
PATIENT/FAMILY TEACHING: All family questions were answered and emotional support provided. Chaplain paged per family request. _________________________________________________ Patty Fisher, RN
OSTOMY CARE
An ostomy is a surgically created opening used to replace a normal physiologic function. Ostomies are used to facilitate the elimination of solid or liquid waste or to support respirations if placed in the trachea. The type and amount of care an ostomy requires depend on the output and location of the stoma. The nurse is responsible for providing ostomy care and assessing the condition of the stoma. Provide patient and family teaching regarding ostomy and peristomal skin care. The nurse may also need to help the patient adapt to the care and wearing of an appliance while helping with acceptance of a change in body image.
Essential Documentation
Record the time of ostomy care. Describe the location of the ostomy and the condition of the stoma, including size, shape, and color. Chart the condition of the peristomal skin, noting any redness, irritation, breakdown, bleeding, or other unusual conditions. Note the character of drainage, including color, amount, type, and consistency. Record the type of appliance used, appliance size, and type of adhesive used. Document patient and family teaching, describing the teaching content. Record the patient’s response to self-care, and evaluate learning progress. Some facilities use a patient-teaching record to document patient teaching.
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