Evidence Bulletins: Bringing Evidence-Based Recommendations on Donor Management to the Bedside
CCCF ePoster library. Arora S. Nov 7, 2018; 233402; 29 Disclosure(s): Department of Medicine, McMaster University Hamilton Health Sciences RFA Strategic Initiatives Program Canadian Blood Services Kenneth J. Fyke award Canadian Institutes for Health Research
Dr. Samantha Arora
Dr. Samantha Arora
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Abstract
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Introduction: The need for donor organs exceeds supply. Nationally, 4,492 people were on Canada’s organ transplant waitlists in 2016. Unfortunately, 260 patients on waitlists that same year died before receiving transplants. The majority of organ donors are deceased donors, donating through either neurologically deceased donation or controlled donation after cardiac death. Since both of these donation categories involve life-sustaining therapy, deceased donor management is primarily the purview of the intensive care clinician. In 2016, Canada had a deceased donation rate of 20.1 per million population, ranking 19th among 68 countries.



Multiple organizations, including the World Health Organization, have highlighted the need for research to advance donor management in order to increase supply. In addition to the need for further research, however, there is also a paucity of tools to help clinicians provide optimal donor care. Such tools could have a significant impact on donation rates, since there is currently significant variability in how donors are managed across the country. This is despite research suggesting that best practice in the management of potential donors increases organ yield per donor.





Objectives: The objective of this knowledge translation initiative was to develop attractive, user-friendly, bedside tools to educate ICU clinicians about current Canadian practices and recommendations in deceased donor care.

 

Methods: We identified topics of interest through focused groups, and a self-administered survey of members attending a 2016 scientific meeting of the Canadian Critical Care Trials Group (CCCTG). Following this, we performed dedicated literature searches and systematic reviews. We utilized Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) for assessing the quality of the evidence. Recommendations arrived at using this GRADE-focused approach were cross-referenced to the most recently published Canadian recommendations for deceased donor care (2006). Each one-page Evidence Bulletin (EB) addresses a single treatment in the management of deceased organ donors.  Designed in collaboration with a communication designer, each EB summarizes (1) current recommendations and (2) the evidence underlying these recommendations, (3) highlights tips for clinical applications, and (4) provides data on current practices in 34 Canadian hospitals, as recorded in an observational study of the Canada DONATE Research Program. Future steps for this knowledge translation initiative will include formal needs assessments and feedback through bedside testing, as well as through surveying of the CCCTG and provincial donation experts.

 

Results: Sample evidence bulletins are attached as electronic copies and cover 5 of 10 selected topics: corticosteroid therapy, thyroid hormone supplementation, high-dose heparin administration, lung protective mechanical ventilation, and vasopressin therapy. Their final form is as a set of laminated cards bound together by a ring at the top left corner, for easy referral at the bedside while caring for deceased organ donors.

 

Conclusions: Evidence Bulletins are a new and potentially useful tool for distilling complex clinical information for rapid uptake and application at the bedside.

 


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