/policies/,/policies/administrative/,/policies/administrative/uwhc/,/policies/administrative/uwhc/department-specific/,/policies/administrative/uwhc/department-specific/transplant/,/policies/administrative/uwhc/department-specific/transplant/transplant---solid-organ/,

/policies/administrative/uwhc/department-specific/transplant/transplant---solid-organ/316.policy

201605137

page

100

UWHC,

Policies,Administrative,UWHC,Department Specific,Transplant,Transplant - Solid Organ

Management of Patients During Inpatient Stay and Discharge – Abdominal Transplant (3.16)

Management of Patients During Inpatient Stay and Discharge – Abdominal Transplant (3.16) - Policies, Administrative, UWHC, Department Specific, Transplant, Transplant - Solid Organ

3.16



POLICY & PROCEDURE
Effective Date: February 2012
Revised Date: March 2016
Title: Management of Patients During Inpatient
Stay and Discharge – Abdominal Transplant Policy Number: 3.16

Page 1 of 4
I. PURPOSE

The purpose of this policy is to provide standards of care for multidisciplinary team to ensure that
transplant patients are being managed with a consistent, high level standard of care, and that
discharge criteria are met prior to the patient being discharged from the hospital.

II. POLICY

It is the policy of the UW Transplant program to adhere to the University of Wisconsin Hospitals &
Clinics (UWHC) standards of patient care, as well as the standards determined by regulatory and
accrediting agencies, such as The Joint Commission, the Organ Procurement and Transplantation
Network (“OPTN”) and the United Network of Organ Sharing (“UNOS”), and the Centers of Medicare
and Medicaid Services (“CMS”).


III. PROCEDURE
The involvement of multidisciplinary staff occurs per Policy 3.39 Multidisciplinary Patient Care -
Abdominal.
A. Upon admission to the Transplant Unit:
1. The registered nurse will :
A. Complete nursing assessment in patient electronic medical record (HealthLink).
B. Perform preoperative care per physician orders for patients admitted prior to
surgery.
C. Begin patient and family education regarding surgery and post-transplant care
2. The Intern/Resident or Advanced Practice Provider (“APP”) will:
A. Complete patient history and physical
B. Discuss surgical procedure with patient and complete consent process for patients
admitted prior to surgery.
3. The attending surgeon will:
A. Discuss plan of care with intern/resident or APP.
B. Sign off on intern/resident or APP admission history and physical.
4. The unit pharmacist will:
A. Complete a medication history assessment
B. Complete a medication admission history.
5. The dietitian will complete a nutrition assessment, if time permits prior to surgery.
6. The social worker will participate in the initial assessment, care planning, and discharge
planning.



POLICY & PROCEDURE
Effective Date: February 2012
Revised Date: March 2016
Title: Management of Patients During Inpatient
Stay and Discharge – Abdominal Transplant Policy Number: 3.16

Page 2 of 4
B. During the Hospital Stay following the transplant surgery:
1. Following the transplant surgical procedure, the registered nurse will:
A. Perform post-operative care per physician orders, including monitoring intake and
output and vital signs.
B. Initiate actions to ensure individualized interventions to promote pain prevention
and/or relief. Patients’ pain and comfort level is assessed per UWHC Policy 8.76.
C. Teach patient/family re: post-op care and specific transplant instructions and give
patient home care binder.
D. Perform nursing assessments
E. Document patient assessments and patient education in electronic record.
2. Following the transplant surgical procedure, the Intern/Resident or APP will:
A. Complete assessments and update progress note daily.
B. Write orders to guide patient care.
C. Discuss patients’ care with attending surgeon.
3. Following the transplant surgical procedure the attending surgeon will discuss daily plan of
care with intern/resident or APP.
4. Following the transplant surgical procedure the unit pharmacist will:
A. Perform patient and family education regarding medication.
B. Perform medication reconciliation
5. Following the transplant surgical procedure, if patient was not admitted prior to surgery the
dietitian will complete a nutrition assessment
C. Each patient will receive the following standard of care during their transplant inpatient stay:
1. Daily Rounds: Daily rounds are performed by the multidisciplinary team for assessment and
evaluation of all abdominal transplant patients to evaluate their current condition of health
and to document the patient care. Each day, Monday through Friday, morning working
rounds are conducted with the multidisciplinary team which may include attending,
transplant fellow, intern, resident and/or APP along with representatives from nursing, case
management and social work, pharmacy, and nutrition. Rounds are then performed again in
the afternoon with the multidisciplinary staff, including the transplant physicians and
surgeons, pharmacy, nursing, etc., and patient participation is also encouraged. The
multidisciplinary afternoon rounds are conducted daily, with the exception of liver rounds,
which are conducted two-three times per week. Content of rounds is communicated to
transplant coordinators via the case managers. On the weekends, rounds are performed
only once daily.
2. Progress Notes: The APP or intern/resident updates the progress notes in the patient
medical records daily. The attending surgeon will sign off on these notes.



POLICY & PROCEDURE
Effective Date: February 2012
Revised Date: March 2016
Title: Management of Patients During Inpatient
Stay and Discharge – Abdominal Transplant Policy Number: 3.16

Page 3 of 4
3. Coordinated Care/Discharge Plan: Coordinated care case management team completes a
discharge planning assessment and discharge plan and documents in the electronic medical
record.
4. Patient Care Plan: The multidisciplinary team updates and maintains the interdisciplinary
plan of care in the electronic medical record.
D. Discharge Process:
1. In the discharge phase, the registered nurse will
A. Complete patient and family education and documentation of education.
B. Provide discharge instructions to patient and family.
C. Complete discharge documentation.
D. Work with case management, nutritionist, pharmacist, social work, and physicians to
organize post discharge care.
2. In the discharge phase, the intern/resident or APP will:
A. Write discharge orders.
B. Provide discharge instructions to patient and family.
C. Work with nursing, case management and social work to organize post discharge
care.
3. In the discharge phase, the attending surgeon will discuss plan for discharge with the
intern/resident or APP.
4. In the discharge phase, the unit pharmacist will:
A. Complete medication reconciliation.
B. Provide patients will a medication list of current medications upon discharge.
C. Complete patient and family education regarding medications.
5. In the discharge phase, the dietitian will assess diet tolerance and recommend discharge
diet.
6. In the discharge phase, the social worker will assist in discharge planning needs.
7. In the discharge phase, the post-transplant coordinator will provide and document
supplemental discharge teaching and confirm that the patient attended the appropriate
educational sessions.
8. Prior to discharge, the below criteria must be met:
A. Progression in recovery to a level where the patient can be managed in the
outpatient setting
B. Patient caregiver / support person has demonstrated proficiency with self-
medication.
C. No signs of untreated infection or active bleeding
D. Stable or improving allograft function
E. Tolerating diet
F. Appropriate bowel function



POLICY & PROCEDURE
Effective Date: February 2012
Revised Date: March 2016
Title: Management of Patients During Inpatient
Stay and Discharge – Abdominal Transplant Policy Number: 3.16

Page 4 of 4
E. Refer to UWHC Patient Care Policy 14.12 Discharge of the Patient for further details on the
discharge process.

IV. COORDINATION

University of Wisconsin Transplant Program

V. REVIEWED AND APPROVED BY

Kidney Transplant Manager
Liver and Pancreas Transplant Manager
Operations Director

VI. SIGNED BY


________________________________ _________________________________
Jill Ellefson, MBA Dixon Kaufman, M.D., PhD
Director, Organ Donation and Transplant Service Line Chair, UW Transplant Program