Checklists

Candidates Evaluation

Transplant indications and candidacy

Etiology

Signs and symptoms of organ failure

Organ failure managements

Complication of organ failure managements

Etiology specific other organs problems

MELD Score

EPTS

CPRA

Potential living donor

Mental status assessment

Stroke risk assessment

Cardiac evaluation

Pulmonary evaluation

Blood clotting disorders evaluation

Other systems evaluation

Arterial calcification (CT- non contrast)

Aberrant arteries (CT, MRI)

Iliac veins patency (US with doppler, CT venography, MR venography)- if needed

Portal vein thrombosis (US, CT, MRI)

Frailty assessment

Smoking, alcohol and drugs

Social worker evaluation

Psych evaluation

Pharmacy evaluation

Nutritionist evaluation

Finance evaluation

Tests, imaging, and other stuff

Consulting Candidates

Risks and benefits

Goals and expectations

Different types of organs

Pre-op education

Smoking, alcohol and drugs

Consents

Organ Transplantation

High KDPI kidneys

PHS increased risk organs

HCV positive organs

Anti-HBc (+) organs

Admission

OR scheduler

Book OR case

Not needed for deceased donor organs. Arrangements are already in place for deceased donor transplantations.

OR case order

• Date and time

• Immunosuppressive medications

• Thymoglobulin vs. Campath vs. Basiliximab vs. none

• Pre-medications for induction agent

• Preop antibiotics

• Hepatitis B immune globulin, if needed.

• Blood products (pRBCs, PLTs, and FFP)

• Others

Admission center

Bed request

Admission orders

• Routine admission orders, tests, EKG, CXR

• NPO

• COVID-19 test

• Pregnancy test

• HLA antibodies and cross match

• Blood products (pRBCs, PLTs, and FFP)

• Consult Nephro and/or Hepatology

History and physical exam

Consent(s): Transplant, additional procedures, PHS increased risk donor

Other Considerations

Make sure:

• There is no fever

• There is no new stroke, chest pain, heart attack, arrhythmias, shortness of breath

• There is no new SBP, or other active infection(s)

• Na, K and other electrolytes are OK

• Pregnancy test is negative

• New EKG and CXR are OK

• Anticoagulation has been addressed

• Diabetes has been addressed

• Steroids have been addressed

• Peritoneal dialysis solution has been emptied

• Team is aware of presence and locations of portal vein thrombus, TIPS, and aberrant arteries

• Nephrology and/or hepatology are informed

• HLA and cross match tests have been sent

• Pre-op dialysis is planned, if needed

Post-op

Add the patient to the list.

Add a problem list for this admission, if not done already.

Orders

Patient status

Inpatient

Bed Type

Regular/ Surgical Telemetry / ICU

Diagnosis or S/P

Universal Patient Care Orders

Resuscitation

Nursing

Telemetry

Vital signs

Monitor SpO2

Input and output (I & O)

Drains

Notify MD setting

Daily weights

Oral Care Protocol

Activity

Bed rest /Up to chair with assistance/ Ambulate with assistance

Oxygen Supplement

Incentive Spirometer

Urinary Catheter: Foley to gravity

NG Tube

Wound Care

Nutrition / Diet

NPO

Ice chips

Clear liquids

Full liquids

Regular

Glucose Monitoring

Glycemic Control Order Set

Hypoglycemia Protocol

One Time Labs

AM Labs

Tacrolimus levels

Imaging

IV Fluids

Electrolytes Management

Address each electrolyte according to its level.

DVT Prophylaxis

Compression stockings (TED hose)

Pneumatic compression device

Enoxaparin (Lovenox) / Heparin

Antibiotic prophylaxis

Per policies

GI bleeding prophylaxis

Famotidine (Pepcid): 20 mg, IV / PO, bid

Pantoprazole (Protonix): 40 mg IV / PO daily or bid

Immunosuppressives

Thymoglobulin or Basiliximab

Next dose(s) per polices and/or labs

Steroids

Taper per policies

Tacrolimus

Adjust per level and polices

Mycophenolate

Dose per policies.

ID Prophylactic Medications

Trimethoprim-sulfamethoxazole

Valganciclovir

Nystatin

Start per policies and/ or labs.

Pre-op Meds Reconciliation

Others:

CPAP

If patient was on it before surgery.

Pre-op Coordinator Communication

You need to receive the following information from the coordinator:

Patient name and MRN

DBD vs DCD

PHS increased risk organ

Patient ETA to hospital

Recipient OR time

Recipient surgeon

Discharge

Case Manager or Discharge Planner

Assign a case manager or discharge planner to the patient, if not already.

Discharge Planning

Include the patient and family in the discharge planning.

Patient's Discharge Checklist and Booklet

Will be taken care of by patient advocate, nurse, discharge planner, and physician.

Education

Educate the patient and family about the patient’s condition, the discharge process, and next steps.

Explain tests results.

Go over stuff patient needs to do at home.

Go over medications.

Explain warning signs and problems.

Explain when patient should contact.

Pharmacist teaching

Wound care teaching

Foley, JP, and other tubes or drains teaching

Diabetes teaching

Care Transition From Hospital to Another Facility

Home-based Care

Special Equipment Needs

Coordinate home-based care and special equipment needs.

Diabetes Supplies:

Glucose meter: Accu-Chek

Blood Lancets

Diabetic Test Strips

Follow-up Appointments

Will be taken care of by patient advocate, nurse, discharge planner, and physician.

Discharge Order

Medication Reconciliation

Reconciled Medications Review by Pharmacy

Discharge Instructions

Hospital Contact Person

Write the name, position, and phone of the hospital person to contact if there is a problem after discharge.

Discharge Summary

Outpatient Investigations : Labs

Post-discharge Follow‐up Phone Call

Arrange for post-discharge follow‐up phone calls.

EPIC Discharge Workflow

Steps:

1- Admission/Discharge/ Transfer (ADT) Navigator

2- Discharge Tab

Click on it. Then while inside this tab, follow as below:

1- Problem List subtab

Add problems if not done already.

Choose one of the problems as principal problem for this hospitalization.

2- Follow-Up subtab

Internal follow-up appointments can be added here, if not done already during the hospitalization.

3- Patient Instructions subtab

Place your instructions here if your department does not have a special instruction section in discharge order set. If there is such a segment in discharge order set, MD who is discharging the patient can put instructions there. Other teams would put instructions here.

4- Med Rec/Orders subtab

A- Reconcile medications

B- New orders

Appointment requests are made here, if not done already on the floor.

C- Discharge Order Set:

Notice: You need to place following orders or instructions separately, if your department does not have this order set.

1- ADT (Admission/Discharge/Transfer) : Discharge patient

2- Notify

3- Activity

4- Diet

5- Special instruction

6- Other orders, per department preferences

D- Summary- Review all orders before signing them.

E- Discharge pharmacy: Send meds to discharge pharmacy. Print and sign narcotics.

F- Sign

5- Preview AVS- Preview After Visit Summary

6- Discharge summary: write discharge note here.