Transplant 101 Module 10A Social work

Pre-Transplant Evaluations

• Look at readiness for transplant

• suitable - judgemental

• make a plan for people for tranpslant

• expectation that are transplant specific resources for transport to and from hopsital - none

• introudce to the pre and post tx team

Assesment/Evaluation

• come to eval with a support person

• can bring potential donor if they are a support person - will not talk about living donation with living donor person in the room

• use interpreter for language barriers

  

• people are often confused why transplant social work is necessary - dont know what they dont know about tranpslant

• Used to do in person visits for those who are out of province - now that it is virtual - have to get registered with other social work colleges of other provinces

Readiness

• Look at if expetations of transplant are realistic

• willing for informed consent

Readiness for transplant - support

• Some will over or estimate need for support

• executing planned support is importance

Readiness for transplant - adherence

• see that a patient has been nonadherence0 not helpful

• not adherent to med, appointment, treatment

• if ask patient will lie sometimes

• look to see if they can have a frank convo about adherence

• current adherence not a good predictor of future adherence

• memorandum of understanding - lay out terms of adherence for tx in black and white

• Helpful to know what adherence is composed of for support poepl e

Readiness for transplant - coping skills

• how have they dealt with other challenges

• stable relationships are they presen t

• avoidant coping skilsl not good for tx

• map out for what they need for inpatient and outpatien tusport

• open to communicating with team

Readiness for transplant - substance use

• Line between substance use and abuse = poor control, cannot happen

• marijuna is not a contraintradication in kidney tx but is in lung

SIPAT

• tool used at end of visit to asses readiness for tx objectively

• each organs are differnt - transplant follow differs

• psychosocial domains weight differently for differnt organ groups = some may be more hung up on issues like past substance use

Psychiatric screening

• look for suicide risk

• look for stability for psych illness referal to pschy if needed

• hospitalization a trigger

• screen for anxiety and depresison

• how might mental health impact adhernce - plan incase for issue

Powers of Attorney

• think about who they want having this in place in case of bad events

• ensure finnancial life keeps coming

• back to work only if appropriate

Follow up social work care

• introduce them to stuff downstrem

• ask them a lot of questions - listening for health literacy, informed consent

• lots of education

• help them fill in the blanks - understand aspects of their care

Plans for transplant

• come out of assement with plan for transplant

• follow up with patietn many times to get in place

• plan for questions they get called in for interepters and support people if needed

• have a good plan to get to tgh at all hours

• plan for visitors during hospitalization

• figure out if hospitalization triggers trauma or anxiety

Post transplant social work care

• in patient sw - help with discharges that are complex and referals to rehab

• help to organize visits to clinic, labs and tets

• retrun to work - help to return to work for recipients

• support people also may have to take time off

Donor social work team

• conflict of interest in seing both donor and reipeint

• look for any coercion for donatoin

• link to resources

• look at motivation

• help to ensure robust and informed consent

• reiterate program requirements

• anonymous requirements if living donor is anonymous and non directed

Social Work Intervention

• anticipatory grief - some may sturggle with the lack of clearness of whether they will live or dye - recipients prep for both

• inpatient unit - only work with complex uses - can arrange family meetings and refer to toerh team memenrs

• opeate on referal bases post tx- only funded for two years post tx but will see whenever

Transplant pharmacist

• promote safe drug distrinbution for patien

• review drug orders and point out if safety issue comes up- befor nurse given - cannot access by nurs before pharmacist looks at it - encourage nurse to not overrride

• obtain a medication history - use pharmacy record, goverment billing - patient or person redocrd - at least 3 sources

• look for drugs like vancomyocin that have a narrow therapeutic window

• patient and provider education

• determine what meds to be continued during admision in hopsital and what going home on

• second pair of eyes

• identify supports for adherence

Transplant medications

• meds and med aherence critical to success

• meds have narrow therapeutic windo

• patients have other conditions that need to be managed alongside tranpslant - high rate of comorbidities

Drug distribution

• very complex operational system

• has to be a chain of command and safety checkpionts

• pharm tech and drug information team

• clincial pharmicist on floor

• some drugs have storage nees like refrigeration to be met

• pyxis - drug dispenser used by nurse to distribute

• drug aqquition - formulary worked within - how to access outise of formulary

• special access health canada - get drugs for using drug not approved in canada

Review of Medication Orders

• team of 9 inpatient pharmacist to look over patients

• look for therapeutic drug monitoring and issues for drug to drug inteaction

Patient education

• Patients struggle to adjust from dialysis to wrap their mind around having tx

• help patient learn new normal

• self medication program

  • sometimes patietns struggle to understnad how to make a dose change

  • have patients practice taking meds under nurse for the rest of stay

  • practice changing meds for when they go home

• TMITT - virtual patient education platform for tx meds

Discharge planning

• reconcile meds given in hospital and choose which ones going home

• help patient set up dossette or blister pack

• have the only tranplant pharmacy in canada - do blister packing - support patient bring up

Clinical nutrition team

• diffrent dietians for differnt organ groups

• nephrology dietitian - help with patients on dialysis again adjust diet

• diet technician - knows hospital menu - brings food to patients

RD Role

• see patients through tranpslant process

Dietetics before transplant

• lung and liver assesd

• lung is asses as there is a narrow weight range to make the transplant surgery safe

• look at weight history and changes - see if had a lot of weight gain or lost

• look at medical history - concernts like

• food acces and preparation - patients with lung disease cannot go to grocery during covid - can they prep food.

BMI

• healthy bmi - better tranpslant outcome s

• sometimes patients struggle to have enough weight to get thorugh tranpslan t

• help patients eat healthy

Dietetics post op as an inpatient

• low nutrition befor transplant - cannot eat before or after tc - issues with nutrition

• gastroparesis - slow stomach empyting - patients struggle to keep weight on

• getting patients to a point where if tey are on liquid nutrition or an ng tube work with slp to add in oral food safely

Types of nutrition through ng tube

• special one to be usef for renal patient s

After discharge

• nurse will flag patietns with dietitan issues

• sterois increase appetite - patients eat more because they are feeling better

• low physical activity post tx

• low potassium and collestal

• how tomanage blood sugar and vitamin c to stop loss of bone

• support food safety as it can be really bad for patients

Food safety

• avoid unpasteruex milk or yogurt

• no runny eggs, soft chese or raw sprouts