Donor Action (DA) is an international initiative that helps intensive care units (ICUs) improve donation. Existing best practices from around the world have been incorporated into this quality assurance program. Following a validated diagnostic review, areas of weakness in donation practices are identified and the appropriate changes introduced. Corrective measures have been developed in the form of five “core” program modules which correspond to critical steps in the donation process and can be used together or alone according to specific identified needs. Medical records review (MRR) and hospital attitude surveys (HAS) were performed in 11 ICUs in Spain (2), The Netherlands (2), the United Kingdom (1), and Canada (6). Baseline data were gathered on the units potential for donation, staff attitudes toward donation, and self-reported skills/confidence in performing a range of donation roles. Analysis of these data were used to customize the program to individual ICU requirements. MRR data from 579 cases showed a 69% (398) potential for donation from which only 31% (124) were realized. Detection and management failures (166; 42%) and refusal to donate (104; 26%) were the major reasons for loss of potential donors. The HAS returns from staff (2,129) showed consistently strong perceptions that organ donation saves lives (97%). Support for donation (94%) and willingness to donate their own organs (79%) were high in all country samples. Ratings of skills/confidence were highest for comforting the family (70%), with much lower comfort levels reported on explaining brain death (44%), introducing organ donation (38%), and presenting a family with the option for donation (31%). Following introduction of the appropriate program modules, a sustained (2–year) effect of a 33% increase in donation rates is demonstrated. The Donor Action HAS and MRR are useful tools in identifying problems within the donation process and lead to the introduction of improvement strategies integral to the Donor Action program that result in an increase in organ donation.
Implementation and maintenance of a pain management quality assurance program at intensive care units: 360 degree feedback of physicians, nurses and patients