A service improvement to normalise conversation regarding cornea donation within a hospice inpatient unit between the healthcare professional, patient and those close to them

ABSTRACT

BackgroundCornea donation is regarded as a positive act which can potentially improve the quality of life of another person by restoring their sight (Willis & Draper, 2012. Int J Palliat Nurs. 18 5;Madi-Segwagwe, Bracher, Myall et al., 2021. Palliat Med Rep. 2 175). The compatibility of cornea donation to palliative care is well documented, however, barriers become evident when considering communication regarding donation between health care professionals and service users. Barriers include lack of knowledge;fear of distress and lack of confidence. The absence of such communication resulting in a lack of patient knowledge, choice and opportunity, also fails to support the current cornea shortfall (Carrigan, Deane & Brady, 2018. BMJ Support Palliat Care. 8 A46;Madi-Segwagwe, Bracher, Myall et al., 2021;National Health Service Blood and Transplant, 2019;Willis & Draper, 2012).AimsTo introduce a service improvement which will normalise discussions regarding cornea donation with suitable donors within a hospice inpatient unit. Development of staff knowledge will support the improvement as this communication becomes part of Advance Care Planning (ACP) (Rietjens, Sudore, Connolly, et al., 2017. Lancet Oncol. 18 543), allowing patients the opportunity to make an informed choice, supporting their autonomy.MethodApril-July 2021 Service evaluation, literature review, networking National Health Service Blood and Transplant (NHSBT), training material development, patient information leaflet produced, data codes identified for audit/evaluation. June – July 2021 staff training and support. July – November 2021 launch of cornea conversations with donor appropriate patients. Monthly feedback NHSBT. December 2021 evaluation.ResultsJuly - November (inc.) 2021 = 121 patients admitted donation suitable. 29 conversations conducted, 22 patients consented donation (76%). 21 referrals made to NHSBT after patient death. 15 eye retrievals conducted at the hospice. Positive staff feedback regarding conversations with patients. Patients were not upset by the conversation.ConclusionImprovement evaluation identifies positive results including cornea conversation engagement, enabling patient choice, supporting patient legacy, enhancing cornea resources and restoring recipient sight. The COVID-19 pandemic heightened workplace pressures during implementation which was considered to impair overall performance. Use of the Plan, Do, Study Act cycle will support further project enhancement.Innovation/interest of this project?This project is vital considering the positive outcomes for the donor and the recipient of both cornea donation and transplantation (keratoplasty). Keratoplasty, considered the world’s most frequently performed transplantation, holds a high success rate, however, a dilemma presents considering the most frequently performed transplantation carries the highest donor refusal rate (NHSBT, 2021).