Initial Utilization of an Electronic Medical Record Living-Donor Kidney Transplant Preoperative Checklist.

Abstract

Purpose: We created an electronic medical record(EMR) living-donor kidney transplant(LDKT) preoperative checklist used to enhance patient safety and prevent “never” events such as transplant with incompatible (ABO)blood type, positive (XM)cross match, infectious disease(ID) transmission, or an anatomically inappropriate kidney. Methods: Recipient preoperative EMR checklists from September 2011 deployment until present were retrospectively reviewed. The checklist included both recipient and donor information: demographics, ABO, XM / panel reactive antibody(PRA) results, ID status(Hepatitis B, Hepatitis C, Human Immunodeficiency Virus), and kidney anatomy(laterality, arteries, veins, ureters). Attestation statements acknowledging compatibility in each domain were required. The checklist used auto-populated recipient data directly from the EMR and donor data manually entered from source documentation. This ensured critical review of source documentation and facilitated identification of incompatibility by the recipient surgeon. Checklists were completed 1-7 days pre-transplant. Completion rates of the entire document and individual sections were assessed. Results: A total 157 LDKT checklists were reviewed. Mean recipient age was 48.4 years with 56.6% male and 43.5% female. Checklist completion rate was 87.9% across 5 surgeons. All completed checklists contained recipient ABO while 5.1% lacked donor data, but 98.6% noted ABO compatibility. Similarly, XM results were omitted in 7.2% of checklists(up to 18.1% lacked virtual PRA data) but overall XM was acceptable in 93.5% with 1 erroneously noting incompatibility. Risk of ID was completed in all but 6.52% of checklists while 98.5% were deemed acceptable. Anatomic details were present in all but 3.6% of checklists with only 1(paired donor organ from another hospital) not confirming donor and recipient surgeon discussion. The checklist identified 1 instance of inadequate ID screening, which cancelled transplantation 1 day pre-operatively. No “never” events occurred. Conclusions: This novel EMR-based preoperative LDKT checklist enhanced patient safety by preventing “never” events. It operated by facilitating critical review and referencing of source documentation to confirm ABO, XM, ID risk, and anatomic organ compatibility. It is easy to use with high compliance rates and is available to all healthcare team members. Further means to ensure completeness and 100% compliance are being evaluated.