Database Requirement Notes from IQ

Typed up notes from a document used by IQ as the basis for looking for a system to procure.

General

To be used by:

1. Surgical Team
2. Recipient Coordinators
3. Living Donor Team
4. Small bowel Team
5. Pancreas Specialist Nurses
6. Vascular Access nurses
7. Transplant Clinic
8. Anaesthetists
9. Pharmacists
10. Dieticians
11. Researchers
12. Tissue Typing
13. Psychologists

Should produce reports for:

1. NHSBT
2. Collaborative Transplant Study
3. Renal Registry

Recipient Assessment

1. Correspondence
2. Referral Letter
3. Surgical Assessment
4. Further correspondence
5. Nurse notes/emails
6. Clinical Assessment
7. Name of surgeon assessing patient
8. Present history
9. Past medical history
10. Drugs and allergies
11. Social history
12. Examination
13. Compliance
14. Virology
15. CMV
16. EBV
17. Cardiac Assessment
18. MPS
19. ECHO
20. Angio
21. Cardiac MDT
22. Diabetes
23. DM type
24. Date of diagnosis
25. 24 hour insulin dose
26. Pump or sensor
27. Complications - (Peripheral Neuropathy, Autonomic Neuropathy, Hypoglycaemic unawareness, Retinopathy, gastroparesis)
28. Renal
29. Type of dialysis
30. Native output
31. Ureteric reflux
32. Outflow obstruction
33. UTI
34. Vascular access
35. Type of fistula
36. Intervential radiology
37. Anaesthetic assessment
38. Tissue Typing
39. HLA Type
40. Blood group
41. Date of activation on waiting list
42. Screening information (calculated reaction frequency %)
43. Previous transplant offers
44. Other investigations
45. CXR
46. CT
47. Lung function tests
48. Duplex
49. Listing meeting
50. Names of doctors present
51. Issues discussed
52. Concerns
53. Further investigations required
54. Decision

Cadaveric Donor Assessment

1. All information from EOS
2. Follow up information from EOS regarding other organs from the same donor

Retrieval Data

1. HBD/NHBD
2. Retrieval Team
3. Surgeon's Name
4. Organs retrieved
5. Perfusion solution
6. Retrieval times
7. Damage
8. Quality of perfusion
9. Machine perfusion
10. NORS database

Living Donor Assessment

1. Referral letters and all correspondence
2. Surgical Assessment
3. Investigations

Transplant

1. Back table
2. Operation details
3. Anasomosis times
4. Calculated CIT
5. Calculated WIT
6. Automatic operation note with extra free text
7. Post operative instructions
8. Stent
9. Perfusion culture

Post-operative Curse

1. Duplex scan
2. DGF Y/N
3. Rejection - Y/N, Date
4. Biopsy - Date, Histology report/result
5. Blood transfusion - Date, number of units
6. TEGS
7. Anticoagulation
8. Drains
9. Y/N
10. Culture
11. Chemistry
12. Date removed
13. Antibiotics
14. Length of hospital stay
15. Length of ITU stay
16. Re-admissions to ITU
17. Complications
18. Infections
19. Re-operations
20. Collections
21. Interventional radiology
22. Medication during admission and on discharge
23. Discharge summary automatically generated

Transplant Clinic

1. Date
2. Doctor/nurse
3. Weight
4. Blood pressure
5. BMs
6. OGTT
7. Complications
8. Graft dysfunction
9. Medication

Re-admission

1. Complications
2. Operations

Labs results

1. Biochemistry
2. Drug levels
3. Haematology
4. Coagulation

Graft Function

1. Graft Failure
2. Date of failure

Alerts

1. Stent
2. Missed follow-up
3. Tacrolimus levels outside set range
4. CMV
5. BKV PCR

Page 7: Diagram 1

Page 8: Diagram 2

• AR = Acute Rejection
• TEGS = Thromboelastograms
• OGTT = Oral Glucose Tolerance Test
• DGF = Delayed Graft Function
• OPA = Out Patients Assessment
• TT = Tissue Typing

Page 9: Diagram 3

• CxR = Chest X-Ray
• HNI = Histocompatibility and Immunogenetics

2: Surgeon Assessment

Diabetes

• Year/age diagnosis
• Type I / II / Mody (Mature Onset of Diabetes of the Young)
• Insulin dose - total units
• Hypos Y/N
• Awareness / Unawareness
• Frequency of hypos
• Complications

Neuropathy

• Peripheral Y/N
• Extent - Hands / Feet / Lower legs / Thighs
• Wheelchair Y/N
• Autonomic Y/N
• Vomiting Y/N
• Frequency
• Nausea
• Diarrohea / Constipation
• Gastric pacemaker Y/N

Vasculopathy

• Y/N
• Amputations Y/N
• Extent
• Ulcers Y/N
• MI Y/N (Myocardial Infarction)
• Stroke Y/N
• Clauidication Y/N
• Distance

Retinopathy

• Y/N
• Laser Y/N
• Number
• Surgery
• Stable / Unstable
• Regular Follow Up
• Research Link

Nephropathy

• Y/N
• Cause of renal failure
• Polycystic Kidneys - UTIs Y/N; Bleeds Y/N; Large kidneys Y/N; Previous nephrectomies
• Lupus - Antibodies Y/N; Previous thrombotic events: DVT's / Pulmonary Embolism / Miscarriage / Recurrant thrombosis of AVF; Previous treatment
• FSGS (focal segmental glomerulo sclerosis) - Fulminant; Recurrance; Type of treatment
• Biopsy proven Y/N
• Predialysis / dialysis
• (Estimated) start day
• HD (hemodialysis)
• Access type
• Problems Y/N
• HD days
• PD (Peritoneal Dialysis)
• Catheter inserted where?
• Previous peritonitus
• Exit site R/L
• Urine output volume
• Previous UTI Y/N
• Frequency UTIs
• Date of last UTI
• Renal stones
• Reflux
• Outflow obstruction symptoms
• Nocturia Y/N + Number
• Frequency Y/N + Number
• Hesitancy
• Dribbling

Previous Transplant

• Tx Type
• Date of Tx
• Reason for failure
• Previous donor TT
• Previous immunosuppresion

Past Medical History

• Cardiac
• Respiratory
• GI (Gastro Intestinal)
• GU (Genitourinary)
• Surgical
• Gynaecological

Current Drugs

Allergies

Sensitising events

• Tx
• Pregnancies
• Blood transfusions

Social History

• Employment Y/N
• Job
• Disable Y/N
• Wheelchair bound
• Registered Blind
• Lives with family / alone
• Family numbers
• Relatives / friends close by
• Smoker Y/N
• CPD (number per day)
• Alcohol
• Number units
• Other recreational drugs

Examination

• CVS (Cardio Vascular System)
• RS (Respiritory System)
• Abdomen
• Pulses
• Fistula
• Hands
• Teeth

Decision to list

Generate Template Letter

3: Listing Meeting

• List of people present
• Further investigations
• Concerns and name of those with reservations
• Decision to list Y/N

4: Annual Review

...and Report / Letter Tissue Typing (about sensitisation status and calls)

Diabetes

• Insulin dose
• Hypos
• Awareness / Unawareness
• Frequency of hypos

New changes in complications...

Neuropathy

• Peripheral Y/N
• Extent - Hands / Feet / Lower legs / Thighs
• Wheelchair Y/N
• Autonomic Y/N
• Vomiting Y/N
• Frequency
• Nausea
• Diarrohea / Constipation
• Gastric pacemaker Y/N

Retinopathy

• Y/N
• Laser Y/N
• Number
• Surgery
• Stable / Unstable

Vasculopathy

• Y/N
• Amputations Y/N
• Extent - Toes; Forefoot; BKA (Below Knee); AKA (Above Knee);
• Ulcers Y/N
• MI Y/N
• CVA (stroke) Y/N <-- system alert need or carotid duplex
• Stroke Y/N
• Clauidication Y/N <-- system alert - lower limb & iliac duplex
• Distance
• Admissions during last year
• Transfusion or possible sensitisation events
• New problems

Social History

• Any changes?

Examination

Investigations

Decision

• Remain on waiting list
• Suspend
• Remove from waiting list

5: Call / Selected for Transplant

• Not attended
• Unwell
• No transport
• Unable to find patient
• Patient refused
• Other
• Attended
• Back-up
• Donor did not die
• Organ not suitable
• Proceeded with transplant...

6: Donor

• Cadaveric - EOS Information
• Living donor - LRD (Living related donor) team
• Letters - Direct; Paired exchange; altruistic

Retrieval

• Team and surgeon
• DBD - cross clamp date and time
• DCD
• Withdrawal time
• BP < 50
• As?stole
• Certification
• KTS (Knife to skin)
• Perfusion
• HTA A Number
• Type of solution
• Reported damage
• Abnormal anatomy

7: Organ and Backtable

• Name of surgeon and assistant
• Start time

Kidney R / L + Biopsy + Perfusion fluid culture

• Number of arteries
• Number of veins
• Number of ureters
• Number of patches
• Quality of patch
• Quality of arterial ostium

Backtable reconstruction

• Aortic patch shortened
• Ao patch sacrificed
• Arteries troussered
• Arteries anastomosed end-to-side to renal arteries

Damage

• Y/N
• Capsular
• Arterial
• Vein
• Ureter
• Substance of kidney

Perfusion solution on back table + batch number

Machine perfusion Y/N

• at retrieval / base
• time perfusion started / finished
• reason for perfusion
• kps (kidney perfusion solution) batch number

Pancreas + Perfusion fluid culture

• Fatty - No; Mild; Moderate; Severe
• Damage Type - Report to NHSBT + HTA B form
• Vascular reconstruction
• Preservation solution on back table
• UW (University of Wisconsin) Solution
• Batch number

8: Transplant

• Surgeon's name
• Assistant's name
• Consultant in charge

Templates for operations and back table

• Kidney
• SPK (Simultaneous Pancreas Kidney)
• PTA (Pancreas Transplant Alone)
• PAK (Pancreas After Kidney)

HTA B Form - Number keep for tracability