Transplant Center - What's New
June, 2007
Issue #8
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Listing liver transplant candidates
Although portrayed dramatically in modern media, how a patient becomes listed for
liver transplantation is rarely portrayed accurately. Media depictions often ignore the events surrounding the committee meeting that involves physicians, nurses and members of a real transplant team.
Every Monday afternoon, members of the liver transplant committee at UK HealthCare meet to discuss in detail new candidates referred for liver transplant.
Our nurse coordinators present precise and complete patient workup results, including chemistry, hematology, virology, microbiology, CB, ultrasounds, cardiac results, radiology, pulmonology and dental examinations. Each patient's previously obtained history and physical are combined with the social worker's family and social support reviews as well as housing, insurance and drug coverage assistance reports.
Transplant surgeons discuss possible surgical issues and anticipated medical complications. With the surgeons, hepatologists discuss possible pre-transplant treatments. During presentation and subsequent discussion, a detailed transcription is kept by a key member of the team for permanent record of the meeting minutes.
Issues addressed always include:
- Is a transplant the correct therapy for the patient's disease?
- Have the indications and contraindications been properly assessed?
- Have the surgical risks been weighed?
- Will the patient's medical condition tolerate the transplant and the post-operative course of treatment?
- Might the existing disease recur?
Any member of the team may ask questions. A patient may be deferred for additional workup, but usually is listed on the national waiting list before the end of the day. Historically, our listing rate is 98 percent of those initially presented.
Transplant team leads Chandler Hospital in system improvements
Our transplant team has led an initiative within UK HealthCare to improve the collection and reporting of first-draw morning labs when our patients are hospitalized or any time after transplant. Throughout the life of our patients, we track post-transplant lab values on one continuous charting system. These lab values are an instant snapshot of each patient's health at any given moment in time, reflecting immunosuppression levels and providing the status of the graft.
Working with surgeons, unit nurses, nurse managers, laboratory management, phlebotomists, pharmacists, and information systems managers and specialists, our team meets weekly to discuss issues and create final resolutions to improve the health of our patients. Not only do these weekly group meetings result in changes that benefit transplant patients, but patients from other areas of the hospital also benefit as the policies are reviewed and systems refined. The transplant team is proud to be at the front of this positive change for UK HealthCare.
Focused transplant pharmacy practice
Timothy M. Clifford, PharmD, is the clinical pharmacy specialist for the UK Transplant Center.
Dr. Clifford received his Doctor of Pharmacy from the University of Kentucky in 1998 and completed residencies in pharmacy practice and critical care/nutritional support at the University of Tennessee Medical Center in 2000. He is an adjunct assistant professor at the UK College of Pharmacy, provides lectures at the college, precepts pharmacy residents and students, and is involved in several committees nationally and at UK HealthCare.
The transplant team relies on Dr. Clifford's superior expertise in immunosuppressive drug therapies and interactions as well as his extensive research, publications and experience in nutritional support to formulate care plans and hospitalization stays for our transplant patients.
Dr. Clifford personally sees all liver transplant patient candidates before they are listed on the national waiting list. He counsels every kidney, liver and pancreas transplant patient on their medication regimen prior to discharge from the hospital. He is involved in the post-transplant management of complications arising from drug therapy, whether they are side effects, drug interactions or insurance coverage issues.
Without immunosuppressive therapy, transplant surgery would not be possible. Assisting patients through drug interactions, contraindications, episodic rejections and other events requires a highly specialized pharmacist and a compassionate team player.
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