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Ronald Reagan UCLA nurse coordinates team’s pioneering hand transplant

At patient’s side — for entire journey

Ronald Reagan UCLA nurse coordinates team’s pioneering hand transplant

By Karen Schmidt, RN, www.nurse.com
Monday August 1, 2011

Being on the front line of medical innovation has brought Erin Core, RN, BSN, CCTC, the scariest moment of her nursing career. It also has allowed her to guide a young mother’s journey into a life with a restored hand.

In March, Core’s work as Ronald Reagan UCLA Medical Center’s hand transplant coordinator was instrumental in the successful surgery for Emily Fennell, a 26-year-old California mother. Core’s participation was the culmination of months of groundbreaking progress: building a hand patient-donor database, and creating policies and procedures for hand transplantation. Best of all, Core was at the patient’s bedside in the OR when she awoke.

“When she came out of anesthesia and had been extubated, I was able to sit her up in the OR and show her her new hand,” Core said. “It was completely amazing, and a roller coaster of emotions, exhaustion and excitement.”

Steep developmental climb

Reaching that memorable moment of success was gratifying; since hand transplantation still is in the clinical trial stage, Core scaled a mountain of developmental work to get to the actual procedure stage.

“I developed a plan of care for patients and evaluated potential recipients while working within the scope of the research protocol,” she said.

Core interfaced closely with the transplant’s information technology department to tweak the organ database to meet the needs of the hand transplant program. Since no national hand registry existed, they worked to track data and establish a method for communicating recipient information to organ procurement groups for matching patients’ prospective donors.

“I developed the form to use to capture eye and hair color, skin tone, arm hair type and color, and even freckles of the recipient,” Core said. “We want to precisely match the hand to the patient, so we had many measurements — the size of the hand, length of the fingers.”

The database proved its success, surprising Core by resulting in a quick donor-patient match.

“The hand match was amazing,” Core said. “The scariest moment of my nursing career was hearing there was a potential donor.”

A hand transplant isn’t lifesaving like other types of transplants, she explained. Donor families may have varied responses to requests for donating a hand versus a heart.

“My knees went weak when the call came that the donor’s family consented,” Core said. “But I had my ducks all lined up, so after the call, I brought in our 17-member team.”

As she flew with the procurement team to recover the donated hand, Core was already six to seven hours ahead in her mind, planning out nursing orders and who she would need to communicate with as the procedure progressed.

Significant post-op role

Core’s role post-op was still monumental. “I tie in the whole team,” she said, training nurses about the importance of administering immunosuppressant meds and drawing labs on time as well as patient education about medications, drug reactions and organ rejection.

A unique element of hand transplantation, Core said, is that unlike organs — liver, kidney, heart — the body part is visible. One milestone in the recovery stage is how well the patient accepts the new hand. Core said it was apparent early on that Fennell accepted her new hand well. “She calls it her hand,” Core said.

Core also coordinated services for Fennell’s 5-year-old daughter to interface during all phases of the transplant, and assisted Fennell in interacting with her child with her new hand.

In preparation for Fennell’s return home, Core is planning for secure video conferencing to document progress with therapy and monitor her hand for changes.

“Visual assessment provides early intervention in treating rejection or infection,” she said.

While continuing to educate Fennell about her post-transplant lifestyle, Core is already fine-tuning the nursing process related to hand transplantation.

“I want more of our nursing staff to be ready for this,” she said.

Core views her database development as instrumental in the growth of hand transplantation. “My goal is to ensure that hand transplant recipients not only regain function, but come away with a hand that looks and feels like their own,” she said. “It’s really incredible to be part of this research.”

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