CYNET_SYSTEMS_MAIN_LOGO.gif   Transplant Coordinator Skills Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to IMCS Group on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

  
       
Rating Stars (Click) Transplant Coordinator 1 2 3 4  
Accepts on-call responsibilities when contacted and responds to all referrals/donors promptly and appropriately  
Responsible for aspects of basic donor evaluation and management including review and assessment of past and current medical and social histories  
Must be able to assess hemodynamic stability and, in association with clinical staff, implement strategies to maintain and/or improve specific organ function  
Accurate communication of donor status to appropriate staff and other transplant professionals  
Coordinates with donor hospital staff, consulting physicians, and staff to ensure optimal organ recovery  
Consistently provides accurate and complete information regarding potential donors and strives to maximize the number of organs recovered  
Is able to interpret laboratory results of blood work and adjust treatments (ventilator & with medication) to normalize results  
Understands pharmacologic agents used in donor management, and with staff support, is able to implement and adjust medications to maximize organ function  
Identifies instability or deterioration in the hemodynamic status of the donor and is able to communicate effectively to appropriate staff  
Responsible for assisting with scheduling of the OR  
Obtains, stores, labels, packages, and distributes pre-recovery peripheral blood for tissue typing and serological testing  
Maintains concise, accurate records of data regarding donor management. This includes completing all required data forms and logs (I-Transplant donor data, UNOS forms, and other required forms  
Maintains accurate information on all laboratory values, medications and diagnostic tests required to evaluate and manage all potential and/or actual donors. This also includes recording problems/incidents and reporting them in an established manner  
Understands and complies with organ donor management policies and procedures as well as organizational policies and procedures to ensure the maximum outcome of transplantable organs from each donor patient  
Adheres to the standards of practice for quality assurance procedures established within the organization  
Consults with the various clinical resources within facility, as needed, on issues pertaining to the clinical and technical aspects of quality organ donor evaluation and management  
Maintains all equipment/supplies required for donor management and evaluation. This includes notifying the appropriate staff when supplies become depleted  
Provides donor/referral information to conduct an after-action review  
Rating Stars (Click) EMR 1 2 3 4  
Epic  
Cerner  
Eclipsys  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration  
MY EXPERIENCE IS PRIMARILY IN:  
Unit No. of Years Unit No. of Years  
BURN POST PARTUM  
CRITICAL UNIT LABOR & DELIVERY  
PACU NEWBORN NURSERY  
NEUROLOGY LEVEL II NICU  
TELEMETRY LEVEL III NICU  
MEDICAL PICU  
SURGICAL  PEDIATRICS  
ONCOLOGY OB/GYN  
ORTHOPEDICS PSYCHIATRY  
OPERATING ROOM RRT  
EMERGENCY ROOM CRT  
TRAUMA CENTER LEVEL 1    
COMMUNITY ER    
RURAL ER    
Rating Stars (Click) AGE APPROPRIATE CARE 1 2 3 4  
Newborn/Neonatal (birth – 30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschool (3-5 years)  
School Age Children (5-12 years)  
Adolescent (12-17 years)  
Young Adults (18-44 years)  
Middle Adults (45-64 years)  
Older Adults (>65 years)