Honoring the gift of life

Sonya Hirsch always felt called to help people and make a difference. In addition to her life-saving work as a critical care outreach nurse at UCHealth University of Colorado Hospital Burn Intensive Care Unit, Hirsch spearheaded an initiative to develop a thoughtful process around end-of-life honor walks that supports families of organ donor patients in their final moments of goodbye.

During an honor walk, hospital staff gather on both sides of a designated hallway and pay their respects as a donor patient is transported to an operating room, or transferred to a waiting ambulance that will bring the patient to a Donor Alliance facility for organ recovery.

“These honor walks give closure and peace to the patient’s family and help the nurses and other clinicians process this important yet emotional transition,” said Mandy White, a colleague who nominated Hirsch for Celebrating You recognition.

While it’s not always possible for every honor walk to include family, many times loved ones will walk alongside their loved one as they prepare to give the gift of life to those awaiting an organ transplant.

“Honor walks remind us all of the special person the patient becoming an organ donor was during their life,” Hirsch said. “Everyone present for the honor walk takes this opportunity to pause and acknowledge their feelings in an atmosphere of shared support,” she added.

Hirsch joined UCH’s burn ICU as an advanced care partner in 2012 and then a new grad nurse in 2014, becoming active in UCH’s organ and tissue donation committee shortly thereafter. By 2018, Hirsch had advanced to a level III nurse. Later that same year, family requests for honor walks for organ donors started to become more frequent and, by 2019, it was clear more structure was needed to support staff.

While she felt the process could be improved, there was not a lot of best practice research on the topic available.

With the support of her UEXCEL advisor Kelly Tuohy, as well as her mentor David Ricke, UCH neuro ICU nurse manager, Hirsch developed a proposal to bring consistency and structure to the honor walk process at UCH. Two of the greatest opportunities she saw to make the experience better for loved ones of donors were to:

• Gather enough staff to truly honor the donor
• Keep the walk private with only the donor’s family and UCH staff, away from other patients and their visitors

Through research and staff feedback, she created a detailed guide to activate the honor walk process. Once the patient meets certain clinical triggers and Donor Alliance is involved, the plan also addresses:

• Asking the family if they want to be part of the honor walk and customizing it to the patient
• Providing role clarity for charge nurses, spiritual care, hospital managers, leaders and staff
• Establishing an alert process where unit charge nurses notify the hospital manager that an honor walk will occur
• A pre-formatted honor walk scenario in Everbridge to notify spiritual care, hospital leadership, ICU nurse managers and assistant nurse managers and charge nurses
• Identifying a designated hallway for consistent use to ensure privacy
• Access to quilts and also flags for draping the patient: An American flag to honor military veterans or a Donor Alliance Donate Life flag or handmade quilt for non-veterans, which can then be sent to family not present during the walk as a remembrance
• Reminders to staff to silence phones and observe UCH’s social media policy and HIPAA guidelines
• Support resources in case staff need it following the walk

“In 2022, UCH had 34 organ donors which was more than double the previous year. We feel that is in part due to honor walks because it’s so meaningful to staff and family,” Hirsch said.

Hirsch received a 2022 Nightingale Award for Advocacy in Clinical Practice and a standing ovation for her presentation at the 2022 ANCC Magnet Conference for her work. She has also received national attention from other hospitals looking to put a similar process in place.

In addition to honor walks, Hirsch and Ricke have championed the electronic donor referral program, integrated within Epic, for staff to electronically deliver a referral to Donor Alliance and the tissue/eye bank. This electronic donor referral process is now live in metro Denver and southern Colorado regions with roll-out plans in northern Colorado region this fall.

The electronic referral process makes it easier to identify patients eligible for donation, greatly shortens the time required to make the initial referral, and elevates the importance of organ and tissue donation for all staff.

“I am so honored to be part of this. It really keeps giving back, not only to me, but to families, staff and the recipients who have hope thanks to the generosity of organ donors,” Hirsch said.