Aim To make the discussion and practice of corneal donation the norm in our hospice.

Method Baseline data showed that tissue donation was not discussed in the hospice with only one donation during the previous three years. Following Improving Quality Together (IQT) methodology the percentage of eligible donors with whom corneal donation had been discussed before death and the number of referrals for donation was chosen as the measures to achieving the aims. These were recorded weekly. Interventions included educational sessions for both doctors and nurses, developing a referral flow chart and adding a prompt to the electronic clerking template which set a flag within the record for patients expressing the wish to donate. A weekly report of the measures was generated using the reporting tool within the electronic patient record and plotted on run charts.

Results The average percentage of eligible patients dying at the hospice per week who were offered the opportunity to discuss corneal donation rose from an average of 10% over the first four weeks to 92% over the final four weeks. Over the first eight months of the project 50 referrals were made resulting in 29 donations from the hospice. In the preceding 3 years, only one patient had been referred.

Lessons learnt

1. Teach by example: Observing senior clinicians discussing corneal donation was most likely to change practice;

2. Share resources and learning;

3. Involve senior leaders early;

4. Include family early;

5. Early formal MDT education programme is essential.

Conclusion This ongoing IQT project has had a huge impact on practice at the hospice. Patients’ wishes to donate has become part of the language of handovers. We aim to share our learning and resources across all Welsh hospices and increase the number of patients given the opportunity to become donors should they wish.