Leadership Strategy Analysis Nursing 440 Constance Chrisman Katrina Lampman Eric Nelson Laura Parker

Running Head: LEADERSHIP STRATEGY ANALYSIS

Abstract Blood transfusion adverse reactions are not always identified. This is due to staffs lack of knowledge about the signs and symptoms of a blood transfusion reaction. Education is an important component in getting adverse transfusion reactions reported. This document provides recommendations to increase staffs knowledge of the signs and symptoms of a reaction thus preventing hemolytic transfusion reactions.

Keywords: blood, educate, standards, transfusion reaction, hemolytic transfusion reaction

Running Head: LEADERSHIP STRATEGY ANALYSIS

Leadership Strategy Analysis Blood transfusions are a frequent procedure done in hospitals and in outpatient settings. A blood transfusion reaction is a complication that can occur during or after the transfusion. A facility will have protocols set in place for identifying and reporting a reaction. Even with these protocols in place, transfusion reactions are not being identified when they have occurred and then the workup and necessary reporting of these reactions are not being done. A need for better education on what the signs and symptoms of when a transfusion reaction is occurring has been identified. This paper consists of the plan developed to increase education on how to identify these reactions. Clinical Need According to the Center for Disease Control and Prevention (CDC) there are approximately 14.6 million blood transfusions per year (CDC 2011). Blood transfusion reactions are rare occurrences. If a reaction does occur it most often will occur during the transfusion, but it can also develop several weeks later. Common non-life threatening transfusion reactions are hives and itching. Serious reactions include dyspnea, hypotension, anxiety, tachycardia, and nausea (Mayo Clinic 2013). The US Food and Drug Administration (FDA) reports statistics of deaths from blood transfusion reactions with the results from October 2009 to September 2010 with 76 fatalities attributed to being caused from blood transfusion reactions (FDA 2012). Interdisciplinary Team Interdisciplinary teams are vital to improving patient safety and quality care. This collaboration needs to combine many groups of health care in order to achieve high quality and cost-effective care. Team members need to be aware of the roles and backgrounds of each discipline on the team and the members need to develop mutual trust and respect for each other.

Running Head: LEADERSHIP STRATEGY ANALYSIS

Teams whose members have already worked together prior to the team formation tend to work better together. This is due to the ongoing interaction and familiarity already developed (YoderWise 2011). Individual clinicians for addressing blood transfusion adverse events would include: Provider(s) The professional that assures that orders are complete and concise. Provides final clinical approval of orders and policies. Pathologists Reviews the policy ensures evidence based practice per the College of Accredited Pathologists. Additionally, investigates suspected blood transfusion adverse reactions. Department leadership Assists in authoring policies, provides clinical staff with education, monitors outcomes, implements strategies, and evaluates outcomes. Quality and patient safety Provides evidence based practice information, ensure The Joint Commission (TJC) compliance, evaluates data quality, and reviews policies. Risk management Provides data collection reports to team, reviews policies to potentially identify mitigated risks. Nursing These clinicians play a vital role in frontline patient safety. These clinicians that are administering the blood products, assessing patients, and identify blood product adverse reactions. Informatics The professional of the group for technology related concerns. Methods of Data Collection The data analysis information will come from the ISIS reporting system which is the organization patient safety reporting system. Data can be pulled from this system to identify

Running Head: LEADERSHIP STRATEGY ANALYSIS

prominent safety trends per department. This information can be used to create action plans that address precursor safety events to ensure they do not turn into serious safety events. The collections tool used will be the line graph. The line graph technique is often used to show the trend of a particular activity over time, and the result may be called a trend chart (Yoder-Wise, 2011, p. 396).

Suspected Blood Transfussion Reactions

16 14 12 10 8 6 4 2 0 Q1-3 Q2-13 Q3-13 Q4-13 Q1-14 Suspected transfusion reaction Inadequate vital signs taken

The graph shows the growing concern for appropriate temperature management. Early detection of a hemolytic reaction is crucial in preventing negative outcomes for patients. By obtaining vital signs per policy, we can improve early detection.

Standard of Care Monitoring for transfusion reactions is essential to avoid unnecessary morbidity and mortality (Osby, Saxena, Nelson & Shulman, 2007). There are standards in place for hospitals to follow for reporting transfusion reactions. The Joint Commission (TJC) standard pertaining to blood transfusion reaction states the organization collects data on blood and blood use, and all reported and confirmed transfusion reaction (Rhany, 2010, p. 2796). When a transfusion

Running Head: LEADERSHIP STRATEGY ANALYSIS

reaction is suspected, it needs to be reported to the laboratory as soon as possible. Transfusion reaction documentation and an Improved Safety Identification System (ISIS) report will be completed as stated in the facility policy (Patient and Medication Safety Committee, 2012). Implementation Strategies To improve, nursing transfusionist and clinical support staff identification of blood transfusion adverse reactions the following will be implemented: Educate all nurse transfusionists and clinical support staff of signs and symptoms of adverse transfusion reactions Educate nursing transfusionists and clinical support staff of where to document all blood transfusion in Cerner and all suspected reactions in Cerner Create laminated blood transfusion adverse reaction signs and symptoms quick alert cards If vital signs task delegated to clinical support staff, nurse transfusionist is responsible for reviewing vital signs and determining if adverse reaction noted Have standardized thermometers throughout facility to ensure temperature accuracy To maintain awareness through department communication huddles blood transfusion reaction fallouts will be shared to improve compliance Implement department leadership daily rounding on blood transfusions on their department At monthly clinical leadership meetings add blood transfusion adverse reactions to review previous months transfusion reactions and implementation compliance

Running Head: LEADERSHIP STRATEGY ANALYSIS

According to American Association of Blood Banks Technical Manual early recognition, prompt cessation of transfusion, and further evaluation are keys to a successful outcome (AABB, 2008, p. 716). Information is available on the signs and symptoms of a potential blood transfusion reaction. The common indications of a possible blood reaction are the same for more than one type of adverse reactions. Blood tranfusionists need to be aware of what these signs and symptoms could be so the proper protocols and actions can be started immediately for patient safety. The most common sign of an acute hemolytic transfusion reaction is a greater than one degree Celsius increase in temperature above 37 degrees Celsius (Roback, Combs, Grossman, & Hillyer, 2008). Other signs and symptoms that could be indicative of a transfusion reaction include; Chills with or without rigors Respiratory distress, wheezing, coughing, or sneezing Hypertension or Hypotension Pain in the abdomen, chest, flank, or back Painful infusion site Integumentary system conditions such as urticaria, rash, flushing, pruritis, and edema Jaundice or hemoglobinuria Nausea and vomiting Abnormal bleeding Oliguria or anuria

Running Head: LEADERSHIP STRATEGY ANALYSIS

Evaluation Evaluating entails continually judging the degree to which the change process is moving acceptably toward desired outcomes or goals and whether or when outcomes are met (YoderWise (2010, p. 331). The evaluation of the implemented strategies will be assigned to clinical department leadership. Leadership will meet monthly to review previous months transfusion reactions and discuss individual departments compliance of strategies noted above. Data analysis of ISIS reports will be utilized to track and trend hemolytic transfusion reactions. Department data and implementation strategies will be reviewed at the Blood Utilization Committee (BUR), which meets monthly, to evaluate implementation strategies effectiveness. Strategies will be amended if they are determined to be unsuccessful in meeting the identified desired outcomes. The dashboard goal for blood transfusion adverse reaction identification is 100%. Scholarly Evidence Rogers Diffusion of Innovation theory was identified as an appropriate method to implement for assuring staff involvement and engagement. This theory has been used to describe how successful change can occur in an organization. The stages of this model include knowledge, persuasion, decision, implementation, and confirmation. In order to incorporate this change into the work culture, nursing leadership will need to understand the staff dynamics as a group, and how individual staff members will react and adapt to changes. Rogers theory discusses how managers need to identify staff members who would be considered innovators or early adopters to assist with communications and adaptation of this proposed change. These staff members will be the ones to be the unit champions for this proposal (Yoder-Wise, 2011).

Running Head: LEADERSHIP STRATEGY ANALYSIS

Conclusion Blood transfusion adverse reactions are not always identified. The execution of the implementation strategies, which includes educating staff and raising awareness of blood transfusion sign and symptoms reactions, is expected to have a deep decline in adverse reaction events. Leadership and staff will become diligent with reporting adverse reactions to help prevent hemolytic transfusion reactions and therefore improve patient safety.

Running Head: LEADERSHIP STRATEGY ANALYSIS

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References Center for Disease Control and Prevention (2011). Blood Safety. Retrieved from http://www.cdc.gov/bloodsafety/basics.html Mayo Clinic (2013). Blood transfusion. Retrieved from http://www.mayoclinic.com/health/blood-transfusion/MY01054/DSECTION=risks Osby, M.A., Saxena, S., Nelson, J., & Shulman< I. (2007). Safe handling and administration of blood components. Arch Pathol Lab Med, 131, 690-694. Patient and Medication Safety Committee (2012, August 20). Blood or blood product administration. Spectrum Health United Hospital Blood Adminstration Policy. Grand Rapids, MI: Spectrum Health Rhany, J.F. (2010). Synergies between blood center and hospital quality systems. Journal of blood Services Management, 50, 2793-2797. Doi: 10.1111/j.1537-2995.2010.02946.x U.S. Food and Drug Administration (2012). Vaccines, blood, & biologics. Retrieved from http://www.fda.gov/biologicsbloodvaccines/safetyavailability/reportaproblem/transfusion donationfatalities/ucm254802.htm