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 staff’s 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 staff’s knowledge of the signs and symptoms of a reaction thus
preventing hemolytic transfusion reactions.
Keywords: blood, educate, standards, transfusion reaction, hemolytic transfusion reaction
2
Running Head: LEADERSHIP STRATEGY ANALYSIS
3
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
4
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
5
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
Suspected transfusion reaction
Q4-13
Q1-14
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
6
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 transfusionist’s and clinical support staff of signs and symptoms
of adverse transfusion reactions

Educate nursing transfusionist’s 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
7
Running Head: LEADERSHIP STRATEGY ANALYSIS
8
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 month’s transfusion reactions and
discuss individual department’s 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
Roger’s 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. Roger’s 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.
9
Running Head: LEADERSHIP STRATEGY ANALYSIS
10
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