Leading Better Care
Sharing Good Practice
NHS Board: NHS Fife
Ward: Haematology/Oncology Unit Queen Margaret Hospital. This day unit caters for
approximately 100 patients per week and specialises in malignant and non-malignant
haematology, breast and upper gastrointestinal oncology.
Details of Improvement:
What was the particular problem that this case study is about?
The safe authorisation of blood and blood products by nursing staff in the unit. Authorisation
is providing an order for blood products from the laboratory and providing the written
instruction to proceed with the administration of a transfusion in the clinical setting. This is
following the National Framework “To support nurses and midwives making the clinical
decision and providing the written instruction for blood component transfusion” (Green, Pirie
2009)
How was this identified?
A one month audit revealed several areas of risk including patient identification issues, nurse
staffing issues in the haematology unit and medical staff signing requests and authorisations
for blood without knowing the patient.
What were the implemented improvements (what tools/techniques did you use)?
To develop nurse authorisation of blood and blood products two senior nurses for the unit
were identified a clinical mentor. They undertook an educational programme which was
tailored to their individual learning needs and produced a folder of evidence of learning.
Documentation was also developed for the pre-transfusion nursing assessment.
What is the situation now?
Nurse authorisation of blood and blood products is firmly embedded into safe nursing
practice in the haematology/oncology unit.
How is the change sustainable?
With support from senior management team, senior nursing team, hospital transfusion
committee and haematologists and succession planning, by training other experienced
nursing staff.
Measurable outcomes
What are the patient benefits?
There is the improved pre assessment for transfusion authorised by someone who knows
them.
Transfusions are commenced earlier in the day improving waiting times and there is
improved patient flow.
What are the staff benefits?









Improved pre planning of transfusions enables the best utilisation of resources.
No time out of clinical area looking for medical staff to sign authorisation
Only staff who know the patient are authorising blood.
Nurse authorisation now part of holistic patient care.
Using nursing knowledge and skills to improve patient experience.
Improved job satisfaction.
Closer working relationship with laboratory and blood transfusion service.
National recognition of this initiative.
Developing links, networking and sharing knowledge and experience with colleagues
What are the organisational benefits?



Safe patient care.
Minimising risk.
National recognition of their support to innovative nursing practice which benefits patient.
How did staff feel before the improvement/during the improvement and after the
improvement?
Before nurse authorisation, nursing staff were aware of safety issues, difficulties in getting
medical authorisation, spending time out of clinical areas looking for medical signatures.
During this development an audit of the initial 3 month pilot highlighted areas for
improvement such as recording of prescription medicines and amendments required to the
pre transfusion nursing assessment proforma. Nursing staff were encouraged by the results
of the audit and permission was granted to continue the initiative.
After nurse authorisation was embedded into nursing practice in the clinical area, nursing
staff remain convinced it is best practice for the haematology patients due to benefits already
listed. At 6 month audit there were no omissions to completed documentation and 100% of
transfusions were authorised appropriately by nursing staff. Regular 6 monthly audits
continue.
What are the lessons learnt and what would you do differently next time?
This development was planned well with realistic time lines and objectives. We gained
support from appropriate teams within the organisation at the outset of the initiative. These
principles would be used in future developments
What plans are there to spread the improvement?





To train other experienced nursing staff with haematology/oncology across NHS Fife.
Share knowledge and experience with other Health Boards who have expressed an
interest in this development
Involvement in Scottish National Blood Transfusion Service Workshop in May 2011.
A paper has been submitted to the Cancer Nursing Practice journal.
An abstract has been submitted for NHS Scotland Event 2011.
Contact information for case study
Jill Martin Senior Charge Nurse
Haematology/Oncology Unit Queen Margaret Hospital
Telephone: 01383 623623 ext 3858
e-mail: j.martin9@nhs.net