RUNNING HEAD: Blood Administration

Blood Administration Quality Improvement Leadership Project

Delis Bediako
NUR 4144 Professional Role Development: Servant Leadership
March 30, 2015

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Bon Secours St. Francis Medical Center is currently conducting a quality improvement
project on the 5th Floor Medical Unit. The project is a rapid cycle test of change in blood
administration. The purpose of the project is to decrease the risk of harm to patients related to
blood transfusions.
Quality Improvement in Blood Administration
This project was conducted using the Plan Do Study Act (PDSA) method. The first step
was to recruit a team consisting of members of the quality improvement team and nurse
managers from various units with in St. Francis Medical Center. The team then developed the
Plan which included what they hope to accomplish, how they will measure improvement, what
changes should be made to achieve improvement, analysis of current context and process, and
formation of a goal statement. The Do involves how the plan was implemented; beginning with a
team meeting that was held in October, 2014, followed by two weeks of staff education on the
unit which included an updated blood administration documentation reference sheet. Following
the staff education the Rapid cycle test of change was initiated and is scheduled to be completed
on April 1, 2015. The rapid cycle test involves data collection; development and implementation
of blood administration checklist for clinical care leads, shift resource nurses and nurse managers
for use during administration; policy updates; and staff feedback.
Utilizing the Four Domains of Servant Leadership
As discussed in Lead Like Jesus (Blanchard & Hodges, 2005), there are four domains of
servant leadership: heart, head, hands, and habits. As a nurse manager at St. Francis Medical
Center, I can utilize these four domains in the following ways in order to implement this quality
improvement project.

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When the opportunity arises to influence the thinking and behaviors of others, it is
important as a servant leader to first use my Heart by looking within at my own motivation. I
must be clear that I am serving to benefit my team rather than myself. This will require me to be
open and accepting to feedback from my unit staff on the implementation of this project.
By using my Head, I will be able to provide vision and direction. In order to serve my
team and promote the success of this project, it is important that everyone understand the
purpose of it all. This can be done only after I have an understanding of what my purpose is as a
leader and member of this team. The vision this project is working to fulfill is that our patients
will remain safe in our care when performing blood transfusions. I should allow for feedback
from the unit staff and empower them to participate and take ownership of this project and the
opportunity it creates to improve our patient safety.
Through my personal participation and presence, I will use my Hands to contribute to the
successful implementation of this project on my unit. One way I can participate is by attending
the team meeting with the quality improvement members and other nurse managers. In doing so I
will be able to participate in the planning and implementation as well as provide a voice for my
unit staff in the decision making. The most important way I can use my Hands is to as a servant
leader is to support and motivate my team, making sure they have the resources and appropriate
education to successfully implement this project.
As a servant leader I should address the domain of Habits by allowing time for quiet
reflection, meditation on the word of God, and prayer. This is important for me as a leader to be
sure my heart is in the right place and to take a deeper look how I can better serve my team.
Though time is often limited, it is important to spend time studying scriptures because it provides
great guidance on how best to serve others and our Father in any situation we may encounter

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both on the unit and in our personal lives. In the instance of this project, I may be able to find
wisdom in the words of the scripture that will help me encourage my team members and myself.
Reading and meditating on the words and the promises God makes to His children will
strengthen my faith in Him and his ability to work through me and my team members. When
faced with a new challenge, one of my favorite versus I meditate on is Be anxious for nothing,
but in everything by prayer and supplication, with thanksgiving, let your requests be known to
God; and the peace of God, which surpasses all understanding, will guard your hearts and minds
through Christ Jesus (Philippians 4:6-7, New King James Version). Any change can be scary
and it is often difficult to foresee whether an idea will end up being good or bad. But reflecting
on this verse will give me faith that God is working with me and that things will work out. This
will allow me to be free of stress and anxiety which will in turn help me to better support my
team.
Utilizing the Practices of Exemplary Leadership Model
As discussed in Student Leadership Practices Workbook (Kouzes & Posner 2013), the
five practices of exemplary leadership model can also be used as a guide for implementing this
quality improvement project. These five practices include modeling the way, inspiring a shared
vision, challenging the process, encouraging the heart, and enabling others to act.
As a nurse manager, I can model the way through leading by example and displaying the
attitudes and behaviors I value in my team members. It is one thing to motivate and encourage
the team you lead but it is important to go that extra mile and provide an example for them to
follow.
It is also important that I inspire a shared vision so that everyone on the team is on the
same page. I will be able to achieve this by meeting with my staff and allow open discussion to

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ensure they understand the project and the potential impact it can have on the quality of care we
are providing to our patients.
The scope of the rapid cycle test of change requires diligent attention from the unit staff.
In order for data to be collected it is important that those administering blood transfusions utilize
the checklist created by the quality improvement team. The results of the data collected show a
lack of compliance with completing the checklist. As a manager I can challenge the process by
assessing what challenges the staff are facing that prohibit them from complying with the
checklist. Once the problem has been identified I will be able to work with the staff in creating
an innovating process that will ensure compliance.
As a manager it is important that I include my team in every aspect of the implementation
of this quality improvement project and allowing them shared governance. In doing so, I will
enable them to act by giving them ownership of the project and collaborating with them rather
than simply delegating. In order for them to feel ownership and confidence it is important that I
provide them the necessary resources and education so they will have everything the need to be
successful.
Lastly, it is important that I encourage the heart of my team members by supporting and
showing appreciation for their efforts and participation in this project. Quality improvement is a
great tool to ensure that the care you provide is safe, evidence-based care and those who are
willing to work hard to see that that is successfully achieved should be celebrated. This can be
done by verbally acknowledging individuals personally or through celebrating with the whole
team. One example of this would be if I were to throw a pizza party when the team reaches full
compliance with the checklists.

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Implications for Professional Nursing Practice

The implementation of this quality improvement project will affect professional nursing
practice mainly by improving patient safety during transfusions. Two examples of this impact on
patient safety are obtaining informed consent and monitoring vital signs.
Current research shows that non-infectious hazards are the leading cause of serious
morbidity and/or mortality resulting from transfusions (Elhence, 2010, pg. 2772). One of the
non-infectious hazards addressed in this project is obtaining signed consent. This improvement
measure will be measured by a 10% or greater increase demonstrated in consent completion and
review prior to each blood/blood product administration (Bon Secours, 2015, pg.1). Informed
consent for blood transfusion should first involve discussion between the patient and the
physician, and include all risks, benefits, and alternatives (Aulbach, 2013). As nurses it is our
responsibility to witness and verify that informed consent is obtained ensuring that the patient
received adequate information and input in the decision making process of their care plan.
Maskens et. al (2014) discusses the importance of developing reliable systems to ensure
greater transfusion safety (p. 70). Close monitoring of patients vital signs both prior to and
during transfusions is on way to ensure greater transfusion safety. Due to the risk of lifethreatening effects frequently monitoring the patient is required of those administering
transfusions to allow early detection and intervention. With the implementation of this project
units will be required to complete a checklist during the transfusion process verifying that vitals
were completed at the required 15, 30, 60, 120, and 180 minute intervals and properly
documented in ConnectCare. This will be measured by a 20% or greater increase demonstrated
in vital sign completion pre, during, and post transfusion (Bon Secours, 2015, pg.1).

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7
Conclusion

In conclusion, I as a nurse manager have the ability to use my skills as a servant leader to
encourage, motivate, and support my team in implementing this quality improvement rapid cycle
test of change regarding blood transfusions. The ultimate outcome of this project will be a
decrease in the risk of harm related to blood transfusions for our patient population. This will be
achieved by addressing nursing practice regarding compliance with required verification of
informed consent and frequent, timely vitals assessments.

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8
References

Aulbach, R. K. (2013). Nurses practices with blood transfusion in medical-surgical patient care
units of acute care u.s. hospitals: The state of the science (Doctoral dissertation). Texas
Woman's University, Denton, Texas
Blanchard, K. & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.
Bon Secours St. Francis Medical Center (2015). Blood Administration Rapid Cycle Test of
Change.
Elhence, P., Veena, S., Sharma, R., Chaudhary, R. (2010). Root cause analysis of transfusion
error: identifying causes to implement changes. Journal of Blood Services Management,
50, 2772-2777.
Kouzes, J. M., & Posner, B. Z. (2013). The Student Leadership Challenge: Student Workbook
and Personal Leadership Journal. San Francisco: Jossey-Bass.
Maskens, C., Downie, H., Wendt, A., Lima, A., Merkley, L., Lin, Y., Callum, J. (2014). Hospitalbased transfusion error tracking from 2005 to 2010; identifying the key errors threatening
patient transfusion safety. Transfusion Complications, 54, 66-73.