Storyboard submission Follow the detailed instructions in this template for writing a description of your storyboard. Type your information in each section below and save this completed storyboard document as a Microsoft Word file. Please spell check your storyboard before submission as it will be published on the NHS Wales Awards website. Please note: The storyboard should be between 500 1000 words maximum (including references but excluding headings, images or graphs) Submit your storyboard using the online submission system at www.nhswalesawards.org.uk by Friday 25 January 2013. Storyboard submission 1. Storyboard Title Authorisation of blood transfusion: developing non-medical professionals for an extended role 2. Brief Outline of Context (Where this improvement work was done; what sort of unit/department; what staff/client groups were involved) This collaborative work took place in 3 Health Boards (Aneurin Bevan, ABM and C&V), led by the WBS Better Blood Transfusion Team and Swansea University. This innovative project set out to prepare specialist nurses to udertake the extended role to make the decision to transfuse and authorise transfusion. The specialist areas covered were clinical haematology, renal medicine, paediatric intensive care and general intensive care. This pilot phase set the standard for an accredited programme of study and roll-out throughout all hospitals in Wales.
3. Brief Outline of Problem (Statement of problem; how they set out to tackle it; how it affected patient/client care) Prescription of blood transfusion is historically a medical role but following amendments to Section 50 of the Medicines Act (1968) by the Blood Safety and Quality Regulations (2005/50) blood components were no longer classed as medicinal products and therefore could not be prescribed. This resulted in there being no legal obstacle to non-medical health care professionals making the decision to transfuse and providing the written instruction. A National (UK) scoping exercise was undertaken and following consultation with the Nursing and Midwifery Council the resulting framework produced recommendations for practice by nurses (Green and Pirie, 2009). In response to publication of the Framework (Green and Pirie 2009) the then Health Minister for Wales requested that a standardised approach be taken in Wales. A steering group was formed at the request of Welsh Government s Medical Director and Chief Nursing Officer to take this work forward. The steering group was representative of the Health Boards and clinical specialties who had agreed to participate in the pilot work. The aim of this work was to prevent independent and piecemeal implementation of the Framework that would in itself constitute additional risk. Ultimately the desire was to streamline the patient pathway through an holistic approach. 4. Assessment of Problem and Analysis of its Causes (Quantified problem; staff involvement; assessment of the cause of problem; solutions/changes needed to make improvements) Anecdotally, nurses were already making the decision to transfuse on an informal basis but without signing the final authorisation to transfuse. This latter function was undertaken by a doctor who might not know the individual patient and may not have performed an individual assessment or clinical examination before providing the final authorisation to transfuse. The initial UK scoping exercise had also demonstrated this practice. Work-arounds of this nature increase risk in an already critical process (SHOT 2011 and previous). Additionally, the risks associated with piecemeal implementation were acknowledged by the steering group. Baseline audit of participating sites was designed by the steering group and undertaken to ascertain which groups of staff were involved in decision making and authorising the transfusion. Results demonstrated that it was common to see different members of staff fulfilling these functions for the same patient.
The steering group also investigated the availability of existing opportunities for education that could support the competencies as described in the Framework (Green and Pirie 2009). During this time it became apparent that it would not be possible to achieve a standardised approach by accessing the random assortment of educational opportunities on offer. It was at this point that support was gained from Swansea University in developing a specific, accredited programme of study. Whilst this approach would be more demanding in terms of time and resource it would provide a robust and sustainable solution. 5. Strategy for Change (How the proposed change was implemented; clear client or staff group described; explain how they disseminated the results of the analysis and plans for change to the groups involved with/affected by the planned change; include a timetable for change) After baseline audit, scoping of educational opportunities and engagement with Swansea University the project continued as follows. a. Development of educational programme b. Programme accreditation and validation gained c. Collaboration with participating Health Boards to identify suitable participants for the pilot cohort (included 2 Registered Pharmacists already practicing autonomously in renal anaemia management) d. Delivery of programme as a collaborative process by Better Blood Transfusion Team Consultant and manager, and Swansea University academic staff e. CNO briefings to Directors of Nursing f. Formal assessment of students g. Final Health Board sign off by Director of Nursing/Director of Therapies (or deputies) 6. Measurement of Improvement (Details of how the effects of the planned changes were measured) Longitudinal evaluation through student questionnaires, student focus groups, telephone interviews with managers and medical mentors (repeated at 6 months after HCPs commence new role), economic evaluation, repeat audit.
7. Effects of Changes (Statement of the effects of the change; how far these changes resolve the problem that triggered the work; how this improved patient/client care; the problems encountered with the process of changes or with the changes) Consensus from students, mentors and managers that: 1) Students had developed personally and professionally and gained confidence in their assessment skills and clinical decision making and the ability to discuss patient management with colleagues 2) Students now well equipped to work more autonomously and at advanced level 3) Patient experience and safety greatly enhanced because of; continuity of care provided by one practitioner who knew them and their situation, reduction in waiting time for transfusion (increasing concordance in some instances) provision of appropriate, alternative management of presenting symptoms. 4) work based learning module more challenging than the theoretical module 8. Lessons Learnt (Statement of lessons learnt from the work; what would be done differently next time) Early explanation of work based learning module and greater linking of the two modules- ie the art and science of authorisation of blood component transfusion Prolonged engagement with students after taught module to provide peer support Increased teaching of assessment skills- especially for those who were not independent prescribers 9. Message for Others (Statement of the main message they would like to convey to others, based on the experience described) Experienced practitioners working in relevant clinical areas are keen to extend their skills in order to enhance the patient experience. They valued the new knowledge received as part of this programme and became increasingly confident in their own assessment and clinical decision making. The practitioners have become Champions for transfusion and its safe and appropriate use within their clinical specialties, influencing peers and senior colleagues. This programme provides appropriate preparation for practitioners to undertake a new role. References
Green, J. & Pirie, E (2009) A framework to support nurses and midwives making the clinical decision and providing the written instruction for blood component transfusion Bolton-Maggs, PHB. (Ed) & Cohen, H. on behalf of the Serious Hazards of Transfusion (SHOT) Steering Group. The 2011 Annual SHOT Report (2012)