Leading and Managing Change in Clinical Practice: a Critical Analysis and Evaluation of Policy Implementation in Blood Transfusion Practice in an Acute Setting.
Module Code: TLM16
Module Title: Leading and Managing Programmes of Learning in Professional Education
Assignment Title:
Leading and managing change in clinical practice: A critical analysis and evaluation of policy implementation in blood transfusion practice in an acute setting.
Course: PG Diploma in Education
Word Count: 3,315
Submission Date:
The change in nurse education from apprenticeship training to the higher education setting has raised concerns about the lack of practical skills newly qualified nurses have on registration (NMC 2005). In blood transfusion practice for example, every practitioner must be competent to administer blood components safely however, the Serious Hazards of Transfusion (SHOT) scheme have consistently demonstrated that ‘wrong blood’ incidents are a major cause of morbidity and mortality related to transfusion in the United Kingdom. As a result the SHOT working group have recommended that all practitioners should have their clinical competency formally assessed.
Transfusion of blood and blood components remains essential for medical practice but is subject to a number of concerns. Its management involves a complex sequence of activities and, to ensure the right patient receives the right blood, there must be strict checking procedures in place at each stage. Several publications including the SHOT annual reports demonstrated that receiving the wrong blood was the commonest risk associated with blood transfusion (McClelland and Phillips, 1994; Ottewill, 2003; SHOT, 2005).
SHOT is a national, anonymous reporting scheme for the serious sequel of blood components. Since its launch in 1996, the SHOT report (2006) acknowledged that there have been a total 2717 incorrect blood component transfused (IBCT) incidents, resulting in 18 deaths and 91 cases of major morbidity, (Appendix1). Incorrect ordering, prescribing, and incorrect management of adverse reactions of transfusion have
Module Title: Leading and Managing Programmes of Learning in Professional Education
Assignment Title:
Leading and managing change in clinical practice: A critical analysis and evaluation of policy implementation in blood transfusion practice in an acute setting.
Course: PG Diploma in Education
Word Count: 3,315
Submission Date:
The change in nurse education from apprenticeship training to the higher education setting has raised concerns about the lack of practical skills newly qualified nurses have on registration (NMC 2005). In blood transfusion practice for example, every practitioner must be competent to administer blood components safely however, the Serious Hazards of Transfusion (SHOT) scheme have consistently demonstrated that ‘wrong blood’ incidents are a major cause of morbidity and mortality related to transfusion in the United Kingdom. As a result the SHOT working group have recommended that all practitioners should have their clinical competency formally assessed.
Transfusion of blood and blood components remains essential for medical practice but is subject to a number of concerns. Its management involves a complex sequence of activities and, to ensure the right patient receives the right blood, there must be strict checking procedures in place at each stage. Several publications including the SHOT annual reports demonstrated that receiving the wrong blood was the commonest risk associated with blood transfusion (McClelland and Phillips, 1994; Ottewill, 2003; SHOT, 2005).
SHOT is a national, anonymous reporting scheme for the serious sequel of blood components. Since its launch in 1996, the SHOT report (2006) acknowledged that there have been a total 2717 incorrect blood component transfused (IBCT) incidents, resulting in 18 deaths and 91 cases of major morbidity, (Appendix1). Incorrect ordering, prescribing, and incorrect management of adverse reactions of transfusion have
References: 3. Bennis, W.G., & Nanus, B.I. (1985). Leaders: Strategies for taking charge. New York, NY: Harper & Row 4. Bridges, W 7. Department of Health (2002). Better blood transfusion: appropriate use of blood. HSC 2007/001 Accessed 18th June 2008 8. Dolan, G., (2003) 9. Girot, E. A., (1993) Assessment of competence in clinical practice: a review of the literature. Nurse Education Today 13(2): 83-90 10. Hall, R 11. Kotter, J. (1995) Leading change: why transformation efforts fail, Harvard Business Review, March –April 12. Kotter, J., (2002) The Heart of Change, Real Life Stories of How people Change their organisation New York: Free Press 13. LaSala, C. A., Connors, P.M., Pedro, J.T., Phipps, M. (2007). The Role of the Clinical Nurse Specialist in Promoting Evidence-Based Practice and Effecting Positive Patient Outcomes. The Journal of Continuing Education in Nursing 38:6 14. Lewin, K 15. Lockett, M. & Spear, R. (1980), Organizations as systems. Milton Keynes: Open University Press. 16. Mahoney, M 19. Mark, H.C., Larson, S. L. (2006) Implementing Change in the Front Lines: A Management Case Study of West Feliciana Parish Hospital. Public Administration Review 20. National Blood Service and Royal College of Physicians (2005). 21. National Patient Safety Agency (2004) Seven steps to patient safety: the full reference guide. Available at: www.npsa.nhs.uk/sevensteps Accessed 18th June 2008 22. Nicklin, P 23. NMC (2005) Assuring Fitness for Practice: a policy review commissioned by the NMC Nursing Task and Finish Group (internet) Available from: http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1251 Date accessed 18th June March 2008 24. Office of Public Sector Information (2005) 25. Pirie, E., Gray, M.A. (2007) Exploring the assessors and nurses experience of formal assessment of clinical competency in the administration of blood components. Nurse Education in Practice 7, 215-227 26. Right patient, right blood evaluation reports http://www.dh.gov.uk/en/News/Speeches/Speecheslist/DH_4074910 29. Stainsby, D., (2005) 30. Serious Hazards of Transfusion. (2001-2006). Annual Reports. Available at: www.shotuk.org Accessed 18th June 2008 31. Toohey, S., Ryan, G., Hughes, C., (1996) 32. Yukl, G. (2002). Leadership in organizations. Upper Saddle River, NJ: Prentice-Hall