INSider_JULY_AUG_2021

INSIDER

JANUARY/FEBRUARY 2021

T H E O F F I C I A L M E M B E R S H I P N E W S P U B L I C AT I O N O F I N F U S I O N N U R S E S S O C I E T Y

Reconnecting in Las Vegas The INS 2021 Annual Meeting and Exhibition

Healthy Infusion Nurses, Healthy Nation

Members Share Their Experiences

J U LY / A U G U S T 2 0 2 1

Using Malpractice Claims Data to Identify Risks in Nursing Practice

VOLUME 4 INFUSION NURSES SOCIETY

•

ISSUE 4

1 Ig

#

Prescribed for PI

Hizentra is an Ig* therapy that provides proven PI protection with the convenience of self-administration, so you can focus on everyday living *Ig=immunoglobulin

Important Safety Information Hizentra®, Immune Globulin Subcutaneous (Human), 20% Liquid, is a prescription medicine used to treat: • Primary immune deficiency (PI) in patients 2 years and older • Chronic inflammatory demyelinating polyneuropathy (CIDP) in adults WARNING: Thrombosis (blood clots) can occur with immune globulin products, including Hizentra. Risk factors can include: advanced age, prolonged immobilization, a history of blood clotting or hyperviscosity (blood thickness), use of estrogens, installed vascular catheters, and cardiovascular risk factors.

If you are at high risk of blood clots, your doctor will prescribe Hizentra at the minimum dose and infusion rate practicable and will monitor for signs of clotting events and hyperviscosity.

Always drink sufficient fluids before infusing Hizentra.

See your doctor for a full explanation, and the full prescribing information for complete boxed warning.

Treatment with Hizentra might not be possible if your doctor determines you have hyperprolinemia (too much proline in the blood), or are IgA-deficient with antibodies to IgA and a history of hypersensitivity. Tell your doctor if you have previously had a severe allergic reaction (including anaphylaxis) to the administration of human immune globulin. Tell your doctor right away or go to the emergency room if you have hives, trouble breathing, wheezing, dizziness, or fainting. These could be signs of a bad allergic reaction.

Inform your doctor of any medications you are taking, as well as any medical conditions you may have had, especially if you have a history of diseases related to the heart or blood vessels, or have been immobile for some time. Inform your physician if you are pregnant or nursing, or plan to become pregnant.

Infuse Hizentra under your skin only ; do not inject into a blood vessel. Self-administer Hizentra only after having been taught to do so by your doctor or other healthcare professional, and having received dosing instructions for treating your condition.

Please see Brief Summary of full Prescribing Information on reverse.

Simplify your infusions with the first and only Ig prefilled syringes —only from Hizentra

Simple, convenient, and ready to use, so you can get back to everyday living

Choose when and where you infuse Self-administration with Hizentra means you and your doctor can decide when and where you infuse. Convenient dosing options (from daily to once every 2 weeks) mean you won’t have to adjust or cancel your plans due to IV infusion appointments.

No more IV infusions

Proven Safety

IV infusions can be challenging for people who have hard-to-find or damaged veins.

Hizentra allows you to infuse just under the skin, not into a vein, after training from your doctor.

Hizentra has an established safety profile and demonstrated tolerability. In clinical trials, the most common side effects were redness, swelling, itching, and/or bruising at the infusion site; headache; chest, joint, or back pain; diarrhea; tiredness; cough; rash; itching; fever, nausea, and vomiting. These are not the only side effects possible.

Visit www.HizentraPFS.com or ask your doctor about Hizentra prefilled syringes.

Immediately report to your physician any of the following symptoms, which could be signs of serious adverse reactions to Hizentra: • Reduced urination, sudden weight gain, or swelling in your legs (possible signs of a kidney problem).

• Pain and/or swelling or discoloration of an arm or leg, unexplained shortness of breath, chest pain or discomfort that worsens on deep breathing, unexplained rapid pulse, or numbness/weakness on one side of the body (possible signs of a blood clot).

• Bad headache with nausea; vomiting; stiff neck; fever; and sensitivity to light (possible signs of meningitis).

• Brown or red urine; rapid heart rate; yellowing of the skin or eyes; chest pains or breathing trouble; fever over 100°F (possible symptoms of other conditions that require prompt treatment).

Hizentra is made from human blood. The risk of transmission of infectious agents, including viruses and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent and its variant (vCJD), cannot be completely eliminated.

The most common side effects in the clinical trials for Hizentra include redness, swelling, itching, and/or bruising at the infusion site; headache; chest, joint or back pain; diarrhea; tiredness; cough; rash; itching; fever, nausea, and vomiting. These are not the only side effects possible. Tell your doctor about any side effect that bothers you or does not go away.

Before receiving any vaccine, tell immunizing physician if you have had recent therapy with Hizentra, as effectiveness of the vaccine could be compromised.

Please see full prescribing information for Hizentra, including boxed warning and the patient product information, available at Hizentra.com.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

You can also report side effects to CSL Behring’s Pharmacovigilance Department at 1-866-915-6958.

IgIQ®: Support Programs to Help You Get Started Call IgIQ to find out about programs such as:

One-month free trial of Hizentra with at-home nurse visits

Most patients with commercial insurance pay $0 out-of-pocket*

Protection if you lose insurance*

1-877-355-IGIQ (4447) *Other terms and conditions apply. Call IgIQ to learn more.

Hizentra®, Immune Globulin Subcutaneous (Human), 20% Liquid Initial US Approval: 2010 BRIEF SUMMARY OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use Hizentra safely and effectively. Please see full prescribing information for Hizentra, which has a section with information directed specifically to patients.

What is HIZENTRA? HIZENTRA is a prescription medicine used to treat primary immune deficiency (PI) and chronic inflammatory demyelinating polyneuropathy (CIDP). Infuse HIZENTRA only after you have been trained by your doctor or healthcare professional. HIZENTRA is to be infused under your skin only. DO NOT inject HIZENTRA into a blood vessel (vein or artery).

Who should NOT take HIZENTRA? Do not take HIZENTRA if you have too much proline in your blood (called “hyperprolinemia”) or if you have had reactions to polysorbate 80. Tell your doctor if you have had a serious reaction to other immune globulin medicines or have been told that you have a deficiency of the immunoglobulin called IgA. Tell your doctor if you have a history of heart or blood vessel disease or blood clots, have thick blood, or have been immobile for some time. These things may increase your risk of having a blood clot after using HIZENTRA. Also tell your doctor what drugs you are using, as some drugs, such as those that contain the hormone estrogen (for example, birth control pills), may increase your risk of developing a blood clot.

What are possible side effects of HIZENTRA? The most common side effects with HIZENTRA are: • Redness, swelling, itching, and/or bruising at the infusion site • Headache/migraine • Nausea and/or vomiting • Pain (including pain in the chest, back, joints, arms, legs) • Fatigue • Diarrhea • Stomach ache/bloating • Cough, cold or flu symptoms • Rash (including hives)

• Itching • Fever and/or chills • Shortness of breath • Dizziness • Fall • Runny or stuffy nose Tell your doctor right away or go to the emergency room if you have hives, trouble breathing, wheezing, dizziness, or fainting. These could be signs of a bad allergic reaction.

Tell your doctor right away if you have any of the following symptoms. They could be signs of a serious problem.

• Reduced urination, sudden weight gain, or swelling in your legs. These could be signs of a kidney problem.

• Pain and/or swelling of an arm or leg with warmth over the affected area, discoloration of an arm or leg, unexplained shortness of breath, chest pain or discomfort that worsens on deep breathing, unexplained rapid pulse, or numbness or weakness on one side of the body. These could be signs of a blood clot.

• Bad headache with nausea, vomiting, stiff neck, fever, and sensitivity to light. These could be signs of a brain swelling called meningitis.

• Brown or red urine, fast heart rate, yellow skin or eyes. These could be signs of a blood problem.

• Chest pains or trouble breathing.

• Fever over 100ºF. This could be a sign of an infection.

Tell your doctor about any side effects that concern you. You can ask your doctor to give you more information that is available to healthcare professionals.

Please see full prescribing information, including full boxed warning and FDAapproved patient product information. For more information, visit Hizentra.com.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

You can also report side effects to CSL Behring’s Pharmacovigilance Department at 1-866-915-6958.

Hizentra is manufactured by CSL Behring AG and distributed by CSL Behring LLC. Hizentra® is a registered trademark of CSL Behring AG. Biotherapies for Life® and IgIQ® are registered trademarks of CSL Behring LLC. Premier StartSM and CSL Behring AssuranceSM are service marks of CSL Behring LLC. ©2020 CSL Behring LLC 1020 First Avenue, PO Box 61501, King of Prussia, PA 19406-0901 USA www.CSLBehring.com www.Hizentra.com HIZ-1315-DEC20

Order your copies today! www.ins1.org

INS BOARD OF DIRECTORS 2021-2022 PRESIDENT

Sue Weaver, PhD, RN, CRNI®, NEA-BC PRESIDENT-ELECT

Max Holder, MSN, RN, CRNI®, NE-BC SECRETARY/TREASURER

Joan Couden, BSN, RN, CRNI®

INSIDER T H E O F F I C I A L M E M B E R S H I P N E W S P U B L I C AT I O N

PRESIDENTIAL ADVISOR

OF INFUSION NURSES SOCIETY

Angelia Sims, MSN, RN, CRNI®, OCN® DIRECTORS-AT LARGE

Nancy Bowles, MHA, RN, OCN®, CRNI®, NEA-BE, CPC-A Angela Skelton, BSN, RN, CRNI®

INSider encourages the submission of articles, press releases, and other materials for editorial consideration, which are subject to editing and/or

PUBLIC MEMBER

condensation. Such submissions do

John S. Garrett, MD, FACEP

not guarantee publication. If you are

CHIEF EXECUTIVE OFFICER

Mary Alexander, MA, RN, CRNI®, CAE, FAAN

interested in contributing to INSider, please contact the INS Publications Department. Photos become the property of INSider; return requests must be in writing. INSider is an official bimonthly publication of the Infusion Nurses Society.

I N S S TA F F Chief Executive Officer: Mary Alexander, MA, RN, CRNI®, CAE, FAAN

FUSION NURSES SOCIETY Executive Vice President: Chris Hunt

Director of Operations and Member Services: Maria Connors, CAE Clinical Education & Publications Manager: Dawn Berndt, DNP, RN, CRNI® Managing Editor: Leslie Nikou Editorial Production Coordinator: Rachel King Director of Clinical Education: Marlene Steinheiser, PhD, RN, CRNI® Member Services Senior Associate: Jill Cavanaugh

INFUSION NURSES SOCIETY

Meetings Manager: Meghan Trupiano, CMP Conference Education Coordinator: Judy Clapp, CMP, DES

©2021 Infusion Nurses Society, Inc. All rights reserved.

Marketing Project Manager: Whitney Wilkins Hall Certification Manager: Adrienne Segundo, IOM

For information contact: INS Publications Department

Certification Administrator: Bill Taylor

One Edgewater Drive, Suite 209

Senior Certification & Member Services Associate: Maureen Fertitta

Norwood, MA 02062

Member Services Associate: Susan Richberg

(781) 440-9408

Bookkeeper: Cheryl Sylvia

rachel.king@ins1.org

In this Issue 6 8 10

President’s Message:

12 16 20 25 26

Using Malpractice Claims Data

Healthy Infusion Nurses, Healthy Nation ®

CRNI Connection: It’s never too early to think about recertification.

Cover Story: Reconnecting in Las Vegas: The INS 2021 Annual Meeting and Exhibition

to Identify Risks in Nursing Practice to Enhance Patient Safety, Part 1

Welcome New INS Members: Domestic and International

Member Spotlight: Our members share their experiences with the infusion community.

INS Certification Award: Recognizing exceptional leadership in the infusion therapy specialty

INSide Scoop: A closer look at what’s going on within INS

P R E S I D E N T ’ S

M E S S A G E

Healthy Infusion Nurses, Healthy Nation Do you want to eat healthier, be more active, get better sleep, and have more joy? As we begin to return to the “new normal” after the COVID-19 pandemic, I propose that we take time this summer for self-care. I would like to invite you on a journey with me to be healthier infusion nurses. Let’s join the American Nurses Association (ANA) Healthy Nurse, Healthy Nation™.

40% of nurses getting 6 hours or fewer of sleep in a typical 24-hour period.

As we start on the path to be healthier infusion nurses, it is important to recognize that everyone’s journey is different: that becoming healthier is not only about nutrition and physical activity. HNHN has 5 fundamental indicators of wellness: rest, nutrition, physical activity, quality of life, and safety.

The ANA conducted a Health Risk Appraisal of When I first joined HNHN, I realized I was not registered nurses (RN) which revealed nurses Susan H. Weaver getting enough sleep. Life was so busy that I in the United States are overweight, do not get PhD, RN, CRNI®, NEA-BC would often do just one more thing at night, enough sleep or eat the recommended daily sacrificing sleep and feeling exhausted in the amount of fruits and vegetables, and have morning. I recognized that getting enough high workplace stress. In recognition of this alarming sleep is just as important as exercising and eating information, the ANA created Healthy Nurse, Healthy nutritiously.

So, I started tracking my sleep and went to Nation™ (HNHN) in May 2017. The vision of HNHN is to bed just 12 minutes earlier each night until I reached my increase the health of the 3.8 million RNs in the United goal of 7 hours of sleep.

I now consistently sleep 7 hours States, thereby impacting and improving the health of each night, even though it may be challenging at times, the nation. especially when I visit my twin grandbabies in August!

The latest HealthyNurse® Survey data, from May 29, 2019 Currently, I am working on being more mindful. Do you to May 28, 2020, with responses from 6,142 RNs, found remember your car ride to work today? What were you nurses could benefit from increasing their physical activity thinking about the last time you inserted an intravenous level. The results also revealed that nurses’ average body catheter? When you were on a Zoom meeting, were you mass index (BMI) is 27.94, which falls into the overweight doing anything other than listening to those who were category, and that many nurses lack adequate sleep, with speaking? Often, I have trouble remembering my car ride 6

INSider

to work, or when baking a cake I loose count of how much flour I added, or when I play tennis I can never remember the score—and I love to multitask when I’m on a Zoom meeting. But HNHN has introduced me to mindfulness and I’m starting to change! Just this week, when playing tennis, I tried to push out thoughts of what I was doing after tennis and just focus on the moment, and I ended up remembering the score because my mind was in the game. But being more attentive during Zoom meetings and conference calls is still a work in progress!

posted each month on wellness topics and nurse health journeys, live events including Twitter chats, and discussion boards. I participate in the HNHN challenges each month and receive text reminders on what I should incorporate into my day.

Jon Kabat-Zinn, an expert in mindfulness, explains, “Mindfulness is awareness, cultivated by paying attention in a sustained and particular way: on purpose, in the present moment, and non-judgmentally.” Mindfulness is living in the moment—which doesn’t take any time at all. Research studies have shown that it is worth our time to invest in mindfulness practices because mindfulness makes a difference. An integrative review in Nurse Education Today revealed that mindfulness meditation is an effective strategy for preventing and managing workplace stress and burnout, which so often plagues nurses.

September: Work-Life Balance challenge

“Mindfulness is awareness, cultivated by paying attention in a sustained and particular way: on purpose, in the present moment, and non-judgmentally.”

The upcoming HNHN challenges are: July: Physical Activity challenge August: Hydration challenge

Attending the INS 2021 Annual Meeting in Las Vegas will also assist us on our healthy infusion nurse journey. Dr. Lesly Kelly will guide us on how to create more joy at work in her session “More Than Resilience: Finding Joy at Work.” So, I look forward to seeing everyone in Las Vegas and talking about our journey to becoming healthier infusion nurses.

Kudos to you for reading through this message. If you’d like a chance to win the book Mindfulness for Beginners by Jon Kabat-Zinn, email me at ins@ins1.org. I will select one person at random to receive a free copy.

Enjoy the summer and try to take some time for self-care.

– Jon Kabat-Zinn References

We really don’t have time NOT to be mindful.

It takes discipline.

Take a moment to feel your body breathing.

Take a moment to NOTICE what is happening.

What I like about mindfulness is there is no right or wrong way.

INS has partnered with HNHN and encourages infusion nurses to join Healthy Nurse Healthy Nation, which has an abundance of resources and is FREE for all nurses. You do NOT need to be an ANA member to join.

HNHN members have access to so much, including a health survey with immediate results in the form of a heat map, new blogs

Executive summary: American Nurses Association health risk appraisal. American Nurses Association (ANA). http://www.nursingworld.org/~495c56/globalassets/practiceandp olicy/healthy-nurse-healthy-nation/anahealthriskappraisalsummary_2013-2016.pdf. 2017.

Healthy Nurse Healthy Nation (HNHN) year three highlights.

Am. Nurse Today, 2020;15(9): 35-44.

Kabat-Zinn, J. Mindfulness for Beginners: Reclaiming the Present Moment and Your Life. Louisville, CO: Sounds True; 2012.

Van der Riet, P, Levett-Jones, T, Aquino-Russell, C. The effectiveness of mindfulness meditation for nurses and nursing students: an integrated review. Nurse Educ. Today 2018;65: 201-211.

July/August 2021

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It’s never too early to think about recertification.

Congratulations to those who recently passed the CRNI® Exam for the first time! You just passed this very important Exam in your career path in infusion nursing. Now let’s shift your focus to the recertification process.

You may ask, “I just certified or recertified, why should this be on my radar now?”

GREAT question!

It’s extremely important to schedule the time and budget your resources for your recertification cycle. There’s no time like right after you obtain your CRNI® to plan it out. We understand that everyone’s schedule is different and let’s face it LIFE HAPPENS. We hope you use this article as a guide to kick-start your individual recertification cycle. In addition, if you’re not a Member, we’ll show a snippet on how being an INS Member can help save you money.

We’ve broken down the process so you’ll be ready to apply for recertification when the time comes and keep this most valuable certification you so proudly earned.

To maintain your CRNI® credential, you must recertify every 3 years.

For the CRNI Recertification 3-year Budget Plan

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For the information on Certification

For the information on Member Benefits

You can choose to recertify in one of two ways: 1) by recertifying through Continuing Education (CE) or 2) by passing the CRNI® Exam again.

1) Recertify by (CE) has 2 paths. Let’s explore them.

If recertifying by (CE), you must obtain a total of 40 Recertification Units (RUs), of which at least 30 RUs must be from INS meetings, either in-person or online. The additional RUs can be obtained through other recertification options listed in the CRNI® Recertification approved tab in the LEARNING CENTER. First Path to Recertification by (CE): Attend an Annual INS Meeting during your 3-year certification cycle.

Advantages: • Power comes in numbers. By connecting with other attendees from across the globe, you will strengthen your professional network exponentially in just a few days.

• Building relationships with the best practitioners in the infusion world means access to unparalleled mentorship. An INS Annual Meeting is the best place to ask questions and get answers!

• It is the easiest, most rewarding way to acquire all 40 RUs needed for recertification, in one place and at one time.

Investment: INS Annual Meeting registration fee + recertification application fee in your 3rd year.

Incentive: Members save $145 off the regular registration fee. For a greater discount, register early. When you think about it, you just saved half the enrollment fees of a 3-year Membership.

Time Line: Attend at least 1 INS Annual Meeting in person during your 3-year certification cycle. Learn more about INS Annual Meetings at www.ins1.org/conferences In year 3, submit an application fee for recertification.

Second Path to Recertification by (CE): If you’re a CRNI® and unable to travel to an INS Annual Meeting, the Virtual Infusion Education platform in the INS Learning Center is the perfect solution. You can view conference programing live or on-demand and earn all 40 RUs online.

Advantages: • With our CRNI® recertification approved section, you no longer have to wonder whether a webinar or a conference will qualify for RUs. Every learning activity in this section has been approved for RUs. • You can recertify and earn all 40 RUs from the comfort of your home or office.

Investment: INS Learning Center registration costs (spread out over 3 years) + recertification application fee in your 3rd year.

Incentive: If you are not an INS Member, you may want to consider joining.

As an INS Member, you’ll receive significant savings on other recertification learning activities.

Time Line: Register for INS Learning Center activities each year during your 3-year certification cycle.

In year 3 submit application fee for recertification.

2) Recertify by Exam: The second option in the recertification process is to sit for the CRNI® Exam. We understand some people don’t mind exams and have scheduled to take this one. You must complete a Recertification by Exam application and take the Exam in your 3rd year of your certification cycle (the recertification fee is included when you recertify by Exam).

Incentive: If you are not an INS Member, consider joining: Members save $165 on Exam registration fees. That’s a savings of over half of a 3-year INS Membership.

Any of these recertification options allow you to schedule your time and budget your resources to pace your recertification cycle. No matter your path, plan now—year 3 will be here before you know it!

We also encourage you to consider Membership in INS. Not only does it save you money, but INS is the trusted resource in infusion nursing.

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S T O R Y

Reconnecting in Las Vegas: The INS 2021 Annual Meeting and Exhibition

by Dawn Berndt, DNP, RN, CRNI®, Marlene M. Steinheiser, PhD, RN, CRNI®, and Meghan Trupiano, CMP

The INS Annual Meeting—the go-to event for infusion specialists for over 40 years—is back! In 2020, INS continued our educational offerings and mission through an array of virtual conferences and new products, but we are so excited that INS 2021 will be live in Las Vegas from August 14-17!

The Venue INS 2021 will take place at the Paris Las Vegas, a hotel conveniently located in the center of the Las Vegas Strip.

Not only is the hotel providing discounted room rates of $169/per night (plus tax), but they’re giving INS attendees free tickets to the High Roller Ferris wheel and 10% off at the spa. At the Paris, you can visit the Eiffel Tower Viewing Deck which has a breathtaking view of the Las Vegas Strip and a spectacular light show at night.

The hotel also offers celebrity-chef restaurants, a rooftop nightclub, and much more. Not to the mention the entertainment that the rest of Las Vegas will provide you!

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The Exhibition Hall For the first time, the Meeting will kick-off in the exhibition hall. Start your morning and your Meeting visiting the top infusion vendors in the industry, testing out projects, chatting over coffee, talking with fellow attendees, and podcasting at the INS booth.

That’s right; for the first time, we’re podcasting live at INS 2021! Industry partners will present patient care innovations and initiatives; conference presenters will share about patient safety and population-specific infusion practices; and attendees are invited to join the discussions on clinical practice, the role of infusion nursing, and INS membership activities!

After hanging out in the exhibition hall at the beginning of the Meeting, attendees will attend educational sessions, then return to the exhibition to enjoy lunch with the vendors, other attendees, conference presenters, and podcasters.

And that’s just Saturday! Each day has a different schedule; luckily, attendees can download the INS 2021 mobile app and not miss anything.

The Conference Sessions Your requests have been heard! We’ve gathered data about the educational topics that interest you by reviewing evaluations and surveys and by noting your attendance at on-ground and virtual educational offerings. As a result, we’ve packed the INS 2021 Las Vegas Annual Meeting with a variety of your desired topics. Our speakers, who clinically practice in various health care disciplines, will present a blend of clinical and health care–related topics, noting the clinical practice changes impacted by the INS 2021 Infusion Therapy Standards of Practice.

Some of this year’s conference sessions will include education on various vascular access devices and current trends in infusion therapy such as short PIVC challenges, caring for patients with COVID-19 and cancer, patient safety issues, and specific pediatric and older adult topics. General sessions will provide education on topics relevant to all practice settings and patient populations, including education on safe flushing practices, improvement opportunities with short peripheral intravenous catheters, and unintentional bias in health care.

During the concurrent sessions offered on Saturday and Sunday, in order to provide clinicians in home infusion, skilled nursing facilities, and ambulatory care clinics the opportunity to enhance their practice, we’ve included sessions related to patient care in alternative sites.

On Monday, concurrent sessions will focus on vascular access device and infusion-related complications. You can spend your day learning how to assess, intervene, and minimize the risk of these complications.

Our final conference day, Tuesday, offers education in a variety of topics related to the patient experience, disease states, and clinical challenges.

By the end of Tuesday, our brains will be filled with updated knowledge that will blend well with our compassionate care for others. As we prepare to go back to our clinical roles and apply all the technical knowledge gained at this conference, we will conclude with a session about how to create joy in our work.

Thank you so much for your continued support virtually this past year! Although a lot has changed in the world since we last hosted an Annual Meeting, many of our goals and offerings remain the same. As always, we have a wonderful venue, an exhibition hall, sessions led by industry experts, and networking opportunities.

We’re excited to be back in person and look forward to seeing you in Las Vegas to learn and connect once again!

Click here to visit the INS 2021 website to register today!

July/August 2021

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Using Malpractice Claims Data to Identify Risks in Nursing Practice to Enhance Patient Safety, Part 1

by Jennifer Flynn, CPHRM, Risk Manager, Nurses Service Organization (NSO)

The Nurse Professional Liability Exposure Claim Report, 4th Edition is a study by CNA and NSO analyzing registered nurse (RN), licensed practical nurse (LPN), and licensed vocational nurse (LVN) closed professional liability claims over a 5-year period. The study identifies current liability patterns and trends and provides risk control recommendations to enhance patient safety and minimize liability exposure. The study, as well as the information in this article, which was obtained through the study, can help nurses, nurse educators, administrators, health care employers, and health care leaders identify and manage the risk exposures most likely to affect nursing practice.

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Nurse Professional Liability 5-Year Closed Claim Analysis Database and Methodology Part 1 of the report analyzes professional liability claims affecting registered nurses (RN), licensed practical nurses (LPN), licensed vocational nurses (LVN), or nursing students that closed between January 1, 2015 and December 21, 2019 and resulted in an indemnity payment of $10,000 or greater. The database for this report was derived by applying this specific exclusion criteria to the claims

database of the CNA–insured nurses through the NSO program during this time period. These exclusion criteria narrowed the database to 455 closed nurse claims, which were subsequently reviewed and analyzed.

Notably, home care accounted for 20.7% of the closed claims in the 2020 claim dataset, as compared to 12.4% of closed claims in the 2015 claim dataset.

Location

Comparison of 2011, 2015, and 2020 Closed Claim Count Distributions

$1,000,000 and above

3.5% 3.1% 3.7%

$750,000 to $999,999

2.1% 2.7% 1.3%

$500,000 to $749,999

2.1% 3.8% 4.6%

2011 2015 2020

11.2% $250,000 to $499,999 10.6% 15.9% 24.8% $100,000 to $249,999 20.9% 23.8% 56.2% $10,000 to $99,999 58.8% 50.7%

The health care delivery settings that experienced the greatest number of claims were the patient’s home, hospital inpatient surgical services, and aging services communities. Both the frequency and severity of the patient’s home closed claims have increased significantly since the 2015 dataset. In 2015, this setting accounted for 12.6% of the closed claims. In 2020, this setting accounted for 21.8% of the closed claims, an increase of 73% from the 2015 dataset. This paradigm shift of patient care from the hospital to the home will likely continue as technology, such as telehealth and other virtual health care tools, improves and third-party payors adopt its use. The shift does not necessarily mean that nurses working in the home care specialty are more likely to be involved in a lawsuit. Rather, it is more reflective of the overall shift in patient care locations.

Allegation Figure 1. Comparison of Average Indemnity Payments over $10,000 between 2011, 2015, and 2020 Nurse Closed Professional Liability Claim Datasets.1

Data Analysis Of the 455 closed claims, 86.8% involved individually insured registered nurses, 12.8% involved licensed practical nurse/vocational nurses, and less than 1% involved student nurses. While the distribution of licensure types within the CNA/NSO insureds varies somewhat over time, the current ratio of our insured nurses represents 89% RNs to 11% LPNs/LVNs. For purposes of the study, incurred payment represents the total costs or financial obligations, including indemnity and expenses, resulting from the resolution of a claim.

The overall average total incurred per claim was $210,513.

In the 2015 CNA/NSO nurse claims analysis, which included claims that occurred between 2010 and 2014, the average total incurred for closed claims with an indemnity payment of $10,000 or greater that closed during the study period was $201,670. Thus, the average total incurred has increased 4.4% in the interim (Figure 1).

Specialty The 3 specialties with the highest average total incurred were obstetrics (labor and delivery), post-anesthesia care unit (PACU), and behavioral health. The highest percentage of closed claims occurred in the home care, adult medical/surgical, and gerontology specialties.

Six allegation categories accounted for 96% of all the closed claims in the analysis (Figure 2). Treatment and care-related claims had the highest percentage of closed claims, accounting for 56.0% of all closed claims and with an average paid indemnity at $209,937 per claim, followed by claims with allegations related to patient’s rights/abuse/professional conduct, medication administration, monitoring, assessment, and scope of practice (Figure 3). Claims arising from allegations related to communication, or lack of communication, resulted in the highest average total incurred at $324.260 per claim.

Distribution of Top 6 Closed Claims

by Allegation Closed Claims with Paid Indemnity of > $10,000 This figure only highlights those allegations with the highest distribution.

56.0%

Treatment/Care

14.3% Patients’ Rights/Abuse/Professional Conduct 10.1% Medication Administration 7.6% Monitoring 5.1% Assessment 3.3% Scope of Practice

Figure 2. Distribution of Nurse Closed Professional Liability Claims

by Major Allegation Category.1

July/August 2021

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Average Total Incurred of Closed Claims by Allegation Closed Claims with Paid Indemnity of > $10,000

According to the National Practitioner Data Bank, nursing professionals were on average more than 62 times more likely to be involved in an adverse licensing action than a medical malpractice payment in 2019.

2

Allegation

Average Total Incurred

Communication

$324,260

Monitoring

$265,010

Scope of Practice

$252,531

Documentation

$238,761

Medication Administration

$214,035

Treatment/Care

$209,937

Assessment

$192,880

Patients’ Rights/Abuse/Professional Conduct

$165,732

Overall Average Total Incurred

$210,513

Figure 3. Average Total Incurred of Nurse Closed Professional Liability Claims by Major Allegation Category.1

• License defense matters by allegation class: License defense matters involved both medical and nonmedical regulatory board complaints against nurses. The allegation classes with the highest percentage of license defense matters were professional conduct (32.5%), scope of practice (24.8%), documentation error or omission (9.7%), treatment and care (9.3%), and patient’s rights/patient abuse (8.8%) (Figure 4).

License Defense Matters

by Primary Allegation Class 24.8% Scope of Practice 9.7% Documentation Error or Omission

Injury Death remained the most common injury, accounting for 40.9% of claims in the 2020 dataset. The distribution by cause of death was attributed to cardiopulmonary injury/arrest which accounted for 47.3% of closed claims, followed by infection/abscess/sepsis, pressure injury, bleeding/hemorrhage, and brain injury other than birthrelated brain injury. Death due to bleeding/hemorrhage had the highest average total incurred of all death-related claims at $304,181 per claim.

Analysis of License Protection Paid Claims An action taken against a nurse’s license to practice nursing differs from a professional liability claim in that it may or may not involve allegations related to patient care and treatment provided by the nurse. Another distinction relates to amounts paid in response to license protection claims.

Such disciplinary matters represent the cost of providing legal representation to the nurse in defending such actions, rather than indemnity or settlement payments to a plaintiff.

During the time frame of this report (January 1, 2015, through December 31, 2019), the 4th edition of the NSO/CNA Nurse Professionality Liability Exposure Claim Report revealed a total of 1,377 closed license protection matters with payment in the 5-year analysis affecting CNA/NSO–insured nurses, with an average defense expense of $5,330. This data reflects an increase in both the total number of license protection matters as well as the reimbursement costs as compared to the previous dataset.

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32.5%

9.3% Treatment and Care

Professional Conduct 8.8% Patients’ Rights/Patient Abuse 6.2% Medication Administration 3.8% Assessment 2.8% Monitoring 1.8% Breach of Confidentialty <1% Adjudication (Mental Illness)

Figure 4. Frequency of Nurse License Defense Paid Claims

by Major Allegation Category.1

• License defense matters by sub-allegation category related to professional conduct found: – The top sub-allegations related to professional conduct involved drug diversion and/or substance abuse (42.3%), professional conduct as defined by the state (21.5%), criminal act or conduct (16.1%), and reciprocal actions (6.0%) (Figure 5).

– As in the 2015 dataset, allegations related to drug diversion and/or substance abuse remained the top allegations for both RNs and LPNs/LVNs, representing 42.3% of professional conduct matters. Examples include diverting medications for oneself or others, and apparent intoxication from alcohol or drugs while on duty.

– Professional misconduct as defined by the state, which accounts for 21.5% of all professional conduct allegations and is a broad allegation category that includes unprofessional conduct toward coworkers and/or patients. One example relative to this category includes allegations of falling asleep while on duty.

– Reciprocal actions taken against a nurse represented 6.0% of the matters related to professional conduct. The State Board of Nursing has the authority to take actions against a licensee based upon disciplinary action in another jurisdiction.

Allegations Related to Professional Conduct 21.5% Professional Misconduct as Defined by the State

42.3%

16.1% Criminal Act or Conduct

Drug Diversion and/ or Substance Abuse

regarding nursing techniques, clinical practice, biologics, and equipment.

• Document your patient care assessments, observations, communications, and actions in an objective, timely, accurate, complete, and appropriate manner.

• If necessary, utilize the chain of command or the risk management or legal department regarding patient care or practice issues.

• Maintain files that can be helpful with respect to your character, such as letters of recommendation, performance evaluations, and continuing education certificates.

6.0% Reciprocal Actions 4.3% Issue Related to Information Provided on License Renewal 3.6% Wasteage Errors

References

2.9% Practicing without a License 1.8% Inappropriate Nurse Supervision <1% Hiring Practices <1% Failure to Renew License

Figure 5. Frequency of Nurse License Defense Paid Claims

by Sub-allegation Category Professional Conduct.1

Licensing Board Actions Any complaint filed against a nursing license can result in career-altering consequences, such as suspension, probation, license surrender, or license revocation. In the 2020 dataset, the largest percentage of license protection matters, 45.6%, of the board’s final decisions resulting in no action taken. A smaller number of decisions resulted in the end of a nurse’s career, including license surrender at 4.8% and revocation at 1.5%.

A nursing board complaint can be filed against a nursing license by a patient, a patient’s family member, a colleague, or an employer. By knowing the most common types of allegations filed, nurses can identify their vulnerabilities and take appropriate action to protect their licenses. By incorporating the following essential risk control recommendations into their practice, nurses can help protect patients, as well as themselves, against a board complaint: • Practice within the requirements of your state nurse practice act, in compliance with organizational policies and procedures, and within the national standard of care.

If regulatory requirements and organizational scope of practice differ, comply with the most stringent of the applicable regulations or policy.

1. CNA and Nurses Service Organization. Nurse Professional Liability Exposure Claim Report, 4th edition: Minimizing Risk, Achieving Excellence. https://aonaffinity-blobcdn.azureedge.net/affinitytemplate-dev/media/nso/claimreports/cna_cls_nurse20_061120p2_cf_prod_online_sec.pdf.

Accessed May 4, 2021.

2. Singh, Harnam. National Practitioner Data Bank.

Generated using the Data Analysis Tool. Accessed March 1, 2021.

3. NCSBN and American Nurses Association (ANA).

National Guidelines for Nursing Delegation. https://www.ncsbn.org/NGND-PosPaper_06.pdf?refID=iiWLTNPi. Accessed May 4, 2021.

The second part of this article will appear in the September/October 2021 issue of INSider.

The purpose of this article is to provide information rather than advice or opinion. It is accurate to the best of the author’s knowledge as of the date of the article.

Accordingly, this article should not be viewed as a substitute for the guidance and recommendation of a retained professional. For the full report visit www.nso.com/nurseclaimreport.

Nurses Service Organization (NSO), the nation’s largest administrator of professional liability insurance coverage to individual nursing professionals, also maintains a variety of online materials for nurses, including articles, legal cases, and useful clinical and risk control resources.

For more information, contact NSO at (800) 247-1500 or visit NSO online at www.nso.com.

• Maintain basic clinical and specialty competencies by proactively obtaining the professional information, education, and training needed to remain current July/August 2021

15

Welcome New Members!

NEW DOMESTIC MEMBERS

16

Nelson Doma

Alejandra “Alex” Hernandez

Katherine Dong

Erin Hess

Alicia Ahart

Katie Donnelly

Carol Hinton

Carissa Ainsworth

Susan Dudick

Kimberly Holland

Edward Almeida

Ashley Duffner

Megan Hopf

Tori Amsler

Christine Duncan

Nicole Hull

Michelle Andersen

Alisha Dutkiewicz

Carman Hultgren

Amy Arredondo

Wendy Dybas

Kristin Inglis

Jill Aubrecht

Elizabeth Edwards

Brandon Johns

Amarjeet Aulakh

Lynae Envik

Erin Jordanger

Lacey Babcock

Nicolette Ernsting

Jestin Jose

Mercedes Barajas

Stacie Ethington

Boyd Kennemer

Sara Barboza

Allison Eustace

Dorothy Kerr

Patricia Barry

Ami Faerber

Anthony King

Jennifer Bartowitz

Theresa Fanasch

Laura Kingsbury

Julie Bastek

Lauren Faulkner

Traci Kittleson

CristinaBenshoff

Corey Fava

Kimberley Koivu

Douglas Bischoff

Michael Fernandez

Jenifer Krause

Catherine Black

Dawn Fitzgerald

Tracy Kuykendall

Lucy Blankson

Rita Fordos-Huebel

Gail Kwarciany

Tiffany Blauvelt

Sherl Fox

Emilienne Kwi

Rosanna Bremer

Derek Fox

Ashley Lambert

Killeen Brock

Candace Gandy

Jessica Landers

Sheryl Buckner

Dawn Garcia-Brinker

Di Lenz

April Bullock

Annie Gazda

Lucy Licameli

Mary Burkart

Mark Gibbs

Amy Liddell

Devin Callan

Nikki Gibson

Marika Lolley

GeorgeCarrillo

Genesi Gonzalez

Jennifer Mancebo

Danielle Chavez

Angelica Gonzalez

Dave Martin

Dawn Christiansen

Kathleen Gormley

Sheila McConnell

Karin Cierzan

Angela Graff

Amber McFerren

Ashley Colberg

Kathleen Graham

Shelly McGahee

William Courtney

Melissa Gramigna

Ron Mehaffy

Johanna Cruz

Kristin Grasse

Cassandra Mitchell

Tammy Danielson

Denise Hannigan

Danielle Moody

Carmela Darilag

Shonda Harden

Andrew Morris

Wendy Deblaquiere

Mariam Hasan

April Moslen

Christina Marie Dee

Tanya Hastings

Chrissy Murphy

Karen DeLuca

Jill Hawk

Meg Murphy

Jennifer Devlin

Megan Haworth

Erika Mushipe

Erin Dias

Kristi Hayhurst

Frank Myers

Janelle Dietrich

Celina Hazelrig

Wendy Namken

Casey DiFrancesco

Mary Lynn Helman

Kathrine Newsom

INSider

Heather Nichols

I N F U S I O N N NUE W R SI NET ESR NSATO CIETY IONAL MEMBERS Leslie Shumaker

Sarah Nichols

Karen Slaven

Christopher Nies

Paige Soltes

Sheri Noble

Teresa Spinella

Maryam Ebrahim Ahmed Al Bashkardi – United Arab Emirates

Travis Nykamp

Timothy Spurlin

Dolil Biswas – India

Patricia O'Brien

Maria Anna Stallings

Rossette Ocampo

Susan Stell

Brenda Ohmes

Vanessa Sumner

Paul Ooyi

Lisa Svatek

Luis Enrique Estevez Cruz – Mexico

Courtney Parker

Jessica Swanson

Salatiel Machuca Figueroa – Mexico

Amy Parker

Jamie Swartz

Debra Parks

Bethanie Szydlowski

Michelle Parsons

Bill Taylor

Vangie Gervais – Canada

Monica Parsons

Huntre Taylor

Mariam Hasan – United Arab Emirates

Christy Pearre

William Taylor

Gabor Kollar – Hungary

Laura Perry

Danita Taylor

Margaret Perry

Traci Taylor

Jamie Petroski

Suzanne Tejeda

Eunhye Kim – South Korea

Christina Pettit

Carrol Thomas

Minkyoung Kim – South Korea

Holly Prater

Jodi Thompson

Michelle Pugel

Suhyun Lee – South Korea

Clayton Tillett

Linda Puls

Lynda Townsend

Angelina Pusateri

Tracy Tran

Silvia Mendoza Olvera – Mexico

Justin Rammage

Henry Troche-Smith

Jothi Clara J. Michael – India

Tamara Raybon

Ludmila Tsyryulnikov

Valerie Redman

Susan Mok – Canada

Brittany Turley

Antoinette Reino

Brian Underwood

Elizabeth Ricenberg

Kate Van Hooff

Janet Roberts

Ruth Van Orden

Ann Rodrigues

Matthew Vanasse

Michelle Pothier – Canada

Karen Ross

Liwliwa Villagomeza

Ellen Roth

Teresa Wagner

Victor David Guerrero Reynaga – Mexico

Maria Rubio

Phuong Ward

Kit YingTsang – China

Amanda Rufer

Cornelia Watts

Leslie Russell

Caroline Winchenbach

Sarale Russ-Gilliam

Aileen Wolf

CarolynSarlo

Raeann Wolf

Lisa Schomburg

Whitney Wyland

Xavier Sciandra

Kaitlin Yeager

DanielaScotto

Lenora Young

Carrie Self

Bianca Zafra

CynthiaSerrano-Colon

Miriam Ziegler

Sandra Shaw

Mary Ann Zock

Shirley Briggs – United Kingdom Teresa Davis – New Zealand

Lisa Gangol – United Arab Emirates

Julia Lindsay – Australia

Eileen Loveland – United Kingdom

Seyed Amirmasoud Nematollahi – Canada Jenny Percival – New Zealand

Ida Virtala – Sweden

July/August 2021

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PA R I S H OT E L

*

LAS VEGAS

INS 2021 REGISTRATION NOW OPEN! LEARN MORE

We invite you to join us on August 14 -17, 2021 at the Paris Hotel in Las Vegas to reconnect live with members of the infusion community.

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We look forward to seeing you in Vegas!

View these webinars and more on-demand: www.learningcenter.ins1.org/webinars Prevention and Early Recognition of Infiltration and Extravasation

Vesicant Identification and Appropriate Extravasation and Infiltration Treatment

Aseptic Non Touch Technique (ANTT®) Clinical Practice Framework

Listen to these podcasts and more on-demand: www.learningcenter.ins1.org/podcasts Tips and Tricks for Effective Educational Programs

Sickle Cell Disease: My Story– Remembering Kelsey Taylor

Vein Visualization and Vessel Health

July/August 2021

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INS Member Spotlight

Nicole Colamesta Infusion Nurse Specialty Infusions What led you into the nursing profession? A desire to improve the lives of patients and their family members.

What made you decide to specialize in infusion therapy? My first IV insertion and infusion. Finally, here is my true calling as a registered nurse, I thought. After six years of being an infusion nurse, how I care for my patients continues to evolve. I can truly say that I love being an infusion nurse. Words cannot describe how much I love witnessing the improvement in quality of life of my clients!

How has INS Membership benefited you in your journey? The knowledge of Infusion Therapy Standards of Practice has opened new pathways to new learning experiences.

Has there been a mentor, colleague, or other INS member who has helped along the way? There is one person, a regional manager, who taught me everything he knows. His name is Jason Sylvia, MBA, RN. I have extreme gratitude toward him.

Do you have stories from your practice that you would like to share with the infusion community? While I have many stories I could share, my recent favorite occurred while working at a COVID research center. We have been able to not only conduct much-needed research on COVID, but also to provide a form of income to the many laid-off workers and/or undocumented immigrants. Because all of the studies require IV access and/or multiple lab draws, it is necessary for us to have IV access. When we found ourselves turning away some willing participants due to the inability to obtain access, I decided something else had to be done. I work as a mobile PICC line nurse per diem, and have an ultrasound that is not in use. I decided to use that in order to ensure that we could allow more willing participants to become a part of the study and earn income at the same time. We have used the ultrasound on several participants who were appreciative that (1) we were able to gain access on the first try and (2) they could be part of the study while earning money.

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INS is honored to share our members’ stories with the infusion nursing community. Each nursing journey is unique and we can learn so much from each other. We will continue to share stories from our members who care for patients in a variety of care settings. We are proud of you all and commend you for your hard work, passion, and dedication to patient care.

Steven Morris Staff Nurse Physicians Choice Home Health, Premier Pharmacy What led you into the nursing profession? I owned and operated the largest retail meat market in the southern half of Los Angeles from 1974 until 1981, having purchased it from my dad when he retired. We made an excellent living, but I did not feel fulfilled. I sold the business in 1981. When I sold the store, I also sold my job. My wife had been a nurse since we’d married and I always said I liked what she did, so I decided to go back to school and become an RN. I already had a BA in biology so I was quickly accepted into the nursing program at Harbor College. I graduated 2 years later and have not looked back!

What made you decide to specialize in infusion therapy? After graduation, I worked on a surgical floor for 12-hour night shifts. We frequently had patients that had to be prepped for surgery early in the morning and needed an IV started. I have always been mechanically talented, so as I gained some level of expertise, I would volunteer to start the IVs on my workmate's pre-op patients. I became fairly adept at it in time. After 5 years, in 1989, I left the hospital to work in home health. I was frequently asked to start PIVs and to draw blood—both which I’d never been trained to do. I was constantly improving my skill level. In 1991, while working for the VNA of LA, I took a class in home PICC insertion. Over the next 9 years, I inserted about 300 PICCs in some of the most adverse home environments imaginable. On a waterbed, with dogs and cats running around, sweltering apartments without air-conditioning, no state-of-the-art vein finders, etc. Very challenging! But very fulfilling!

How has INS Membership benefited you in your journey? I have been able to keep up with the advances in IV therapy by attending the INS conventions and reading the Journal of Infusing Nursing. When there was an INS chapter in LA I attended meetings regularly.

Has there been a mentor, colleague, or other INS member who has helped along the way? Fe Saint Angel, CRNI® was the main motivator of the LA chapter for several years, and from her I learned new ideas. But the most rewarding part of my job is acting as a preceptor for the local nursing colleges and taking student nurses on their home-health rotation.

Do you have stories from your practice that you would like to share with the infusion community? I have been fortunate over the past few years to have been given the opportunity to share infusion knowledge, based on the INS Standards, in skills day. Skills day is a requirement for nursing at Wheeling Hospital annually. Thank you for that opportunity Cara Gazdik and Renee Tarovisky!

COVID-19 put a halt to skills day. Education was limited to online courses and small gatherings for hands-on training. I can honestly say this has been the most challenging year for nursing in all my 43 years in health care. As COVID-19 cases decline, I look forward to some kind of normalcy returning. I am confident all nurses feel this way. I am 63 years old and my nursing career is winding down, but I will never grow tired of learning all that INS has to offer in the infusion world. Your Standards have been the solid rock of safety in health care across the world!

July/August 2021

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I N S

M E M B E R

S P O T L I G H T

Elena Nelson Squires Vascular Access Specialist, Program Coordinator Northern Colorado Banner Health

What led you into the nursing profession? I was 22, with a husband and toddler.

Since high school, I'd sold vacuums, waited tables, and aided teachers. We lived hand-to-mouth, check to check. Barbara Connelly, the librarian I aided, saw more in me, and I wanted better for the tiny girl who rocked my world. I didn’t want her to repeat the cycle someday; I didn’t want her ever to go hungry so her own child could eat.

But to remain in the nursing field, you need more than a monetary incentive. One night, as a new grad on oncology, my patient was alone and dying of lung cancer. Family had been called, but no one came.

He begged me to stay. I held his hand and sat with him. Each of his breaths was a struggle, then he had moments of peace. When I stood, he looked up and said softly, “Thank you, baby.” I knew I had just done the most profound service of my life.

Barbara Connelly

What made you decide to specialize in infusion therapy? I'm handy with a needle. An excellent lab instructor, Carol Withrow, taught me skills that clicked. Of course, hospitalized oncology patients usually receive infusion therapy. I was in it from the start.

In the nineties, central access for chemo was often offered as a last option, so venous access was a challenging art. In Kentucky, the IV team placed PICCs, and soon after I moved, my Colorado manager wanted to add the option here. There was no IV team, so it fell to us oncology nurses.

I was in the first class. For nine years, I inserted the lines through which I gave treatment.

Carol Withrow

Specialized vascular access grew with our advocacy. PICC insertions became too numerous for a small group of oncology nurses. In 2001, I developed a vascular access specialist role. Within three weeks, a new service bloomed.

Through the early 2000s, I flirted with other roles like clinical informatics and intensive care, but I ultimately returned to lead and grow the vascular access program.

How has INS Membership benefited you in your journey? In college, I learned the value afforded by membership in a professional organization. I was exposed to the Infusion Nurses Society from the moment I entered oncology. Once I embraced specialty vascular access, INS was my first stop. The Infusion Therapy Standards of Practice and other INS publications guide my practice and assist with my creation of education, quality, and guideline documents.

Through the encouragement of my colleague, Ann Plohal, I spoke on central access at INS 2013, my first time speaking nationally! I was well received and felt fulfilled in a way that challenged me. INS recently afforded me the honor of reviewing the latest Standards; I am blessed.

INS publications sit next to my desk for easy reference, their spines creased, their pages worn. I am currently revising our adult peripheral IV guidelines, and changes based on the 2021 Standards will likely make a significant, positive impact on patient care across our system.

Ann Plohal

Has there been a mentor, colleague, or other INS member who has helped along the way? What is life without mentors: those who lead us, teach us, challenge us. I have many; three of them I mentioned previously. It would be impossible to name all the rest in the space allotted; however, there are two more who must be included in this particular part of my life story. Both are former teammates, now retired.

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I N S

M E M B E R

S P O T L I G H T

Traudl Renner understands the research process; moreover, she uses evidence and persistence to influence others, while insisting on a level of mutual respect. I hope that her thoroughness, perseverance, and collegiality reflect in me from time to time.

Barbara Bonito is the consummate vein whisperer. She was a staffing manager of an IV team before I met her. She showed me how to take my "free-hand" IV skills to the next level and taught me the blunt truths about the ups and downs of management.

I sometimes think of her as the mother of my vascular access career; at the least, she helped me to attain any of the success I enjoy.

Traudi Renner

I am forever grateful to both.

Barbara Bonito

Do you have stories from your practice that you would like to share with the infusion community? Above all else, when the patient has a story to tell, listen. When I was young, I cared for an elderly nurse. She spoke of the arrival of penicillin during World War II as though the miracle still awed her, as though someone had handed her a revelation that allowed her to save lives rather than to soften death. Her eyes were far away as she told the tale. I followed her eyes and saw it too.

It is with me still.

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I N S

M E M B E R

S P O T L I G H T

Cheryl (Cheri) Gandy CRN (VAIS) dept. PICC Team Wheeling Medical Park

What led you into the nursing profession? It’s a very sensible story: I was one of 5 girls in a middle-class family. My parents worked very hard to provide for us. Maybe because there were 4 nursing programs within a 50-mile radius, I ended up starting in the nursing profession in 1978. Three of my siblings are also in health care; the youngest sister chose to be a teacher.

I very much appreciated the respect and professionalism of becoming a nurse. I truly loved helping people and making them feel better. I worked in different areas of nursing including long-term care, medical/surgical, intermediate care with heart patients, and a critical-care unit with more acute heart patients.

What made you decide to specialize in infusion therapy? The group of ladies with whom I began this nursing journey was very knowledgeable. Six out of 8 staff members were INS members and had their CRNI®. The experience and learning opportunity I had with this group of women inspired me! Thank you to all of you fine ladies: Theresa Faykus, Kathy Keedy, Ronna Wilkerson, Cathy Winzenreid, Barb Wojtowicz, Debbie Zamski! For 18 years now I have been working in infusion care and I absolutely love it!

How has INS Membership benefited you in your journey? I began a new job at Wheeling Hospital in 2011. I was so impressed with the vascular access and infusion service (VAIS) department. I also was motivated to join INS, and very much wanted to obtain my CRNI® to help me meet the demands of my new job. Our department here at Wheeling Hospital shared links to the INS website many times while celebrating IV Nurse Day. I achieved my CRNI® in 2013 and felt even more confident in infusion care with the knowledge base it provided. The information from the conventions, conferences, and the website has been wonderful. I now truly understand the advantage of CRNI® status and INS membership: it continues to keep me informed. I had the surprising and extremely fortunate opportunity to earn one of the Scholarship Awards through the Gardner Foundation in 2016. My husband Tom, who was also a nurse, was very proud of me and enjoyed traveling with me to the conventions.

Has there been a mentor, colleague, or other INS member who has helped along the way? Life changed drastically when Tom was suddenly diagnosed with stage 4 lung cancer on May 9, 2018. The VAIS family here at Wheeling Hospital were amazingly supportive. The hospital approved the department to hold a fundraiser to help us through the financial strain. My husband’s facility, where he had been employed, also supported Tom and me with a generous gift. I felt so blessed to have Tom’s caring coworkers and the supportive VAIS staff—in particular my own nurse manager (Lori Jones)—to help us through this difficult time.

To my great sadness, on March 2, 2019, my husband lost his hard-fought battle to cancer. I counted my blessings: the support of my family, my friends, my work family, Tom’s work family, and our employers.

Do you have stories from your practice that you would like to share with the infusion community? What can I share to afford some insight or revelation? Turn on the light; position self and patient; look at both arms; think big vein, small catheter; avoid flexion; and anchor! Use ultrasound if there is any question of failure without it; maximize gain and depth; alternate views (transverse and longitudinal). Learn the appearance of nerves, veins, and arteries; and when in doubt, double check before the introducer or dilator goes in. Go slow. Ride the flow. Moreover, greet patients with compassionate and confidence—but don't get cocky!

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INS Certification Award Recepient

Cindy Sumrall, BSN, RN, CRNI®, IgCN The Infusion Excellence Award is presented to a CRNI® whose certification through INCC has advanced the welfare of his or her patients, organization, or the infusion specialty. The current award recipient is Cindy Sumrall, BSN, RN, CRNI®, IgCN. Cindy was nominated by Danielle R. Jenkins, BSN, RN, Cindy’s colleague of 13 years.

Cindy Sumrall has 25 years of infusion nursing experience.

After receiving her BSN from Texas Woman’s University, she discovered her love for home infusion at Optioncare in Rockwall, Texas, as an infusion nurse. She is currently Chief Clinical Officer at Paragon Healthcare, Inc., where she serves in multiple arenas, including infusion center management, physician office infusion clinics, home infusion nursing, hemophilia services, the quality assurance program, and the staff development program. Cindy is a member of many supporting organizations, such as INS, NHIA, NICA, and IgNS, and serves on the advisory committee for NICA. Cindy also serves on the board for Empower 7, a faith-based organization that provides strategic life solutions to empower the lives of vulnerable youth in North Texas.

Cindy is also the recipient of the 2021 Lynn Giglione Women in Leadership Award, one of the highest honors given by NHIA. This award recognizes and honors

trailblazing and emerging women leaders who have demonstrated exemplary service to patients and their peers while promoting the mission of the National Home Infusion Foundation. These award winners have made significant contributions to the home infusion industry through their leadership and by inspiring others to overcome barriers to achieve excellence.

Cindy is passionate about establishing a foundation of excellent patient care by providing continued education and competency programs for the clinical staff within her organization and partnering nursing agencies. She, along with Paragon leadership, offers INS membership to all full-time nurses within the organization to ensure that every nurse has access to the INS Standards and educational tools. By encouraging nurses to earn their CRNI® credentials, she has increased the number of CRNI®s on her team by 50% and climbing. She spearheads committees within her organization to bring awareness to areas that impact infusion nursing and provides seminars on new drugs and INS Standards. During the pandemic, she has mastered the use of Zoom and developed virtual skills trainings with her team. She is a pillar of excellence in nursing practice.

July/August 2021

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INSide Scoop Our recurring feature, INSide Scoop, serves to keep you informed on things happening within INS as well as upcoming events, items of interest, new educational deliverables, certification news, and other current information.

Here we communicate directly with our membership as well as with the larger infusion nursing community to keep you informed on topics—in real time.

Education News The INS education department is continuing this summer with webinar topics aimed to guide your clinical practice while implementing the revised INS 2021 Infusion Therapy Standards of Practice.

During the INS July webinar, Becky S. Linn, PharmD, BCPS, a professor of therapeutics and clinical pharmacokinetics, will provide education on managing osteomyelitis. This session will give an overview of osteomyelitis, including the pathophysiology, etiology, and predisposing conditions, and will conclude with a detailed discussion on antibiotic treatment. Join us in July to discuss the role of the infusion nurse in treating patients with osteomyelitis.

In August, join Mary E. Hagle, PhD, RN-BC, FAAN, an author of the INS Infusion Therapy Standards of Practice, as we discuss the importance of the Standards in promoting consistency in patient care and guidance in clinical decision-making. Dr. Hagle will explore how to apply INS Standard 7.1: the clinician integrates evidence-based knowledge with clinical expertise and the patient’s preferences and values in the current context when providing safe, effective, and patient-centered infusion therapy. Plan to participate in this webinar to learn how to use the Standards when creating policies and making clinical decisions for your patients.

If you were unable to join us in June during the live webinar on Aseptic Non Touch Technique (ANTT®) Clinical Practice Framework, with presenters Stephen Rowley, MSc, BSc (Hons), RN, RSCN and Simon Clare, MRes, BA, RGN, consider viewing the on-demand version in the INS Learning Center by accessing it here.

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INSider

Stephen Rowley, who has led the ongoing development and dissemination of ANTT® globally, is also the originator of ANTT® and Clinical Director of The Association for Safe Aseptic Practice (ASAP), a nonprofit, non-governmental organization (NGO) based in the United Kingdom. Simon Clare, Research and Practice Development Director at The ASAP, has been working with ANTT® framework teaching and developing resources for over 15 years. During this webinar, Mr. Rowley and Mr. Clare provide education about the fundamentals of the ANTT® framework, the new INS Standard for ANTT®, and how to implement ANTT® into your daily practice and organization.

Membership News Chat with us!

We’ve added a new feature to this INS website! Have a quick question? Forgot your password? Wondering how many RUs you have? We’re here to help! Ask us a question in the INS Live Chat box located at the bottom of the INS website.

If none of our member services associates are available to assist you live, don’t worry! You can leave us a message and we will get back to you as soon as we can.

Please note that we are unable to answer any clinical questions. Members are highly encouraged to post clinical questions in the Clinical Community Discussion forum found in the INS Learning Center.

We will also direct you to the Infusion Therapy Standards of Practice and/or the Policies and Procedures for Infusion Therapy.

INCC News Are you using all the benefits of earning your CRNI® to the fullest? Your CRNI® credential affords you the unique and distinct opportunity of using the personalized CRNI® certified badge in your correspondence. To see an example, please click on the badge. For more helpful hints on how to market yourself, go to the CRNI® resource information page on the INS website.

July/August 2021

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