2023 INSider November/December by InfusionNursesSociety

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

On Revising One Hospital’s IV Therapy Policies according to the INS Standards

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1973-2023

INS in the United Arab Emirates

Year End Review

NOVEMBER/DECEMBER 2023

Meet Two New NCOE Members VOLUME 6 • ISSUE 6

INFUSION NURSES SOCIETY

INS BOARD OF DIRECTORS 2023-2024 PRESIDENT

Inez Nichols, DNP, FNP-BC, CRNI®, VA-BC PRESIDENT ELECT

Danielle Jenkins, MBA, BSN, RN, CRNI® PRESIDENTIAL ADVISOR

Sue Weaver, PhD, RN, CRNI®, NEA-BC

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

SECRETARY/TREASURER

OF INFUSION NURSES SOCIETY

Joan Couden, BSN, RN, CRNI® DIRECTORS-AT LARGE

Jannifer Stovall, MBA, BSN, RN, CRNI®, IgCN Pamela McIntyre, MSN, RN, CRNI®, IgCN, OCN®

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

Lisa M. Ong, CPA, PCC

not guarantee publication. If you are

CHIEF EXECUTIVE OFFICER

Chris Hunt, MBA

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.

FUSION NURSES SOCIETY I N S S TA F F Chief Operating Officer: Maria Connors, CAE Director of Publications and Educational Design: Dawn Berndt, DNP, RN, CRNI® Graphic Design and Marketing Manager: Whitney Wilkins Hall Editorial Production Coordinator: Rachel King Managing Editor: Donna Knauss

INFUSION NURSES SOCIETY

Director of Clinical Education: Marlene Steinheiser, PhD, RN, CRNI® Education and Member Services Project Manager: Jill Cavanaugh Meetings Manager: Meghan Trupiano, CMP

Certification Administrator: Darlene Leuschke

For information contact:

Member Services Associate: Susan Richberg

One Edgewater Drive, Suite 209

Bookkeeper: Cheryl Sylvia

INS Publications Department Norwood, MA 02062 (781) 702-5908 rachel.king@ins1.org

In this Issue 3 5

Year End Review

On Revising One Hospital’s Policies according to the INS Standards Susan Gray RN, BSN, CRNI®

INS Overseas Part 1: United Arab Emirates Marlene Steinheiser, PhD, RN, CRNI®

The Many Benefits of the Policies and Procedures Dawn Berndt, DNP, RN, CRNI®

New NCOE Members Alicia Dickenson, BSN, RN, CRNI® and Eddie Korycka, MSN, RN

INS Learning Center Webinars and Podcasts

INSide Scoop Keep informed on things happening within INS

Welcome New INS Members Domestic and International

Year End Review 2023 at INS has been full of celebrations and changes. To start off in January, we released our 50th anniversary supplement to the INSider, which includes a message from Mary Alexander, a timeline that showcases the many highlights in INS/INCC history, video testimonials from members, and much more. The annual meeting in April was a success on many levels. We had 476 in-person attendees, 249 virtual attendees, and 56 exhibitors. All 50 states were represented and 23 countries. We celebrated Mary Alexander’s career and the past 50 years of INS as well as welcomed Chris Hunt to his new position as CEO. Our March/April issue, which also commemorated Mary Alexander, included many photos and testimonials about her from INS staff and members. In the May/June INSider, we got to know our new CEO Chris Hunt a little better through a Q&A. In addition to the INSider’s human interest articles, such as testimonials by long-term CRNI®s or an essay by a young woman with a chronic illness, this year’s membership publication also included features that dug deeper into medical issues, such as one clinician asking whether excessive flushing was detrimental or three clinicians demonstrating the successful implementation of a mobile blood transfusion service. INS continues to be a global presence. We have included interviews and features with infusion nurses across the world in the INSider, from our inaugural DEI scholarship award recipient in Washington State to a clinician in Warsaw, Poland who started an infusion team at his hospital. In this issue, INS director of clinical education, Marlene Steinheiser, details her travels among infusion clinicians in the United Arab Emirates. We’ve also had a global team working on revising the Infusion Therapy Standards of Practice: thank you to those of you who assisted in this process by participating in our public comment period this summer. As we look ahead to 2024, we will continue to celebrate and support infusion clinicians. Marlene Steinheiser will again describe her overseas travels in the January/February issue, this time to Saudi Arabia. As always in January, we’ll celebrate IV Nurse Day, this time by featuring professional photos of clinicians and accompanying narratives. Our new CEO, Chris Hunt, will also begin to share his thoughts with you in each 2024 INSider issue. And maybe most importantly, the new editions of the Infusion Therapy Standards of Practice and the Policies and Procedures come out next year! Join us in February 2024 for virtual educational sessions where we will detail the new practice recommendations and answer any of your questions. We can’t wait to see you there.

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Celebrating Mary Alexander Mary Alexander, MA, RN, CRNI®, CAE, FAAN, has served as the chief executive officer of the Infusion Nurses Society (INS) and the Infusion Nurses Certification Corporation (INCC) for 26 years, from 1997 to 2023. As CEO, she has been responsible for the management of an international, nonprofit specialty nursing organization of 5,000 members and for providing the consistent delivery of the highest-quality education and professional TH

services. She has had the honor and privilege to travel nationally and internationally promoting the specialty

practice of infusion nursing and INS as well as teaching best practices and the application of Infusion Therapy Standards of Practice (the Standards). As INCC’s CEO, Mary has overseen the Certified Registered Nurse Infusion (CRNI®) certification program, including accreditations by the American Board of Specialty Nursing Certification

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Thank you for Celebrating 50 Years ni n With Us!a

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(ABSNC) and the National Commission for Certifying Agencies (NCCA). Mary received her nursing diploma from Massachusetts General Hospital School of Nursing in 1976, her Bachelor of Science in Health Care Administration from Emmanuel College in Boston, Massachusetts in 2000,

1973-2023

and her Master of Arts in Business Administration from Framingham State College in Framingham, Massachusetts

1973-2023

in 2005. She became an INS member in the late 1970s while working in infusion therapy in the acute care and home care settings, and immediately entered INS leadership at the local level. In 1985, Mary received her CRNI® in the very first class; in 1992, the same year she began her national involvement, she was named the INS Member of the Year; from 1992-1994, she served as the INS secretary/treasurer; and in 1996-1997, right before she became CEO, Mary served as the INS president. In 2005, she achieved the Certified Association Executive (CAE) designation from the American Society of Association Executives, and in 2008, she was inducted as a Fellow of the American Academy of Nursing. As someone who has strongly supported the importance of both achieving and maintaining certifications, Mary has always led by example, keeping her CAE and CRNI® up to date: her CRNI® has never lapsed since 1985, and she is currently recertified for over two years beyond the date of her retirement. For over 25 years, Mary has been the editor of the Journal of Infusion Nursing, the scientific, research-based, peer-reviewed publication of the Infusion Nurses Society, and has written an editorial for each issue. Mary has served as an editor of INS’ textbook, Infusion Therapy: An Evidence-Based Approach, and as one of the editors for the 2nd, 3rd, and 4th editions of Core Curriculum for Infusion Nursing. She has been involved with the Standards revisions since 1998. Other examples of her numerous publications include chapters in Anatomy of Writing for Publication for Nurses and Nursing Without Borders: Values, Wisdom, Success Markers. In 2002 and 2011, she was part of a team to revise the CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections. Mary’s leadership roles have been many and various, including the American Board of Nursing Specialties

INSider

May/June 2023

(ABNS), Global Education Development Institute (GEDI), New England Society of Association Executives (NESAE), Nursing Organizations Alliance (NOA), and Nurses on Boards Coalition (NOBC), and she has been invited to serve on numerous expert panels and advisory boards.

Getting to Know the New CEO

For over 45 years, Mary has worked in the ﬁeld of infusion therapy, starting at the bedside in her home state and eventually traveling the world promoting her passion for infusion nursing and the impact it has on the

How originally did you start working for INS? What was it like at that time—how was it different than now?

patients we serve. Clinicians and patients across the globe owe Mary a debt of gratitude for her contributions and dedicated service to the Infusion Nurses Society and INCC.

One of the questions that people who work in the association/nonprofit space ask each other is “how did you end up here?” And the most common response is “by accident!” My response was no different. When I applied to INS, I did not know anything about associations. I had the requisite skills (sales and administration) for the position they were seeking to fill (meetings manager) but not the background in association management. One month and one Annual Meeting after I was hired, I was hooked! When I began working for INS we had one product, Standards of Practice, and two in-person meetings. There was no internet, email, website, or online learning. I would say it is quite a bit different today! However, the constant that did exist back then, and still exists today, is our commitment to change, flexibility, strategic planning/growth, and most importantly teamwork.

Most everyone in the INS/INCC community already knows Chris Hunt, the incoming CEO. He has been with INS since 1995 and has served as the meetings manager, the director of meetings, the director of marketing, and the executive vice president. We decided to ask him a few informal questions so the membership might get to know him even better.

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What are changes that have occurred on the business side of INS since you began? From a business standpoint in the late 90s early 2000s, most of INS’s revenue was generated from our Annual Meeting and Industrial Exhibition and our National Academy of Infusion Therapy. Many members received ﬁnancial support from their employer to become and remain members and to attend in person meetings. However, as employer support decreased and technology continued to increase, it was incumbent upon INS to develop new modes of education delivery and new revenue streams. The creation of the INS LEARNING CENTER did just that.

CHRIS HUNT

What is your favorite restaurant and why? Abe & Louie’s in Boston is my go-to restaurant for special occasions and celebrations with family and friends. The food is outstanding, and the atmosphere is exciting and energetic. There’s always a buzz that ﬁlls the restaurant and everyone has a smile on their face. The restaurant is always ﬁlled so it is not unusual to get a 9:30 p.m. reservation. Thank goodness for OpenTable!

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What motivates you every day? The opportunity to have a better day than the day before motivates me both from a personal and work aspect. As I look back on my career at INS/INCC and see how far we have come as an organization, I am motivated to take it even further. In addition, having the opportunity to work with a tremendous staff who are committed to advancing INS/INCC’s missions motivates me. Business writer Patrick Lencioni has said, “Not ﬁnance. Not strategy. Not technology. It is teamwork that remains the ultimate competitive advantage, both because it is so powerful and so rare.” Without question, INS’s and INCC’s strength lies in its staff of committed professionals. It is what makes us tick, and I have been privileged to have a front row seat to watch all that they have accomplished.

What kind of books do you like to read? Far and away, novels are my favorite. I am always amazed at how authors can make a story come to life. I am a huge fan of John Irving. I remember going to one of his readings while I was in college. It was right after he wrote his blockbuster novel, The World According to Garp. Fast forward to 2009 and I attended his reading for Last Night in Twisted River along with my son, who is also a big fan. It was at this reading where I learned that he always writes the end of his novels ﬁrst, then goes back to write the beginning. Hands down, my favorite John Irving novel, in fact my favorite novel of all-time is A Prayer for Owen Meany.

What meetings or other educational programs have been the most useful to you? The educational programs that have been most helpful to me are the in-person and virtual national meetings, and the online learning center. Personally, I prefer the in-person meetings for the additional networking opportunities. However, this year I was physically unable to attend the national meeting in person, and the virtual meeting proved to be wonderful as well.

Testimonials for IV Nurse Day from Two Long-Term CRNI s ®

We are tremendously excited that the revision of Infusion Therapy Standards of Practice and all 5 versions of Policies and Procedures for Infusion Therapy will be completed and ready for publication in 2024. All members will receive a free copy of the print version of the Standards as well as free access to the digital version. In addition, members will receive a signiﬁcant discount on the P&Ps. The publication of these resources is another example of INS’s commitment to education, our members, and the entire infusion community.

What kind of music do you like to listen to? Seventies music as well as alternative rock are high on my list, but my favorite recording artist is, and always will be, Boz Scaggs.

The constant that has remained the same with INS is the commitment to promote excellence in the field of infusion care. What would you tell someone to encourage them to become a CRNI®? Becoming a CRNI® is the first step to being confident in your nursing care related to infusion therapy. It opens up innumerable networking opportunities to help in your infusion nursing practice.

Where is your favorite place to vacation? Is there anything else you’d like to share?

Italy! My wife and I have been there twice with our best friends and absolutely loved it each time. Venice, Sorrento, and Tuscany were the highlight cities for us.

I am extremely appreciative of the opportunity to serve as the new CEO of INS and INCC. As INS celebrates its IV Nurse Day is January 25, 2022! In order to celebrate, we are featuring two INS 50th anniversary in 2023, it is important to not only celebrate our successes and our position as the leading voice for infusion nursing, but also to look forward to ensure that we continue our path. This will require us to be members who have been CRNI®s for over twenty years. Please read their stories below. forward thinking, engaged, solutions-based, connected, and value centric. It will also require us to reﬂect on what we do and how well we do it. Looking at short-term accomplishments and long-term change is critical to success and growth. It is also part of INS’s and INCC’s continuing self-assessment process and a major component of what will help us deliver meaningful results. Sandra Herring, RN, CRNI®

What was your ﬁrst job? I began my working career at the age of 11 as a caddie! While lugging golf bags around a course for 4-5 hours (sometimes twice a day) wasn’t work for the faint of heart, it taught me to appreciate hard work, concentration, and discipline. It also afforded me the opportunity to earn the Francis Ouimet Caddie Scholarship that helped defray the cost of college years later.

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With the help and support of our truly engaged membership, we look forward to the start of the next 50 years of setting the standard for infusion care!

Sandra has been in nursing for 37 years, and a CRNI® since 1998. She is passionate about helping people. Currently, she works as an infection control practitioner, clinical educator, employee health nurse, and infusion specialist.

Her interests outside of work include church, spending time with family, horses, and pretty much any water activity—whether participating or just observing. She is married to her lifelong best friend, Ken, and has been very blessed with two children (and their spouses), Sarai Barnett (Wes), Chase (Colleen), and a very special granddaughter Patrycja Barnett.

Alicia is a certiﬁed registered nurse in infusion therapy (CRNI®). She was a reviewer for the 2011, 2016, and 2021 Infusion Therapy Standards of Practice and is currently an editorial reviewer for the Journal of Infusion Nursing. Alicia lectures domestically and internationally on a variety of infusion therapy topics.

How did you originally hear about INS? I ﬁrst heard of INS from a colleague.

Have you ever wondered why peripherally or centrally inserted vascular catheters fail? Try to think back to a catheter that you worked with that failed. It might be yesterday, last week, or perhaps last month. The rate of vascular access device failure is surprisingly high, with about 50% of peripherally inserted devices failing within 48 hours of insertion. Having to replace these devices costs time, delays procedures, and can cause pain and discomfort to patients; therefore, we should do everything in our power to preserve their function. Of course, we can improve the function of these devices only by reﬂecting on our own practice, attending conferences, and reading published studies that study these problems.

What drew you to the organization?

studied ﬂushing, and therefore we can’t set The validation and conﬁdence to know I was using the very best standards for infusion therapy. explicit guidelines. Secondly, it’s likely that we simply don’t see it as being What do youimportant— think is the most valuable aspect of being a CRNI®? or perhaps not as important infection The mostas valuable aspect of being a CRNI® is having the knowledge to practice infusion nursing and bring the best possible prevention, the insertion process, etc.— so we care to my patients. just don’t think about it.

I believe how we devices is very important. 5 flushINSider I’m not only referring to the clearing of the device (which is clearly beneficial): evidence now suggests that the simple act of flushing a device with saline, or more accurately how we flush a device, could contribute very importantly to their failure. Yes, just to clarify, how we flush devices could lead to vascular access devices failing. How did we come In this article, I’d like share to this conclusion? a little information about Colleagues of flushing. Before we jump mine recently Region of shear force applied to a simulated blood vessel to the conclusion that I’m published some and calculated according to computational fluid dynamics. Note that the area 2 to 7 mm in front of the catheter is impacted. talking about toilet habits, intriguing data. Reference: The mechanistic causes of peripheral intravenous catheter I’d like to clarify: I’m Together, four failure based on a parametric computational study - PMC (nih.gov) referring to the testing and studies clearing of vascular access devices with saline demonstrate that about 60-80% of PIVCs have (usually). When was the last time you actively small thrombi in front of the device tips within thought about your flushing practice, either 4-24 hours. We have shown that these clots during, before, or after the act of this procedure? develop about 1 cm (a quarter inch) in front of In my conversations with clinicians, often the the device tip. These clots develop even when answer is “I don’t think about it.” I then ask, medications are not delivered—when just saline “Why do we need to flush devices?” If you is used, for example—which reduces the answer “to keep the catheter from blocking” or likelihood that chemical injury is to blame. “to flush out any precipitate or blood clots,” you Furthermore, clots develop in patients on would be right. I then ask, “How do you flush?” medical/surgical wards, in emergency How clinicians flush devices is about as variable departments, and even in healthy participants as the weather in my hometown of the Gold in my lab. These data suggest that the cause Coast in Australia. Sometimes it’s blustery, other of these clots is common in all studies. What times calm; ultimately it is highly unpredictable. is common across all sites? Well, every This got me thinking: why don’t we have better participant had a cannula inserted, every definitions/procedures regarding how to flush device was maintained (at the least) with saline, or devices that help us flush appropriately? and obviously, all individuals were human, Well, the answer to this question is probably whose bodies respond to injury/irritation by 2-fold. Firstly, there is very little relevant data clotting. So what could be the cause of this to guide our practice: very few people have irritation/injury leading to clots forming near

by Andrew Bulmer, PhD

Is there anything else you’d like to share? The only thing that is constant is change. For our patients, we must keep learning and adapting to provide the best possible care. Thanks to INS, we can keep learning, adapting, and growing!

Alicia Mares, BSN, RN, CRNI® Alicia, the associate director of Global Medical Affairs at BD, has been a CRNI® since 1999. Alicia has over 35 years of experience in the ﬁeld of infusion therapy and vascular access. Her ﬁeld of practice include pediatrics and infusion therapy in both the hospital and home settings. Over her career, Alicia has developed and implemented a home infusion therapy program, developed numerous infusion therapy and vascular access education and training programs, and overseen quality improvement programs. Working with research and development engineers, Alicia has provided clinical input into the development of a multitude of infusion therapy products. She has also been a contributor to several clinical research studies and programs with vascular access devices.

Areas of4practice through the years include acute care, medical/surgical nursing, May/June 2023 labor and delivery, homecare and hospice, long term acute care, and specialty home infusion therapies.

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Too Much of a Good Thing: Could Excessive Flushing of Vascular Access Devices Be Detrimental?

How have you used the Standards or other INS publications in your day-to-day work? I have used the INS Standards in my day-to-day work providing direct and indirect patient care. Direct patient care speaks for itself. I also use INS Standards with indirect care, including mentoring my coworkers, encouraging my colleagues, writing infusion-related work such as policy/procedures, and in writing and presenting educational work in-services. Compare and contrast the INS of the past to the INS of the present. What has changed? What has remained the same? Many things have changed from the past to present INS. For example, I can remember accessing patient catheters through a “rubber stopper.” Change occurred, and we moved to use of a negative pressure needleless connector, then a positive pressure connector. Change occurred yet again and we went to a neutral pressure needleless connector. INS has consistently evolved through the years to advance with the various changes relating to infusion therapy.

What would you like the membership to know about the months ahead?

How did you originally hear about INS? What drew you to the organization? When I began working in home infusion therapy, I had a lot of questions and wanted to ensure I was performing the best practice for my patients. When seeking out information, I came across the Infusion Nurses Society and found it to be a great resource for what I was in looking for.

January/February 2023

One Patient’s Perspective

would reach her hand up to the sore spot at the base of her neck and realize it had all been real, in some way, those minutes when someone was taking pieces of her heart.

An excerpt from “Should You Hold Me Down (Go on, Take It)” from Your Hearts, Your Scars

Here, in this new hospital, the nurse tells me that during the procedure I should pick a spot on the wall to focus on. I search the wall for stars, but there are only patches of more white and less white. I choose less, just above my head. The nurse tells me that she’s going to insert the IV now. “Better you don’t look, sweetheart,” she says. “I’m a really difﬁcult stick,” I say. “But this vein, this vein is good.” I point to a spot in the crook of my arm, to the veins that have held IVs successfully in the past and still retain just the faintest mark of tiny blue dots. I want to ask the nurse to count to three, to make sure I’m ready so that I can breathe deeply to try to stay relaxed to prevent the vein from contracting, and to please not dig, because, truly, it’s not the sticks that I mind; it’s only the digging around, the rooting for the vein in my skin, that sometimes makes me cry, because I had this nurse once and she shoved a needle in my arm and she wouldn’t pull it out even after I screamed Stop. I want to give her that speech, the speech I always give nurses before IVs, but they don’t count to three here and I feel silly asking. I just point to the crook of my right arm.

by Adina Talve-Goodman As clinicians, it’s beneﬁcial to listen not only to other clinicians, but also to patients, to hear what they have experienced and to remember their expertise about their own bodies. With that in mind, in this INSider, we’d like to share an excerpt from Adina Talve-Goodman’s recently published posthumous collection, Your Hearts, Your Scars. Adina was born with a congenital heart condition and survived multiple operations over the course of her childhood, including a heart transplant at age nineteen.

“That’s the best spot,” I say. “And, if it’s okay, can I have a twenty-four needle?” “That’s too small,” the doctor says. “I know it’s for babies,” I say. “But anything bigger usually blows the vein.”

“Will I feel it?” I ask the doctor as I do a slight hop onto the operating table. He turns to me while pulling on his gloves. “Latex allergy,” I say, lifting my wrist to show him my plastic bracelet that says just that.

“I’d like to try a twenty-ﬁrst,” the doctor says.

“What happens when you come into contact with latex?”

The nurse laughs. “Wow, somebody’s an expert. I think a twenty-four is ﬁne. I pulled one anyway when I saw how tiny you are.”

My eyes meet the resident’s gaze and he quickly looks away, blushing. He’s about my age, I guess, and suddenly I’m conscious of the sheerness of my hospital gown and the outline of my breasts. If he looks closely enough, he might be able to see my new heart pounding, my chest rising and falling from the beat, my skin pulled tight like a drum over the new instrument. I think about telling the doctor the truth: If I take it in my mouth, nothing happens, but if I have sex with latex condoms, it burns for days. Instead, I look at the ﬂoor and say, “Rash.”

“Thank you,” I say.

The doctor switches his gloves and tells me to “lay down.” It’s lie, I think.

The nurse holds my head ﬁrmly to the right and says, “Got your point?”

Instruments start moving, metal-on-metal sounds, and I whip my head from one direction to another, trying to see. The nurse pulls my hair back into a shower cap and tells me that I’m so pretty, she didn’t think I was a patient when she came out to call my name in the waiting room. I smile at her and resist the urge to ask what other patients look like. She means it as a kindness, I know. But pretty is the wrong word, I want to tell her. The truth is, we don’t really have a word to describe a woman who comes through something a lot like death and remains light. We don’t have it for boys, either, so we say strong for them. We say pretty when we mean you look a lot like life.

I smile and say yes, though, really, I can’t ﬁnd one and all I can think is, Why did I need an IV if you’re going to give me a shot in my neck and no drugs to put me to sleep?

“I’m sorry,” I say, “but I’d really prefer the twenty-four. You’re not giving me much, right? I’m going to be awake the whole time, right?”

“Are you ready, sweetheart?” she asks. I nod and the IV is inserted. I want to close my eyes, but I don’t because I’m not sure if that might be rude, and I feel like I’ve gained some clout with the needle talk. Once it’s in, I thank the nurse and tell her it wasn’t so bad. The doctor tells me that ﬁrst he’ll numb my neck using a shot. “It might burn,” he says.

The shot burns and I try to concentrate on not moving, not looking around, not thinking about the size of the needle in my neck. I focus on my breathing and think that maybe this counts as going to yoga.

I thank her and ask, “Do you strap me in?

“I’m going to start now,” the doctor says, “threading the catheter to your heart. You might feel it skip a few beats. You might feel it, y’know, react. Inhale deep and hold it.”

Should you hold me down?”

I inhale. I close my eyes.

I M P L E M E N T“Haven’t I N G you A had M aOlotBofI these?” L E B the L Odoctor O D asks. TRANSFUSION SERVICE

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“I was always asleep.” March/April 2023

“Why?” I was a kid, I guess. Because I might try toand run,red maybe.” at my smallIron attempt at a joke. I smile and make jokes iron supplementation, iron “Because infusion, erythropoietin stimulating agents (ESAs), bloodI smile cell transfusion. these because I think thatraise people, doctors, are more likely want to keep supplementation and ESAsincan takesituations several weeks to effectively hemoglobin. Red blood celltotransfusion hasfunny an people alive. The doctor laughs he holds up catheter, small he plans 5to insert into the base of my neck, and then cast a thin line down into immediate effect of raising as hemoglobin anthe average of 1the g/dl perneedle unit transfused. my heart. The nurse stands to my right and strokes my hair. I take a deep breath to slow my heart and I think about how used to be for me I was younger. The walls lab at St. Louis Children’s Hospital were painted with stars. Moderate-severe anemia isbiopsies most commonly treated viawhen transfusion of red blood cells.of6,7the Historically, patients who resided Maybe it wasvia comforting to to think of something like infusion this happening in an theemergency dead of night, when a kid could sleep in SNFs requiring transfusions werebecause transported ambulance either an outpatient center or through it, wake six hourscare, laterincreased still a littleexposure drugged,tosaying, And you were there, and you, and you. But inevitably, that kid department to receive this care, resulting inup disrupted nosocomial infections, increased

Implementing a Mobile Blood Transfusion Service

hospital readmission for the patient, and lost revenue and increased health care costs for the SNF.

Describe what you do on a daily basis. PICC/imaging and procedural nurse at Harbor Regional Health, a rural community hospital. She has served as a clinical nurse educator of vascular access devices/procedures for a medical supply company for the past 13 years as well and is an on-call vascular access specialist for inner city hospitals in the Washington Puget Sound area. She is also the cofounder and nurse-injector for an aesthetics business. She started nursing a bit later in life because she was in the US Navy loading torpedoes and missiles on submarines, serving on the USS Canopus AS-34 in the Atlantic Fleet. Her clinical background includes medical/surgical, operating room, and multispecialty. She identiﬁed and created the ﬁrst and currently the only nursing position in her radiology department, moving the vascular access line—PICCs, midlines, and phlebotomy as well port accessing and catheter evaluations (dye studies)—from the operating room. In the event a chest X-ray is obtained, she has been credentialed by the chief of radiology to verify tip placement. She is motivated by patients telling her “Wow! No one can ever get a vein on me, and you did it!” She wants to be patients’ superhero, and loves that patients ask for her by name, and if they don’t remember her name, ask for “the gal with the special machine.” She tells them that’s her superpower.

Please describe your hospital and the location of your hospital both in general and in relation to the Quinault Indian Nation. Harbor Regional Health, formally known at Grays Harbor Community Hospital, serves residents in the southwestern region of Washington State, near the Paciﬁc Ocean. The hospital is a publicly owned rural facility that helps support the county, including the Quinault Indian Nation. The reservation is located in Taholah, just shy of an hour from the hospital, in an even more rural area along the ocean coast.

Please describe your community population. Our community is known as the “Gateway to the Olympic Peninsula.” The region has a rich history of being an old logging community. Logging, ﬁshing, wildlife observation, and other outdoor activities are abundant. The Quinault Indian Nation is a sovereign nation that descends from other coastal tribes. The Quinault population is 10 percent of the population of the county, and their culture and contributions feel present: they are a major element of the community, working hard at maintaining their developed businesses, such as Quinault Pride (seafood distributing), Quinault Beach Resort and Casino, a health and social services department, a natural resources department, a maritime resort, and a mercantile. Only about a third of the Native Americans live on the reservation; the other two-thirds live throughout the county.

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As a result of these issues, the CCN medical director contacted the manager of the CCN with his concerns. They then formed a transfusion committee that consisted of various members of the health care team, including the medical director of the blood bank, the lab manager for quality management and transfusion, the patient safety manager, and members of the SNF community network. The SNF community network consists of medical directors, administrators, and directors of nursing for the various SNFs participating in the network.

Skilled nursing patients are typically admitted to a facility on a short-term basis for rehabilitation services of some sort following a fall, accident, or surgery. For 2023, Medicare Part A fully covers 20 skilled therapy days for SNF patients after patients meet their deductible for the beneﬁt period. For days 21-100, patients must pay $200 daily for their services. After day 100, patients are responsible for the full cost of their treatment.1 This means each therapy day is valuable for the patient and the goal should be to discharge patients as quickly as safely possible from skilled units.

Over the next several months, with an interruption during the COVID-19 outbreak, the committee met to discuss the full scope of this issue. Once the COVID-19 pandemic was in full force, this patient problem escalated, as outpatient infusion centers were wary of accepting SNF patients with known COVID-19 exposure in their centers because it exposed other O V EThese R outpatient S T O Rcenters Y often cared for cancer patients or other patients with vulnerable patients toC COVID-19. compromised immune systems, and exposure to COVID-19 was potentially deadly for these patients. Thus, the hospital system began to see an increase of patients from SNFs coming to the emergency department (ED) for blood transfusions. The problem with this is that the patients sat in the ED for hours waiting for a nonemergent treatment. As a result, because of the time it takes to transfuse, patients were readmitted to the hospital unnecessarily.

Anemia in the older adult is an often undiagnosed condition associated with increased falls, confusion, dementia, hospitalizations, and mortality. The exact prevalence of anemia in the SNF patient is unknown. A 2021 review published in the Journal of the American Geriatrics Society suggested that up to 15% of people 60 and above have a diagnosis of anemia.2 Other research data, though, estimates the prevalence to range anywhere from 34-60%.3,4 The rate of anemia increases with age as well due to nutrient deﬁciencies, chronic diseases (especially kidney disease), and malignancies. Anemia is deﬁned as a hemoglobin of less than 13 g/dl in men and 12 g/dl in women; more recent data states that in postmenopausal women, the threshold for diagnosis should be 13 g/dl.2 Anemia is treated in a variety of ways, including

The committee carefully analyzed the total cost of the blood transfusion therapy, including both direct and indirect costs (cost of actual treatment versus hospital readmission risk). With consolidated billing for SNF patients under Medicare

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September/October 2023

The Quinaults are family-oriented, and beyond the family comes the community of the tribe. When end-of-life situations arise, it involves the tribe, whether immediate family or not. The goal is to surround the family member at home, and meals, transportation, or any other support is provided by extended family or tribal members. Prior to COVID, the local hospital was able to accommodate many of the tribal members who desired to surround the family at their time of need. Like elsewhere, COVID created obstacles: out-sourced services and “big city” appointments became virtual, and younger, tech-savvy or formally educated members helped the population navigate this new reality. On the other end of the spectrum of life, when a child is born, the ﬁrst sound the newborn hears is the mother or father of the child sing in their native tongue. Like with non-natives, there are many religious practices that vary. As COVID restrictions loosen, Harbor Regional Health is attempting to be more culturally sensitive to tribe members’ needs.

What were the steps you took to set up this team? Please share with our readers your timeline. It all started in the COVID-19 pandemic. It was 2020, and we were running an intensive care unit for COVID-19 patients in an atmosphere of great stress. Many patients only had respiratory failure and therefore rarely required a central line. Their condition on the ward deteriorated suddenly and reliable intravenous access was needed by everyone, but not always a CVC. My colleagues, Bartosz Sadownik (a doctor) and Marceli Solecki (a nurse), and I wondered what could be done. How was the world dealing with these problems, which the pandemic had amplified? Our colleague Dr. Robert Becler, who works not only with us but also in Sweden, told us about midline catheters. There was basically 6no widespread distribution of them in Poland, but we managed to import a few samples. I remember like it was yesterday when two of my colleagues—Dr. Mateusz Zawadka and Dr. Maciej Michałowski—told me, come on, you're going to insert a midline, it's a peripheral insertion, we should be able to do it. It worked, and new possibilities opened up for me. We started reading, looking for protocols, and observing patients and staff. In 2020, we introduced 5 midline catheters. In Poland, nursing competencies are very unstructured and we were faced with the dilemma of whether midline placement could be carried out by nursing staff. We wrote to national consultants and scientific societies, and got the green light. We created a procedure, and started proposing midline catheters as an alternative to CVCs when the only indication was difficult intravenous access. Insertion was handled by the emergency team, which until then had been helping patients and nurses when there were difficulties with cannulation. Thanks to our head nurse, Elżbieta Żurawska, and chief physicians, Piotrowski Nowakowski and Paweł Andruszkiewicz, we began to implement midline catheters into routine practice, not only based on difficult intravenous access, but also on the expected duration of therapy. This has been successful.

Establishing a Vascular Access Team Overseas

How does your facility supplement the tribe’s facility? What additional support do you offer? Harbor Regional Health offers many specialties that the Roger Saux Clinic does not. We get referrals from Roger Saux Clinic to assist in keeping the patient and their family members as local as possible. I have come to know many of these tribal members and their families, and therefore I offer to speak with them on the phone or to answer questions or offer referral support. I make it clear that I may not have the answers, but I know where to seek out the support.

Over the years, INS has expanded its reach and inﬂuence across the globe. In this issue, we are featuring an interview with Maciej Latos, who utilized the Standards while establishing a vascular access team in Warsaw, Poland.

May/June 2023

In 2019, a local community care network (CCN) medical director recognized that SNF patients receiving timely, costeffective blood transfusions was an issue. Often, patients were being sent to the emergency department for the transfusion because the outpatient infusion centers were scheduling patients too far out, resulting in decreased access to care for SNF patients. In addition, even though SNFs were approved to perform transfusions in house, none in the area actually provided this service. Instead, they outsourced treatment to the local infusion center or to the emergency department. Additionally, it was becoming more difﬁcult to schedule transportation for these treatments via ambulance because they were considered nonemergent services.

Quinault Indian Nation?

How do Quinault Indian Nation member care for one another, culturally? What is their cultural support system?

July/August 2023

The typical criteria for a red blood cell transfusion in the SNF population is hemoglobin of 7 g/dl or less, with or without symptoms. According to the grading system of anemia, this criteria places the patient in the severe anemia category.8 Because of the consistent low supply of packed red blood cells, many blood banks do not release blood products to patients with a hemoglobin over 7 g/dl without symptoms. In a patient with a hemoglobin over 7 g/dl, the patient should have other comorbidities present such as chronic kidney disease or malignancy, or exhibit some kind of symptoms related to anemia: confusion, dyspnea, fatigue, increased weakness, pallor, or tachycardia. However, the actual decision whether to transfuse is ultimately left to the patient’s provider.

By Don E. Adams III, MD, Bert J. Smith, MD, FACP, and Christy M. Smith, PhD, MSN, RN

I currently work as the solo radiology nurse, a position I developed myself. Working in the operating room, I was one of only 2 PICC clinicians of the facility. At the time of X-ray verification, I found myself in radiology frequently, discussing tip confirmation. The chief of radiology would then request that I access ports and assess patients with contrast extravasations. As a result of my frequent presence, I built a case to show they needed a nurse. I could move my PICC service to radiology and place longer catheters in DIVA (difficult IV access) patients to assist with fewer extravasations and access their ports. The added bonus was Introduction that I was a procedural nurse that could pull procedures from the operating room and move them into an outpatient setting and decrease the cost to the patient by not needing an operating room suite. I then led a process improvement project to help Mr. Anderson is a 70-year-old male recovering from a hip replacement and undergoing rehabilitation in a skilled nursing identify DIVA patients so that they didn’t have to be “poked” multiple times, ultimately resulting in failed attempts. They would facility (SNF). He is told that his hemoglobin is 6.5 g/dl and he needs to have a blood transfusion. The local outpatient come in 15 minutes prior to their CT or MRI, and I would place a catheter under ultrasound guidance, usually on the first infusion center is unable to schedule him for several days, so he will need to go to the hospital emergency department to attempt. This increased patient satisfaction, vein preservation, and patient throughput. have this treatment. Mr. Anderson knows this means a painful ambulance ride and he questions why he must leave what he considers a “hospital-like” setting to receive the transfusion. The SNF nurse tells him that “they do not do those here.” At best, Mr. Anderson will miss his therapy for the day, his routine medications, and perhaps a meal. However, he is also What kind of facility is on the fearful of getting readmitted to the hospital during this treatment. Roger Saux Clinic is a primary and urgent care facility located on the reservation. Resources and staff are limited in this rural area, and they tend to frequently refer to other facilities all over that state, as needed. The Quinaults have a diabetes and nutrition program, and also contract with an optometrist that comes weekly from outside the reservation area. Currently, they are seeking out other types of treatment, such as massage and acupuncture. Their team includes but is not limited to a dietician, a nutritionist, pharmacists, pharmacy techs, RNs, LPNs, an ARNP, an MD, and MAs, led by a health and wellness director who is a tribal member.

There are four common reasons why SNF patients need a red blood cell transfusion during their stay. Many times, 9 INSider postoperative patients experience some blood loss during surgery and level out at a lower than normal hemoglobin. A transfusion helps these patients have an immediate increase in hemoglobin levels. For example, Mr. Anderson’s decreased hemoglobin level puts him at an increased risk for dizziness and falls. As he is trying to mobilize with therapy postoperatively, this risk needs to be minimized as much as possible. Second, many patients start anticoagulant therapy postoperatively and may have a small amount of bleeding related to this medication use, dropping the patient’s hemoglobin level to an anemic level. Cancer patients also have issues with anemia. These patients may be receiving ESA therapy to help increase hemoglobin levels, but still need transfusions on occasion. Finally, in chronic kidney disease (CKD) patients typically have problems making erythropoietin, resulting in lower hemoglobin levels. Sometimes, CKD patients receive blood transfusions as a part of their dialysis treatment, but not all dialysis centers provide transfusion therapy. None of these scenarios is an emergent transfusion situation, as long as the patient is otherwise stable, and ideally should not result in an emergency department visit.

Meet the Inaugural DEI Scholarship Winner Kimberly DuBore, BSN, RN, began her nursing career in her late twenties, and is currently the

Adina Talve-Goodman was born on December 12th, 1986, and passed away on January 12th, 2018. She was an actress, editor, and writer, who was working on her ﬁrst book when she was diagnosed with cancer. In the seven essays in Your Hearts, Your Scars, she tells the story of her chronic illness and her search for meaning and love, never forgetting that her adult life is tied to the loss of another person—the donor of her transplanted heart. Read the rest of this essay and/or the entire collection by buying the book in digital or hard copy through Amazon. Excerpt from Your Hearts, Your Scars. [https://www.amazon.com/Your-Hearts-Scars-Adina-Talve-Goodman/dp/1954276052] Copyright © 2023 by the Estate of Adina Talve-Goodman. Published by Bellevue Literary Press: www.blpress.org.

What is the name and size of your organization? The University Clinical Centre of the Medical University of Warsaw is made up of three academic hospitals: 2 for adults and 1 for children. The complex was established at the Central Clinical Hospital (for adults) and has approximately 1,000 patient beds. There are 16 clinics and 6 departments.

Why did you decide that your hospital needed a vascular access and infusion team? I think the reasons are the same as everywhere: we have numerous cannulations and numerous hospitalizations and difficult intravenous access. Working in a large hospital, we observed that everyone was playing their own game, that there was a problem with implementing strategies and thinking about the patient and their future in terms of vascular access. It's sad to admit, but the quality of vascular access care wasn't the best either. This, of course, stems from general problems in Poland—infusion nursing is not an official specialty in Poland. We don't have a certification similar to yours. It is usually dealt with by anesthesia nurses and anesthesiologists. There are times when, as clinicians, we place another PIVC and eventually, when there is no other option left: you have to insert a central venous catheter (CVC). We decided to change that. At the same time, it's hard to ask people to think about strategy when they don't have real support in access selection and infusion management. There was a strong need for a team, and we started to be aware of the possibilities.

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By 2021, we already had an additional person on shift to do insertions and staff training, and we inserted 150 midline catheters. In 2022, we started to talk seriously about the need for systemic change in our hospital, and after training staff more effectively, we inserted 261 midline catheters. In February 2023, a team was ofﬁcially established, and we inserted more than 100 in the ﬁrst quarter of 2023. What's more, through training, webinars, and social media, we started a debate on the need to develop the specialty of infusion nursing in Poland. It turned out that clinicians saw this problem, but hadn’t made any progress. Now more teams are being formed in our country, which makes us very happy. Remember, we are talking about a country where still many clinicians do not know what midline catheters are, and where inserting ultrasound-guided peripheral cannulas is not known.

Tell us about the process of introducing midline catheters and ultrasound-guided PIVCs. What was that process like for you? Who is performing these procedures? This is a difficult question. To answer it you have to start with the fact that in Poland the nurse does everything, from typically caring activities to highly specialized ones. A lot of activity is based on the enthusiasm and activity of the nurses themselves. So, together with the emergency nursing team, we started to observe doctors who insert not only CVCs with ultrasound guidance (USG), but also PIVCs. I asked myself: is using USG for cannulation so difficult? We started looking for courses dedicated to nurses, but there were none. With the help of doctors, I started using ultrasound for cannulation, although we had and still have problems with the availability of ultrasound devices dedicated to nurses, for example. Nevertheless, I gained experience and passed it on to the rest of the team. This has been successful. Within two years, we ourselves had trained more than 500 nurses and doctors in Poland to guide the needle with ultrasound as well as midline catheter placement. They all saw the sense in delegating these competencies to the nurses who are closest to the patient, who most often have to solve problems in obtaining peripheral access. At the same time, we realized that these skills needed to be possessed by a small group of people who would specialize in it and do it effectively. This has been successful: nurses and doctors from the wards qualify patients, and the nurses from our IV team obtain vascular access. However, we knew that the work of such a team had to be interdisciplinary, so the team also has doctors who provide support, and also perform CVC-type procedures when a patient presenting for midline or ultrasound PIVC should have a central line inserted instead. This works. In 2018, due to difficult intravenous access, central catheters were inserted in 77 patients, but in 2022, only 19 were utilized.

July/August 2023

November/December 2023

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On Revising One Hospital’s IV Therapy Policies according to the INS Standards by Susan Gray, RN, BSN, CRNI®

Why did your organization decide to revise your internal policies and procedures according to the INS Standards? While I was studying for the CRNI® exam, I learned so much that I then wanted to share this valuable information. I began thinking about how to apply this information to elevate our organization’s IV policies. Improvements to our IV policies have typically been more responsive to patient safety concerns as they arise. As an organization, we are always looking for evidence-based practices that can be applied to enhance the quality of patient care and speak to the specific needs of our hospital.

What person or group spearheaded this process? I spearheaded this process and presented it to management and our Nursing Professional Practice Council (NPCC). We have a robust nurse-driven organization and shared governance. I knew I was taking on a significant project because it affected multiple departments throughout the hospital. The NPCC provided valuable input to the process.

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What did the timeline look like for the revision? The entire process from initiation to implementation of the new policies was about 18 months, including reviewing other facility policies to see their approaches, writing, rewriting, obtaining approval, and educating staff. The COVID-19 pandemic impacted our ability to meet in person, requiring more virtual meetings, and also impacted our priorities as the pandemic evolved and changed. However, I see this as an ongoing process because these policies will keep evolving based on the most current INS Standards of Practice.

Tell me about the details of the revision process. I began this revision process by dissecting the original policy and fact checking every line to each INS SOP in 2021. These Standards are organized, realistic, applicable, and completely transparent; the Standards inspired me to elevate our policies to be aligned with theirs. I referenced Policies and Procedures for Infusion Therapy: Acute Care, 6th edition as well as accessed the Clinical Community Discussions frequently and submitted questions. I particularly appreciated Lynn Hadaway’s expert responses. When the policy was completed, I presented it to the NPCC, and from there, it was sent to the chief nursing officer for approval. Once that was accomplished, the new policy became active online in Policy Manager where all employees can access it. The revisions ranged in scale. For example, we made minor revisions to the terminology used in the policy, such as replacing “central line” with CVAD (central venous access devices). More substantive changes included revising our existing policy for CVAD tip confirmation to include the following: “For a femoral CVAD, obtain a VBG or use transduction with waveform analysis to confirm tip location (SOP 54).” Education around this change was required, not only for RNs, but for physicians, respiratory therapists, and other practitioners as well. Our entire staff, especially the ED, embraced this new standard and continues to uphold this practice. All data on femoral CVADs were monitored in the first year, and as a result, there was a significant increase in the use of VBGs to confirm femoral CVAD tip location.

Did your work group include other disciplines? The support of the multidisciplinary team was extremely important. The intervention radiology (IR) department has been extremely collaborative and receptive to new practices that provided best patient care. They maintain Aseptic Non Touch Technique (ANTT®) and provide exceptional service to our inpatients and outpatients. I also worked closely with the professional development department to review the new policies and launch the education surrounding it. Educational HealthStreams were created specifically about CVADs and central line-associated bloodstream infection (CLABSI) prevention, and our manager of infection prevention and regulatory programs monitors the data collected on rates of infection. Materials management is another department that took part in this: they were instrumental in comparing CHG dressings, making sure all the bundled dressing kits have the necessary items and are stocked in the appropriate units. They are incredibly attentive to product quality and IV therapy needs. Other departments included were the emergency department, who places a majority of vascular access devices; pharmacy, who implemented the change in the Cathflo dose; the cancer care center, who adopted changes to locking ports with NS instead of heparin; the ICU, who continually takes meticulous care of all CVADs and rounds daily to assess patients' vascular needs; and clinical informatics, who has been extremely valuable in making the vascular access documentation comprehensive and accurate. We truly work as a team in my hospital and consistently prioritize patient-focused care across all departments.

November/December 2023

9th Edition

NOW REVISED EVERY 3 YEARS

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What advice would you have for an organization that wanted to revise their internal policy and procedures to align with the Standards? Any organization that wants to revise their internal policies and procedures to align with the Standards should first review their current policy and be receptive to the ever-evolving nature of best practices. It is important not to be complacent with existing policies and practices and to understand why certain standards are in place. Additionally, recognize your facility’s patient-specific needs: no matter the size of your facility, knowing your patients’ needs and your staff’s needs according to their department and level of practice is crucial. I would recommend establishing an IV team that is passionate about learning, teaching, and growing while also maintaining patient safety. Having an IV team, large or small, can be extremely valuable to any facility because it creates a central location for data collection and allows for consistent VAD monitoring throughout the facility. For example, in our IV department, we have a CVAD data sheet on each relevant patient, which includes detailed info on the CVAD, monitor dressing and cap changes, risk factors for potential complications, and the current IV infusions they are receiving. Additionally, our department has an IV dashboard to track all CVADs and complications and line days. Next, I suggest reading the Standards thoroughly alongside your existing policies to see where the gaps are. As you are revising your policies, make sure to use a format that is organized and easy to follow for everyone. Be confident with the expert knowledge provided by the Standards and their relevance to both your patient population and the different departments at your facility. As you write the new policy, fact-check every standard of practice as you move forward. As you do this, consider questions that the staff frequently ask regarding VADs such as flushing, locking, and blood sampling. The policy is not only for the writer, it's for everyone: every department, every shift, and every level of experience. Then be enthusiastic about it, talk it up to staff on a daily basis, connect with your staff so they are comfortable asking questions, and show them how to access the policies online. For example, when I receive questions from various departments, I will include SOP references. Sometimes I will also provide a daily “fun fact” about VAD practices and the reasoning behind them to staff. It is important to remember that policies that cannot be implemented have no value to your facility. Lastly, be patient, listen to your patients, and be the example for best practice in this specialty.

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What were some of the organizational challenges your group faced while aligning existing practices with the Standards? Some organizational challenges were establishing credibility with clinicians, converting “old ways” into updated evidence-based practices, educating nurses with differing experience levels, and supporting experienced nurses from other facilities to acclimate to our new policies. Other challenges included providing comprehensive education to all departments and facing unexpected product supply changes and/or shortages. Throughout these challenges, our management, professional development department, and NPPC were very supportive of instituting these updated policies.

Did implementation of the revised policies require educating clinicians? If so, what process did you use to share this information? Clinicians are key decision-makers in our facility, and their support of the policy revisions was valuable in this process. We engaged clinicians about the policies through meetings, emails, daily rounds, and face-to-face conversations. Our clinicians value evidence-based practice, and the credibility of the INS and their Standards made clinicians receptive to these changes.

Do you have anything else you’d like to share? I cannot overemphasize the importance of working together to achieve the highest quality of care for patients. While important, having an IV department does not achieve this alone; the collaboration and support of all departments is vital. I would also like to thank the INS for providing these Standards, an incredible resource that brings together an international group of experts to share their knowledge so that we can improve our practices for the benefit of the patients.

Susan Gray has been a registered nurse for over 30 years. Over the span of her career, Susan has made meaningful contributions to the professional development of the next generation of nurses and continues to be a lifelong learner and practitioner of best practices in the field of nursing. Since graduating from St Mary's School of Nursing in 1988 and the University of Connecticut in 1994, Susan has worked at St. Mary’s Hospital in the ICU and at Bristol Hospital in the ICU, IR, and IV therapy. For a large part of her career, Susan has specialized in adult medical/surgical critical care with CCRN certification. Susan has served on numerous committees at Bristol Hospital, including the Patient and Family Advisory Council, Medication Task Force, Code Blue, a committee that improved EMR documentation related to patient care and hospice patients, and the Nursing Professional Practice Committee. It was Susan’s passion for learning that led her to reread and revise Bristol Hospital’s CVAD and PIVC policies. In 2016, Susan was the recipient of the Nightingale Nursing Excellence Award. Susan values the sense of community at Bristol Hospital, where she has been able to collaborate across departments to uphold the best practices and standards for infusion therapy and has also been able to build meaningful relationships with patients and families. 9

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Virtual Infusion Education

February 8 - 9 2024

Registration Opens November 13

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Part 1: INS in the United Arab Emirates

by Marlene Steinheiser, PhD, RN, CRNI®

As a globally recognized leader in infusion therapy, INS disseminates current infusion therapy evidence as part of its mission. To further this goal, I was invited to present at the 34th annual Sigma Theta Tau International Nursing Research Congress in Abu Dhabi, United Arab Emirates in July 2023. The presentation was entitled "Advancing Clinical Practice: Dissemination of an Evidenced-Based Practice Checklist for Administration of Intravenous Push Medications,” and was a result of collaborative work done with a group of infusion therapy experts as part of the Quality and Safety Education for Nurses (QSEN) Patient Safety Task Force. The aim of the QSEN Patient Safety Task Force is to draw awareness to gaps in evidence-based practice when administering IV push medications and to disseminate a checklist for global use in nursing education and clinical practice. The checklist was a result of the task force finding significant variations and gaps in use of evidencebased standards related to IV push medication safety. While there were evidence-based practice standards available, the step between understanding the evidence and implementing the evidence did not occur in many institutions, so this task force developed an IV Push Administration Standardized Practice Checklist addressing the noted areas of inconsistent education and clinical competency validation. The checklist was developed in accordance with the Infusion Nurses Society 2021 Infusion Therapy Standards of Practice, and is

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intended for use in all clinical practice settings with both student nurses and licensed nurses and can be used to standardize practice between nursing programs and clinical practice sites. Clinical nurses, nurse educators, nurse administrators, and nurse researchers who attended the Sigma Congress represented about 30 countries. It is so interesting that our clinical challenges are similar across the globe: we are all striving to reduce CLABSIs, prevent PIVC failures, increase first-time PIVC insertion success, and reduce infusion-related complications while retaining and recruiting nurses and validating IV therapy competency. Also interesting, but unsurprisingly, I heard from nurses around the world that they rely on the INS Standards in their practice. INS is truly reaching the whole world and making a difference for patients. During my visit to the UAE, BD coordinated visits to 3 hospitals within Abu Dhabi and Dubai. Elia El Hachache, senior clinical resource and Dr. Osama Kamal, medical affairs lead for the Middle East, North Africa, and Turkey introduced us to key nursing leaders in the region. Joining me on these visits was Dr. Tiffanie Rampley, PhD, RN, NEA-BC, CCRN-K. Dr. Rampley’s experience as a Magnet program director was valuable as we discussed the resources and support INS can offer during their Magnet journey.

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Our first 2 visits were to Abu Dhabi. We visited Sheikh Khalifa Medical City (SKMC), which consists of a 586-bed acute care hospital, 14 outpatient specialty clinics, and a blood bank, all accredited by Joint Commission International (JCI), 125-bed Behavioral Sciences Pavilion (BSP), and an Urgent Care Center located within the city of Abu Dhabi. During our visit, we learned about SKMC’s educational needs and shared INS resources with Linda Haskin, CNO, and their education team. We also discussed the development of infusion therapy competency assessments. Next, we visited Sheikh Shakhbout Medical City (SSMC), established in 2019, which has made its footprint in the nation and region as one of the largest hospitals providing world-class, complex health care. SSMC operates in partnership with Mayo Clinic, a nonprofit global leader in medical care, education, and research, headquartered in the United States. SSMC expects to treat 20,000 inpatients, 250,000 outpatients, and 70,000 emergency patients per year, and has 732 beds with a leading infusion center in oncology (immunotherapy and chemotherapy) and nononcology (neurology, dermatology, rheumatology, GI, and general AB). We had the pleasure of meeting Dr. Mohammad Mahmoud Awwad, Magnet program director, Zahra Mohemed, education manager, Zulaikha Al Hosani, CNO, and others from the education team. We discussed ways that INS can support their new vascular access team (VAT) with education, such as the Fundamentals of Infusion Therapy (FIT) program. We also discussed support for those seeking CRNI®s and the implementation of the INS Standards into their evolving practice. Our final visit was to Dubai with the team at Emirates Health Services (EHS), which oversees clinical practice and development in over 17 hospitals under the Ministry of Health. EHS employs 5,000 nurses. We met with Dr. Sumayah and EHS leadership team, discussed their needs, and offered resources to address practice standardization in relation to vascular access management. We also

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discussed the importance of vascular access teams and certified infusion nurses, back-to-basics infusion therapy education, and how nursing governance is driving patient care on a broad scale. We had conversations regarding policy updates, competency assessment, risk management, and evidence generation as key components to promoting safe infusion therapy practice. During this visit, we connected with key leaders from the Emirates Nurse Association to discuss their interest in disseminating the INS Standards across all of the UAE. Thanks to the kindness and generosity of the people of the UAE, our visit to the region felt like more than just a business trip. Taken on guided visits by locals from BD, Dr. Tiffany Rampley and I experienced the best the UAE had to offer. In addition to being introduced to key nursing leaders at local hospitals, we walked through public markets and spaces, most filled with the traditional scent of bakhoor incense. The BD locals taught us about the prayer rooms that appeared in most buildings, available to anyone for the five daily prayers, and introduced us to various delicious staples of the UAE diet, including fish, lamb and rice, and dates prepared in savory and sweet dishes. I will remember this visit in detail, from the conference rooms to the marketplaces—but most of all I’ll remember the wonderful people of the UAE.

November/December 2023

The Many Benefits of the Policies and Procedures by Dawn Berndt, DNP, RN, CRNI® The Policies and Procedures (P&Ps) are a population-based and care center–based set of references providing policy structure for acute care, home infusion, ambulatory infusion centers, neonate to adolescent populations, and older adults. Using the Policies and Procedures alongside the Infusion Therapy Standards of Practice enhances your knowledge, understanding, and practice of infusion therapy, ensuring that you have the necessary guidance to provide safe infusion therapy-related procedures.

Each of the 5 versions: • Offers easy-to-read information and step-by-step procedure instructions for vascular access device insertion, management, removal, and many other infusion therapy–related practices. • Outlines the immediate interventions to take when complications occur; you are armed with instant steps to mitigate harm and to provide the best care for your patients. • Lists the procedural steps and all the key points and assessment recommendations, patient education, and documentation information necessary to perform each task. • Is a handy reference available both in a spiral paperback and a digital version to best meet your day-to-day needs. With 60 separate infusion-related practices addressed, the INS Policies and Procedures are an invaluable tool for bedside practice, which also may be used to develop your own organization’s evidence-based policies.

Policies and Procedures for Infusion Therapy: Acute Care, 7th edition (2024) provides a consistent,

step-by-step guide to infusion procedures. When used in conjunction with Infusion Therapy Standards of Practice, this P&P will enhance your knowledge, understanding, and practice of the infusion nursing specialty.

Policies and Procedures for Infusion Therapy: Ambulatory Infusion Centers, 3rd edition (2024)

provides guidance to clinicians delivering infusion therapies in an ambulatory setting, where care is best accomplished through a specialized team structure to meet patient and organizational needs for safe, effective, and high-quality infusion therapy.

Policies and Procedures for Infusion Therapy: Home Infusion, 3rd edition (2024) was formulated in response to the growth of treatments and care available in the home setting. In some cases, hospitalization for uncomplicated conditions can be avoided and patients can receive infusion therapy in the comfort of their own home. Policies and Procedures for Infusion Therapy: Older Adult, 5th edition (2024) is your updated guide

to clinical practice for the older adult patient. This edition addresses key points, patient/caregiver education, and assessment of this patient population.

Policy and Procedures: Neonate to Adolescent, 4th edition (2024) serves as a guide to clinical practice for this special population. This edition has been adapted to recognize the differences not only from the adult population but also within the group itself. 15

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THE NEWEST EDITION OF ALL 5 POLICIES AND PROCEDURES COMING 2024

We have four new NCOE members: Katrina Ceci, MSN, RN, Alicia Dickenson, BSN, RN, CRNI®, Derek Fox, MSN, RN, CRNI®, VA-BC, and Eddie Korycka, MSN, RN. They will join the current members to help choose and mentor the speakers for the 2024 Annual Meeting. In this issue, Alicia Dickenson and Eddie Korycka share their backgrounds and interests. (Katrina Ceci and Derek Fox were featured in the September/October issue.)

Alicia Dickenson, BSN, RN, CRNI® Alicia Dickenson, BSN, RN, CRNI®, is the global training manager for BD, where she is responsible for internal learning management and development of strategies and tools for customer training. Alicia joined BD through Velano Vascular where she worked as a customer engagement manager. Prior to Velano, Alicia worked for J&J as a clinical nurse educator. She brings extensive experience as a vascular access nurse, was an INS Member of the Year, and was a reviewer for the 2021 Infusion Therapy Standards of Practice. Alicia holds a BS in nursing from Grand Canyon University, and lives in Oregon on a small farm with her husband and two sons. In her spare time, she enjoys gardening, wine tasting, camping, and boating adventures with family and friends.

Eddie Korycka, MSN, RN Eddie Korycka, RN, has nearly 30 years of nursing experience with 20 years in the vascular access specialty. Professionally he has worked in staff level positions in the emergency department and home infusion. He has held management positions as a nursing care coordinator and clinical specialist, and has held executive clinical education positions in the medical device industry for the last 10 years. His focus with his current employer, Access Vascular Inc., is on optimizing patient outcomes through the promotion of novel products and innovative training for clinicians. In service, he is an active member of the Association for Vascular Access and the Infusion Nurses Society: he has served as chapter president on the local level of INS, has served on national committees for INS, and was an editorial reviewer for the Journal of Infusion Nursing and the 2024 Infusion Therapy Standards of Practice. He has also served as president of the AVA Foundation.

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TAKE THE HOME INFUSION WORKFORCE SURVEY TODAY!

The home infusion nurse has specialized knowledge and skills. There is a void in research that describes the education, training, and experience of nurses in the home infusion workforce. An understanding of this information will inform infusion stakeholders about the credentials, training, and experience of home infusion nurses. By completing this survey, you will assist the national home infusion foundation with acquiring the data needed to gain this understanding, as well as to assess the current and future state of the infusion nursing workforce. All information will be confidential and de-identified prior to analysis. The results of the data analysis will be published and presented in an aggregated manner. Please assist us with this research project by completing the attached survey. This voluntary survey will take no more than 10 minutes to complete and you are not required to complete the survey in its entirety. Thank you for your time.

Learn More and Take the Survey! Survey Closes on November 19, 2023

NHIA: PROVIDING SOLUTIONS FOR THE HOME AND ALTERNATE SITE INFUSION THERAPY COMMUNITY

Founded in 1991, NHIA is the leading organization representing companies that provide medically necessary infusion therapies to patients in alternate sites, as well as the manufacturers, suppliers, and service companies that support the field. NHIA provides education, information, advocacy, and resources for the industry so the patients they serve can lead healthy, independent lives. The National Home Infusion Association (NHIA) is committed to meeting the needs of its growing and diverse membership—and to advocating on behalf of our members and the home-based infusion patient. Home and alternate site infusion providers coordinate care through highly skilled professionals in a team that will often include the infusion pharmacist, infusion nurses, physician, and dietitian to help ensure the patient is receiving the best care possible.

View these webinars and more on-demand: www.learningcenter.ins1.org/webinars Understanding Thyroid Eye Disease and Treatment

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Don’t Touch that Vein: Think SUBQ for Infusions

When to Consider a Midline Catheter

VIRTUAL INFUSION EDUCATION

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, exciting new educational deliverables, certification news, and additional, current information.

Executive INS is thrilled to announce the promotion of Maria Connors to Chief Operating Officer (COO). Maria joined INS in 2013 and has served the organization in a variety of roles, including Member Services Manager and most recently as Director of Operations and Member Services where she was instrumental in the implementation of a new association management software system that guides us in all aspects of our business. In her role as COO, Maria will work to implement the strategic view and initiatives of the organization as set forth by the board of directors and help to ensure that all mission objectives are met. In addition, she will collaborate with the CEO as a member of the executive team in setting and driving organizational vision and goals, translating strategy into actionable steps for growth, and setting organization-wide goals. Please join us in congratulating Maria on her new role.

INCC Congratulations to the 119 new CRNI®s who passed the September 2023 examination! These elite nurses join the nearly 3,000 who have earned the prestigious Certified Registered Nurse Infusion (CRNI®) credential. The CRNI® exam tests the knowledge and expertise of registered nurses in three core areas of infusion therapy practice: Principles of Practice, Access Devices, and Infusion Therapies. The exam validates the extensive knowledge and skills an expert registered nurse in infusion nursing possesses. The CRNI® examination is available twice annually, in March and September. Registration for the March 2024 examination is now open. For further information on the CRNI® examination, go to the INS website or email incc@incc1.org.

Education Join us for a deep dive into the all-new 2024 INS Standards of Practice. This 2-day symposium will provide a comprehensive overview of the revisions introduced in the 9th edition. Here’s what you can expect: 1. In-Depth Insights: Our Standards of Practice Committee members will cover vital topics such as patient safety, vascular access device management, and infusion administration to enhance your clinical practice. 2. New Standards Unveiled: Explore significant changes in the 9th edition, including drug diversion, vasopressor administration, and home infusion, to ensure compliance with the latest industry evidence. 3. Interactive Discussion Panel: Engage directly with our Standards committee members during the panel session to seek clarification and gain insights. We believe staying up-to-date on the evolving standards is crucial for delivering high-quality patient care, so mark your calendars for February 8-9. 21

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Publications INS is excited to report that the Journal of Infusion Nursing received a Journal Impact Factor (JIF) of 2. The JIF is a journal-level metric calculated from data indexed in the Web of Science Core Collection. This ranking takes into account how recently and frequently JIN has been cited. You can view the top 20 journals that cite JIN here.

Meetings Save the dates for future INS Annual Meetings & Exhibitions! INS 2024

INS 2025

INS 2026

INS 2027

May 18-21

April 26-29

April 11-14

May 1-4

Sheraton Kansas City Hotel at Crown Center

Paris Las Vegas Hotel

The Galt House Hotel

Hyatt Regency Dallas

Las Vegas, NV

Louisville, KY

Dallas, TX

Kansas City, MO

MAY 18-21

INS 2024 KANSAS CITY MISSOURI

Welcome New Members! DOMESTIC MEMBERS

Jennifer Alley Heather Arms Sharon Arrowood Lisa Barr Terry Barry Megan Beamer Shannon Bergeron Laura Betthauser Lindsay Blake Carolyn Brennan Stephanie Brookins Sharon Broussard Olivia Browder Kimberly Brown Helen T. Brugger Jason Buchovecky Marie Burns Michele Cage Gabirela Camara Robyn Capio Rubi Carbajal Nancy Carew Amanda Carroll Ashley Carter Shantell Carufel Lisa Coe Dorothy Coiro Susan Colbert Taylor Cook

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Jody Coolman

Minoude Gustave

Suzanne April Cooper

Kimberly Hall

Sharon Crowell

Lori Ann Halterman

Caroline Cutler

Raven Hathaway

Marie Demir

Susan Hauversburk

Christen Demont

Sandy Hayes

Frank DeVito

Taryn Heinrich

Mary Rose Devlin

Sigurlin Helgadottir

Amy Dimattia-Turmell

Stacey Hield

Sarah Doucette

Amy Howard

Brian Dougherty

Tifphany Howard

Diane Doukellis

Anthony Izzi

Kelsey Druhot

Tiffany Jackson

Annette Durette

Marie Jeanphilippe

Stephanie Ecoff

Jennifer Joslin

Andrew Edwards

Bonnabille Jovero

Chris Fagan

Liesa Kennedy

Karlen Fields

Stase Kilinskaite

Heather Fitzhugh-Boehm

Stephanie Kirkland

Caroline Fletcher

Stacy Koeppen

Julianne Fowler

Renae Laffin

Denise Franco

Amanda Lindbloom

Teresa Fullington

Sandy Little

Shannon Gagnon

Tammy Lopez

Johanna Gammon

Jishel Lund

Jason Gatlin

Brenda Maas

Dawn Gibbs

Sarah Maloney

Jennifer Gilley

Janice Marchand

Tana Gipson

Heather Marcoux

Tiffany Goodwin

Laura Marrufo

Sarah Gradwell

INFUSION NURSES SOCIETY Gerry Mazola

Misty Potter

Katelynn Williams

Megan MC

Tammy Puhalovich

Stacey Williams

Dustin McCallum

Stephanie Purcell

Tammy Wilson

Laurie McCarter

Kelli Ressl

Fiona Winterbottom

Lauren McDaniel

Andrew Rieck

Sonja Woods

Christina McFarlane-Henry

Jennifer Riesenberg

Rosalinda Yap

Nahzaya Mendez

Rhiannon Romero Moore

Patrice Yarbrough

Jacqueline Messier

Danielle Rousayne

Jessica Miller

Candace Rowland

Lois Molko

Sarah Ruckman

Melissa Montalban

Roxanne Schroeder

Virginia Morales

Sabra Scott

Breanne Moravcik

Martha Servin

Rick Mott

Madison Sexton

Susannah Murphy

Lisa Sheridan

Ellen Naughton

Makaya Sloan

Michael Niall

Laurie Smith

Amanda Nichols

Heather Smith

Theresa Normile

Madeleine Smith

Ashley O’Bannon

Tara Sturges

Katie O’Gara

Amanda Sutherland

Tawakalitu “Wally” Olagunju

Tiffany Talley

Dawn Orsogna

Patricia Taylor

Rita Patrylo

Sherrie Theroux

Tamechia Pennyman

Lori Thomas

Sally Peralsky

Ellen Tichich

Sable Phillippi

Justine Walker

Ashley Pierce

Shannon Walker

Melaina Pletsch

Erin Wheeler

Tashika Porter

Cassandra Wholey

I N T E R N AT I O N A L M E M B E R S

Princess Shyne Austria Saudi Arabia Yiyong Chen Canada Paola Andrea Cubillos Moreno Columbia Julie Ann Hervas Ireland Taeeun Kim South Korea Meghan McKenna Canada Noran Adel Abdullah Mirdad Saudi Arabia Maria Pelser South Africa Lisandro Rendón Columbia Sandra Schonfeld Switzerland Sharon Wallace United Kingdom

November/December 2023

Retrospective Issue