I. V. ROU N DS
Advocating for patients with an infusion alliance By Kathleen Marie Wilson, MPH, BSN, CRNI
CLINICAL NURSES can advocate for patients’ vascular access needs with these key steps: • maintaining an up-to-date knowledge base • performing early and regular assessments • communicating effectively. This article explains how nurses can take these critical measures to advocate for their patients appropriately and then develop an infusion alliance to make sure patients receive care based on best practices. Detailed steps for creating such an alliance are provided. Pumping up knowledge Hospital-based clinical nurses can influence the choice of vascular access device (VAD) for their patients. The first element in advocating for patients is nurses’
knowledge; an understanding of VADs’ key elements is critical. Knowledge can be acquired by: • reading medical and nursing literature • attending conferences • earning continuing-education credits • joining and actively participating in professional associations • achieving certification. For more ideas, see Tapping infusion and vascular access resources. Assessment and communication Assessments of VAD functionality and appropriateness for the patient must be shared with the healthcare provider. Remember that, as patient advocates, nurses are responsible for communicating and sharing information. Although the provider isn’t
Tapping infusion and vascular access resources Professional organizations such as those listed below often provide position papers, standards of care, and printed materials that can be extremely useful to clinical nurses involved in I.V. therapy. Consider exploring these sites to learn more, answer a particular clinical question, or become more involved in a professional organization.
• • • • •
Infusion Nurses Society (INS) http://www.ins1.org Association for Vascular Access (AVA) http://www.avainfo.org Rheumatology Nurses Association (RNS) http://rnsnetwork.org Oncology Nursing Society (ONS) http://www.ons.org CDC http://www.cdc.gov
Online forums, which sometimes require membership, can post nurses’ questions; for example:
•
Ask INS at INS Knowledge Center http://knowledge.ins1.org.
Card decks from the INS online store are straightforward and easy-to-use. Go to http://www.ins1.org for card decks with information about flushing protocols, central venous access device occlusions, and infusion therapy device selection.
68 l Nursing2014 l February
with the patient 24/7, nurses are. Optimal patient care is provided through collegiality and teamwork.1 Colleagues in infection prevention and control, radiology, discharge planning, and pharmacy are just a few professionals who could be involved. Communication also includes information that’s shared from nurse to nurse. Whether mentoring a new graduate, sharing information on best practices, giving report, or attending to vascular issues promptly and proactively, nurses demonstrate and reinforce the importance of thorough VAD assessment. Documentation is a type of communication that’s essential for safe VAD management. Documenting the chronology of assessments can help nurses determine a plan of care. The Infusion Nurses Society phlebitis scale is one tool that standardizes assessments and documentation.1 Powerful allies If a hospital has an I.V. or infusion team, consulting with team members about the most appropriate VAD to use is an excellent intervention. If the hospital doesn’t have an infusion team, nurses should seriously consider forming an internal infusion alliance such as an I.V. standards committee. Developing such an alliance, team, or committee can lay the groundwork for processes that promote standards-based infusion care—an important component of patient advocacy. An infusion alliance, a decentralized resource group, has the goal of empowering nurses to deliver www.Nursing2014.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
standards-compliant and evidencebased infusion care. Research substantiates the benefits of offering such services through infusion alliances such as reducing infusion complications and encouraging professional collaboration.2-5 This type of alliance provides a platform for patient VAD advocacy in the organization. Implementing the alliance If the hospital has achieved Magnet® status or is aspiring to it, nurses can consult the Magnet director for assistance. If not, nurses can speak with the chief nursing officer to gain support for an infusion alliance. Ideally, membership will represent every patient-care area, including pharmacy and infection control, and at least one healthcare provider such as a hospitalist. Approach specific staff or directors to describe how their involvement in the alliance will help staff in their area improve patient care and use resources appropriately. Nurses with infusion expertise are needed, as are other clinicians who administer I.V. therapy and want to help standardize practices.6 This group’s work should start with the choice of an infusion topic that’s been identified for quality improvement throughout the hospital. The topic can provide the impetus for the committee coming together, especially if it affects staff and patients across departments. Avoid choosing a concern particular to only one department. Explain the topic and provide evidence that identifies the need for improvement. For example, the group might recognize that various departments label an I.V. dressing differently. Standardizing the technique used can improve patient safety and staff efficiency. www.Nursing2014.com
Developing an infusion alliance can lay the groundwork for processes that promote standards-based infusion care.
Another example is finding that various departments use different products for the same procedure. Standardization to the same products for all departments can increase both staff efficiency and adherence to protocol. Developing a charter statement will help focus the group’s work. An example of this is “To improve patient outcomes through quality care and evidence-based infusion therapy.”7 Promoting the sentinel project will easily grow into other areas requiring attention. As the alliance becomes known throughout the institution, staff will pose questions or concerns. This interaction will initially occur informally, such as during staff meetings. Later, formal methods can be used to support this communication; for example, internal blogs or questions sent to the alliance e-mail address. Both informal and formal approaches are useful to nurses involved in improvement activities.8 Areas of focus for the alliance can include product evaluation, staff education, communication, and protocol review or update. All areas of focus lead to VAD advocacy for the patient. Evaluating the impact and outcomes of the infusion alliance is important for validation and for future direction.6 Have meetings bimonthly and communicate progress and outcomes
to the entire organization. Examples of outcomes could include converting to a superior product, updating policies and procedures with current standards, measuring changes in infection rates, or increasing staff members’ knowledge about infusion topics. Proactive approach Clinical nurses are a vital component of a proactive VAD plan of care. If your facility doesn’t have one, consider starting an infusion alliance, then call upon its expertise when needed. The results of nurses’ efforts could be improved teamwork and a higher level of care. ■ REFERENCES 1. Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs. 2011;34(suppl 1):S1S110. http://www.vardhandboken.se/Dokument/ INS_2011.pdf. 2. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011. Atlanta, GA: Centers for Disease Control and Prevention; 2011. http://www.cdc.gov/hicpac/pdf/guidelines/ bsi-guidelines-2011.pdf. 3. Hadaway L. Development of an infusion alliance. J Infus Nurs. 2010;33(5):278-290. 4. Harpel J. Best practices for vascular resource teams. J Infus Nurs. 2013;36(1):46-50. 5. Meyer BM. Implementing and maintaining an infusion alliance. J Infus Nurs. 2010;33(5):292-303. 6. Wilson KM. Solution time: mixing a different kind of I.V. team. Poster presented at Nursing Symposium; March 2013; Las Vegas, NV. http:// www.softconference.com/lww/sessionDetail. asp?SID=322445. 7. Community Hospital, Magnet Committees: I.V. Standards Committee. Mission Statement. 2012. Grand Junction, CO. 8. Houser J, ErkenBrack L, Handberry L, Ricker F, Stroup L. Involving nurses in decisions: improving both nurse and patient outcomes. J Nurs Adm. 2012;42(7-8):375-382. Kathleen Marie Wilson is a procedure and infusion specialist RN and I.V. standards committee chairadvisor at the Community Hospital of Grand Junction and RN care coordinator at Marillac Clinic of Grand Junction, Colo. She’s also a member of the INS Editorial Review Board and the INS National Council on Education. The author has disclosed that she has no financial relationships related to this article. DOI-10.1097/01.NURSE.0000441886.25867.26
February l Nursing2014 l 69
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Advocating for patients with an infusion alliance By Kathleen Marie Wilson, MPH, BSN, CRNI
CLINICAL NURSES can advocate for patients’ vascular access needs with these key steps: • maintaining an up-to-date knowledge base • performing early and regular assessments • communicating effectively. This article explains how nurses can take these critical measures to advocate for their patients appropriately and then develop an infusion alliance to make sure patients receive care based on best practices. Detailed steps for creating such an alliance are provided. Pumping up knowledge Hospital-based clinical nurses can influence the choice of vascular access device (VAD) for their patients. The first element in advocating for patients is nurses’
knowledge; an understanding of VADs’ key elements is critical. Knowledge can be acquired by: • reading medical and nursing literature • attending conferences • earning continuing-education credits • joining and actively participating in professional associations • achieving certification. For more ideas, see Tapping infusion and vascular access resources. Assessment and communication Assessments of VAD functionality and appropriateness for the patient must be shared with the healthcare provider. Remember that, as patient advocates, nurses are responsible for communicating and sharing information. Although the provider isn’t
Tapping infusion and vascular access resources Professional organizations such as those listed below often provide position papers, standards of care, and printed materials that can be extremely useful to clinical nurses involved in I.V. therapy. Consider exploring these sites to learn more, answer a particular clinical question, or become more involved in a professional organization.
• • • • •
Infusion Nurses Society (INS) http://www.ins1.org Association for Vascular Access (AVA) http://www.avainfo.org Rheumatology Nurses Association (RNS) http://rnsnetwork.org Oncology Nursing Society (ONS) http://www.ons.org CDC http://www.cdc.gov
Online forums, which sometimes require membership, can post nurses’ questions; for example:
•
Ask INS at INS Knowledge Center http://knowledge.ins1.org.
Card decks from the INS online store are straightforward and easy-to-use. Go to http://www.ins1.org for card decks with information about flushing protocols, central venous access device occlusions, and infusion therapy device selection.
68 l Nursing2014 l February
with the patient 24/7, nurses are. Optimal patient care is provided through collegiality and teamwork.1 Colleagues in infection prevention and control, radiology, discharge planning, and pharmacy are just a few professionals who could be involved. Communication also includes information that’s shared from nurse to nurse. Whether mentoring a new graduate, sharing information on best practices, giving report, or attending to vascular issues promptly and proactively, nurses demonstrate and reinforce the importance of thorough VAD assessment. Documentation is a type of communication that’s essential for safe VAD management. Documenting the chronology of assessments can help nurses determine a plan of care. The Infusion Nurses Society phlebitis scale is one tool that standardizes assessments and documentation.1 Powerful allies If a hospital has an I.V. or infusion team, consulting with team members about the most appropriate VAD to use is an excellent intervention. If the hospital doesn’t have an infusion team, nurses should seriously consider forming an internal infusion alliance such as an I.V. standards committee. Developing such an alliance, team, or committee can lay the groundwork for processes that promote standards-based infusion care—an important component of patient advocacy. An infusion alliance, a decentralized resource group, has the goal of empowering nurses to deliver www.Nursing2014.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
standards-compliant and evidencebased infusion care. Research substantiates the benefits of offering such services through infusion alliances such as reducing infusion complications and encouraging professional collaboration.2-5 This type of alliance provides a platform for patient VAD advocacy in the organization. Implementing the alliance If the hospital has achieved Magnet® status or is aspiring to it, nurses can consult the Magnet director for assistance. If not, nurses can speak with the chief nursing officer to gain support for an infusion alliance. Ideally, membership will represent every patient-care area, including pharmacy and infection control, and at least one healthcare provider such as a hospitalist. Approach specific staff or directors to describe how their involvement in the alliance will help staff in their area improve patient care and use resources appropriately. Nurses with infusion expertise are needed, as are other clinicians who administer I.V. therapy and want to help standardize practices.6 This group’s work should start with the choice of an infusion topic that’s been identified for quality improvement throughout the hospital. The topic can provide the impetus for the committee coming together, especially if it affects staff and patients across departments. Avoid choosing a concern particular to only one department. Explain the topic and provide evidence that identifies the need for improvement. For example, the group might recognize that various departments label an I.V. dressing differently. Standardizing the technique used can improve patient safety and staff efficiency. www.Nursing2014.com
Developing an infusion alliance can lay the groundwork for processes that promote standards-based infusion care.
Another example is finding that various departments use different products for the same procedure. Standardization to the same products for all departments can increase both staff efficiency and adherence to protocol. Developing a charter statement will help focus the group’s work. An example of this is “To improve patient outcomes through quality care and evidence-based infusion therapy.”7 Promoting the sentinel project will easily grow into other areas requiring attention. As the alliance becomes known throughout the institution, staff will pose questions or concerns. This interaction will initially occur informally, such as during staff meetings. Later, formal methods can be used to support this communication; for example, internal blogs or questions sent to the alliance e-mail address. Both informal and formal approaches are useful to nurses involved in improvement activities.8 Areas of focus for the alliance can include product evaluation, staff education, communication, and protocol review or update. All areas of focus lead to VAD advocacy for the patient. Evaluating the impact and outcomes of the infusion alliance is important for validation and for future direction.6 Have meetings bimonthly and communicate progress and outcomes
to the entire organization. Examples of outcomes could include converting to a superior product, updating policies and procedures with current standards, measuring changes in infection rates, or increasing staff members’ knowledge about infusion topics. Proactive approach Clinical nurses are a vital component of a proactive VAD plan of care. If your facility doesn’t have one, consider starting an infusion alliance, then call upon its expertise when needed. The results of nurses’ efforts could be improved teamwork and a higher level of care. ■ REFERENCES 1. Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs. 2011;34(suppl 1):S1S110. http://www.vardhandboken.se/Dokument/ INS_2011.pdf. 2. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011. Atlanta, GA: Centers for Disease Control and Prevention; 2011. http://www.cdc.gov/hicpac/pdf/guidelines/ bsi-guidelines-2011.pdf. 3. Hadaway L. Development of an infusion alliance. J Infus Nurs. 2010;33(5):278-290. 4. Harpel J. Best practices for vascular resource teams. J Infus Nurs. 2013;36(1):46-50. 5. Meyer BM. Implementing and maintaining an infusion alliance. J Infus Nurs. 2010;33(5):292-303. 6. Wilson KM. Solution time: mixing a different kind of I.V. team. Poster presented at Nursing Symposium; March 2013; Las Vegas, NV. http:// www.softconference.com/lww/sessionDetail. asp?SID=322445. 7. Community Hospital, Magnet Committees: I.V. Standards Committee. Mission Statement. 2012. Grand Junction, CO. 8. Houser J, ErkenBrack L, Handberry L, Ricker F, Stroup L. Involving nurses in decisions: improving both nurse and patient outcomes. J Nurs Adm. 2012;42(7-8):375-382. Kathleen Marie Wilson is a procedure and infusion specialist RN and I.V. standards committee chairadvisor at the Community Hospital of Grand Junction and RN care coordinator at Marillac Clinic of Grand Junction, Colo. She’s also a member of the INS Editorial Review Board and the INS National Council on Education. The author has disclosed that she has no financial relationships related to this article. DOI-10.1097/01.NURSE.0000441886.25867.26
February l Nursing2014 l 69
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
