Don’t Just “go with the Flow”: how standards promote infusion pump Safety Mary Alexander, MA, RN, CRNI®, CAE, FAAN Chief Executive Officer Infusion Nurses Society Norwood, MA

Objectives Discuss the importance of an interprofessional approach to promote infusion pump safety. Discuss the application of the Infusion Therapy Standards of Practice for optimizing infusion pump safety.

INS Mission Develop and disseminate standards of practice 1980, 1990, 1998, 2000, 2006, 2011, 2016 Provide professional development opportunities and education Advance best practice through synthesis and research Support professional certification Advocate for the public

Evidence-Based Practice Increased recognition of the importance of evidence-based practice (EBP) Where is the evidence to support clinical decisions? Not continuing to practice “as we’ve always done” Eliminate unnecessary traditional practices

Evidence-Based Practice Definition: the integration of best research evidence with clinical expertise and patient values INS calls for clinicians to use research findings, to practice with the current best evidence, and integrate evidence and research findings into practice (SOP, 2016). 17 years is the time it takes to translate research into practice.

Infusion Therapy Standards of Practice Published in 2016; revised every 5 yrs 64 Standards, 9 sections Explanations Methodology Rating the body of evidence Practice Criteria recommendations Appendices Infusion Team definition New illustrations Expanded glossary

Coming Soon! Chinese Spanish Portuguese

Title Change: Infusion Therapy Standards of Practice ‘Infusion therapy does not “belong” to one group of clinicians, but is the responsibility of any clinician who is involved in the practice.’ SOP 3: Scope of Practice Definition of roles and responsibilities Collaboration among the health care team Scope of practice within legal framework

Evidence: Appraised & Rated Standards are not rated Expectations of practice applicable to infusion therapy in all settings Practice Criteria are rated: based on high quality evidence Reflects the body of evidence available and retrievable at the time of review Rating Scale: I, IA/P, II-V, Regulatory References for each Practice Criterion are listed

Evaluating Evidence Highest quality used: Research Non-research Meta-analysis or systematic review Individual studies and quality of the study Non-research Quality Improvement (QI) or clinical articles Case reports or position papers Textbooks or papers on anatomy/physiology

“Evidence” of the Evolving Science of Infusion Therapy INS Standards 2011 Level I evidence – 3.8% of rankings Level V evidence – 67% INS Standards 2016 Level I evidence – 5.8% of rankings Level V evidence – 46% 350 more references

5. Competency Assessment and Validation The clinician is competent in the safe delivery of infusion therapy and vascular access device insertion and/or management within her or his scope of practice. The clinician is responsible for attaining and maintaining competence. Competency assessment and validation is performed initially and on an ongoing basis. .

7. Evidence-Based Practice and Research Uses research findings and current best evidence to expand knowledge and validate and improve practice Actively participates in evaluating, interpreting, synthesizing, and implementing research findings Product technology selection Practice guideline implementation Evidence-based quality improvements (IV) Shares innovations and knowledge gained with other clinicians internally and externally (I)

12. Product Evaluation, Integrity, and Defect Reporting Clinician end users are involved with the evaluated outcomes of infusion-related technologies Clinical application Expected outcomes Performance Infection prevention Safety Efficacy Reliability Cost

12. Product Evaluation, Integrity, and Defect Reporting Include an interprofessional group of direct and indirect clinician end users in product evaluation Orient and educate clinicians on new product/device Use data collection tools for analysis and ongoing monitoring (V)

13. Medication Verification Use technology, when available Use of bar-code technology is associated with decreased risk of medication errors Errors still occur as staff create “work-arounds” bypassing safety mechanisms and bar-code technology (III) Use of electronic infusion devices EIDs) that include dose-error reduction software (“smart pumps”) associated with reduced risk for medication errors, including error interceptions, and reduced adverse drug events Failure to comply with appropriate use, overriding alerts, use of wrong drug library contribute to risks associated with smart pumps (II)

24. Flow-Control Devices Dose-error reduction systems are considered in the selection and use of EIDs. Consider use of smart pumps with dose-error reduction software (II) Do not rely on EID alarms to detect IV infiltration or extravasation as alarms are not intended to detect disruption of the fluid flow pathway (V) Standardize types of pumps used in an organization (IV) Recognize the problem of alarm fatigue; implement evidence-based recommendations using an interprofessional approach (III)

57. Parenteral Medication and Solution Administration Identify and verify medications and IV solutions Use technology according to organizational policies and procedures, eg, bar codes, smart pumps (III, II)

“Where technology, practice, and interdisciplinary teams meet”

Infusion Nurses Society www.ins1.org