1. 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

2. 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.

3. 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

4. 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

5. 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.

6. 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

7. Coming Soon! Chinese Spanish Portuguese

8. 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

9. 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

10. 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

11. “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

12. 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. .

13. 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)

14. 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

15. 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)

16. 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)

17. 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)

18. 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)

19. “Where technology, practice, and interdisciplinary teams meet”

20. Infusion Nurses Society www.ins1.org