March/April INSider

INSIDER

I want to dive into the vascular access track.

Did you know this year INS has an alternative settings track?

I'm here early to attend the preconference!

A Sneak Peek into the Abundance of Learning Opportunities at INS 2024

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

SECRETARY/TREASURER

Joan Couden, BSN, RN, CRNI®

DIRECTORS-AT LARGE

Jannifer Stovall, MBA, BSN, RN, CRNI®, IgCN

Pamela McIntyre, MSN, RN, CRNI®, IgCN, OCN®

PUBLIC MEMBER

Lisa M. Ong, CPA, PCC

CHIEF EXECUTIVE OFFICER

Chris Hunt, MBA

FUSION NURSES SOCIETY

INS STAFF

Chief Operating Officer: Maria Connors, CAE

Editor-in-Chief – Journal of Infusion Nursing,

Director of INS Publications: Dawn Berndt, DNP, RN, CRNI®

Graphic Design and Marketing Manager: Whitney Wilkins Hall

Managing Editor: Donna Knauss

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

Senior Membership Services Associate: Susan Richberg

THE

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INFUSION

©2024 Infusion Nurses Society, Inc. All rights reserved.

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In this Issue

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CEO Message: INS – The Symbol of Excellence

Chris Hunt, MBA

Cover Story: A Sneak Peek into the Abundance of Learning Opportunities at INS 2024

Marlene Steinheiser, PhD, RN, CRNI® and Meghan Trupiano, CMP

Sue Boyles, RN, CRNI®, VA-BC: Her Nursing Career and Legacy

INSide Scoop

Keep informed on things happening within INS

Do’s And Don’ts of Defensive Documentation NSO

INS Learning Center

Welcome New INS Members

Domestic and International

Membership Updates

New Professional Accomplishments

INS – The Symbol of Excellence

As you browse through the INS website, I am sure you are struck by the numerous types of educational offerings available. They range from virtual programs, webinars, position papers, and our Fundamentals of Infusion Therapy online program to our seminal resource, Infusion Therapy Standards of Practice. The commonality of each of these important resources is the INS logo that accompanies them. This symbol of excellence helps distinguish INS from other products or resources.

We have often heard that when presented with two different infusion-related programs/resources, clinicians will choose the one developed by INS because they trust the information in it will be accurate, current, and meet our Standards. We embrace the responsibility that this logo carries and appreciate the confidence those in our specialty have in us.

they have developed. We recognize the demand for credible and reliable information and understand that many of these programs developed outside of INS are excellent. In response to the increasing number of inquiries from external organizations, we developed the INS Seal of Approval Program. This program was designed to ensure accuracy and adherence to INS Standards and serves as a symbol of excellence, granting recognition to programs and resources that meet our rigorous standards.

What we also heard were inquiries from external organizations asking INS to approve programs

The interest in this program has been phenomenal. Numerous organizations reached out within minutes of the initial email announcing the program. We commend the organizations seeking the INS Seal of Approval, as it demonstrates your commitment to delivering high-quality information. It is testament to the power of the INS logo, brand, and reputation!

Chris Hunt, MBA

NOW REVISED EVERY 3 YEARS

www.ins1.org

A Sneak Peek into the Abundance of Learning Opportunities at INS 2024

By Marlene Steinheiser, PhD, RN, CRNI® and Meghan Trupiano, CMP

Join us May 18-21 at the Sheraton Kansas City Hotel at Crown Center in Kansas City, Missouri! Connect live with members of the infusion specialty from all over the globe to learn about the latest improvements to patient care and see the newest products on the infusion market today.

INS 2024 will feature three dynamic specialty tracks tailored for diverse infusion professionals, ensuring there's something valuable for everyone. Attendees will be immersed in a wealth of expertise as infusion experts take the stage to share their profound knowledge. INS 2024 will even provide a global perspective from international experts hailing from Brazil, Canada, the Netherlands, and Australia. Brace yourself for an enriching experience as we present more sessions than ever before, with over 60 thought-provoking sessions and 80 speakers covering a wide spectrum of topics. Come hear from several of the INS Standards of Practice committee members as they present sessions throughout the meeting and on the last day during the Q & A panel discussion.

We invite you to explore these dynamic tracks and immerse yourself in the wealth of knowledge awaiting you at INS 2024. For the complete Agenda visit our website

Vascular Access Device (VAD) Track

The INS National Council on Education Committee (NCOE) developed sessions devoted to an important aspect of infusion therapy, vascular access devices. Without diligent care of our patients’ vasculature, supported by knowledge of the evidence, clinicians cannot safely provide infusion therapy solutions or medications. These selected sessions will provide attendees with evidence from the experts pertaining to vascular access, intravascular infections, vascular access device (VAD) selection, VAD care and management, and much more. Speakers from around the world will share their research endeavors and disseminate their findings aimed at improving the care of our patients’ vasculature.

Alternative Care Setting Track

A substantial number of INS members are employed in alternative care settings, such as home infusion, outpatient clinics, and skilled nursing facilities. While many other sessions will include considerations for care of patients outside of acute care settings, these sessions are dedicated to alternative care and are being presented by experts in areas outside of the hospital. Join these sessions to learn more about various disease states, vascular access care, and complication management in alternative care settings.

Back-to-Basics Track

Back-to-Basics is dedicated to the fundamentals of vascular access devices (VADs) and infusion therapy patient care for the novice to expert clinician and educators. Each session will provide you with vital information when caring for patients receiving infusion therapy, including evaluation of essential elements such as medication dilution, infusate pH, administration methods, infusion rates, and therapy frequency. You will learn how to select the most suitable type of VAD and location for placement, how to identify critical factors influencing drug absorption, and how infusion technology can serve the clinician and patient in the effective and safe infusion of fluids and medications. We will not only examine important but often overlooked considerations for the use of the short peripheral catheter, we will also discuss misconceptions about VAD care, dressing change, and assessment. As we work to mitigate complications associated with vascular access devices (VADs), we will explore prompt interventions, specifically addressing the critical issues of phlebitis, infiltration, extravasation, nerve injury, and infection. These sessions will enhance your knowledge of vital principal practices in infusion therapy.

New This Year! Quality Improvement Challenge

The Quality Improvement Challenge will feature INS members sharing how they are advancing safety and excellence in infusion therapy in various health care settings. A chance to hear from your peers.

INS 2024 Virtual Conference: May 19-20

If you cannot make it to Kansas City, the virtual conference will provide a wide range of learning opportunities, including sessions from the specialty tracks. Virtual registrants can join live or enjoy the sessions on demand. CRNIs will receive 36 recertification units. Registration opens on March 11.

Early Arrival to INS 2024:

Dive into 2 Preconference Workshops on Friday, May 17!

CRNI®s will receive 8 recertification units for each workshop.

Cadaver Lab, presented by Teleflex

Friday, May 17th 8am – 12pm

This comprehensive preconference workshop is for new and experienced vascular access specialists. This workshop will include several hands-on stations to increase knowledge and skill to include basic and advanced techniques. Stations will include ultrasound assessment with a review and hands-on rapid peripheral vein assessment (RaPeVA) and importance of catheter to vessel ratio. Attendees will be provided with an in-depth training on peripheral vascular ultrasound, intraosseous vascular access, and hemostatic dressing utilization techniques. We will also review the literature that shows support of intraosseous access as a bridge to definitive vascular access. Finally, navigation focusing on several types of CVAD insertion with use of the gold standard tip location and navigation modalities. Navigation hands-on training will include PICC, port and, CVC insertion utilizing ECG only, ECG with navigation, and discussion of when X-ray should be utilized.

Implementing PIVC Excellence, presented by BD

Friday, May 17th 1pm – 5pm

Vascular access complications are dangerous, costly, and far too common. Whether they occur at placement or during care and management, most complications can be prevented. It requires a commitment to a comprehensive, collaborative approach, and thorough education that reflects current standards of practice. From insertion to removal, each vascular access device includes complex variations in technology, technique, and treatment. This workshop is designed to provide tools to all levels, from the novice to expert, and will cover device selection, placement, and care and management. It is designed to provide clinical foundation, points to practice, and tools to educate clinicians on how to implement PIVC best practice and prevent vascular access-related complications. Attendees will participate in hands-on stations and have an opportunity at the end to share learnings as well as discuss practical clinical application. They will leave with tools to assist them in educating and implementing best practices in their care setting.

The educational sessions are only the beginning: INS 2024 has in store an array of sponsored programs, hands-on workshops, featured symposia, an interactive exhibition, and more. Visit our website, check your email updates, and follow us on social media to stay up-to-date and informed.

We look forward to seeing you in Kansas City!

Sue Boyles, RN, CRNI®, VA-BC: Her Nursing Career and Legacy

Sue Boyles (January 31, 1965 – November 29, 2023) from Evansville, Indiana had a passion for nursing and vascular access. She taught, inspired, and advocated endlessly throughout her 30-year nursing career, 26 of those years dedicated to the vascular access profession. She held board certification in both infusion (CRNI®) and vascular access (VA-BC), which she valued and encouraged her peers to seek. She believed in the power of knowledge. Through her professional membership and earned continued education, she remained inspired to always uphold the INS Standards within her practice. Her commitment to the profession has led many clinicians toward improved practice standards that have enhanced patient experiences and outcomes.

Sue’s passion lives on with the Sue Smiles Initiative

This initiative focuses on creating opportunities for nurses to achieve certification in vascular access or infusion, obtain profession-related continued education, and/or supplement costs associated with traveling to the profession’s conferences. All proceeds will aid in the initiative of helping nurses within the specialty commit to life-long learning. The official website with applicant criteria, application instructions, and additional information about the initiative to come.

You can donate or keep up-to date by visiting this link in the interim:

Visit Sue Boyles, RN, CRNI®, VA-BC's Memorial Website

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.

Member Services

Celebrating Susan

After an impressive 16 years of outstanding contributions to the company, we are delighted to announce the promotion of Susan Richberg to the position of Senior Member Services Associate. Susan’s journey within the organization began as Office Administrator. As that role phased out, Susan became a Member Services Associate where she has consistently demonstrated exceptional skills in customer service, a deep understanding of member needs, and a knack for problem-solving. Her wealth of experience and ability to cultivate positive relationships with members have set a benchmark for excellence. As a Senior Membership Services Associate, Susan will play a pivotal role in contributing her expertise to enhance the overall member experience, and continuing to uphold the high standards that define our company. This promotion not only recognizes Susan's achievements but also underlines our dedication to fostering internal talent. Join with us in celebrating Susan on this fitting tribute to her dedication and diligence.

LEARNING CENTER

Become a member today to receive access to a variety of educational resources such as free webinars, virtual conferences, position papers, podcasts and more. Available wherever and whenever you need them!

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Do’s & don’ts of defensive documentation

Documenting care is a basic nursing responsibility, but it’s one that nurses often struggle with because of time constraints and challenges associated with electronic health records (EHRs), such as poor user interfaces that leave nurses unclear as to where to document findings. However, taking time to document correctly and completely provides the first line of defense should you be named in a lawsuit.

Consequences of poor documentation

Documentation issues can have serious legal consequences. The NSO/CNA Nurse Liability Claim Report (4th Ed.) found that failure to document or falsifying documentation increased in frequency and severity in 2020, compared to 2015 and 2021. The average total incurred professional liability claims by documentation allegations rose from $139,920 in 2015 to $210,513 in 2020.

Documentation issues also can impact your license; the board of nursing may take disciplinary action or even rescind a license in the case of documentation maleficence. The NSO/CNA report noted that about half (49.6 percent) of all license protection matters related to documentation involved fraudulent or falsified patient care or billing records. Most nurses would not knowingly engage in these practices, but keep in mind that this category includes situations such as failing to document care as required by a regulatory agency. Thus, simply omitting information can lead to punitive action.

Finally, deliberately falsifying documentation (such as submitting false claim to Medicare) can subject nurses to sanctions under the federal False Claims Act.

Here are some strategies to follow to ensure your documentation is effective:

Do’s

• Follow organizational policies and local, state, and federal regulations related to documentation. Failure to do so is a red flag to an attorney.

• Ensure you are in the correct patient record.

• Be accurate. This may seem obvious, but a 2020 study by Bell and colleagues found that 21 percent of patients who reviewed EHR ambulatory care notes about them reported an error, with 42 percent labeling the error as serious.

• Use accepted abbreviations and medical terminology. One resource is The Joint Commission’s list of “do not use” abbreviations, published in 2018. For example, it states to write out “unit” instead of using “U” or “u.” Another resource is the Institute for Safe Medication Practices’ “List of Error-Prone Abbreviations, Symbols, and Dose Designations.”

• Document positive and negative findings. Negative findings may be overlooked. For example, nurses know to document signs and symptoms of infection, but they may forget to note the absence of them.

• Record all care, even if it’s “routine.” For instance, regular checks for signs of skin injury around an endotracheal tube should documented.

• Document in real time to help ensure accuracy. In some organizations, you can access the EHR from a secure mobile device you carry with you.

• Note when you notified other healthcare providers of a change in a patient’s condition. You’ll also want to note the response. If the response is inadequate or not appropriate, document that you followed up with another person, such as your supervisor.

• Document communications with patients and their families/caregivers. This include providing education (both verbal and written): If a patient suffers harm as a direct result of not following instructions, this information can protect you.

• Use checklists appropriately. Checklists can save time, but it’s easy to move too quickly, accidentally selecting “yes” because several of the previous answers were “yes,” when “no” is correct. In addition, remember that checklists are not all-inclusive, so avoid relying too much on them. For instance, an assessment checklist doesn’t necessarily cover everything you need to check on a patient.

• Be cautious of templates. Templates can help reduce missed care and save time, particularly for routine assessments; however, they are simply a starting point. You still need to ensure you completely assess patients and document care provided.

• Pay attention to alerts. Over-riding a valid EHR alert can lead to practice errors.

• Review entries before submitting and sign and date each entry. In EHRs, signatures are generally automatic, but you should verify the information is correct.

• Make documentation changes and corrections per organizational policy. It’s helpful to provide a reason for the change, if possible. Make changes and corrections as soon as possible.

• Speak up about what’s not working. This is particularly important for the EHR. A well-designed EHR can save time, but one that is not well designed can rob you of time. Even the best EHRs can benefit from tweaking. In some cases, forms can be created or refined to make it easier to document care, or the number of false alerts can be reduced. The IT staff can sometimes make a simple adjustment such as including a new option for recording sputum findings. Although these simple changes may only save a few seconds, those seconds add up over the course of a day, week, month, and year.

Here are some strategies to follow to ensure your documentation is effective:

Don’ts

• Don’t share your password for EHR records.

• Don’t leave blanks in forms. Use N/A (not applicable) if something does not apply.

• Don’t be subjective. State only the facts. For example, “patient slurring words, eyes bloodshot” rather than “drunk”. In addition to creating potential legal issues, keep in mind that many patients are now requesting their medical records and will see what you have written.

• Don’t be judgmental. Avoid negative descriptors such as “noncompliant.” Be particularly sensitive to possible racial biases. For example, a 2022 study by Sun and colleagues found that Black patients had 2.54 times the odds of having at least one negative descriptor in the history and physical.

• Don’t prechart (for example, entering information into the EHR before the start of a routine procedure). Situations can change and you may forget to amend the record. For example, during a procedure, a medical device different from what was originally planned may be used. In addition, the EHR keeps track of entries, so anyone reviewing the entry would know the timing was not correct.

• Don’t copy and paste text from one patient record to another. If you do decide to do this, be sure to carefully review the text and make changes as necessary. Otherwise, you may introduce errors.

• Don’t make late entries. If you must, be sure to make the late entry per your organization’s policy. Remember that the EHR will have a record of each entry, including date and time.

• Don’t assume you have to be the one to document something. When a new piece of information must be obtained on a regular basis, organizations often automatically turn to nurses. However, someone else in the organization may be able to collect the data, which helps avoid additional time demands on you, reducing the potential for documentation errors.

Protection through documentation

Your documentation should include clinical information (such as assessments and responses to medications); patient education; and diagnostic tests, referrals, and consultations. Following the tips in this article will help ensure you cover these areas, thus protecting yourself from legal action and promoting optimal patient care (sidebar). As you document, you may want to keep in mind some of the characteristics of high-quality documentation from the American Nurses Association: accurate, relevant, consistent, clear, concise, complete, thoughtful, timely, and reflective of the nursing process.

Value of documentation

It can be easy to focus on documenting in the healthcare record as an onerous task, but in addition to being a legal document, the record provides a tool to:

• Document services provided to patients, their responses to treatments, and caregiver decisions.

• Communicate information about the plan of care and outcomes to other members of the healthcare team.

• Demonstrate nurses’ contribution to patient care outcomes. It also helps nurses meet standards of professional practice. For example, to meet standards related to evaluating a patient’s progress towards goals, the nurse and others on the healthcare team need to review past documentation.

• Identify areas that need improvement; nurses can work with a team to address quality issues to enhance patient care.

• Provide evidence that an organization is meeting standards set by accrediting bodies that are protecting patients.

• Provide information to ensure proper billing coding so that organizations receive the reimbursement they are entitled to. Proper reimbursement promotes an organization’s financial health, enabling it to deliver quality care to patients.

Article

by:

Cynthia Saver, MS,

RN, is president of CLS Development, Inc., in Columbia, Md.

REFERENCES

American Nurses Association. Principles for nursing documentation: Guidance for registered nurses. 2010

American Nurses Association. Nursing: Scope and Standards of Practice, 4th Ed. 2021.

CNA, NSO. Nurse spotlight: Healthcare documentation. 2020.

Bell SK, Elmore JG, Fitzgerald PS, et al. Frequency and types of patient-reported errors in electronic health record ambulatory care notes. JAMA Netw Open. 2020;3(6):e205867.

Institute for Safe Medication Practices. List of error-prone abbreviations, symbols, and dose designations. 2021. https://www.ismp.org/recommendations/error-prone-abbreviations-list

Saver C. Easing the pain of electronic health records: Part 1. OR Manager. 2022;19-22.

Sun M, Oliwa T, Peek ME, Tung EL. Negative patient descriptors: Documenting racial biases in the electronic health record. Health Aff. 2022;41(2):203-2011.

The Joint Commission. Official “do not use” list. 2018. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safetytopics/patient-safety/do_not_use_list_9_14_18.pdf

Disclaimer: The information offered within this article reflects general principles only and does not constitute legal advice by Nurses Service Organization (NSO) or establish appropriate or acceptable standards of professional conduct. Readers should consult with an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for how this information is applied in practice or for the accuracy of this information. Please note that Internet hyperlinks cited herein are active as of the date of publication but may be subject to change or discontinuation.

This risk management information was provided by Nurses Service Organization (NSO), the nation's largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. The individual professional liability insurance policy administered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247-1500. www.nso.com

Legal Issues That Every Infusion Nurse Needs to Know

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Yuliya Yefimov

Fatemeh Youssefi

Joanne Zaks

Wisam Zeineh

Jessica Zielinski

INTERNATIONAL MEMBERS

Mohd Ridzuan Abd Rahman –Malaysia

Tanya Baker – Canada

Cesare Bargiggia – Italy

Rebecca Bejhed – Sweden

Andrzej Bernas – Poland

Katharina Bosshart –Switzerland

Sarah Burns – Canada

Angela Chan – Canada

Joanne Charbonneau – Canada

Seul A Choi – South Korea

Grzegorz Cichowlas – Poland

Poliana Constantino – Brazil

Elia El Hachache –United Arab Emirates

Katherine Evely – Canada

Suyeon Kim – South Korea

Ghrim Kim – South Korea

Christina Korstanje – Canada

Juyeon Lee – South Korea

Brittni Lingwood – Canada

Romina Marchesano – Canada

Wendy Matthews –New Zealand

Mona Mourad – Canada

Machiko Naito – Japan

Jolanta Piatek – Canada

Donna Pletsch – Canada

Fabienne Ruffini – Luxembourg

Marie Russell – New Zealand

Sara Saba – Italy

Camila Custódia Salustiano –Brazil

Amélie Samson – Canada

Enelia Sandoval – Colombia

Geraldine Schaack – Canada

Doris Scott – Canada

Orawan Suitthimeathegorn

Singapore

Luciane Vieira – Brazil

Karen Zepeda – Brazil

INFUSION NURSES SOCIETY

Membership Updates

INS is pleased to recognize the following individuals for their recent accomplishments, awards, and promotions.

Do you have an accomplishment, award, and/or promotion you’d like to share?

If so, please email whitney.hall@ins1.org

Lucilla Acosta, BSN, RN, the owner/founder of Superior Nursing, PLLC is proud that her company has recently earned well-deserved recognition for its commitment to excellence in health care. The company has been accredited with the Community Health Accreditation Partner (CHAP) for its outstanding home infusion services. This accreditation is a testament to Superior Nursing, PLLC's unwavering dedication to delivering high-quality health care in the comfort of patients’ homes.

Karin Cierzan, RN, CGRN, CRNI®, VA-BC, a staff RN in endoscopy and infusion therapy at MNGI Digestive Health, passed the vascular access certification exam on December 16, 2023. She also received the Gabrielle Schindler Award for Clinical Excellence from the Society of Gastroenterology Nurses and Associates (SGNA) at the Annual Course in Phoenix in May 2023.

Luciana Ludiciani, BSN, RN, CRNI®, who works IV therapy at Beverly Hospital, instigated information stations to represent the IV Team on National IV Nurse Day, January 25, 2024.

Colleen Seeber-Combs, DNP, RN, a senior section editor at EBSCO, graduated from Temple University in Philadelphia in 2023 with a Doctor of Nursing Practice and a Teaching in Higher Education certificate

Patricia Westcott, CRNI®, who works in home care/home infusion at Brightstar, is proud to be an employee of an INS-endorsed company providing infusion therapy. It builds her confidence and demonstrates that the Standards of Practice really do matter in providing the best quality patient care possible.

Sierra Torres, ADN, RN, CCRN, TCRN, VA-BC, a charge nurse at Stormont Vail Health has been able to participate in several house-wide projects that will standardize and improve practices related to central venous access device (CVAD) insertion, care, and maintenance. With research, education, and implementation phases, I have been able to facilitate the use of ECG tip confirmation and ISP alcohol impregnated caps. I also assisted with the standardization of our CVAD insertion checklist across the patient care spectrum that Stormont Vail Health encompasses in order for one documentation format to be used by all CVAD inserters and assisting personnel.