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  • Episode 17: February 7, 2018 - Infusion-related Infection

    Contains 1 Component(s)

    From insertion site infections to catheter-related blood stream infections, every patient receiving infusion therapy is at risk of this potentially serious complication. Despite ongoing prevention and awareness campaigns, infections still happen. Are you putting your patients at risk?

    From insertion site infections to catheter-related blood stream infections, every patient receiving infusion therapy is at risk of this potentially serious complication. Despite ongoing prevention and awareness campaigns, infections still happen. Are you putting your patients at risk? 

    Guest:
    Lynda Cook, MSN, RN, CRNI®
    Vascular Access Consultant

    Knowing how to treat infusion therapy-related complications means recognizing the signs and symptoms. Identifying the problem as early as possible will significantly impact positive patient outcomes. Treating the sequelae of unrecognized complications can be costly, result in poor outcomes, and decrease patient satisfaction.

    From insertion site infections to catheter-related blood stream infections, every patient receiving infusion therapy is at risk of this potentially serious complication. Despite ongoing prevention and awareness campaigns, infections still happen. Are you putting your patients at risk? 

    Links to helpful information and resources:
    Nursing Infection Control and Education (NICE) Network:  A joint venture of the ANA, the CDC and 20 nursing organizations, including INS. The goal of the NICE Network is to improve adherence to infection prevention and control practices.
    http://www.nursingworld.org/In...

    CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011)
    https://www.cdc.gov/infectionc...

    Association for Professionals in Infection Control and Epidemiology (APIC)
    https://apic.org/

  • Episode 16: January 24, 2018 - Phlebitis: Mechanical, Chemical, Bacterial, Oh My!

    Contains 1 Component(s)

    Infusion therapy-related phlebitis is the most common, and preventable, complication of infusion therapy. Phlebitis prevention begins with critically assessing and evaluating the therapy ordered and the patient’s vascular status. Strict adherence to established insertion policies and procedures as well as frequent assessment can greatly reduce the occurrence of this complication.

    Infusion therapy-related phlebitis is the most common, and preventable, complication of infusion therapy. Phlebitis prevention begins with critically assessing and evaluating the therapy ordered and the patient’s vascular status. Strict adherence to established insertion policies and procedures as well as frequent assessment can greatly reduce the occurrence of this complication.

    Guest:
    Irma Sivieria, MS, BSN, CRNI®, VA-BC
    Vascular Access Clinical Coordinator
    South Shore Hospital, Weymouth, MA

    Knowing how to treat infusion therapy-related complications means recognizing the signs and symptoms. Identifying the problem as early as possible will significantly impact positive patient outcomes. Treating the sequelae of unrecognized complications can be costly, result in poor outcomes, and decrease patient satisfaction.

    Infusion therapy-related phlebitis is the most common, and preventable, complication of infusion therapy. Phlebitis prevention begins with critically assessing and evaluating the therapy ordered and the patient’s vascular status. Strict adherence to established insertion policies and procedures as well as frequent assessment can greatly reduce the occurrence of this complication.

    Resources:

    2016 Infusion Therapy Standards of Practice

    Policies and Procedures for Infusion Therapy, 5th Edition

    INS Phlebitis Scale

    GradeClinical Criteria
    0No symptoms
    1Erythema at access site with or without pain
    2Pain at access site with erythema and/or edema
    3-Pain at access site with erythema
    -Streak formation
    -Palpable venous cord
    4-Pain at access site with erythema
    -Streak formation
    -Palpable venous cord > 1 inch in length
    -Purlulent drainage
  • Frequency of Assessment of the Short Peripheral Catheter

    Contains 3 Component(s), Includes Credits Recorded On: 01/17/2018

    Short peripheral catheters (SPCs) are the most commonly used invasive device among hospitalized patients, yet nurses often underestimate the risk and the potential for serious consequences associated with peripheral access. Critically important to reducing the risks associated with SPCs are appropriate device and site selection, impeccable insertion technique, and regular and careful assessment for signs/symptoms with prompt catheter removal if present. INS established recommendations for the frequency of SPC assessment as presented in a 2012 position paper and incorporated these recommendations in the 2016 Infusion Therapy Standards of Practice. This presentation will explore and describe assessment recommendations in relation to current evidence.

    Short peripheral catheters (SPCs) are the most commonly used invasive device among hospitalized patients, yet nurses often underestimate the risk and the potential for serious consequences associated with peripheral access. Critically important to reducing the risks associated with SPCs are appropriate device and site selection, impeccable insertion technique, and regular and careful assessment for signs/symptoms with prompt catheter removal if present. INS established recommendations for the frequency of SPC assessment as presented in a 2012 position paper and incorporated these recommendations in the 2016 Infusion Therapy Standards of Practice. This presentation will explore and describe assessment recommendations in relation to current evidence.

    Lisa Gorski, MS, HHCNS, CRNI®, FAAN

    Lisa Gorski has worked as a Clinical Nurse Specialist (CNS) at Wheaton Franciscan Home Health & Hospice in Milwaukee, Wisconsin for more than 30 years. She received her bachelor’s and master’s degrees from the University of Wisconsin-Milwaukee College of Nursing. She is the author of Fast Facts for Nurses About Home Infusion Therapy, the upcoming 7th edition of Manual of IV Therapeutics, and more than 50 journal articles related to infusion therapy. She was also an editor for INS’ 2010 textbook, Infusion Nursing: An Evidence-Based Approach and is currently working on an updated edition scheduled for 2018 release. Lisa was named CRNI® of the year by INS in 2003 and CNS of the year by the National Association of Clinical Nurse Specialists in 2011. In 2006, she was inducted as a Fellow into the American Academy of Nursing. Lisa served as INS President from 2007-2008 and was chair of the 2011 and 2016 INS Standards of Practice committees. She currently lectures throughout the U.S. and abroad on infusion therapy-related topics, standards development, and home health care. 

    CRNI® RUs: This session has been approved for 1 CRNI® recertification unit and meets the non INS Meeting criteria.

    Contact Hours: This session has been approved for 1 contact hour

    Expiration date for receipt of contact hours: January 17, 2021

  • Episode 15: January 10, 2018- Infiltration & Extravasation: similar start, very different results

    Contains 1 Component(s)

    For all intents and purposes, infiltration and extravasation could be the same thing, except for one major difference. Listen in to the first episode of the series to find out why early identification of infiltration and extravasation is key to the prevention of potentially devastating complications.

    For all intents and purposes, infiltration and extravasation could be the same thing, except for one major difference. Listen in to the first episode of the series to find out why early identification of infiltration and extravasation is key to the prevention of potentially devastating complications.

    Guest:
    Britt Meyer Ph.D., RN, CRNI®, VA-BC, NE-BC
    Nurse Manager Operations- Vascular Access Team 
    Duke University Medical Center

    Knowing how to treat infusion therapy-related complications means recognizing the signs and symptoms. Identifying the problem as early as possible will significantly impact positive patient outcomes. Treating the sequelae of unrecognized complications can be costly, result in poor outcomes, and decrease patient satisfaction.

    For all intents and purposes, infiltration and extravasation could be the same thing, except for one major difference. Listen in to the first episode of the series to find out why early identification of infiltration and extravasation is key to the prevention of potentially devastating complications.

    Information and resources:
    Journal of Infusion Nursing Volume 40 Number 1. January/February 2017
    “Development of an Evidence-Based List of Noncytotoxic Vesicant Medications and Solutions”
    Infusion Nurses Society Vesicant Task Force

    Download your copy of “Noncytotoxic Vesicant Medications and Solutions” from the INS LEARNING CENTER. Log in at the INS website: www.ins1.org

  • Episode 14: December 22, 2017 - SOS: Shortage of Saline

    Contains 1 Component(s)

    In this episode, is the current shortage of saline impacting your practice? The main manufacturing facilities that supply much of small volume parenteral solutions to the United States were severely damaged when Hurricane Maria devastated the island of Puerto Rico in September 2017. We discuss what has been done to minimize the impact of these shortages on nurses and patients in various practice settings.

    In this episode, is the current shortage of saline impacting your practice? The main manufacturing facilities that supply much of small volume parenteral solutions to the United States were severely damaged when Hurricane Maria devastated the island of Puerto Rico in September 2017. We discuss what has been done to minimize the impact of these shortages on nurses and patients in various practice settings.

    Guests: Dan Heaton, Pharm D, Clinical Pharmacist

    Intermountain Home Care and Hospice of South Jordan, UT

    Valerie Grapensteter, DNP, RN, AC-AGCNS

    Associate Director of Clinical Practice, Rochester Regional Health, Rochester, NY

    In this episode, is the current shortage of saline impacting your practice? The main manufacturing facilities that supply much of small volume parenteral solutions to the United States were severely damaged when Hurricane Maria devastated the island of Puerto Rico in September 2017. We discuss what has been done to minimize the impact of these shortages on nurses and patients in various practice settings.

    Resources:
    U.S. Food and Drug Administration Drug Shortages: https://www.fda.gov/Drugs/Drug...
    ASHP and the University of Utah Drug Information Service 
    Small-Volume Parenteral Solutions Shortages Suggestions for Management and Conservation
    https://www.fda.gov/downloads/...

    The Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC) One and Only Campaign 
    http://www.oneandonlycampaign....

  • Infusion Alliances – A New Approach to Familiar Problems

    Contains 3 Component(s), Includes Credits Recorded On: 12/06/2017

    Infusion therapy continues to grow rapidly with an aging population, new and enhanced types of therapies, extensive development of new technologies, and expansion into all venues of healthcare. Infusion therapy involves many stakeholders from different professions, departments within a single organization, and across different organizations in a variety of healthcare venues. The days of each profession or organization practicing in silos with limited and ineffective communication should be gone. Alliances, also known as collaboratives, partnerships, and coalitions, in healthcare have had a tumultuous start, but could offer the promise for improvement in infusion therapy. All stakeholders must be identified and involved to bring about effective collaboration, collective decision-making, and interdependence. This presentation will apply the concept of an alliance to the practice of infusion therapy and explore what is needed for this approach to improve patient care.

    Infusion therapy continues to grow rapidly with an aging population, new and enhanced types of therapies, extensive development of new technologies, and expansion into all venues of healthcare. Infusion therapy involves many stakeholders from different professions, departments within a single organization, and across different organizations in a variety of healthcare venues. The days of each profession or organization practicing in silos with limited and ineffective communication should be gone. 

    Alliances, also known as collaboratives, partnerships, and coalitions, in healthcare have had a tumultuous start, but could offer the promise for improvement in infusion therapy. All stakeholders must be identified and involved to bring about effective collaboration, collective decision-making, and interdependence. This presentation will apply the concept of an alliance to the practice of infusion therapy and explore what is needed for this approach to improve patient care.  

    Lynn Hadaway M.Ed, RN-BC, CRNI®

    CRNI® RUs: This session has been approved for 1 CRNI® recertification unit and meets the non INS Meeting criteria.

    Contact Hours: This session has been approved for 1 contact hours

    Expiration date for receipt of contact hours: December 6, 2020

  • Episode 13: November 17, 2017 - The Second Victim of Infusion Therapy-Related Adverse Events

    Contains 1 Component(s)

    No one plans on it happening to them, becoming a victim as the result of care provided to a patient. By its nature, infusion therapy carries a higher risk for serious errors that can result in patient harm. When an adverse event occurs, the nurse involved often experiences emotional distress, and becomes the “second victim”. Professors Jackie Jones and Linda Treiber discuss their research and continuing studies of the phenomenon.

    No one plans on it happening to them, becoming a victim as the result of care provided to a patient. By its nature, infusion therapy carries a higher risk for serious errors that can result in patient harm. When an adverse event occurs, the nurse involved often experiences emotional distress, and becomes the “second victim”. Professors Jackie Jones and Linda Treiber discuss their research and continuing studies of the phenomenon.  

    Guests: 

    • Jackie Jones, RN, MSN, EdD, Director of Institutional Quality & Accreditation, Professor of Nursing, Kennesaw State University ltreiber@kennesaw.edu
    • Linda Treiber, PhD, RN, Professor of Sociology, Kennesaw State University jjone229@kennesaw.edu

    No one plans on it happening to them, becoming a victim as the result of care provided to a patient. By its nature, infusion therapy carries a higher risk for serious errors that can result in patient harm. When an adverse event occurs, the nurse involved often experiences emotional distress, and becomes the “second victim”. Professors Jackie Jones and Linda Treiber discuss their research and continuing studies of the phenomenon.


    List of Second Victim Resources

    “Do’s and Don’ts” of peer support:
    • Connors, Cheryl. What Any Caregiver Can Do to Support a ‘Second Victim’ https://armstronginstitute.blo... 

    Caring for the Caregiver Program at Johns Hopkins:

    https://www.johnshopkinssoluti... 

    American Association of Nurse Anesthetists Guidelines for Coping: 
    http://www.aana.com/resources2...

    Sidney Dekker's book "Second Victim: Error, Guilt, Trauma, and Resilience” (CRC Press)

    https://www.crcpress.com/Secon...

    University of Missouri Health System work on the second victim:
    http://www.muhealth.org/about/...

  • Recognizing and Preventing Tumor Lysis Syndrome

    Contains 3 Component(s), Includes Credits Recorded On: 11/15/2017

    Tumor lysis syndrome (TLS) is a metabolic oncologic emergency characterized by the rapid destruction of neoplastic cells. TLS usually occurs after the initiation of antineoplastic therapy. Large amounts of intracellular components are released into the bloodstream, posing life-threatening complications including, acid-base disturbances, electrolyte imbalances and kidney injury. This presentation will allow nurses to recognize patients at risk for TLS and perform the necessary interventions to prevent or manage this fatal complication.

    Tumor lysis syndrome (TLS) is a metabolic oncologic emergency characterized by the rapid destruction of neoplastic cells. TLS usually occurs after the initiation of antineoplastic therapy.  Large amounts of intracellular components are released into the bloodstream, posing life-threatening complications including, acid-base disturbances, electrolyte imbalances and kidney injury.  This presentation will allow nurses to recognize patients at risk for TLS and perform the necessary interventions to prevent or manage this fatal complication.

    Karen Iyere

    Karen Iyere earned her bachelor’s degree in nursing from Howard University in 2012. She worked as a registered nurse for 1 year before earning her master’s degree in nursing from Georgia State University. During her master’s schooling, Ms. Iyere worked full time at the Veterans Affairs Hospital in Decatur, Georgia on the medical-oncology unit, where she realized her passion for caring for veterans who were newly diagnosed with cancer. Ms. Iyere’s clinical rotation at Emory University Hospital in Atlanta, Georgia allowed her to explore oncologic disease processes with a more diverse population. She observed and studied patients on the various oncology units including, bone-marrow transplant, medical-oncology, and hematology. Her dedication to nursing practice and oncology led her to co-author a series of 3 clinical articles on oncology emergency that were published in Nursing 2016 and Nursing 2017. Ms. Iyere is currently an adult-gerontology nurse practitioner and acute care clinical nurse specialist for adults and geriatric population in Atlanta, Georgia area.

    CRNI® RUs: This session has been approved for 1 CRNI® recertification unit and meets the non INS Meeting criteria.

    Contact Hours: This session has been approved for 1 contact hours

    Expiration date for receipt of contact hours: November 15, 2020

  • Virtual Conference: Are you Ready for USP General Chapter ?

    Contains 3 Component(s), Includes Credits Recorded On: 11/03/2017

    This program will provide an in-depth understanding of USP and its role in advancing public health safety for patients and health care personnel. Presenters will review challenges and risks, as well as provide guidance on how to safely handle HDs as defined by USP General Chapter standards, which become enforceable in December 2019. This entire program has been approved for 5 contact hours and 10 CRNI® RUs and meets the INS Meeting criteria.

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    Are you Ready for USP General Chapter <800>?

    This program will provide an in-depth understanding of USP and its role in advancing public health safety for patients and health care personnel. Presenters will review challenges and risks, as well as provide guidance on how to safely handle HDs as defined by USP General Chapter <800> standards, which become enforceable in December 2019.

    Participants who attended the live version of this program at the 2017 National Academy in Atlanta, GA are not eligible to receive contact hours or CRNI® recertification units through this online program.

    Unforeseen Dangers: Drugs That Are Hazardous to Us

    9:00 - 10:00 AM EST
    • USP General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings becomes a federally enforceable standard on December 1, 2019.
    • Strategies to mitigate the hazards of exposure

    Leveraging Nursing Expertise For Hazardous Drug Safety

    10:00 - 11:00 AM EST
    • Infusion nurses’ role in increasing safe drug handling awareness
    • Practical advice and tools to understand the requirements around USP General Chapter <800>

    Administering Hazardous Drugs and Necessary Personal Protective Equipment

    11:00 AM - 12:00 PM EST
    • USP requires three effective protection mechanisms for nurses
    • In-depth analysis of closed system drug-transfer devices (CSTDs) and importance of and use of personal protective equipment (PPE)

    Pulling it all together: Implementing the Standards

    1:30 - 3:30 PM EST
    • Practical recommendations for achieving compliance with USP General Chapter <800>
    • Use of case studies to:
      • Develop a facility-specific hazardous drug (HD) list
      • Implement elements of medical surveillance
      • Design and implement an acknowledgment-of-risk form
    One-Day Program Outcomes:

    Attendees will be able to define the value and scope of USP Chapter <800> and obtain a high-level understanding of the practice and quality standards for handling HDs in health care settings that help promote patient and worker safety, and environmental protection. Attendees will also be able to identify additional resources and educational opportunities to further augment their understanding of implementation procedures of USP Chapter <800> in their practice settings.

    Unforeseen Dangers: Drugs That Are Hazardous to Us

    Patricia Kienle, RPh, MPA, FASHP
    9:00 – 10:00 AM EST

    USP Hazardous Drugs—Handling in Healthcare Settings becomes a federally enforceable standard on December 1, 2019. The purpose of USP is to protect patients, the environment, and health care personnel who handle hazardous drugs (HDs). These drugs include cytotoxic agents and reproductive hazards, as well as a variety of other agents, including some antibiotics, antipsychotics, and hormones.

    This session will provide an overview of the hazards and will list strategies you and your employer can incorporate to mitigate the hazards of exposure to these agents. Emphasis will be on containment strategies and work practices you need to use when mixing and administering HDs.

    Leveraging Nursing Expertise For Hazardous Drug Safety

    Martha Polovich, PhD, RN, AOCN
    10:00 - 11:00 AM EST

    Information about the standards for hazardous drug (HD) safety is essential for all nurses, because HDs are present in nearly every type of health care setting. Infusion nurses play a vital role in increasing safe handling awareness, providing HD education, promoting safe practices for HD handling, and reducing HD exposure. Nurses must take action to assess current practices and implement changes that improve HD safety.

    The goal of this session is to provide practical advice and tools nurses need in order to understand the requirements and implications of the USP Chapter standards.

    Administering Hazardous Drugs and Necessary Personal Protective Equipment

    Seth Eisenberg, RN, ASN, OCN®, BMTCN™
    11:00 AM - 12:00 PM EST

    USP requires three effective protection mechanisms for nurses: closed system drug-transfer devices (CSTDs), personal protective equipment (PPE), and administrative controls. It has been established that contamination of hazardous drugs can occur at multiple points during the process of administration. Examples include the use of luer fittings or open-system connections, spiking the bag at the bedside, priming intravenous tubing, connecting and disconnecting tubing and syringes, and leaking. For nurses not already using CSTDs, incorporating these devices into administration will require a significant change in practice. 

    This session will provide an in-depth analysis of CSTDs, as well as the importance of and use of PPE.

    Pulling it all together: Implementing the Standards

    Patricia Kienle, RPh, MPA, FASHP and Martha Polovich, PhD, RN, AOCN
    1:30 - 3:30 PM EST

    The goal of this session is to provide practical recommendations for achieving compliance with the hazardous drug (HD) standards discussed in the morning presentation.

    Using examples and case studies, the speakers will explain how to: 

    • Develop a facility-specific HD list 
    • Meet requirements for safe handling policies and procedures 
    • Design and implement an acknowledgment-of-risk form 
    • Evaluate safe administration practices, including personal protective equipment and closed system drug-transfer devices 
    • Decontaminate surfaces that have come into contact with HDs 
    • Handle an HD spill 
    • Implement elements of medical surveillance
    Contact Hours

    This entire program has been approved for 5 contact hours. Expiration date for receipt of contact hours: November 3, 2020

    CRNI® Recertification Units

    This entire program has been approved for 10 CRNI® recertification units and meets the INS meeting criteria.

    *Note: Participants who attend the live version of this program at the 2017 National Academy in Atlanta, GA are not eligible to receive contact hours or CRNI® recertification units through this online program.

    Patricia Kienle, RPh, MPA, FASHP

    Cardinal Health

    Patricia Kienle is a member of the USP Compounding Expert Committee and the author of Compounding Sterile Preparations: ASHP’s Visual Guide to Chapter <797> and the Chapter <800> Answer Book. She has cowritten the 8th edition of Assuring Continuous Compliance with Joint Commission Standards: A Pharmacy Guide. She received a pharmacy degree from the Philadelphia College of Pharmacy and Science and a master's degree in public administration from Marywood University in Scranton, Pennsylvania.

    Martha Polovich, PhD, RN, AOCN

    Georgia State University

    Martha Polovich, PhD, has been an oncology nurse since 1980. She was an oncology clinical nurse specialist between 1987 and 2012. As the Oncology Nursing Society's liaison to the National Institute for Occupational Safety and Health (NIOSH), she served on NIOSH's Hazardous Drug  Working Group from 2000 to 2007. She was also a member of the United States Pharmacopeia Convention's expert panel for its new general chapter,  <800> Hazardous Drugs – Handling in Healthcare Settings. The editor of several Oncology Nursing Society publications related to chemotherapy, Dr. Polovich is a nurse-researcher with a special interest in occupational hazardous drug exposure in health care.

    Seth Eisenberg, RN, ASN, OCN®, BMTCN™

    Seattle Cancer Care Alliance

    Seth Eisenberg has practiced in the field of oncology since 1983. His experience includes 31 years in hematopoietic stem cell transplantation. He has published articles on hazardous drug safety, chemotherapy, and biotherapy, as well as three book chapters, including a one for Joint Commission Resources. Seth also has presented at national and international nursing and pharmacy conferences, and has been the principal investigator in two published nursing research studies.

  • The Role of the Registered Nurse in the Insertion of Nontunneled Central Vascular Access Devices

    Contains 1 Component(s)

    As the result of requests from several state boards of nursing, INS convened a task force to determine if insertion of central vascular access devices by appropriately trained registered nurses (RNs) should be recommended. The task force consisted of RNs and advanced practice registered nurses with infusion therapy experience in various practice settings. The results are presented in the following INS position paper. (09/14/2017)

    As the result of requests from several state boards of nursing, INS convened a task force to determine if insertion of central vascular access devices by appropriately trained registered nurses (RNs) should be recommended. The task force consisted of RNs and advanced practice registered nurses with infusion therapy experience in various practice settings. The results are presented in the following INS position paper. (09/14/2017)