Celebrate passion and love

Do you love what you do? Today is Valentine’s Day, a day that we traditionally celebrate love. I challenge you to make a difference by loving what you do.

Nurses from across the country shared their passion for the profession in survey response to the American Nurses Foundation in June of 2012. The purpose of the survey was to explore why nurses value their profession, their colleagues and themselves.

The desire to “make a difference” was the most common reason to become a nurse. Other reasons stated were:

I became a nurse because:

• Of my mother
• Job security and flexible hours
• To have a meaningful career
• Of a sense of pride I observed when I saw a nurse in action
• To be an example to my children

Nurses love their profession because:

• Its role in coordinating care
• How it provides caring from beginning to end
• Kids, elderly, (fill in the blank here to match the specialty)
• My passion for nursing
• It’s never boring
• My colleagues
• The power to make a change

America’s 3.1 million nurses make a difference by “transforming the nation’s health through the power of nursing”, the stated mission of the American Nurses Foundation. Love a nurse. Honor a nurse during the month of February, visit: www.givetonursing.org

And if you are not a nurse, don’t despair. You too, can LOVE what you do. Celebrate a love for what you do. LOVE making a difference. How do you do that?

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A New Year’s Wish for You

Some traditions die hard.  My mom always said that if your house was a mess at midnight on New Year’s Eve, then it would forebode messiness in your house all year long.  In recollection, it may have just been a ploy to get me to clean my house. Although some traditions die hard, others are the gift that keeps on giving.  After all, my house is cleaner at midnight on New Year’s Eve, than it is all year long.

Do you have a family New Year’s Tradition or do you make New Year Resolutions?

This year my New Year’s resolution is to be blatantly honest.  OK, I admit it.  I love Oprah.  I said it.  I go to her website: Oprah.com – daily.  I just read:  6 New Years Traditions You Can Steal.  I plan to steal all of them and the best news is none of them are time sensitive.  There is still time.  Due to the “global factor”  you can all make these resolutions at New Years Eve.   Check them out:

1) Part Ways with the Past - Jewish New Year, Rosh Hashanah, let go of emotional baggage by doing Tashlikh .  You have until September 4, 2013 at sundown to do it.

2) Go HomeOn the eve of the Chinese New Year, it’s customary to plan a reunion dinner with extended families gathering under one roof .  You define: “extended”.  This year:  February 10, 2013

3) Light a CandleDuring Diwali, the Hindu festival of lights, that marks the beginning of the New Year, India is illuminated by lanterns and fireworks representing the triumph of good over evil. – This year, more than any other, you need to light a candle on :  Sunday, November 3, 2013

4) Watch Something Bloom Give yourself or someone else, fresh flowers once a month.  3 point plan:  inhale, dream, relax.  In Ethiopia, New Year’s Day, called Enkutatash is celebrated on Wednesday, 2013-09-11, this year.  Buy yourself some flowers.

5) Visit Your Grandmother -Songkran, the Thai New Year’s festival reminds us to respect our elders.  This year, relish wisdom on April 13th – 15th, 2013 and never stop relishing wisdom.

6) Turn Your Resolution Inside Out - Naw-Rúz, the Bahá’í New Year’s Day celebrates rejuvenation.  Detox.  Turn your inside out.  Body, Mind and Soul on March 21, 2013

Read more: http://www.oprah.com/world/New-Years-Traditions-New-Years-Customs-Around-the-World_1/1#ixzz2Gejwd3gj

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Thank you for your readership

InfuSystem provides a monthly corporate training session for employees.  A 15 minute in-service on a topic that addresses making our job, our life, or our way, a little easier.

Sharing November’s tips on protecting the precious gift of health

During the week of Thanksgiving we can be thankful for so many different things.  Perhaps for you it is family, friends, food, or  fun.  For all of you,  I hope it is also your health.  This is the time of year that none of us can take our health for granted.  It is definitely something that we all need to work to maintain.

3 INFECTION CONTROL tips to best protect your health:

1) Everyone 6 months of age and older should get the flu vaccine. Seasonal flu vaccines have a very good safety track record. If you have not as yet gotten your flu vaccine, it is not too late.  Go to :  www.flu.gov for more info and to find the most conveniently located flu vaccine clinic.

2)  Wash your hands.  Clean Hands Save Lives.  Amazingly, about 80% of infectious diseases are transmitted by touch. According to the CDC, the simple act of hand washing is the single most important means of preventing the spread of viral and bacterial infections.  There is a technique to washing your hands.  Hum Happy Birthday to yourself twice while washing your hands.  Not only will you be healthier, but happier too!  It is a proven fact.  For more info go to:  http://www.cdc.gov/handwashing/

3)  Practice surface environmental safety.  If it is as simple as scrubbing the cutting surface before turkey preparation this week, or a daily wipe down of your desk and work surface, practice environmental safety every day.  A recent study evidenced 40 times greater bacteria on the average desk computer mouse, than on the average toilet seat.  If your job takes you to a healthcare facility, be aware that universal precautions are practiced from the moment you walk in a healthcare institution, not only when presented with dirty equipment, in the ER or at a bedside.

Infectious diseases cost the U.S. $120 billion a year. More than 160,000 people in the U.S. die annually from an infectious disease.

Protect your health.  It is precious.

Questions or comments?

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Disaster Plans and Emergency Preparedness

Today, several tunnels and subways remain under water, as NYC recovers from the natural disaster, Hurricane Sandy. Such events reinforce the need for disaster planning in all healthcare settings.

It is not uncommon that healthcare providers minimize the need for an emergency plan if not geographically located in a coastal community, on a fault line, or along a tornado corridor. Yet Sandy very poignantly showed how the unthinkable can become a reality. In the 108 years of NYC transit history, this disaster is unprecedented.

Every accredited healthcare organization is required to establish an emergency preparedness plan and educate all personnel about the process to meet client/patient needs in a disaster or crisis situation. The personnel education requirements include, but are not limited to: orientation to the emergency plan and an annual review of the emergency plan.

The organization is also responsible for providing for the patient a plan that identifies: how to contact the organization in the event of an emergency or disaster, how to handle a missed treatment/therapy/delivery, and how to best manage their currently available care/equipment/medications, etc. When provided to the patient, as a written emergency checklist, at start of care, this tool can easily save a life.

Heath Centers and Health Care Providers can find information on planning management programs at the Health and Human Services Website: http://bphc.hrsa.gov/.  CMS provides an actual planning checklist at: http://preview.tinyurl.com/cfjwhnn

The rest of us can best prepare individually and within our communities by referencing the FEMA publication: Are you Ready? ( http://www.ready.gov/are-you-ready-guide ) available on the FEMA website. For those responsible for younger persons, refer to the American Pediatrics Association Publication “Family Readiness Kit” available online at: http://www2.aap.org/family/frk/aapfrkfull.pdf or the “Kids Readiness” webpage at the FEMA website: http://www.ready.gov/kids/ . Check out the “Pack It Up Readiness Game” while you are there.

The only time to prepare for a disaster is before it occurs. “Just like no coach would bring a team onto a field without a game plan, every family needs a game plan for emergencies. When disaster strikes, it’s too late,” says Russ Paulsen, Red Cross Executive Director of Community Preparedness and Resilience.

The healthcare team is comprised of many key players. Our MVP is our patient.

1) Get a game plan

2) Learn it

3) Share it

Before the big game!

 

 

 

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September is Thyroid Cancer Awareness Month

Did you know that thyroid cancer is the fastest growing cancer? Cases of thyroid cancer have doubled since 1990. Why? The jury is still out. There are numerous theories as to the increased incidence. Who? Women are three times more likely to be diagnosed with thyroid cancer than men. Increased risk? Those with a history of exposure to ionizing radiation and those with a family history of thyroid cancer are at an increased risk.

Signs and symptoms: Look for a lump in the neck. Do the Neck Check. Don’t know what that is? Go to: http://thyroidawareness.com. Early detection is the key.

Thyroid cancer is curable.

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Dancing with his daughter: the best rationale for HealthIT

I took a pledge today to engage and empower individuals to be partners in their health through information technology.  Health IT offers secure resources that enable consumers
to access their confidential health records where and when they are needed.

You may recognize EHR as the acronym for electronic health record, which is essentially a
digitalized version of a patient record.  The paper version was once restricted to health professional input.  Now the EHR is an interactive tool for patient and professional.  It is not uncommon that if you are a new patient to a facility, that today you start your own record on a secure website and your physician has your health information and associated records at his fingertips before your arrive for the first visit.  This is not the EHR in a “perfect world”, but the EHR as it functions today.  The EHR in a perfect world is likely years away and holds the opportunity for optimal health cost efficiency and safety for all of us.

More info on health information technology can be found at www.healthIT.gov There
you can find the story of a dad, Dave, who states that he beat cancer so he could dance with his daughter at her wedding.  Dave was referred to an online patient community by his physician.  There he found that patients are the most underutilized resource in all of health care. Dave tells the story of treatment outcomes that were very different, because of informed patient involvement in treatment decisions.  We have the power to improve health care through better quality information, delivered to the person who needs it, when they need it. You can read Dave’s story at www.healthIT.gov, along with Heidi’s story of how EHR’s can effectively assist in navigating and managing cancer treatment.  Coordination of care is truly challenging, especially for the cancer patient, yet Heidi tells of how under the worst of circumstances “my dad received the best of care” thanks to the benefits of health IT.  These are two of many life changing stories that can be found at the
HealthIT.gov website.

What about PHRs?  Do you have one?  What is a Blue Button?

To find out how you can set up a digital Personal Health Record to best partner in your health through information technology go to http://www.myphr.com/ for seven easy steps to setting up your PHR.

No matter if you are a healthcare provider, or a provider/consumer, we all have an interest in improved healthcare outcomes.  Take control of your own personal health record today to best align those records with reform initiatives.

 

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June in Legislation and July in Regulation

June was an active month in Washington, DC for healthcare reform.  The week of June 20, 2012, I had an opportunity to work closely with the legislators as a patient advocate.  Rare bi-partisan agreement was experienced on the Hill when patient safety and welfare was addressed.

That week, a bill reauthorizing the PDUFA (Prescription Drug User Fee Act) and MDUFA (Medical Device User Fee Act) programs and creating new user fee programs for biosimilars and generics was approved by both the House and Senate.   It is anticipated that these fees will save the government $311 million over ten years, while providing sorely needed resources for monitoring drug/device development and combating  drug shortages and counterfeit drugs trafficking.

The following week, the Affordable Care Act was upheld by the Supreme Court.  All the changes that worked for us, like:  elimination of pre-existing conditions as a barrier to coverage, elimination of annual and lifetime caps on insurance coverage and capping out-of-pocket healthcare expenditures will continue.  For a timeline of what has changed since April 2010 when ACA was enacted through today, you can go to the website HealthCare.Gov <http://www.healthcare.gov/law/timeline/> managed by the Department of Health and Human Services.  The timeline page displays in a succinct manner the past, present and future ACA initiatives.  There you can also find out more about “Partnership for Patients”.  InfuSystem is a partner in this program that highlights providers making a commitment to reducing medical errors, improving health care quality, and reducing costs.

If your voice was not heard in Washington during June of 2012, now is your chance to positively impact patient safety, healthcare affordability and improved access to care.   Today (July 10, 2012), with bi-partisan support, the FDA published the proposed rule for the Unique Device Identification (UDI) System, as set forth in 2007. “The safety of medical devices is a top priority for the FDA, Congress, industry, and patients,” said FDA Commissioner Margaret A. Hamburg, M.D. “The unique identification system will enhance the flow of information about medical devices, especially adverse events and, as a result, will advance our ability to improve patient safety.”

The UDI will allow for accurate reporting of high risk medical device adverse events in a consistent manner, with the intent of reducing medical errors and provide a foundation for secure distribution to eliminate diversion and better prepare for any future medical emergencies.  The FDA is actively seeking public comment for the next 120 days.

Anyone who has ever experienced the frustration of securing infusion pump data from the current MedWatch or MedSun database will be able to appreciate the need for consistency and overhaul of the reporting system implemented to track device error.

I encourage you to review Federal Register, Vol.77, No.132 at the HHS website: http://www.gpo.gov/fdsys/pkg/FR-2012-07-10/html/2012-16621.htm and provide comment on this very important ruling that impacts infusion device regulation safety.  For more info on UDI, go to:  http://www.fda.gov/udi

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Were you in Chicago last week? ASCO 2012 – Collaborating to Conquer Cancer

So much info has hit the media since the annual ASCO meeting last week.  The estimated attendance for the June 1-5 conference was over 30,000.  Can that be right?  My twitter account was full of tweets and retweets on abstracts and presentations.

Of interest to continuous infusion:  T. Conroy, MD, of Centre Alexis Vautrin, France, presented results of the randomized, phase II/III PRODIGE 5/ACCORD 17 trial (Abstract LBA4003). Although the study failed to show an efficacy improvement with FOLFOX over 5-FU/cisplatin, FOLFOX did offer advantages over the cisplatin- containing regimen. He called FOLFOX plus radiotherapy “a new option for chemoradiation of patients with esophageal cancer,” particularly for patients with contraindications to cisplatin.

B. Saltz, MD, of Memorial Sloan-Kettering Cancer Center addressed curative-intent liver treatment.  He cited use of FOLFOX and the importance of sequencing of treatment therapies, stating that we still had a way to go towards cure with treatments to include new agents as well as predictive molecular markers.

A new continuous infusion drug in phase one study, obatoclax, is currently being investigated as a treatment for solid tumors as well as for a variety of blood cancers, including multiple myeloma, leukemia, and lymphoma. Dr. A. K. Stewart from the Mayo Clinic in Arizona discussed results of obatoclax in combination, for the treatment of relapsed multiple myeloma.

Immunotherapy was the talk of the day, preventative screening was the word of the day and the impact of patient centered medical homes on surveillance was the question of the day.

If you attended ASCO, comment on what impressed you the most.

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Nurses Advocating, Leading, Caring – 2012 National Nurses Week Celebration

National Nurses Week is celebrated annually from May 6, also known as National Nurses Day, through May 12, the birthday of Florence Nightingale, the founder of modern nursing.  As an art and a science, the nursing profession has a colorful history that reflects the tapestry of more than three generations of nursing professionals currently in
practice, interacting and providing the best in patient care.

Veteran (born from 1922-19435), Baby Boomer (1946-1964), Gen X (1965-1076) and Gen Y (1077-1997) nursing professionals work side by side with one clear goal: patient care.  Nurses committed to their patients.  Their varying values make them unique to their patients, and their similarities make them precious to healthcare.  By listening to, and learning from each other, they exhibit professional synergy.  Our patients deserve no less.

ANA defines professional nursing as the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations.

Often described as an art and a science, nursing is a profession that embraces dedicated people with varied interest, strengths and passions because of the many opportunities the profession has to offer.

As dynamic as the healthcare arena in which they practice, nursing is an ever evolving profession, where nursing professionals advocate for patients.  Nurses strive to make a difference in healthcare, never complacent or content with good enough. As Florence Nightingale one stated, ”Were there none who were discontented with what they have, the world would never reach anything better”.  Florence was an activist who demonstrated
advocacy, leadership and caring throughout her profession.

How will you celebrate Nurses Day, May 6, 2012?

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ISMP – Oncology Self Assessment

Oncology practitioners around the world can
now access a tool that will assist in making drug treatment for cancer
even safer for their patients. The Institute for Safe Medication
Practices (ISMP), along with ISMP Canada and the International Society
of Oncology Pharmacy Practitioners, has launched the 2012 ISMP
International Medication Safety Self Assessment for Oncology. The
assessment will help to identify a baseline of oncology-related
medication practices and opportunities for improvement. Hospitals,
ambulatory cancer centers, and physician office practices where
chemotherapy is administered are being asked to convene
interdisciplinary teams to complete the assessment tool. You can
access the tool on the websites of all three organizations
(www.ismp.org, www.ismp-canada.org, www.isopp.org). Data can be
submitted online, anonymously, through June 29, 2012. At the
completion of the project, respondents will be able to compare their
confidential results with aggregate results from demographically
similar organizations and use the information to improve safety.

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Chemotherapy drugs must be labeled immediately upon preparation.

I recall receiving an evening hour hot-line call from a frantic ER nurse in Florida. A patient had just been brought in unresponsive. He had a pump infusing to a PICC line. The pump reservoir was near empty and unlabeled, so the staff had no way of knowing what drug he’d been getting, what dosage, or for how long. The only label on the pump was the InfuSystem address label. The pump serial number provided InfuSystem with a means of tracking down the patient’s physician office. The patient was identified and the ER staff and his family were provided the needed medical history. This occurred before HIPAA was enacted. Can you imagine the complexity and delays we would encounter today?

Don’t forget to label your patient’s pump reservoir!

The Institute for Safe Medication Practices (ISMP) has identified specific safety strategies for healthcare professionals and community healthcare providers using infusion devices. ISMP has a free newsletter for nurses, Nurse Advise-ERR, published monthly that you can sign-up for online. They also provide free online CE based on their safety alerts.

You will easily relate to the May 2008 ISMP Nurse Advise-ERR issue: Seven lapses add up to Tragedy, which tells the story of infusion pump error and techniques to prevent them. http://www.ismp.org/newsletters/nursing/Issues/NurseAdviseERR200805.pdf

How would you answer the following?

Adding medications to hanging IV bags should be avoided because it can result in:

a. An overdose if the medication pools at the spiked end of the bag

b. Drug incompatibilities if other medications are already in the bag

c. Label inaccuracies related to the actual concentration of the drug in solution

d. B and C

e. All of the above.

The answer to this question and free CE can be found at – http://www.ismp.org/Newsletters/nursing/default.asp

Guidelines for Standard Order Sets, tools to assess risk in community pharmacy, community pharmacy medication safety tools, other resources, and webinars can be found at: www.ismp.org

Remember to always label your patient’s pump reservoir. Develop uniform policy, and use it throughout your facility to ensure safe medication administration and device use. And let us know what works for you!

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Guidelines for Best Practice

Guidelines for Best Practice – 

Success!

The meaning of the word “success” has been debated over many years in many different  forums, with just as many definitions. That would be an interesting debate to get into on this blog in the future.  But for now: 

Infusion success is not up for debate, it is dependent upon practice.

  • Nursing procedural guidelines for patient safe and effective ambulatory infusion will include:
  • Verify medication orders—verify dosage—verify math.
  • Verify access device patency and blood return.
  • Label medication container/cassette—per order and pump parameters.
  • Prepare/verify drug preparation. Make certain that all air is removed from container. 
  • Program the pump, and verify all settings with a second nurse.
  • Lock the pump keypad, when applicable.
  • Provide patient teaching/demonstration, including defining the end time of infusion and any patient responsibilities for the pump. Education is imperative, as the patient is ultimately the one who monitors and manages the infusion in the individual setting.
  • Upon hook-up and start-up, demonstrate what the patient should see at all times to confirm operation. Address questions, such as “What are the possible alarms that may be experienced?” and “What does an alarm sound and/or look like?” 
  • Provide support tools and a contact number for 24/7 oncology nurse assistance. 
  • When the patient returns to the office at the end of the infusion, record the pump settings in the patient record, and visualize the medication container to verify the completed infusion.

These guidelines are an excerpt from an article that I previously wrote for ONS,  Ambulatory Infusion Success, ONS Chemotherapy SIG Newsletter, October 2008, Volume 19, Issue 4.

Continuous infusion has changed the treatment landscape for many disease states since the 1960s.  Continuous infusion transitioned from inpatient to outpatient over the next twenty years.  A recent study reviewed in the International Journal of Nursing Practice 2010 compared outcomes of inpatient and outpatient chemotherapy patients on FOLFOX and FOLFIRI.  Patients in the ambulatory infusion group performed better than the inpatient groupComparison between ambulatory infusion mode and inpatient infusion mode from the perspective of quality of life among colorectal cancer patients receiving chemotherapy (Lee YM, Hung YK, Mo FKF, Ho WM. International Journal of Nursing Practice 2010; 16: 508–516) concludes that this performance level was dependent upon the quality and efficacy of patient education and support.

What does your patient education and support consist of?  Looking forward to your comments!

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InfuSystem cited in ONS Access Device Standards

In January 2011, ONS (Oncology Nursing Society) released the third Edition of “Access Device Guidelines– Recommendations for Nursing Practice and Education”. 

If you are interested in all there is to know about Ambulatory Infusion Pumps, get yourself a copy and turn to Chapter IX. Ambulatory infusion pumps, where you will find InfuSystem cited repeatedly.  There you can find the history, advantages, and operational procedure guidelines for safe pump use. 

What about pump problems?  Occlusion alarm troubleshooting is reviewed in the guidelines and then Chapter IX.G.2 goes on to minimally discuss what can really go wrong.  All of the possibilities are worth reviewing to prevent programming and operation error. 

The FDA received 56,000 adverse event reports linked to infusion pumps from 2005-2009.  In April 2010, the FDA announced the Generic Infusion Pump project (GIP), an unprecedented and ambitious project focused on improving infusion pump safety.   The goal of the Generic Infusion Pump (GIP) project is to develop a set of generic infusion pump (safety) models and reference specifications that can be used as a standard to verify pump safety. If you are part of the GIP project, let us know how you are involved.  For more info on GIP go to:  http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/

Smart pump technology is recommended by ECRI to minimize the risk of incorrect dosing, yet today “smart pumps” are still an evolving science.  First Biomedical Inc. (FBI), provides a smart pump primer in  the article, “What Makes A “Smart” Infusion Pump Smart”.  The article can be found at:  http://www.firstbiomed.com/images/Smart%20IV%20Pumps.pdf   

Last but not least, ONS addresses educational and documentation issues in general. You would do best to go right to the INFU clinical support staff to get some sample documentation forms.  Always chart the pump serial number, always chart pump settings, and never forget to give the patient 24/7 contact information for clinical support. 

Comment here on what a great job InfuSystem does educating the profession on ambulatory infusion pumps.  Go to www.ons.org to get the 2011 revised edition of “Access Device Guidelines”. 

Oh, and another insiders tip! — Look in your mailbox for the newest INS (Infusion Nurses Society) Clinical Practice Standards.  There are important revisions since the last publication in 2006.  If you are an INS member they should be in your mailbox with your Jan/Feb Journal of Infusion Nursing. 

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Infusion Nursing Standards of Practice – Updated 2011

The Infusion Nursing Standards of Practice (INS, 2011) may have arrived in your mailbox last month, as a supplement to the Journal of Infusion Nursing.  It is noted in the preface that “Clinicians should be advised that the Standards is a legally recognized document” (S4).  One new aspect of the publication is the well defined: Strength of the Body of Evidence, as noted within each standard.

Two updated standards of particular interest to infusion pump use are: 

Standard 29. Flow-Control Devices addresses:  1) device selection criteria, 2) administration-set-based anti-free-flow mechanisms, 3) dose-error reduction systems, 4) organizational policies, procedures and practices guidelines, and 4) nurse competence (S34)

The standard recommends consulting FDA adverse event reports when considering flow-control  device selection.  For all regulatory information device related go to the following page and input your device query into the search box:         http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/

In the newly released issue of Nursing: March 2011, there is an excellent article written by K. Cummings, BSN, RN and R. McGowan, BS titled: “Smart” infusion pumps are selectively intelligent”.  Case studies are provided where smart pumps went wrong.  Bottom-line is that while pump technology is meant to reduce medication errors and avert patient harm it is not intended to replace clinical practices, institutional policies, and patient-centered care.                  http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=1127647

Standard 62. Antineoplastic Therapy, Practice Criteria, Item (E) states: “The nurse should use electronic infusion devices (EIDs) for specific types of antineoplastic administration and for all continuous administration”. 

I have heard discussion in the field lately about administration of continuous 5FU via elastomeric device.  This INS stated practice criteria would indicate elastomeric use inappropriate.  Further citations to support this recommendation, as provided within the standard, can be found at reference point: American Society of Health-System Pharmacists.  ASHP guidelines on handling hazardous drugs.  Am J. Heatlh-Syst Pharm. 2006;63:1172-1193

Other INS Standards that you may find of interest are:  Standard 45 – addressing flushing solutions and protocols and Standard 46 – addressing dressing and cleansing agent controversies. 

More information on the Infusion Nursing Standards of Practice can be found at:  http://www.INS1.org  or http://www.journalofinfusionnursing.com (ISSN 1533-1458)

Infusion Pump specific FDA database can be found at:  http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/InfusionPumps/

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Professional Development Opportunities, Blogs and Information Exchange

If you have registered for the Oncology Nursing Society 36th Annual Congress, then I am sure your mailboxes, both electronic and snail varieties, are brimming with invites.   ONS Congress is the premier international oncology nursing conference.  Yet, attending Congress can be a real challenge and commitment in terms of time and finance.  I have been a faithful ONS Congress attendee since 1995, and Congress 2011 will be no exception, thanks to my local ONS chapter.  Many ONS chapters provide congress grants to members at the local level and the ONS Foundation provides Congress grants at the national level.   Awarding educational grants provides the awardees’ with an opportunity to gain and share knowledge.  I am the fortunate recipient of a grant from the Metro Detroit ONS chapter to attend this event in Boston, MA, April 28-May 01, 2011. 

One thing I have learned about this conference is that you start planning early.  I have my accommodations and here is my shortlist of must attend sessions: 

  • Thursday – April 28 – Don’t miss the Opening Ceremonies and Keynote Session, FDA’s Tools for Oncology Clinical Practice, Adherence and Oral Oncolytics, Poster presentations and Exhibits
  • Friday – April 29 – Bench to Bedside Lecture, The Five W’s of Chemo  Competency , Poster presentations and Exhibits
  • Saturday – April 29 – Using Social Media to Connect with Colleagues and Patients ,  Poster presentations and Exhibits

If you are planning to attend you can post comments and plan networking by posting on this BLOG.  I hope to see many of you there.

Make plans to check back here after May 1 for a summary of congress events and short course in what’s new in cancer care. 

Can’t make it to ONS but plan on being in Louisville for the INS Annual Convention and Industrial Exhibition May 21-26?  For those of you going to the Spring National Academy of Infusion Therapy, I want to hear all about the “Chronotherapeutic Drug Delivery” session.  There was significant interest in chronotherapy in the late 90’s, but limited technical means to accomplish those protocols.  It will be interesting to see if outcomes from that period are now measurable.  Meet here for a discussion on the benefits of chronotherapy in June. 

Professional development is an ongoing nursing responsibility.  Healthcare is a dynamic and ever changing environment that dictates continuous knowledge acquisition.  In an ideal world we would all attend all the events that enhance our knowledge-base to provide our patients with optimal nursing care.  In lieu of that perfect world, we can use this blog as an info exchange.

Don’t let the cost of educational opportunities be a barrier to your professional development.  Make the most of your professional memberships and affiliations and apply for educational grant funding.  Acquire the knowledge and pass it on! 

If you are starting to plan for the 2012 ONS 37th Annual Congress – to be held in New Orleans, May 3-6, 2012 – also start planning your poster presentations NOW and start applying for local and national grant opportunities TODAY.

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Poppy Pocket/ONS/InfuSystem

My name is Sandy Smith with Poppy Pocket. My business partner, Julie Hyzdu invented and patented our initial product offering to help her Father as he was undergoing treatment for colo-rectal cancer.

The product, Poppy Pocket, is an infusion pump transport and holding system composed of an elastic band and pocket that completely encloses the infusion pump and tubes and is discreetly worn underneath clothes.

InfuSystem is the leader in their industry, providing portable infusion pumps to patients undergoing a variety of treatment protocols. It is refreshing to align ourselves with a company whose core values and mission statement is all about compassion and dignity coupled with the ability to listen to their customer and patients alike. To better serve their customers and a wider patient/customer base, we joined forces with Infusystem via a partnership. ONS Congress (Oncology Nursing Society) this year in Boston, MA, was our official announcement of that partnership. You could say it was our “coming-out” party!

The event and reaction to Poppy Pocket and our partnership with InfuSystem was overwhelmingly positive. On the exhibit hall floor we heard from nurses, physicians and patients alike how they had searched for a product like Poppy Pocket only to be frustrated by much research, with little result. We heard stories of modified purses, fanny-packs, tangled tubes, ruptured ostomy bags, and my personal favorite – a gun holster used to hold the pump. Inventive for sure, but not the best service and product for patients suffering through a difficult time in their lives.

We are so excited about the future, and helping patients enjoy a better quality of life coupled with the partnership with InfuSystem. Our hope is to help deliver all this – and I had to share my thoughts here in this blog.

I hope to deliver updates and stories from my experience on a regular basis. If you would like to get in touch with me, or need more info on poppy pocket, go to www.poppypocket.net.

Sandy Smith, President, Sales & Marketing

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Patient Education

Patient education….

Patient education is an important part of the nurse’s everyday role, but is often left as the last thing after all of the technical details have been completed.  I learned a long time ago that if I took a few minutes to educate the patient first it actually saved me a lot of time in the long run.

Patient education is even more important when we send patients home with a cytotoxic medication running though an IV pump.  It scares me to think about the responsibility I am giving a person that has no medical background, not to mention the fear of the patient and families.

Over the years I have heard many things about home infusions from patients.  Patients have called or come back in to the clinic because they have burned through their line with a cigarette, the cat chewed through the line and the most common – they dropped it when getting up.  After each of these interactions with the patient I would think back to the education that was provided to them.

What have we taught the patient about the medication/pump to help them get through even the worse situation?  What do they know about that cytotoxic drug that is dripping on the floor now?  Do they know what they need to do to keep themselves and their family safe?  Do they know who to call?

InfuSystem provides patient education regarding the pump and has a customer service hotline open 24/7 to assist patients.  The customer service line is staffed by Oncology Certified Nurses to help the patient problem-solve most issues.  This is very helpful not only for the companies/institutions that use InfuSystem, but also for the patient who has a line leaking at 2am.

Information about the medication and side effects is also important.  There are many places out there for the patients and us, as healthcare workers, to get the information.  At Karmanos Cancer Center in Detroit (where I work) we use www.chemocare.com as our source of educational literature for patients.  This is a website provided by Cleveland Clinic Cancer Center funded in part by the Scott Hamilton CARES initiative.  Cleveland Clinic Cancer Center monitors the website and updates the information after FDA changes have been reported.

It’s so nice to be able to go to one place to get all of my educational needs met.  I know the website is updated and the information is at a reading level appropriate for most patients.  Not only do the sheets talk about what the drug is, how it is given and side effects, it also talks about self-care.  The self-care tips are a great resource for the patient that has very little medical background and can’t remember everything the nurse told them when they were in the clinic.

I will tell one brief story about the importance of patient education.  I had co-worker whose husband’s cancer relapsed and he needed a bone marrow transplant.  Now, this nurse and I worked together for many years in the infusion center.  She knew cancer and chemotherapy, but transplant was a little different.  Not to mention that she was scared to death that she was going to lose her best friend.  Often the staff didn’t teach her all the things about the treatments because she was an “oncology nurse.”  My friend was very scared and when it came to taking care of her husband and his post transplant issues she was often lost and would call for help.  She knew about cancer, she knew about chemotherapy and she knew about side effect management.  But she was unsure of how to take that knowledge and apply it to a transplant patient and even more so the man that she loved.  It was a struggle for her until the nurses stopped treating her like a nurse and started treating her like a wife and caregiver.

That story helps me remind people that when it is us or someone we love it really doesn’t matter how much we know or how much we do it every single day.  We still need to educate.  Think of you or your family member in that chair/bed the next time you are hooking someone up to chemotherapy and think, “What would I want to know?”.  Give the patients every educational tool you have available and help them learn about how to work with their treatment.

Remember, we are sending equipment home with people who most likely have no prior medical background.  This is a very scary time for them.  Continue to educate your patients and reinforce that education every time they come in.

About the Author:

Clara Beaver is a Clinical Nurse Specialist at Barbara Ann Karmanos Cancer Center in Detroit, MI and has been in the Nursing field for more than 15 years.  Clara is an Oncology Certified Nurse and has held a variety of positions from Staff Nurse, Infusion Nurse, Homecare Nurse, Camp Nurse and Nurisng Faculty.  Clara serves on the Customer Advisory Board for InfuSystem.

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Drug Shortages and How You Can Help

On August 26th USA Today published an article titled “Cancer drug shortages getting worse”. Various explanations were offered for the causes leading to and perpetuating injectable drug shortages. Authorities from the FDA to ASCO to ASHP to ACS sounded off with everything from evidence of verifiable delivery issues to alleged price gouging, depending on who was being quoted and who was doing the quoting.

The facts:

1) The main contributors to drug shortages fall into three categories: regulatory issues, source and manufacturing factors, and distribution problems (FDA)

 2) Most hard-to-find medications are liquid, injectable drugs that need to be kept sterile (FDA)

 3) Drug shortages are directly linked to adverse patient outcomes (ISMP)

 4) The shortage list continues to grow: http://www.fda.gov/Drugs/DrugSafety/DrugShortages/

[my story] A family member recently diagnosed with carcinoma of unknown primary was provided with limited chemotherapy options. The first regimen chosen failed to impact her markers although it did negatively impact her liver function. The second regimen was working well until Cisplatin came up on the shortage list. She was devastated. She asked how a company can just take away someone’s hope for survival by stopping the manufacturing of a drug.

 The FDA has been lauded for its vigilance and condemned for its contributions to the overall shortage situation. They do require drug manufacturers to notify them if a drug is on the chopping block, yet there are limits to this requirement that fail to create the safety net of original intent. Currently, the manufacturer is only required to notify the FDA if: 1) the company is the sole manufacturer of the drug and 2) the drug is “life-supporting,” “life-sustaining,” or “intended for use in the prevention of a debilitating disease or condition.” By definition, this does not include cancer treatment agents. More so, the FDA cannot penalize a manufacturer for failure to notify the FDA of a drug discontinuation or a temporary manufacturing suspension. The FDA cannot require a manufacturer to produce a product. Once off patent, some drugs cost more to make than they benefit the manufacturer in revenue, especially with documented quality issues of late.

The September 1, 2011, ASCO POST, Volume 2, Issue 13, details the impact of the shortage on the healthcare professional who must make the decision of who to treat with what drugs are available during this unprecedented shortage. A simple solution to this complicated problem is put forth in “Fixing the Drug Shortage: It’s About Time”. D. Raghavan, MD, PhD, states “legislation can fix this problem”.

Senate Bill S. 296, the Preserving Access to Life-Saving Medications Act, was introduced in February 2011 as a proposed solution to this dilemma which is quickly reaching crisis status. The bill would improve the capacity of the FDA to monitor potential drug shortages and theoretically circumvent negative patient outcomes. This bill has been referred to the Senate Health, Education, Labor, and Pensions committee. There are 22 members on this committee. Is your state senator one of them? Is your senator the sponsor or one of the 11 co-sponsors? For more info on S.296 go to THOMAS www.thomas.loc.gov.

Introduction of the bill is only the start. If you are a patient, caretaker, or healthcare professional and have a story, tell it to your legislator [your story]. Support your legislator’s efforts to fix the drug shortage.

For further analysis of the drug shortage situation see:

1) Fact Sheet on Cancer Drug Shortages, ACS Cancer Action Network: http://www.acscan.org/content/wp-content/uploads/2011/08/Cancer-Drug-Shortages-Fact-Sheet_FINAL.pdf

2) Drug Shortages: National Survey Reveals High Level of Frustration, Low Level of Safety, ISMP Medication Safety Alert, September 23, 2010.

To sign up for drug shortage notifications and updates: http://www.fda.gov/drugs/drugsafety/drugshortages/default.htm

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A trip to Chicago- NCCN Congress series

NCCN provided a GI clinical practice update on Monday, October 10, in the windy city. The 2011 Congress Series:  Gastorintestinal Cancers, was well attended at Memorial-Northwestern.  The impressive faculty hailed from MD Anderson, Northwestern, Memorial Sloan-Kettering, Fox Chase, Duke and UCSF.  Current management strategies for colorectal cancer, hepatocellular carcinoma, pancreatic cancer, and gastric/esophageal cancers were presented. 

The most significant presentation of the day, was the report by Dr. John Skibber, University of Texas MD Anderson Cancer Center, presenting outcomes data from the NCCN Colorectal Cancer Outcomes Database.   Data on stage and age distribution at time of diagnosis is more readily collected than patterns of care data.  Concordance with guidelines was particularly scrutinized as the oncology community is under increased pressure to justify those patterns to the government and third-party payers.  Questions such as why a greater number of practitioners acknowledge adjuvant therapy as the standard of care for Stage II CRC, than the number of those who prescribe adjuvant therapy for their CRC patients, was examined.  Outcome analysis is still in the early stages, but ability to analyze patterns of care will provide the oncology community with the evidence to positively impact the quality of cancer care across the disease spectrum and national landscape. 

Later that day, I was walking down Michigan Avenue, when I passed the Apple Store.  The plate glass windows, now a 20 foot memorial to Steve Jobs, made me reflect on the conference discussions on pancreatic cancer treatment.    

Margaret Tempro, MD, former ASCO president and chair, spoke of, what she called:  “The Emperor of all Epithelial Malignancies”, or pancreatic cancer.  Progress in the treatment of this disease has been very slow.  In this most aggressive cancer, where the cure rate is 4-5%, Dr. Tempro spoke to the “optimal infusion” of 5FU.  Little in literature evidences a better drug treatment combination that continuous infusion 5FU and leucovorin.  As a second line treatment for patients with pancreatic carcinoma, 5FU, leucovorin and oxaliplatin improves survival compared to 5FU and leucovorin alone.  Newest research concludes that we are achieving slow but steady progress  in the treatment of this disease, gradually moving away from gemcitabine monotherapy, and beginning to address non-gemcitabine front line regimens. NCCN provides annual practice update, free practice guidelines, chemotherapy order templates, and guidelines for patients. 

More info on NCCN and upcoming conferences can be found at:  www.NCCN.org   If you know of any educational events, that would be of particular interest to the infusional chemotherapy community, that are presented at no cost, please post those opportunities here for us to share.

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No Time Like the Holidays for Thanks and Giving

November is the month for thanks and December is the month for giving. We all agree that it is far better to give than receive.  No one would refute the fact that one would rather be on the giving end of healthcare than be on the receiving end.  I am thankful to be a healthcare provider. 

As an oncology healthcare provider – I am especially thankful that in November 2011, the CDC released two resources to help us improve patient safety and quality of care for cancer patients.   The “Prevention Plan for Outpatient Oncology Settings”, accessible via the CDC website http://www.cdc.gov/hicpac/basic-infection-control-prevention-plan-2011/,  can provide the outpatient center with basic guidelines for developing policies and procedures to best manage infection control in the oncology setting.  Also available is an interactive tool for cancer patients and their caregivers..  The podcast:  “Prevent Infections During Chemotherapy” is especially useful for patients receiving chemo in outpatient settings.  This video walks the patient through steps they can take to prevent infections during cancer treatment.  All of this can be found at:  www.cdc.gov/cancer/preventinfections

Do  you use a tablet or iPad to assist with patient education?    If so, be sure to bookmark the CDC website for your patient to review during that all important chair time.   

During the month of December, when we are all focusing on giving, be sure to check out the article on “Improving the Safety of Chemotherapy Administration” in the ONS Connect, December 2011 issue http://www.onsconnect.org/wp-content/issues/2011/12.pdf Demonstration of a failure mode and effects analysis (FMEA) to improve infusion safety in practice is discussed in this ONS Connect article.  The discussion, based on the November 2011 issue of the Oncology Nursing Forum article, “Improving the safety of chemotherapy administration: An oncology nurse-led failure mode and effects analysis” (Ashley et.al, 2011) outlines the use of FMEA to improve safety of chemotherapy administration.  The study identified numerous high-priority failure modes requiring remedial strategies.  Two identified opportunities for error, specific to infusion pumps, were:   1) Incorrectly programmed infusion pumps and 2) infusion pump stops during infusion and is not immediately noted and restarted. 

Mitigation strategies were identified during the FMEA process.  More important than specific resolutions, was the overall reported outcome of analysis activities that elevated the healthcare provider’s awareness of patient safety threats and raised their confidence to effectively manage those threats. 

This December, as you focus on giving, focus on giving safe care and include FMEA, as recommended by the Institute for Safe Medication Practices, into your policy and practice process improvement strategies. 

For more information on FMEA see: 

Becze, E. (2011) Five-Minute In-Services, Oncology Nursing Forum Article Recap:  Improving the Safety of Chemotherapy Administration, ONS Connect, December 2011, pp 16-172) 

Institute for Safe Medication Practice, Failure Mode Effects Analysis, A Tool To Help Guide Error Prevention, accessed 12/2011, http://www.ismp.org/tools/FMEA.asp3

Ashley, L. et al (2011).  Improving the safety of chemotherapy administration: An oncology nurse-led failure mode and effects analysis.  Oncology Nursing Forum, 38, E436-E44.

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InfuSystem puts the E in WAVE

You can save lives and prevent injuries to millions of Americans.  Just do the WAVE.

As a partner in the Department of Health and Human Services (HHS), Partnership for Patients, InfuSystem shares in the effort to make healthcare safer, more reliable, and
less costly.  HHS encourages us to do the WAVE against healthcare-associated infections.

W – Wash Hands, to protect against germs

A – Ask Questions, to improve the quality of care

V – Vaccinate, against flu and pneumonia

E- Ensure Safety, by making sure medical devices are clean and used properly

InfuSystem has a unique opportunity to impact the E, in WAVE.
InfuSystem maintains strict adherence to infusion pump testing criteria
to verify pump accuracy. Comprehensive pump cleaning procedures ensure our
patient that the equipment provided is disinfected as outlined by CDC and
manufacturer guidelines.

The Partnership for Patients brings together leaders of major
hospitals, employers, physicians, nurses, healthcare providers, and patient
advocates along with state and federal governments in a shared effort to make patient
care safer, more reliable, and less costly.

Two goals of this new partnership are:  •Keeping patients from getting injured or sicker through prevention of harm achieved by education and standard of care compliance. •Helping patients heal without complication through continuity of care transition
from one setting to another (i.e. InfuSystem Clinical Support)

HHS projects that through this partner collaboration, achieving these goals will
save lives and prevent injuries to millions of Americans, and “has the
potential to save up to $35 billion dollars across the health care system, over
the next three years.  Over the next ten years, it could reduce costs to
Medicare by about $50 billion and result in billions more in Medicaid savings”.
As partners, InfuSystem takes great pride in our contribution to put our nation on the path toward a more sustainable health care system.

For more information about the Partnership for Patients and doing the WAVE, go to: http://www.healthcare.gov/compare/partnership-for-patients/index.html

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Colorectal Cancer Awareness – There’s an App for that

March is Colorectal Cancer Awareness Month. Colorectal cancer is the second most deadly cancer for both men and women. Yet according to the Centers for Disease Control and Prevention, most of these deaths could be prevented if everyone over the age of 50 got screened for colorectal cancer. The best way to prevent colorectal cancer is to get screened. There are often no signs or symptoms of colorectal cancer. If left undiagnosed or undetected, colorectal cancer can spread throughout the body.

You’re at high risk if you have any of the following risk factors:

• A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp (a type of polyp that could become cancerous)

• A family history of familial adenomatous polyposis (this involves multiple adenomatous polyps, often in the hundreds, and carries a very high risk of colon cancer)

• A family history of hereditary nonpolyposis colorectal cancer (a type of colorectal cancer that runs in families and tends to cause cancer at a relatively young age – under 45 years)

• A personal history of adenomatous polyps

• A personal history of colorectal cancer

• A personal history of inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis

If you, like me, are over 50, then get a colonoscopy. I did.

Want to save a life? Spread the word during Colorectal Cancer Awareness Month.

There is an app for that! Go to: iTunes, your local app store or the CDC Website to download CDC’s successful eCards app. Send your friends and family the message to get screened and save a life. This application will feature popular eCards and timely updates to coincide with important health events throughout the year, including American Heart Month, Flu Season, and Great American Smokeout.

You can access the eCards also, through the following links:

• CDC: Colorectal cancer screening saves lives (http://www2c.cdc.gov/ecards/message/message.asp?cardid=117&category=230)

• CDC: I got screened. Now it’s your turn. (http://www2c.cdc.gov/ecards/message/message.asp?cardid=168&category=230

 

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Death, Spring, and Nurses Month – Are you ready?

For those of you who are regular readers of InfuBlog, you know that I have a family member who diagnosed with cancer, experienced challenges during therapy over the last 17 months, not limited to: drug shortages. We continue to deliberate the topic of drug shortages, yet …
Barb died this last week. Her three week, palliative care/hospice experience was wonderful, albeit: short. Thank you to those of you who emailed me with words of encouragement over the 17 month course of our family cancer experience.
So here is another question – When will we recognize the value of palliative care? How can we best integrate that care into the overall cancer experience?
If you have answers to these questions – please chime in.
Nurses Month:  If you are actively planning for next month – MAY – National Nurses Month, let us know what you are up to.  InfuSystem will be celebrating National Nurses Week, and Oncology Nurse Day, in New Orleans at the ONS Conference, May 3-6 . We have a special evening planned just for RNs. Reply to this blog with contact info if you want to be part of the festivities.

And remember:  Today is a gift.  That is why it is called the present!

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