Infusion errors continue to occur more frequently than they should. In fact, in 2017, the ECRI Institute, an independent nonprofit that strives to improve patient care through researching health care approaches, rated infusion errors as the number one hazard in health technology.
Sue Niemeier, RN
“Infusion pumps are ubiquitous in the hospital. Nine out of 10 patients admitted to the hospital receive an infusion. There are approximately 1.5 million adverse drugs events each year, of which 54% are related to infusion errors,” says Sue Niemeier, RN, Chief Nursing Officer, Ivenix. In 2013, she continues, the FDA issued new guidance for infusion pump manufacturers to “improve the quality of infusion pumps in order to reduce the number of recalls and adverse events associated with their use.” The most commonly reported infusion pump device problems cited by the FDA are human factors, broken components, battery failure, alarm failure, and over/under infusion. And companies are stepping up to overcome these issues.
“At Ivenix, we have designed an infusion system that helps to put the nurses’ focus on their patients, with the guiding principles to simplify every step of the process, remove unnecessary and error-prone tasks, and inform care,” says Niemeier. This system, which is awaiting FDA approval, has a pump with an integrated handle with quick release button, eight hours of battery, and bag hooks on the side to facilitate patient mobility. It features a touchscreen to eliminate buttons and possible points of confusion. “The interface was designed with the intent to be as simple and familiar as a smartphone to significantly enhance ease of use and help prevent potential misprogramming of the pump, a common source of user error that can potentially lead to patient harm,” Niemeier explains.
“From talking with nurses and observing the challenges that nurses have with current infusion technology, we discovered nurses are forced to know almost as much about the anatomy of their pumps as the anatomy of their patients,” says Niemeier. “Valuable nursing time is spent on complex set-up and programming, administration, troubleshooting, manual documentation, and unrelenting alarms that have the potential to increase errors and take clinicians away from the bedside. What we learned from these observation is that in order to help improve infusion delivery, we needed to design an infusion system with the goal of helping nurses put the focus back on their patients, making the clinician’s life easier, and, ultimately, patient care safer.”
Until this and other new infusion systems are available, Niemeier gives these tips on how nurses can help lessen or put a stop to infusion errors to keep patients safe:
When evaluating a new or current infusion pump, there are many key considerations to understand in helping to reduce errors. Ask the following questions:
- Is the user interface of the pump easily understood by nurses? Are there multiple buttons or other user interface elements that could potentially lead to an error?
- How easy is the administration set to load/unload in the pump, and is it possible to misload an administration set? A misloaded administration set has the potential to lead to free flow.
- What are the requirements for the pump to be set up to maintain accurate fluid delivery, and is this impacted by external factors (e.g. medication container height, viscous fluids, or back pressure)?
- What is the programming workflow for infusions that require multiple programming steps and may therefore be more prone to error? This includes: weight-based infusions; bolus dose infusions; secondary, or intermittent infusions; and multiple infusions given to the same patient.
- Does the pump have a drug library? If yes, does the interface automatically default to the drug library?
- What mechanisms are in place to help minimize common sources of alarms, such as air-in-line and occlusions alarms, that may disrupt or distress the patient’s environment?
- How easy is it to assess the status of a patient’s infusion without disrupting the patient, particularly during nighttime hours or when managing multiple patients who are on infusions?
- What mechanisms are in place to allow for ease of transport and/or patient ambulation?
- How easy is it to change drug libraries as a patient moves through different care areas of the hospital? Is it possible to change a drug library (or care profile) during an active infusion?
- Does the pump have the capability to communicate with the hospital’s EMR to support auto-programming and auto-documentation of infusions to reduce the number of manual steps required by nurses?
Geneve Rumohr, RN, SNC, CMSRN, CCRN works as a transplant nurse at NYU Langone Health on 34th Street in New York City. Over her years there, she has seen many miracles as well as disappointments. She got into nursing because, as she says, “I find the nursing profession extremely rewarding because I get to play a pivotal role in helping patients when they are vulnerable and assist them in getting well both physically and mentally. I’m inspired every day by the opportunity to make a positive difference in someone’s life. The expression of gratitude on a patient’s face and the overwhelming joy of family members gives me great satisfaction and is the reason why I am a nurse.”
“If you are not already, become a registered organ donor!” Rumohr stresses. “Give the gift of life and participate in increasing public awareness for organ donation.”
In celebration of Transplant Nurses Day, We interviewed Rumohr about what it’s like to work as a transplant nurse, what’s difficult, and what she loves about it. What follows is an edited version of that interview.
As a transplant nurse, what does your job entail? What do you do on a daily basis?
As a transplant nurse in a major medical center in New York City, I am an integral part of the interdisciplinary team that formulates a comprehensive plan of care for the transplant patients and their families—from admission to discharge. My role is to ensure that patients receive the best care I can provide during their hospitalization. I am a direct caregiver, patient and family advocate, and an educator who provides the patients and their families with quality and competent care. As a nurse, I demonstrate a caring, empathetic, compassionate, and respectful approach in my daily interactions with the transplant patients and their families as they embark on an incredible journey for a new lease on life.
What are the biggest challenges of your job?
While I’ve seen many miracles on 34th Street, I have also seen many patients die during my tenure as a transplant nurse—primarily because of the organ shortage, especially in New York City. This is a great challenge for a bedside nurse. It can be emotionally taxing to console patients and their families when they are not considered a candidate for transplantation or when they expire because an organ was not available in time. This is an unfortunate experience since we come to form meaningful relationships with our patients and their families. It becomes difficult and painful to witness the disappointment of patients and their families as they wait for a potential donor that may never come.
What are the greatest rewards?
It is heartwarming to hear the surgeons approach patients who have been waiting and are at the brink of death and tell them that they have an organ. To see that spark in their eyes as they celebrate a second chance at life is an amazing gratification.
What would you say to someone considering this type of nursing work?
When considering becoming a transplant nurse, you have to make a conscious effort to be emotionally invested in this specialty. You need to be able to give hope and believe in the miracle of life since the pathway to transplantation is unpredictable.
Thing about your gastrointestinal system—everything from the nourishing food we take in for fuel to the waste that comes out passes through all the different parts. While you learn about all the GI anatomy in nursing school, there’s so much more that a nurse who specializes in this tract of the field needs to know. We interviewed Barbara Vodopest, RN, who works in the GI Lab at North Kansas City Hospital (NKCH) to get more information on what a GI nurse does.
In celebration of GI Nurses and Associates Week, she took time from her schedule to answer our questions. What follows is an edited version of the interview.
As an GI nurse, what does your job entail? What do you do on a daily basis?
I am involved in preparing patients for their GI procedures. This includes educating patients and their families about what to expect. I also work with them on intake forms, consent, vital assessments, and starting IVs as needed.
The majority of procedures we support on a daily basis are colonoscopies and EGDs (Esophagogastroduodenoscopies). However, we also perform a variety of sub-specialty procedures, including esophageal manometries, 24 and 72 pH catheter insertions, pill camera studies, CORTRAK feeding tube placements, ERCP (Endoscopic retrograde cholangiopancreatography) procedures, and fecal microbiota transplantations (FMT).
We believe an important component of our job is education. On the second Wednesday of every month, we spend time at the NKCH Wellness Corner located inside the North Kansas City YMCA. We are there to answer questions from members of the community related to GI conditions and procedures. We also spend time at community health fairs providing education on some of the most common GI-related issues, such as reflux and hemorrhoids.
Why did you choose this field of nursing?
After 30 years as a critical care nurse working with heart patients, I was ready for a change. I was drawn to GI by the variety of experiences you can have on a daily basis. I get to work with inpatients, outpatients, ICU cases, OR cases, and ER cases. I still get to use my critical care skills every day.
What changes, if any, have occurred lately (last year or so) in being a GI nurse?
Seeing the FMTs has been amazing! Even though it may not seem like something directly related to nursing, the nurses have a lot to do with the education as well as everything involved with the procedure.
What are the biggest challenges of your job?
One of the biggest challenges is providing comfort to family members during a time that may be difficult. It’s an important part of our job, but it can be emotionally draining.
What are the greatest rewards?
One of the greatest rewards is getting to share good news with a patient. If a patient with a history of polyps or cancer gets the “all clear” after a check-up, they want to climb a mountain and shout with joy. You can’t help but feel good being a part of that.
Also, working with the team of nurses I get to work with on a daily basis is very rewarding. Many of us have similar backgrounds and similar workflows. It just feels good to come to work every day.
What would you say to someone considering this type of nursing work?
Med/surg nursing is what I would recommend for anyone in their first year of nursing. It will give you a solid foundation from which to build, and it will help you develop time-management skills, which are essential. After that, I’d recommend a critical care area before moving into GI. In fact, my daughter is also a nurse, and this is the advice I have given to her.
Is there anything else about being a GI nurse that is important for people to know?
We play an important role in setting expectations for patients before a procedure. Whether it’s a prep call in the days leading up to a procedure or the conversation we have the morning of a procedure, letting patients know how to prepare and what to expect decreases their anxiety and increases their likelihood of a successful procedure.
In celebration of Certified Nurses Day, we asked certified nurses why they chose to earn extra skills in particular areas of nursing and what their favorite parts are of being a nurse. We heard from quite a number. Thanks to all for your responses!
“I’m certified in adult critical care. I always saw certified nurses as those who’ve gone above and beyond in their profession to distinguish themselves among other cohorts as those who are driven, have the utmost competence in their skillset, and are knowledge seekers, and that is what I wanted to be.
I love the diversity in the patient population. I work with anyone from the age of 17 and beyond. I describe the value of certification to my coworkers as a distinguished honor; it’s something one works very hard to achieve, and while the journey may not be easy, it’s worth it. I tell my patients who ask what a CCRN is that it’s certification which shows individuals I am more than competent and capable to provide the best evidence-based care possible.”
—CPT Laura Wyatt RN, BSN, CCRN, a clinical staff nurse in the United States Army currently working at Tripler Army Medical Center in Honolulu, Hawaii
“I’m certified in Critical Care, Progressive Care, Nursing Education, Healthcare Simulation. I enjoy working in critical care because I find it rewarding to see patients make rapid improvements in response to my interventions. I appreciate the autonomy that this area provides, and I enjoy the low nurse-patient ratio because it provides me with opportunities to provide holistic nursing care and make deep personal connections with each of my patients and families.”
—Jodi Berndt PhD, RN, CCRN, PCCN, CNE, CHSE, College of Saint Benedict/Saint John’s University and St. Cloud Hospital in St. Cloud, Minnesota
“My first certification was the Pediatric CCRN, and I took the exam almost as soon as I had enough hours to qualify because I was so excited at the opportunity to become certified. Once I entered the role of unit-based educator in the Pediatric ICU and had enough hours in nursing professional development, I also became certified in Nursing Professional Development. After completing my MSN, I became certified as a Family Nurse Practitioner. Now that I primarily do research, writing, and teaching, my CCRN has been modified to a CCRN-K, a relatively new credential for nursing professionals who influence the care delivered to acutely/critically ill patients. In this role, I no longer have enough direct patient care hours to qualify for the original CCRN, and I was beyond ecstatic when I learned that AACN offered an option for nurse managers, educators, and those researching or teaching with the same patient population.”
—Alvin D. Jeffery, PhD, RN-BC, CCRN-K, FNP-BC, Post-Doctoral Medical Informatics Fellow (U.S. Department of Veterans Affairs, Nashville, TN) & Education Consultant (Cincinnati Children’s Hospital Medical Center, Cincinnati, OH)
“I wanted to get a certification in nephrology to show my dedication to it. My mom was a dialysis nurse, so I’ve been around it since I was born. I picked nephrology because of the opportunity to take care of patients and their families in a different way than any other outpatient or inpatient fields.
You have to have hard conversations in nephrology, at times, and I love being part of that process as a patient advocate. I also love helping patients during difficult times and making them smile.”
—Kristin Brickel, RN, MSN, MHA, CNN, Director of Clinical Services at DaVita Kidney Care
“I currently have two certifications in infusion therapy: Certified Registered Nurse Infusion (CRNI) and Vascular Access Board Certification (VA-BC). I have spent most of my nursing career specializing in infusion therapy and the sub-specialty of vascular access. I initially was interested in certification purely for the educational opportunity, studying for my certification taught me a broad base of clinical knowledge.
I find infusion therapy to be extremely rewarding. It offers a near perfect mix of technical procedural excellence, while retaining the individual patient care that I value. Outpatient infusion therapy allows you to create a unique personal 1:1 connection with patients. Some of my best memories as an infusion nurse are the conversations I’ve had with these inspiring patients. In my role today, I get to apply my experience connecting with patients to my passion for improving care through research, education, and product design innovation that can help enable continued progress in care quality.”
—Kristopher Hunter BSN, RN, CRNI, VA-BC, Senior Technical Service Engineer, 3M Critical & Chronic Care Solutions Division
“I am a certified oncology nurse. I got certified because I wanted to be able to offer my patients the best care possible by staying on top of the rapidly changing knowledge base in cancer care and research. I find that being certified gives you a wider base of resources and opportunities to network with other oncology professionals.”
—Alene Nitzky, PhD, RN, OCN, CEO & Founder, Cancer Harbors and Author, Navigating the C: A Nurse Charts the Course for Cancer Survivorship Care
“I am now certified in hospice and palliative nursing. I knew the certification would enhance my professional skills. Earning the CPHN also gave me time to learn more about how hospice and palliative care has come to be seen globally, which is especially important because the patient population at MJHS Hospice and Palliative Care is as diverse as you’d imagine. I also appreciated the opportunity to better learn the ins and outs of the operations, insurance, and reimbursement processes.
I love my patients and my work. Contrary to what people think, being a hospice nurse isn’t depressing. Yes, it’s challenging and it’s hard to look into the face of a family member whose loved one is dying. However, it’s so rewarding to provide holistic care, help educate patients and families about what happens at the end of life, as well as to support people during a time when they really need it.”
—Neema Bandyopadhyay, RN, CHPN, RN Case Manager, MJHS Hospice and Palliative Care in New York City
“When I began my nursing career, I worked in OR and met the Chief of Surgical Oncology at Duke University. I transitioned to work on his surgical oncology team and felt that the additional Oncology Nurse Certification added credibility to my career. It also enabled me to move through administration into progressively more responsible positions, including Vice President.
As an OCN, I feel that effective national education in the U.S. is required to resolve the most difficult medical cases. Adult Oncology is a rewarding nursing genre. Patients need support in all aspects—mind, body, and spirit—in order to maximize benefit from their treatment regimens. Families also need support during this time which includes both medical education and emotional support.”
—Gail Trauco, RN, BSN-OCN, CEO, The PharmaKon LLC and CEO, Front Porch Therapy
Besides making sure that patients have everything they need to heal, nurses also have to ensure that their patients are safe. Sharon Roth Maguire, MS, RN, GNP-BC, Chief Clinical Quality Officer at BrightStar Care, has an extensive health care background with more than 15 years of experience in the health care field. Maguire works closely with nurses—in addition to having worked as one herself—and she knows how important patient safety is.
Maguire agreed to answer our questions on patient safety in honor of Patient Safety Awareness Week. What follows is an edited version of our interview.
What are some of the most important tips that nurses need to know regarding patient safety?
Nurses are uniquely poised to think of patient safety in a very broad way—emotionally, physically, socially, and environmentally—while simultaneously narrowing it down to the specific care situation. We need to think of our patients comprehensively, especially within in the home. We at BrightStar Care follow the national patient safety goals of the Joint Commission as accredited home care agencies.
Home safety evaluations are essential. What within their home environment could put the client at risk for falling? We need to evaluate adequate lighting, plumbing, furniture that is hazardous as a way of support, throw rugs, etc. Clients who are on oxygen in the home are at a significant risk for potential fire outbreaks. It’s important that the nurse educate clients and their family members on oxygen safety in the home.
Medication safety is a Joint Commission national patient safety goal. BrightStar Care nurses collect information about what medications clients are taking (prescribed and over-the-counter as well as home remedies) and are aware of potential hazards of the actual medication as well as how it interacts with other medications, diet, alcohol, etc. We advise clients and their family care partners about the risks we’ve identified. These interventions are critical to safe medication practices in the home setting.
What should nurses do if they make a mistake that results in possible patient harm/injury?
Nurses are skilled at following policies, process, and procedures, but despite their best efforts, a mistake can be made occasionally. Nurses are taught and held to a standard of high integrity including the importance of reporting any sort of mistake. The worst thing to do would be to hide a mistake. The quicker the mistake is reported and acted on, the quicker the potential negative outcome can be reduced.
What are the most common tips that new nurses should know so that they can keep their patients safe? What about keeping themselves safe?
When in doubt, ask questions. Even though nurses may have gone to school for many years, they might have never had the chance to practice a particular skill. Never hesitate to ask for help. If you’re unsure, don’t think you know something—instead just ask a more experienced nurse. Have a more experienced nurse mentor be your partner when you’re doing something for the first time.
Some patients tend to get scared in the hospital, rehab center, or any place they would be treated by nurses. What can nurses do to alleviate their fears?
Most patients really just want someone that they can trust and feel safe and confide in. Nurses should be reassuring and empathizing while explaining things simply to patients. It’s also important to listen to our patients and understand their concerns. Be kind and be patient.
Don’t let the schedule dictate your response. At the end of the day, your patient is your primary focus and although tasks need to be done, that shouldn’t be at the expense of your patient. Patient safety, comfort, and peace of mind are top priorities.
Is there any other important information regarding patient safety awareness that nurses should know?
Safety is so extremely important. Nurses should slow down, take time to understand what is required to be safe—whether that’s when performing a procedure, giving a medication, or reading physician orders. Safety is paramount in the world of a nurse especially in the nurse-patient relationship.