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Here, here!!! Well said!
>>> <[EMAIL PROTECTED]> 5/19/2006 7:02 AM >>>
I agree with you, Denise.
I feel the INS document would be more respectable if they called it guidelines instead of standards, and if they labeled each recommendation with a code that reflected the amount and quality of evidence that was used to come to each conclusion, just like the CDC does.
The INS Standards don't always carry weight in court. The lack of acknowledgment in them concerning opinion vs. evidence does nothing to improve the image of nurses as being less than scientific.
Leigh Ann -----Original Message----- From: Denise Macklin <[EMAIL PROTECTED]> To: Dianne Sim <[EMAIL PROTECTED]>; Lynn Hadaway <[EMAIL PROTECTED]>; Marilyn Hanchett <[EMAIL PROTECTED]> Cc: [EMAIL PROTECTED] Sent: Tue, 16 May 2006 17:30:10 -0400 Subject: Re: outpt infusion reusing IV tubing 72hr
Well put Marilyn. I agree with the statement that nurses want and need guidance. We must get to the point where a recommendation is enough. This word standard causes many problems. Infusion therapy needs to develop science to support the actions we take. Just look at infiltration. The INS standard was for years heat. Then the science was done and the real answer was probably nothing or cold. I believe that there are many things we do in practice that the science would surprise us. Years ago heparin in peripheral lines was found to not impact occlusion rates. Nursing in all disciplines is in need of science. We are in a terrific position to see this as an opportunity for growth. Even recommendations can cause problems because they are developed from the past. As many of you know, the future comes fast and furiously. If we do not move forward and try new things many opportuni ties are missed. As nurses we need to stay involved in our specialty, read and stay up on new things, ask questions and use our critical thinking skills. The bottom line is important but not the only issue.
Denise Macklin
----- Original Message -----
Sent: Tuesday, May 16, 2006 4:25 PM
Subject: RE: outpt infusion reusing IV tubing 72hr
You are absolutely right that nurses are looking for guidance. What
can/should INS do to improve and meet this need?
First, as Tim emphatically pointed out, do NOT attempt to proclaim a
standard without adequate scientific support. The organization can,
however, develop a set of recommendations or even guidelines,
acknowledging the limitation of the document in terms of supporting
evidence. This is perfectly acceptable and done by other organizations
to address these types of situations. Mislabeling statements without any
scientific evidence as a "standard" is not helpful to anyone and can
even lead to misunderstanding and confusion.
Second, determine and then consistently apply a reasonable definition of
what constitutes "expert opinion."
Third, re-direct association resources allocated to the current
"standards" model. Channel a portion of those funds 1) to support
development of targeted recommendations a nd/or guideline documents and a
portion to 2) sponsoring new research in those practice issues that need
such investigation AND that have been identified by the association as a
research priority. Done over time, this would go a long way to improving
the knowledge base and generate authoritative documents that are well
grounded in science.
Well, I have other practical suggestions and could go on, but this is
enough for now . . . you get the idea. Meanwhile INS needs to decide if
it is willing to consider a new approach. Willingness to change is the
first step. I realize that for any organization, this is a difficult and
complex. But it is necessary - and increasingly urgent.
Marilyn Hanchett RN
-----Original Message-----
From: Dianne Sim [mailto:[EMAIL PROTECTED]
Sent: Tuesday, May 16, 2006 2:00 PM
To: 'Lynn Hadaway'
Cc: Marilyn Hanchett; [EMAIL PROTECTED]
Subject: RE: outpt infusion reusing IV tubing 72hr
I happen to agree with you on this one Lynn. The masses are looking for
guidance on all IV issues and the INS seems to be the logical place for
them to go. Until investments are made in both money and time to provide
us with studies to establish evidence-based practice, we have to have
position statements provided by our professional organizations , based
on a combination of "logic" and the opinion of nurses experienced in the
subject.
Take a deep breath Marilyn
Dianne Sim RN
CEO & President
IV Assist, Inc.,
2675 Appian Way
Pinole, CA 94564
Phone: (510) 222-8403
Fax: (510) 222-8277
Email: [EMAIL PROTECTED]
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-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]
On Behalf Of Lynn Hadaway
Sent: Tuesday, May 16, 2006 8:48 AM
To: Marilyn Hanchett; [EMAIL PROTECTED]; [EMAIL PROTECTED] u.edu
Subject: RE: outpt infusion reusing IV tubing 72hr
Then my question to you is - In the absence of evidence, what do we use
to guide our practice? Is this just supposed to be a vacuum while we
wait for the science to catch up? I totally understand the need for
evidence, but you know as well as I do that many, many nursing and
medical standards and guidelines are written on nothing less than the
professional opinions of experts. I am not saying that is ideal, but I
am saying that until we have evidence, this is the best that we can do.
I am very curious to know what your approach would be to any situation
when there are no studies, yet professional organizations are expected
to provide some guidance on these issues. Lynn
At 11:26 AM -0400 5/16/06, Marilyn Hanchett wrote:
>So - once again - we have a "national standard" without any evidence
>whatsoever to support it. This process, including the "lo gic" behind
>it, is an embarrassment to all of us who advocate for evidence-based
>practice.
>
>Even if you feel compelled to defend the current (or previous)
>standards documents, this is just too much. Good grief!
>
>Marilyn Hanchett RN
>
>
>-----Original Message-----
>From: [EMAIL PROTECTED]
>[mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway
>Sent: Tuesday, May 16, 2006 9:54 AM
>To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
>Subject: Re: outpt infusion reusing IV tubing 72hr
>
>This practice would be in direct conflict with the INS standards of >practice. This set would be an intermittent set, therefore it should be
>changed every 24 hours according to the INS standards of practice.
>CDC guidelines states this is an unresolved issue. There are absolutely
>no studies that have looked at the use, change interval or anything
>regarding sets used for intermittent infusion. This is the reason for
>the INS standard of changing every 24 hours. You are manipulating both
>ends of the set frequently. Based on principles of basic infection
>control and in the absence of any studies, it seems wise to follow the
>standards. One the other hand, your facility could do a study of this
>practice and publish your findings which would benefit everyone. Also,
>the INS standards apply to all settings.
>While primary and secondary sets should be changed no more frequently
>than 72 hours, INS separates the intermittent sets and this would apply
>to both inpatient and outpatient settings.
>
>One other thought is that you would need to have a foolproof method to
>make sure that the right set gets hooked back to the right patient each
>day. I can imagine lots of cross-contamination between patients if they
>were to get mixed up. With busy, understaffed units, I can easily see
>this happening. Lynn
>
>At 7:50 PM -0400 5/15/06, [EMAIL PROTECTED] wrote:
>>To reduce cost a suggestion was made to reuse the IV tubing for
>>72hours
>
>>on a patient that comes in for daily infusion. The patient would have
>>a
>
>>PICC and come for maybe daily abx's. The infusion is done the tubing
>>flushed with NS, disconnected from the PICC and a sterile cap placed
>>on
>
>>the IV tubing. It is stored in the med room and used by the same pt
>>for
>
>>3 infusions.
>>We have been discarding the tubing daily and replacing with new IV
>>tubing daily.
>>
>>Any support for or against this suggested practice. P&P is for tubing
>>change 72 hrs but that was written for inpt
>>
>>Thanks
>>
>>Pat Dobson
>
>
>--
>Lynn Hadaway, M.Ed., RNC, CRNI
>Lynn Hadaway Associates, Inc.
>126 Main Street, PO Box 10
>Milner, GA 30257
>http://www.hadawayassociates.com
>office 770-358-7861
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
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