Dylan McCabe: WeInfuse podcast, episode number 31. Welcome to WeInfuse podcast. My name is Dylan McCabe. And in every episode, we give you a behind the scenes look at the infusion industry as we interview owners and operators and industry experts, so that you can get the tips, tools, and a roadmap you need to take your own infusion center or practice to the next level. And in this episode, I interview Mary Alexander. She’s the CEO of INS, the infusion nurses society. And she’s going to talk about INS how they help nurses, how they help patients. She’s also going to talk about the fundamentals of infusion therapy that they created. She’s going to get into standards of care. She’s going to get in a lot of great stuff with her seasoned background, starting as an infusion nurse and all the way up to now to being the CEO of the INS. You’re going to get a lot out of this interview, but before you do that, if you haven’t already taken a look at how WeInfuse can save you time and money with WeInfuse software, you owe it to yourself to go to WeInfuse.com. Schedule a discovery call meeting with one of our account executives. You’ll be so glad you did. You may be unaware of how easy the process can be if you have a great system in place, instead of working with a constellation of systems to manage a complicated process. All right guys, let’s jump right into this interview with Mary Alexander. As I stated, we have a special guest on the show today, Mary Alexander, CEO of the Infusion Nurses Society. So Mary, thank you for being on the show.
Mary Alexander: Thank you for having me, Dylan.
Dylan McCabe: Yes, I’m looking forward to it because you’ve got a seasoned background in infusion and you guys are doing some really neat things to help infusion nurses to raise minimum standards, to do all kinds of equipping for the industry in general. But before we jump into all of that, give our listeners a background on your journey in infusion and what you do with INS.
Mary Alexander: Sure. Happy to do that. I am a registered nurse by background and prior to joining INS, for a better part of my clinical practice, I was an infusion nurse and I worked both in the hospital setting as well as home care. And in 1997 became the CEO of the Infusion Nurses Society, which is our membership organization. And I’m also the CEO of the Infusion Nurses Certification Corporation, which is our sister organization that administers our certification program. And I’m also Editor of the Journal of Infusion Nursing.
Dylan McCabe: Okay. So you’re what I would call an industry expert. No doubt about that. Well, it’s really neat. I love it when somebody like you decides, you know what, I want to help other people and I want people to receive the equipping that they need to do an excellent job. And so let’s talk a little bit about INS for people that are listening to this that may not know a lot about it. What is INS and what does INS do for nurses? How does it impact patients as well?
Mary Alexander: Sure, happy to. INS was founded in 1973. So we’ve been around for quite a while and really, our main focus and vision is to make sure that we’re providing excellence in infusion care for our patients. And in order to do that, we want to make sure that we equip our members and our members, mainly nurses. However, we don’t do it exclusively for nurses, but anybody who’s involved in infusion care, to make sure that we provide them with the resources and education, that they need to be able to provide safe quality patient care. So of course the patient is at the center of what we do and we want to make sure that we’re providing safe care, but we’re also aware of the safety issues for our nurses as well. So we want all patient safety as well as clinician safety. So, INS does that in various ways. We have, through our mission, we look at providing education programs, advancing the science of infusion nursing through evidence-based practice and research. We promote certification and the other thing that we do is develop and disseminate our standards of practice. So people see for INS, we have our tagline is setting the standards for infusion care, which we go by. But a little bit more about INS in that, our members, they come from all practice settings and we have about a 50-50 split, with our members working in the hospital and acute care center. And then the other side of that are those that work in-home care and alternative sites. That’s where our ambulatory infusion center members would be. Our nurses take care of all patient populations. We’d go from cradle to grave. So we take care of neonates all the way up to our elderly patients and all these practice settings.
Dylan McCabe: And so help me understand the big problem, if I understand it correctly, that INS solves, Is that if you go to nursing school like I have a niece, she just finished nursing school in Houston, Texas, and she’s been, helping take care of COVID-19 patients, she’s just hit the ground running and loves it, but let’s say she wanted to change and become an infusion nurse. With the knowledge, if I understand it correctly, the training that she got in nursing school was great, but if she really wants to become specialized as an infusion nurse and excel in that area, it’s my understanding that INS bridges that knowledge gap in a way, and brings in a lot more equipping and insight and education and resources. Is that correct?
Mary Alexander: Yes. We do see that there is a gap in the knowledge there and congratulations to your niece too. She’s our future, and we have, a product called fundamentals of infusion therapy. We call it our kick program, and it is ideal for students as well as nurses that need refreshers on how to incorporate the foundations for safe infusion practice. It’s audio and video, it’s self-paced learning, and people have found it very helpful to learn the basic skills for placing catheters and other infusion devices. I don’t think everybody always recognizes the risk that’s associated with infusion therapy, especially where it’s an invasive procedure. Some folks think, oh, it’s just an IV. But, our patients can have simple complications or they could have life-threatening complications if the procedure is not done properly.
Dylan McCabe: And so you guys have… So it sounds like it’s a lot of online training or there’s work in-person workshops or events that the nurses attend as well?
Mary Alexander: We have some programs at our annual meeting when we work face to face. Oftentimes individuals get their training when they are within an institution that they’re working in. The simulation training is very helpful. It still doesn’t beat the actual experience when you’re providing care to patients at the bedside or chairside in the case of our ambulatory infusion nurses.
Dylan McCabe: And so, as it relates to nurses, you guys are doing a lot of equipping. You’re helping nurses to sharpen their skills. How does it affect the patient? Because I am thinking if I am a patient and I’m getting… If somebody is going to stick something in my arm, I want to make sure that they know what they’re doing. And I also want to make sure that they know how to respond if I have an adverse reaction to the treatment. So how have you seen this help the patient population as well?
Mary Alexander: Well, certainly from our standards practice, and practicing according to standards, which are an evidence-based document. It gives individuals the tools that they need in order to provide safe practice. Why are you doing certain procedures a certain way? It gives you the rationale for that and the evidence to support that. So you want somebody who is skilled, who knows what to do, how to assess. Are they putting in the correct catheter for the treatment the patient needs? Are they able to access a port? For example, if they have an existing catheter in place, to your other point it’s also extremely important that the nurses are competent knowing what they’re giving the patient. What is going through those particular catheters, or vascular access devices, and be able to respond, should the patient develop a complication. So, there’s a lot of areas and things that the nurses need to be aware of when they are taking care of somebody who needs infusion therapy, to make sure that the patient is safe and that they’re getting the treatment as it was prescribed for them, over the time it was prescribed and they’re not developing any complications. Because oftentimes you’ll see, ambulatory infusion patients, they oftentimes have chronic problems. So those nurses that want to see those patients for a long, long time, develop great relationships with them. So, they are really key to the patient’s wellbeing, I think, [inaudible] patient outcomes.
Dylan McCabe: Well, it’s just so critical. Obviously, in every field, you’re hoping that you’re dealing with people that are striving to be experts in their field, whether it’s somebody handling your financial affairs or whatever it might be. But in the medical context, I think a lot of people just assume, well, this is a doctor or this is a nurse. So they know everything they need to know. And it’s just not the case, not all nurses are created equal. Not all physicians are created equal. And a lot of times there’s just varying degrees of knowledge and skill with each individual. And I think it’s critical that what you guys are doing is so critical because nurses need the equipping, they need the resources, they need the connection with that community to run at an elite level to make sure that patients’ lives are saved. And I saw a post on LinkedIn a few weeks ago of the owner of an infusion center. And they talked about how it was an ambulatory infusion center. The patient was receiving an infusion. I can’t remember which drug they were getting, but they had an adverse reaction and things went from bad to worse real quick. But because of the training in place, the practices, the guidelines that you guys publish, and also just internal rehearsing of what happens when a patient is starting to go downhill quick, they were able to… The patient actually died. They resuscitated the patient and the way they shared it was, a wife got her husband back and a daughter got her dad back that day. And it’s just an awesome story that shows how critical it is that we all do everything we can to stay on top, to have an elite level of knowledge and skill, and whatever our task is in this world. So I just love what you guys are doing.
Mary Alexander: Yes, healthcare right now is very complex. Our patients are very complex as well, and there’s a lot of technology out there. So when we train, we’re marrying the technology with patient care, so we have a lot of things that help support what we do. But to your point, you really need to know how to do it properly. You need to be competent and you need to make sure that you have the ongoing competency. So practicing, as you say, different scenarios and being able to address an emergency situation that’s critical.
Dylan McCabe: Well, let’s segue into what you guys created. Then the infusion therapy standards of practice. You mentioned that it’s something that you revise about every five years or so, and you guys have done a major update since 2016. So let’s talk about that.
Mary Alexander: Sure, thanks. Yes, INS is committed to revising our standards of practice every five years. Our eighth edition now will be coming out in January of 2021. We began the work back in September of 2018. We’ve always had a global approach to the standards. But we get really focused on it this year in that we have members from outside the US on the standards of practice committee to give us input there. We also expanded our reviewer pool to include individuals outside the US too. So we had folks from 15 countries plus the US give us their feedback. And the standards practice committee right now is reviewing all the public comments for the document. Many folks, folks that are familiar with the standards, know the framework will not change.
Mary Alexander: We will have the standard statement, which is really a declarative statement that is really explained to be the framework for your safe practice. After that, we provide what we’re going to be calling in our new standards, practice recommendations, and that gives the clinician more guidance as to how they’re going to meet that standard. And what we’ve done since the 2011 version is we have ranked those statements based on the strength of the body of evidence that’s in place at the time that the standard is written. So you’re looking at statements that are supported by evidence and research at different levels of the strength of the evidence. From a ranking of a one, which would be the randomized control trials and then the analysis to a five, where it’s not as strong, maybe expert opinion, case studies, and those kinds of things. What we are finding, which is really very exciting, is the level of the evidence is increasing over time. And that’s showing the amount of research that’s being done in the infusion space. And that’s really going to makes an impact on what we do and an impact on patient care. Want to give you one example; in 2016 our vascular access device planning standard had 28 references to support what we were saying in the standard. This current version in 2021 has 114 references. So in a five year period, you see how the science has advanced over time. So that’s very exciting from an infusion therapy standpoint. And I do want to add that, for those individuals that are members as of December 31, 2020, every member will get a free copy of the standards of practice. And that will be in addition to their journal, that comes out at the beginning of the year.
Dylan McCabe: That’s great. And so for people that are not familiar with clinical research pertaining to infusion therapy and patients. What kind of research do you pull from the put together something- which I think is a huge undertaking-standards of practice?
Mary Alexander: Well, we have 66 different standards that will be in this current version. So what this committee does is a massive literature review to see what is out there. So they are looking at all the documents and research that’s been published. And we try, we really look at the most recent research available. So you’re looking at whatever the standard is and looking at the research that aligns with it, to support what it is we have to say. We’ve changed things over time. We got these started back in 1980 and you have to start somewhere. So now people are challenging some of the statements. So you want to make sure that what we’re saying now can be supported by science. Bear in mind, not everything will have a randomized control trial. There are some things in healthcare that just don’t lend themselves to that, especially when you would be looking at involving patients in the science. So you do rely upon expert opinion as well. So, that’s the big piece of what a standards committee does. So what it ends up doing is either supporting the statements and practice that we are doing right now or helping us change practice, based on this available evidence and research.
Dylan McCabe: That is so good. Well, I applaud you for leading that charge because there are so many people directly impacted by that, nurses, and patients that are directed by that. And they don’t, especially on the patient side, they don’t even know it. They don’t know that there’s somebody like Mary Alexander and the infusion nurses society, pushing forth the standards of practice and all of this expert insight combing through teams, combing through medical journals, distilling all the research. It’s an amazing thing you guys are doing. And so another thing you’ve done, not only the standards of practice, but you’ve created policies and procedures for ambulatory infusion centers. So let’s talk about that.
Mary Alexander: Sure. Along to help support the standards they’re are very broad statements, the policies and procedures actualize and operationalize all of this care that we do. And we have our basic policies and procedures, but knowing that ambulatory infusion centers, that’s a unique place, and they have unique experiences there. So we do have a P and P just specially for ambulatory infusion centers. So, we’re very pleased to be able to have that available for our nurses and clinicians, as well in those practice settings, recognizing that you don’t have everything as the same in the hospital versus the ambulatory infusion center.
Dylan McCabe: That’s so good. And so it sounds like you guys really are a hub. You have a lot going on and the resources you produce, but for an infusion nurse, INS is a hub to get an education, get equipping, get these resources that are excellent resources for their trade. Are there any other resources that INS produces, that I’m clearly not aware of because you’re sharing a lot of great stuff with me?
Mary Alexander: Yes. We are now a learning center on the INS website. We have webinars, podcasts on demand, education programs as well. But we also just produced a point of care reference cards, that it’s a clinical tool that helps align the standards and the policies and procedures for about 20 different procedures. And what’s useful right now for this resource is the fact that they are laminated and they can be easily cleaned, especially during this COVID time. So the areas that we’re covering are VAD planning and management, complication management, and some procedures. So the clinician can just take the card right to the bedside or chairside in this case, to help them with practice. It aligns with the standards and the policies and procedures. So we have that. We also have our annual meeting much like every other organization. We have to pivot as well to a virtual event. We won’t be face to face like we typically are, but we will have our virtual events in September. It’ll be on four Thursdays in September. For those nurses that are certified and they have their CRNI, which is the certified registered nurse infusion. They’ll be able to get their recertification units through this program. And I just want to point out it will be for those that attend. It’ll be available for three years, which is the recertification period. So, the nurses can recertify and get their recert units, at their own pace.
Dylan McCabe: That’s good stuff. And so if people want to learn more about INS and get plugged in all of these resources, how do they find it? What next steps should they take?
Mary Alexander: Well, I’d invite them to visit the INS website ins1.org and you’ll find all kinds of information there about the organization, our membership benefits, certainly our membership benefit. The number one membership benefit has been the journal of infusion nursing, which has been the number one benefit for years. I would also invite folks when they do come and become a member, to become an engaged member. We love to have engaged members. We do calls for people to join task forces, to address different issues, clinical issues. Typically they’re clinical issues that are going to impact patient care. So we invite individuals to do that and to publish in the journal. I know that there’s been lots of great work that our nurses are doing in their settings and making a huge difference in patient care. Speaking again to, as I told you, the number of references to one of our standards, that’s based on published research. So if individuals are doing that kind of work to please publish it and share it, because that’s really important to our practice. And we’re always looking to have people give us feedback. What is it that they need from us? We think we may know what it is, but that’s not always the case. So we do periodically survey our members and to see what kinds of programs, products, and services that we can provide. That’s going to make a difference in their clinical practice.
Dylan McCabe: So good. You guys are very collaborative in your approach, which is great. And I’ve been to the INS conference before, and it’s a great event. So I’m a big fan of that. And I know I didn’t give you a heads up that I’d asked you this question, but with somebody with your background in the industry, and you’re the CEO of the INS. What’s just a parting piece of advice that you would have for people listening to this because we’ve got owners, managers, and infusion nurses listening to this podcast at times. What would you hope that you would see them play out? What’s a parting piece of advice you would have for them?
Mary Alexander: I think the parting piece of advice would be to keep doing the great work that you’re doing. Everybody in this space really has the patient at the center of what they do. They all want to make sure that the patient is safe, that they’re getting the care that they need. And, I would just say, continue to keep doing that great work to make sure that our patients are safe.
Dylan McCabe: So good. Keep the patient at the forefront. Well, Mary Alexander CEO of INS, you’ve shared a lot of great insight with us, and I know that anybody listening to this is going to want to check out INS and look further, especially an infusion nurse. And like I said, I’m going to mention this to my niece, who is relatively new to the nursing world, but it has a lot of passion. And I know she’s just doing an excellent job. So I want to tell her about this as well, but Mary, thank you for joining the show today.
Mary Alexander: It was my pleasure, Dylan. Thanks for having me.
Dylan McCabe: That concludes our interview with Mary Alexander. And if you want to learn more about what they have to offer, you can go to ins1.org, that’s ins1.org to learn more about and you can tap into their membership, their learning center, their certification, their conferences, their publications. They have so many resources to equip infusion nurses and also, infusion center owners who have staff. It’s just an amazing resource. And again, if you haven’t done so already to learn how WeInfuse can save you time and money, head on over to WeInfuse.com and schedule a short discovery call with one of our account executives. You will be so glad you did. All right, guys, this is Dylan McCabe, with the WeInfuse podcast and I will catch you in the next episode.