Episode 55: How Standards Deliver Better Patient Care and Improve Our Industry with Kaitey Morgan, RN, BSN, CRNI, and Monica Parsons, RN, BSN

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Transcript: How Standards Deliver Better Patient Care and Improve Our Industry

Amanda Brummitt: We Infuse podcast, episode number 55. Welcome to the We Infuse podcast. My name is Amanda Brummett. In every episode, we give you a seat at the table as we talk to infusion center owners, operators, and experts so you can get the insight you need to run a thriving practice. In this episode, we talk with Katie Morgan and Monica Parsons of National Infusion Center Association or NICA. If you’ve been listening to our show for long, you’ve heard Katie in a past episode. Katie is the chief clinical officer and Monica is director of clinical education. They really do an amazing job of keeping patients at the forefront and remembering that they are the why behind process and procedure. All right. So we are here with Monica and Katie. Thank you both so much for taking the time to be here with us today.

Kaitey Morgan: Absolutely. Happy to be here.

Amanda Brummitt: So I would like to start by having both of you tell our guests about your background. Monica, do you want to go first? Sure.

Monica Parsons: so I started out my nursing career as an inpatient oncology nurse. I loved this setting. You really got to know your patients, build a relationship with them because they were there longer term versus more acute visits where a patient might be in for a day or two and then they go home. You may not see them again. but with this setting, you can imagine, there’s a heavy emotional burden. You develop the relationships with these patients, their families, and it’s difficult when you are transitioning to end of life care. So after doing this for a little while, I was then introduced to infusion therapy in an outpatient hospital setting, ironically with Katie. and here we were really encouraged to. grow as infusion nurses and focus on that nurse patient relationship that I crave so much. and there wasn’t as much of that emotional toll of providing that direct end of life care. Also in this role, we discovered a lack of consistency in training and care due to no policies and procedures directing. The care. So we were fortunate again to be in an environment that fostered our growth. We were allowed time to dedicate to developing these policies, procedures, training manuals, and from there, my passion really just grew to learn as much as I could about the infusion industry medication protocols. And ultimately has led me to NICA, where I again get to work with Katie and I’m really excited to have this opportunity to serve as a resource for the infusion industry and work to preserve access to that high quality, cost effective care for patients.

Amanda Brummitt: Yeah, well, we are also glad that you and Katie got the chance to work together again. Katie, can you tell us a little bit about yourself?

Kaitey Morgan: Sure. So I always knew I would be a nurse. and so did everyone else around me. I’m told when I was a toddler, I would give my baby dolls CPR. so I was going to be a nurse. I’ve been a nurse for 15 years this year, and I’ve been infusion certified for 10. like Monica, my first job out of nursing school was in inpatient oncology. And that was a really great place to start. it was really great clinical experience, but between the schedule You know, I was new, so I was on 12 hour overnight shifts, and then the emotional toll, I felt burnt out and I felt like I’m way too young to be burnt out. so I took a per diem job, a PRN job at a hospital outpatient department that treated non oncology patients for the most part. And I loved it. I was really lucky to have good leadership there. Shout out to Beth Mastretta. I miss her a lot. and I was given opportunities that I frankly didn’t deserve at the time. And that exposure, to the operational and more administrative side of care, it really allowed me to grow and develop skills outside of just clinical patient care. I remember when I first started and I went to that nurse manager, to ask a question about why we did something the way we did it. administered a medication and had to check vital signs every 15 minutes. It just seemed odd and I thought there must be a good reason. So I asked her, and she said she didn’t know. She’d just inherited that department and taken it over. It wasn’t her specialty. so she said, help me look into it. And we couldn’t find a good answer. and so then she offered Well, why don’t you look into it and you can write us a policy about it. which was terrifying to me at the time. And I said, I’ve never written a policy. I don’t know how. And she said, well, I bet you’ve read a few policies, right? Absolutely. She said, well, I bet you’ll figure it out. And she was right. I did. and I loved it. And after a few years there, I think I’d written a policy about everything. I wrote a policy about policies. It became a joke that, Katie would write a policy about it. If you weren’t careful. so, I’ll always be grateful for that experience and that little push she gave me, to step outside my comfort zone and try something I hadn’t done before. I, loved it. And then from there, I worked as a director of clinical operations for an MSL, a management service organization, that specialized in, Opening and managing infusion suites in providers offices. so I had sites from Maine to, Kalamazoo, literally, and during that time, I also served on NICA’s advisory committee and its board of directors, and then, in January of 2020, I joined the NICA team as a full time employee. Right before the pandemic

Amanda Brummitt: great timing. Yeah, so how did you two find each other again? Was it through Nika or did one of you recruit the other one?

Kaitey Morgan: I have done my best to recruit Monica to follow me wherever I work. we worked together, as, new nurses. I think I’d been a nurse for a couple of years, prior to Monica joining, but we worked together. I knew, her. Passion for nursing, for the patients, especially she’s an incredible patient advocate, and is always interested in learning more, which is, I, just, it’s a quality you can’t find in everyone. So I’ve done my best to convince her to work anywhere that I’ve been.

Monica Parsons: I love it. Love it. Very successfully.

Amanda Brummitt: So you both have pretty rich backgrounds. If you would you say that it is.

Monica Parsons: Oh, for me, it really comes down to that clinical education. How about two things, clinical education and the quality and compliance that goes along with specifically infusion nursing. you have to have that foundation. You have to have the education, the policies, the procedures, knowing how and the why we do things the way that we do, but always continuing to assess. The ways that we’re doing it and making sure that we’re doing it the safest and most up to date way.

Amanda Brummitt: Awesome. Katie.

Kaitey Morgan: it’s really just, it’s all infusion therapy. My mom is a retired nurse, and she specialized in outpatient infusion, and she and I are really close. So in high school and college, I would tag along when she went to infusion nursing conferences and I just. The specialty just fascinated me. There’s the blend of all my favorite things about nursing. there are the technical aspects of vascular access and the science of biologic medicines. I just think it’s fascinating. But then there’s also a ton of opportunity to educate and, advocate for patients and to empower them to educate and advocate for themselves. you see the same patients every few weeks or months for years and you can really establish a relationship, and you learn what these treatments mean to patients and, how they change their lives. I just, I find it to be a really, fulfilling specialty.

Amanda Brummitt: I so appreciate that both of you go back to the why and the patients, especially as we’re talking about compliance. Nobody enjoys compliance. Okay. Well, I do. It sounds like we do. Most people don’t enjoy compliance, but when you bring it back to that patient and you make it personal, then all of a sudden it does matter. So, exactly.

Kaitey Morgan: Yeah. And compliance, for compliance sake. is totally different, I think policies get a bad rap because people think of them as this way to point out what you’re doing wrong. but, I think Monica and I think similarly about them in that we both think it should be what you look to figure out how to do it right.

Amanda Brummitt: Absolutely. So, as we talk through the show today, what is one thing that you want the we infused listeners to learn from your areas of expertise?

Monica Parsons: Well, we know that the number of people suffering from chronic diseases is continuing to grow and the emergence of new biologic treatments coming to the market is also growing exponentially. So I think it’s more important than ever to increase patient access to affordable, high quality infusion care when and where they need it. They should know that if they go to infusion center one, they’re getting the same quality care as they would get at the next infusion center. They deserve the peace of mind to know that they don’t have to vet each infusion center. They can get care here and they can get it there. It will be the same. So that’s really why NICA has developed the NICA standards of excellence specifically for ambulatory infusion centers. So I am most excited to share that with everyone. and I will let Katie speak more

Amanda Brummitt: on that. And, Katie, if you’re not going to already, will you cover where people can find the standards of excellence?

Kaitey Morgan: I will, they’ll, I’ll, Cover it now, because otherwise I’ll forget. they’ll be available for purchase. I think May is the target date we’re looking at right now. they won’t be exclusive to NICA members. They’ll be available for the public to purchase. and they’ll be on the NICA website. That’s infusioncenter.org.

Amanda Brummitt: Awesome. And then what about, what do you want us to learn today from your expertise?

Kaitey Morgan: you’ll hear me say it a lot, the people at NICA say it a lot, but provider administered medications, infusions and injections really are the future of health care. these therapies are so targeted and so effective at managing diseases. that were difficult or impossible to treat otherwise with, conventional treatment modalities. the science is there and, you can talk about the clinical improvements and lab values and imaging and all of that, but the human side of it is even more compelling. I have been a nurse for 15 years. I can think of so many stories I’ve heard from and I’m sure Monica can too, that really underscore how much their lives change, their, or in some cases, these are life saving medications. the, sometimes the improvement’s really dramatic, a patient who Previously had to use a wheelchair to get around and then they get on the right treatment for their rheumatoid arthritis and now they can walk and play with their kids and grandkids, really impactful changes like that. But then sometimes the improvements we see aren’t that obvious. I’ll never forget a patient I had, she had a type of allergic asthma, and I was taking care of her back when I was still doing direct patient care, and she came in for her injection and she’d been on it for, a while so I was asking her like I always did if she felt like the treatment was working how it was working for her. and she. Teared up and her voice was shaky and she said, I got a dog and for a second I was confused and I thought maybe she hadn’t heard my question. What are we talking about? but then she went on to say that she had always loved animals and she’d wanted a pet her whole life, but her asthma had always been so bad that she could never tolerate being around animals for very long. So now that she’d been on this treatment and was able to get her disease under control, she got this little poodle that she’d wanted since she was a little girl, and she was in her 60s. It was just an incredible life change for her, that might not mean anything to, or mean as much to someone else, but to her, it was everything.

Amanda Brummitt: Yeah, we don’t have a good way to clinically categorize successes like that, but that’s a huge quality of life improvement for her. And that’s changing lives.

Kaitey Morgan: For sure.

Amanda Brummitt: I love it. So let’s talk a little bit more about your journeys with infusion. Obviously there’s struggles on the way to success. tell me about your biggest challenges you’ve faced and if you’re comfortable, even maybe some specific stories that kind of help us see behind the scenes. Sure.

Monica Parsons: well, I’ve already spoken on it a little bit, but I always tend to bring it back to policies and procedures and that compliance piece because it’s so important. So that really is what. I would like to remind everyone of, Katie and I, we have very similar approach to providing the best possible care to our patients and appreciating the value and purpose of a well written, clear and thorough policy standards, having standards that you can follow when providing care. So as we mentioned, when we first got into this infusion space, we realized there’s a lack of infusion specific policies. Now that wasn’t just the setting that we were in. This was across the board, across the nation. there were some specialty organizations that had standards established, but it still wasn’t. Specific to infusion therapy, and it wasn’t in a clear presentation to really help guide that care. So that’s really what we’re working for working towards. but yeah, that was one of the biggest challenges and continues to be. And that’s what’s driving our work right now.

Amanda Brummitt: Yeah, that makes a lot of sense, Katie.

Kaitey Morgan: Yeah, as you, first of all, when Monica started out by saying she loves policies, you can see why I love Monica, because I’m, I love policies to a rules person. So, one of the biggest. Challenges, to me has been that the growth of this industry, again, the medication pipeline just keeps coming out with new therapies. and for those, we need new sites of care. So, as the industry grows, that has really outpaced the guidance and regulation that we need. when I was asked to, join the startup, infusion management company as the clinical director, we were opening infusion centers in non hospital settings. And, I was coming from a hospital. so we had several things there. One was plenty of rules and regulations, and also, a centralized pharmacy to mix IV medications. And so I like to follow the rules. And so I started looking for those rules and to try to figure out how nurses could mix meds, because that part was new to me. I’d always had a pharmacy to do that and I couldn’t find the guidance I was looking for. it turns out it didn’t exist, but I had a colleague recommended that I emailed this person at the State Board of Pharmacy to see if he could point me in the right direction for these rules that I knew had to be there. side note, if I were to do that again, I would have started with the Board of Nursing. Lesson learned, but I received an email back telling me, in no uncertain terms and actually in all capital letters. no. Nurses cannot mix medications. It has to be done in a pharmacy under a hood. I remember I just started that job and read that email and I remember closing my laptop and thinking, Oh man, I just researched myself out of a really cool job. That would have been awesome. I knew nurses mixed meds outside of pharmacy settings all the time, and I figured I couldn’t be the first person to kick this hornet’s nest. So I started Googling, as I do, to try to figure out how others had dealt with the issue. and again, the, rules just didn’t exist, but in that process, I learned about the National Infusion Center Association, and I thought, okay, if anyone knows where to find these rules, it’s got to be these guys. So I sent them an email explaining. What had happened, what I’d done, and, very quickly found myself on the phone with Brian Nyquist, who was then the executive director of NICA. Today he’s the CEO, and he’s our boss. And he confirmed for me that, no, there were not standards yet. NICA was working on developing the first set. This was back in 2017, but he let me know that I was right. that gentleman from the board of pharmacy was mistaken. nurses can mix medications and administer them in office based settings and that, NICA could help. Then in the meantime, after I said that. infamous email. the Board of Pharmacy started doing surprise inspections of office based infusion centers across the state, and issuing violations of cease and desist letters, ultimately telling those, I think it was 14 practices, that they had to stop preparing these medications because they didn’t have a pharmacy clean room, a laminar flow hood, all of that. And in doing so, they, cut off access to non hospital infusions and injections for patients across the whole state. So, patients and prescribers were trying to scramble to figure out how they could get their treatments and transfer their care back to hospital based settings, but insurance companies were actively trying to push patients down. out of the hospital at that time, because the care is two to three times more expensive. It was, a mess, but it ended up coming down to a, an old and, ambiguous definition of compounding in the statute. So it was, it’s, a long, longer than that, if you could believe it story, but it has a happy ending. We ended up, clarifying that Statutory language for compounding and passed a bill, clarifying that language so that this battle wouldn’t have to be fought again. And then office based infusion centers were able to go back to, offering infusions to their patients and patients could get the treatments they needed again. It was, quite the introduction to the industry.

Amanda Brummitt: Yeah, that must have been so intimidating having also come from the hospital side and it was a big corporation. I’m used to things being spoon fed to me. and so having to do it from the beginning would be terrifying. So I’m super impressed that you did that. that must have taken some guts.

Kaitey Morgan: Well, it took some help. I think, on my own, it wouldn’t have, it wouldn’t have been seemed possible at all.

Amanda Brummitt: Yeah, absolutely. And aside from it becoming your future job, any, takeaways from that experience?

Kaitey Morgan: Yeah, I think that experience taught me that, there’s, power in unifying the collective voice, whether that’s infusion providers or infusion patients, pushing back on the State Board of Pharmacy, as just one nursing, one nursing, excuse me, as just one person, felt overwhelming, daunting, I wouldn’t have done it, but when I reached out to NICA, I wasn’t alone anymore, With Nika and Brian’s leadership, he pulled together this coalition of stakeholders, again, people I wouldn’t have known to reach out to that would be interested in this issue, and they all came together. We introduced legislation, which again is not a route I would have thought of, and, provided testimony at committee hearings and ultimately Pass that bill to clarify what compounding is and is not and separated that from, just preparing a parenteral medication according to the manufacturer’s instructions to be given to a patient. It’s something nurses have been doing forever. So I, couldn’t, I knew that, but I could not have conveyed that on my own. I would not have won that battle on my own. so yeah, I think that takeaway is I want. Infusion providers listening to know that they’re not alone, even if you don’t have the faintest idea how to go about tackling this problem, reach out to, to Nike and we can help.

Amanda Brummitt: Yeah, it starts with 1 nurse, 1 voice. Exactly. You made it happen. So it feels like a real light bulb moment. do you 2 have any others that you would want to share?

Monica Parsons: For me to recall a lightbulb moment, but there have certainly been a number of times where I have found myself saying there has to be a better way or many, times when we know better, we do better. That’s the evolution of care and changing our standards and the way that we do things based on evidence. So, whenever I questioned why we did a procedure a certain way, many times that was the answer. well, that’s because it’s the way we’ve always done it. but again, we need to be providing evidence based care, ensuring that care is guided by an integration of the best available scientific knowledge and that clinical expertise. So, to accomplish this, again, policies, procedures, education, we’ve got to be continually re evaluating and updating all of that. so, to follow up, I would say the biggest light bulb moment came when I joined NICA and realized the potential and opportunity that we have to reach infusion clinicians, patients. All infusion stakeholders, payers, and make a difference. Much like Katie just told us about, going through and passing a bill to make that change, to make sure that patients and everyone has access to the care and treatments that they need.

Amanda Brummitt: That is such a good point. Monica doing things because we’ve always done it. That way is such a bad idea. Dig into it, ask questions, let’s find out why we do it that way. Maybe there’s a good reason, but. Because we do it that way. Isn’t the reason to do it. No, which maybe that just speaks to us since we like policies is right. A great policy is just an explanation of why and how we do something

Monica Parsons: should be. Yeah, it should be in the supporting evidence is right there.

Amanda Brummitt: Yes, absolutely. So, what would you say are some of your biggest lessons that, you to have learned from these experiences?

Monica Parsons: There is still, and there will always be, so much left to discover and learn in medicine. There’s going to be constant changes in research, technology, the way that we do things. it’s our responsibility. We owe it to the community. We owe it to our patients. We owe it to ourselves to remain up to date. We have to put in that work, do the research, continuing your education, to keep current with standards and recommendations. So I would challenge you to always ask questions every step of the way, every opportunity that you get to understand that. Why, are we doing it this way? Is there a better way? But make sure that you have the support behind it,

Kaitey Morgan: right? If you’re asking yourself, why do we do it this way? And the answer you’re coming up with is because that’s the way we’ve always done it, that’s just the beginning. You’re not done. You’re just getting started figuring that out. You have to figure out why, and, the why should be evidence based. And if it’s not, then, fix that.

Amanda Brummitt: You can. Totally agreed. And even if things are working well, what can we do better? How can we make it easier for the patients better for the patients? Monica, I love you’ve used the term lifelong learners and I feel like anybody in medicine has to be, we don’t ever get to quit reading, and not to be a shameless plug, but it is a shameless plug. That is one thing I love about we infuse is, it constantly keeps all that education really easy for people because honestly, I don’t know how you all keep up with. All of the drugs and all of the changes. It’s so rapid, but I appreciate that you do. So it’s changing. Exactly. Speaking of rapid change, what are you two most excited about right now in the industry?

Monica Parsons: Well, specifically, I jumped ahead of myself and I hinted to it earlier. I’m so excited about the launch of accreditation program. Again, it’s for ambulatory infusion centers. While all of the lift for the program happened before I joined NICA, I did follow the progress closely and got to be involved in some of the review processes. I’m just so incredibly proud of the team and everyone involved. What they have accomplished is incredible, just to ensure that patients are getting the standard care that they need and that all of these new sites that are opening are operating at the same level, following the same standards again to ensure that safety and the quality for every infusion patient, And then, of course, our annual conference coming up in June in Miami. So come join us if you want to, Miami Vice

Kaitey Morgan: style. Yes, that’s our theme. It’s a throwback to the nineties. it’s really fun. We’re having fun with it.

Amanda Brummitt: Fantastic. And I’m sure plenty of the We Infuse team will be there with you all. so Katie, what are you most excited about?

Kaitey Morgan: I’m really excited to see the NICA team growing. like I mentioned, bringing Monica on board was very exciting for me. we’re taking on projects that had just been a dream not too long ago. the standards, the accreditation program, all the resources and education we’re building. it all started with one of us saying, wouldn’t it be so cool if we could, or if there was just a thing. and now we’re seeing those things coming to life. at the, Monica mentioned the conference, we’re having an ex, session there, exhibit it’s the infusion center of excellence. So it’s a perfect example of one of those things that we said, Oh, wouldn’t it be so cool if we could just do this? and now we’re going to, so we have this mock infusion center. It’s going to have, some of the latest, equipment like medical recliners and infusion pumps and med fridges and vein visualization devices. all that stuff is fun. And then my. favorite part of it is that the NICA team is going to be leading small groups of attendees through tours, to point out some of the key features of what makes the infusion center of excellence excellent. it’s not just having cool gadgets, but referring them back to the NICA standards and the accreditation program. So it’s going to be a great opportunity for those new to the infusion market to get an idea of what an infusion center of excellence should look like. and then. an opportunity for those with existing infusion centers to learn how they can make their centers even better

Amanda Brummitt: at all. Sounds amazing. and really exciting, a little shocking that it hasn’t existed before, but static that it’s coming

Kaitey Morgan: every. Yes, you think someone must have thought of this, right? And then you say, no, okay, I guess it’s on us. We’re going to do it.

Amanda Brummitt: Yes, absolutely. So if you had one last piece of advice or pearl of wisdom for infusion center owners and operators, what would it be?

Monica Parsons: I would say get involved. Everyone get involved. It takes the entire team, administration, nurses. Advanced practice, nurses, clinician, providers, owners, operators, everyone. Follow NICA, get involved, let us know what’s going well, what your struggles are, what we can help with. we have a community forum, you can pose questions where other, infusion leaders, I’m not sure if any of these partners can respond, but we need to hear from you. We need to know what direction we need to go in, how we can best support you and ensure that this infusion delivery channel will be here to serve patients for years to come. Katie, how about you?

Kaitey Morgan: Yeah, I totally agree with Monica. I, would want to tell listeners to get involved with NICA. and that doesn’t necessarily mean you’re adding more to your plate. It can mean the opposite, getting involved can just be reaching out to us about a struggle you’re having or a resource you’ve been searching for, something you’re trying to build and you think someone else must have made this, whatever the case may be, the NICA team spends a lot of time trying to think of how we can best help infusion providers. So we would love to hear it, directly from you.

Amanda Brummitt: Perfect. Well, thank you both so much for sharing your journey with us, for all that you do for NICA and for patients and for taking the time to be here today.

Monica Parsons: Absolutely. Thanks for having us. Amanda. Yes. Thanks for having me.

Amanda Brummitt: Well, I sure hope you enjoyed hearing Katie and Monica with NICA. Compliance may be daunting at times, but when it allows someone’s disease not only to get better, but improves their quality of life, that’s incentive to push forward. I also really appreciate how important a single voice becomes in this space and how it can be amplified through an organization like NICA.

Watch for the launch of their accreditation program and as Katie and Monica said, let them know if you need anything. And if you aren’t familiar with the WeInfuse software platform and RxToolkit’s web based resources, I encourage you to schedule a test drive. They can save you time and money in your practice while making infusion safer for patients and caregivers.

My name is Amanda Brummett and we’ll catch you in the next episode

Guest Speakers:

Kaitey Morgan is the current Chief Clinical Officer for the National Infusion Center Association (NICA). Before becoming the Chief Clinical Officer, Kaitey served as a NICA board member in 2019 and a full-time employee in 2020 with the role of Director of Quality and Standards.

Monica Parsons is the current Director of Clinical Education for the National Infusion Center Association (NICA). She is a graduate of Husson University, and also has served as the Director of Quality and Compliance for a Ambulatory infusion center.