Podcast Hosted by Amanda Brummitt–
What is your background and how did you get into the infusion industry?
Monica: I started out my nursing career as an inpatient oncology nurse, which I loved because you often cared long-term for patients. However, there was a heavy emotional burden, when you develop relationships with these patients and their families, its very difficult when you then assist with their transition to comfort care or end of life care. After a few years, I was introduced to “infusion therapy” in an outpatient hospital setting that fostered the growth of that nurse-patient relationship that I craved, without the emotional toll of providing direct end-of-life care. Once in this role (ironically working with Kaitey!) we discovered the lack of consistency in training and care, and total absence of policies and procedures. We were fortunate to work in an environment that fostered our growth and allowed us time and support to dedicate to developing policies and procedures based on current evidence-based practice. From here my passion to continually learn as much as I could about the infusion industry, medication protocols, and procedures grew and has ultimately lead me to NICA where I am currently the Director of Clinical Education. I am excited to continue to serve as a resource to the infusion industry and also work to preserve access to high-quality and cost-effective care for infusion patients.
Kaitey: I always knew I would be a nurse. I’ve been a nurse for 15 years, and have been infusion certified for 10 years. My first job out of nursing school was in an inpatient oncology unit, which was a great experience but between the schedule and the emotional toll, I felt burnt out. I took a per diem job in a hospital outpatient department that primarily treated non-oncology patients, and I was hooked. I was really fortunate to have great leadership there and was given opportunities and exposure to the operational and administrative side which allowed me to grow and develop skills beyond direct patient care.
I remember going to my nurse manager shortly after I started working there to ask the rationale for the way they had taught me to administer infliximab and she said she didn’t know. She had recently inherited that department and infusion wasn’t her specialty, so after she tried to help me find a policy citing literature, we concluded it didn’t exist. Then she asked if I wanted to do some research and write a policy about it. I said I’d never written a policy before, and she said “I bet you’ve read a few though. I’m sure you can do it.” She was right, I figured it out, and I really liked it. After a few years there I’d written a policy for just about everything you can imagine. I’ll always be grateful for that experience.
From there I got another opportunity I’ll always be grateful for, which was working as the director of clinical operations for an MSO that specialized in opening and managing infusion suites in providers’ offices from Maine to Kalamazoo– literally.
During that time I also served on NICA’s Advisory Committee and its Board of Directors, before joining the NICA team as a full-time employee in January of 2020.
What is your main area of expertise?
Monica: Most of my career has been in infusion therapy I am an infusion nurse by background and have worked in oncology and infusion throughout my entire career focusing on clinical education and quality and compliance in hospital outpatient, multispecialty office-based and ambulatory clinics, and MSOs.
Kaitey: It’s all infusion therapy. My mom is a retired nurse, and she specialized in outpatient infusion. I used to tag along when she went to infusion nursing conferences; the specialty just fascinated me. It’s such a great blend of all my favorite things about nursing. There are technical skills related to vascular access and the science of biologic medications, and there is also a lot of opportunity to educate and advocate for patients, and more importantly, to empower them to educate and advocate for themselves. When you see the same patients every few months for years, you’re able to establish that human connection and you learn what these treatments mean to patients and how they improve their lives. I find it to be such a fulfilling specialty.
What’s one thing you want WeInfuse listeners to learn from your area of expertise?
Monica: As the number of people suffering from chronic disease continues to grow and the emergence of new biologic treatments coming to the market, it is more important than ever to increase patient access to affordable, high-quality infusion care when and where they need it. Infusion patients deserve the peace of mind that they will receive the same high-quality care regardless of where they go for their infusions, that is why NICA developed the NICA Standards of Excellence for Ambulatory Infusion Centers. NICA’s standards are American National Standards Institute (ANSI) approved set of standards.
Kaitey: Provider-administered medications like infusions and injections really are the future of healthcare. These therapies are so targeted and so effective at managing diseases that were difficult or impossible to treat with conventional treatments. The science is there, and you can talk about improvements in lab values or imaging, but the human side of it is even more compelling. I can think of so many stories I’ve heard from patients over the years, and I know Monica can too, that really underscore how life-changing and in many cases life-saving, these infusions or injections have been for them.
Sometimes the improvement it makes in their life is dramatic and easy to see, like the patients whose rheumatoid arthritis makes it so difficult to get around they have to use a wheelchair, and then they get on the right treatment and are able to not only walk but play with their kids or grandkids.
Sometimes though the changes aren’t that obvious from the outside. I’ll never forget a patient with eosinophilc asthma, she came in for her injection and I was asking her how she felt the treatment was working for her. She teared up and her voice was shaky and she told me “I got a dog.” She went on to say she had wanted a pet her whole life, but her asthma had always been so terrible she could never tolerate being around animals for very long, but since she’d started treatment she had been able to get this little poodle she’d wanted since she was a little girl– and she was in her 60s. I still get teary thinking about it.
Let’s talk about your journey with infusion. There are struggles on the way to success. What would you say has been your biggest challenge in the infusion practice? Tell us a specific story that gives us a behind the scenes look at one experience in particular.
Monica: Kaitey and I have a similar mindset and approach to providing the best possible care to our patients and appreciating the value in and purpose of well-written, clear, and thorough policies and standards. When we were first introduced into the infusion space, we were within a hospital setting so we had a lot of the hospital policies and procedures to follow, however we quickly learned that there was a lack of infusion-specific policies. We worked together to develop policies and training programs, without a lot of structured guidance from a regulatory body with experience in infusion.
Kaitey: As a rules person, I would say one of the biggest challenges is that the growth of the infusion industry has outpaced industry guidance and regulation.
When I started working for an infusion management company, we were opening centers in non-hospital settings. I was coming from hospital settings, where we had plenty of rules and regulations, and a centralized pharmacy to mix IV medications. So I started by looking for the rules and regulations around nurses mixing medications outside pharmacy settings since that part was new to me. I couldn’t find what I was looking for, so a colleague suggested I ask a compliance inspector at the state board of pharmacy. I sent him an email and received an email back telling me in no uncertain terms that nurses cannot mix medications on an open benchtop, that this must be done by pharmacists in a laminar flow hood et cetera.
I knew nurses mixed meds outside of pharmacy settings all the time, so I figured I couldn’t be the first person to kick this hornet’s nest. In my search to find how others had dealt with this issue, I came across the National Infusion Center Association. I reached out and that same day I found myself on the phone with Brian Nyquist, CEO of NICA. He confirmed for me that, no, there weren’t standards in our industry yet, but that the gentleman from the board of pharmacy was mistaken and that NICA could help.
In the meantime, the BOP started doing surprise inspections of office-based infusion centers across the state, telling 14 practices to stop preparing these medications- effectively cutting off access for patients across the state. Patients had to try to transfer their care to hospital-based settings, but insurance companies were actively trying to push patients out of the hospital because those settings cost 2-3x more than non-hospital settings.
It’s a long story with a happy ending. The issue ended up coming down to an ambiguous statutory language around the definition of “compounding,” and we were able to pass a bill clarifying that language, and office-based infusion centers were able to resume their infusion operations and give patients the treatments they needed.
Let’s mine some gold from that experience. What would you want our listeners to learn from that experience you had? What is one key takeaway?
Kaitey: That experience taught me that there is power in unifying the collective voice, whether it be the voice of infusion providers or infusion patients. Pushing back on the state board of pharmacy as just one person felt daunting, but when I reached out to NICA I wasn’t alone anymore. With NICA and Brian’s leadership, a coalition of stakeholders came together to introduce legislation, and we successfully passed a bill to clarify the definition of “compounding” and differentiate that from the simple preparation of a parenteral medication, which is something nurses have been doing safely for decades. I couldn’t have won that battle alone. I want infusion providers listening to know they aren’t alone, and that they can always reach out to NICA for help.
Share another story. With what you’ve experienced in this business so far, what’s the biggest “light bulb” moment you have had about the infusion practice?
Monica: It’s hard to recall a “light bulb” moment but there have certainly been a number of times where I find myself saying “there has to be a better way” or “when we know better, we do better.” Whenever I questioned why we did a procedure a certain way, many times the answer was “because that’s the way we have always done it!”
The entire basis of providing evidence-based care is to ensure that care is guided by an integration of best available scientific knowledge and clinical expertise. To accomplish this, policies, procedures, and education must continually be re-evaluated to ensure care is safe and up-to-date.
With that, I would say that my biggest “light bulb” moment came when I joined NICA and realized the potential and opportunity that we have to reach infusion clinicians and patients.
Let’s talk about this for a minute…. What are some of the biggest lessons our listeners can learn from what you just described, from your lightbulb moment?
Monica: We are life-long learners! There is still so much to be discovered in medicine and constant changes in research and technology. It is our responsibility to our patients to remain up to date with current standards and recommendations. I challenge you to ask questions at every opportunity you get to help understand WHY we do things the way we do.
Kaitey: And “because thats the way we’ve always done it!” is not an acceptable answer. You need to either find out why that’s the way you’ve always done it or find out the evidence-based way it should be done.
Now, tell our listeners about what you’re most excited about right now in the industry?
Monica: I am so excited about the launch of NICA’s Accreditation Program for Ambulatory Infusion Centers! All of the lift for this program happened before I joined, but I followed the progress closely and am so proud of this team. It is truly incredible what they have accomplished to ensure that there are standards in the ambulatory infusion care setting for the delivery of safe, quality care for every infusion therapy patient.
And of course our annual conference in Miami in June! Come join NICA- Miami Vice style 🙂
Kaitey: I’m really excited to see the NICA team growing and taking on projects that had just been a dream not too long ago. The Standards, the Accreditation Program, the education and resources we’re building, it all started with one of us saying “wouldn’t it be so cool if…” and now we’re seeing those things come to life. The Infusion Center of Excellence is a great example:
The conference this year will feature the NICA Infusion Center of Excellence or “NICE” Experience, which is our mock infusion center. It will feature some of the latest infusion equipment like medical recliners, infusion pumps, medication fridges, and vein visualization technology, which is always fun.
My favorite part though is that the NICA team is leading small groups of attendees on a tour to point out some of the key features of what makes an “infusion center of excellence” in reference to the NICA standards and Accreditation Program. 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 also an opportunity for those with existing infusion centers to learn how they can make their centers even better.
What’s one last piece of advice for our listeners?
Monica: Get involved! Follow NICA, join our community forum, we need to hear from you and we need your voice to preserve the infusion delivery channel
Kaitey: Similarly, I want to tell listeners to get involved with NICA! And that doesn’t necessarily mean adding more to your plate; it can mean the opposite. Getting involved can be as simple as reaching out to us about a struggle you’re having at your infusion center, or a resource you’ve been searching for. The NICA team spends a lot of time trying to think of how we can best help infusion providers, so we’d love to hear it directly from you!
Amanda: 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 Kaitey and Monica said, let them know what you need.
If you aren’t familiar with the WeInfuse software platform and RxToolKit’s web-based resources, I encourage you to schedule a test drive (schedule demo here). They can save you time and money in your practice while making infusions safer for patients and caregivers. My name is Amanda Brummitt and we’ll catch you in the next episode.