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Working together to address COVID-19 challenges with INS · The SHEA Podcast

• 0:10
  SPEAKER_00: Welcome to the We're All in This Together COVID-19 Allies and Infection Prevention Podcast Series as part of the Society for Healthcare Epidemiology of America SHA Rapid Response Program.
• 0:22
  SPEAKER_00: I am Sarah Keller and I am an Assistant Professor of Medicine in the Division of Infectious Diseases at John Hopkins University School of Medicine, and I will serve as your SHAY moderator and speaker.
• 0:32
  SPEAKER_00: I'm also very happy to welcome John Barron, INS Clinical Education and Publications Manager, who will serve as your Infusion Nurses Society speaker for today's podcast.
• 0:42
  SPEAKER_00: Discussion on the podcast does not reflect SHAI or INS's perspectives, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:53
  SPEAKER_00: Today's episode will focus on collaborations between Healthcare Epidemiology and the Infusion Nurses Society and how we as a team can work together to address the most important questions surrounding the COVID-19 pandemic.
• 1:05
  SPEAKER_00: Let's get started with our first question.
• 1:06
  SPEAKER_00: So, Dawn, would you please describe what you and your organization are doing to address COVID-19?
• 1:13
  SPEAKER_01: Certainly, Sarah.
• 1:14
  SPEAKER_01: So first of all, let me tell you a little bit about INS.
• 1:18
  SPEAKER_01: I think we want to just share a bit about our organizations on the front end.
• 1:21
  SPEAKER_01: So the Infusion Nurses Society, or INS, was established in 1973.
• 1:27
  SPEAKER_01: The INS is an international nonprofit organization representing infusion nurses and other clinicians who are engaged in the specialty of practice in infusion therapy.
• 1:37
  SPEAKER_01: We are really committed to bringing innovative resources and learning opportunities to the wide range of healthcare professionals, along with the focus of providing information and educational opportunities for clinicians.
• 1:50
  SPEAKER_01: We are equally dedicated to advancing safety and quality of infusion therapy to patients by authoring and establishing the infusion therapy standards of practice.
• 1:59
  SPEAKER_01: Now, the Infusion Nurses Certification Corporation, or INCC, is the certification arm of the company.
• 2:06
  SPEAKER_01: And this is a separate entity that's solely focused on assisting those who wish to gain certification as certified registered nurses in the practice of infusion.
• 2:16
  SPEAKER_01: And this specialty is comprehensive.
• 2:18
  SPEAKER_01: It begins with the establishment of the most appropriate vascular access device and continues into the realm of use, care, and maintenance of that vascular access device, and then on through to discontinuation of the device and post-evaluation of the therapeutic effect.
• 2:35
  SPEAKER_01: With that question, that little description of who INS is, describing what we're doing to address COVID-19, this has been a challenging time.
• 2:45
  SPEAKER_01: At the outset of the pandemic in the United States, INS posted our COVID-19 updates on our website, and we added to that information regularly, and we have tried to include sites that are providing national guidance as well.
• 3:01
  SPEAKER_01: Certainly CBC.
• 3:03
  SPEAKER_01: We found a lot of wonderful information from the American Psychiatric Nurses Association for Clinicians.
• 3:09
  SPEAKER_01: Lippincott Nursing Center, which also included the World Health Organization and the American Nurses Association, also had some really nice information that was at the ready for our clinicians.
• 3:21
  SPEAKER_01: So other ways that the INS is addressing COVID-19.
• 3:25
  SPEAKER_01: Our leaders regularly address individual clinicians' questions via email.
• 3:30
  SPEAKER_01: Because there were so many of the same groups of questions, we created a FAQ, posted that in our COVID-19 information section as well.
• 3:40
  SPEAKER_01: We have also worked to create a number of communication products.
• 3:43
  SPEAKER_01: So we've prepared some webinars, some podcasts that address the current need.
• 3:48
  SPEAKER_01: And as with most of the things that have been surrounding COVID-19, it begins to change as we learn more and as we experience more.
• 3:57
  SPEAKER_01: So our podcasts have included a discussion with Carrie Dillips, the president of the American Psychiatric Nursing Association, and she was talking with us about addressing the mental health needs that are present with all clinicians during the COVID-19 pandemic.
• 4:13
  SPEAKER_01: We had a wonderful conversation with Michelle DeVries.
• 4:17
  SPEAKER_01: She's a senior infection control officer at Methodist Hospitals, and she talked about infection control practices with COVID-19.
• 4:24
  SPEAKER_01: And we just finished a collaborative webinar with the Association for Vascular Access or Ava with INS.
• 4:31
  SPEAKER_01: And we again were discussing the psychological crisis of COVID-19 and addressing the risk that clinicians face there.
• 4:39
  SPEAKER_01: One other thing that we did with our outreach, which I think was kind of nice on the front end, when we first started having the shutdown and schools were closing and students were kind of at the end of their term or at the end of their semester and were just shy of getting the credits that they needed, INS offered the fundamentals of infusion therapy at a discounted rate for nursing students.
• 5:01
  SPEAKER_01: And then that also included a complementary membership, which brought them into our learning center.
• 5:06
  SPEAKER_01: And we were able to design a little education program.
• 5:10
  SPEAKER_01: The director of education pulled together kind of a crosswalk that would give them some educational webinars, podcasts, in addition to the fundamentals of infusion therapy that enabled them to complete their simulation and clinical education portion so they could complete their degree programs.
• 5:27
  SPEAKER_00: I just wanted to be clear so this is all for the schools of nursing and they had shut down directly.
• 5:32
  SPEAKER_01: Certainly.
• 5:32
  SPEAKER_00: That's fantastic that they were able to do some rapid deployment of educational tools to allow them to complete their degrees.
• 5:41
  SPEAKER_01: It was great that we had products that were available that met those needs.
• 5:46
  SPEAKER_01: It was great to be able to package them, to offer those at a discount, and also the free membership.
• 5:52
  SPEAKER_01: And we have received a lot of positive feedback.
• 5:55
  SPEAKER_01: And nurses are now.
• 5:57
  SPEAKER_01: They've gone past their end clocks, they've they've moved on into practice and have entered a space of nursing that few will experience on their first go.
• 6:07
  SPEAKER_01: One last thing that INS is doing right now that I think is just really important, and that is we're sharing the lived experiences from COVID-19.
• 6:17
  SPEAKER_01: So we have captured some stories from some individuals who have shared with us, and they are people in all roles.
• 6:23
  SPEAKER_01: Some are direct care staff, some are managers, some are educators, some are researchers, and these stories are so compelling.
• 6:30
  SPEAKER_01: And I'm going to read to you an excerpt a little bit later in our podcast today, telling a story about a nurse and what it was like for her going to work each day.
• 6:39
  SPEAKER_00: What have been some of your biggest challenges around COVID-19?
• 6:44
  SPEAKER_00: And how have you been able to address those challenges?
• 6:47
  SPEAKER_01: Our organization has a home base that's fully staffed and has employees there.
• 6:52
  SPEAKER_01: And when it became time where everyone needed to shift and work from home, we needed to transition very quickly, take everyone safely into their home, give them all the equipment that was necessary, get them up to work, and all the while not drop the ball on being accessible.
• 7:09
  SPEAKER_01: So we were able to make it so that our membership could reach us either through the INS master account or by phone.
• 7:18
  SPEAKER_01: We had a really nice triage system where we have one person in particular who fields emails and calls and then shuttles those to the right people.
• 7:26
  SPEAKER_01: And there have been a lot of questions.
• 7:28
  SPEAKER_01: There's been a lot of concerns, and I'll share some of those concerns with you as well.
• 7:32
  SPEAKER_01: We were able to transition that work from home place and still maintain our availability to our membership, which is so very important, and then begin to field their questions from there as well.
• 7:44
  SPEAKER_01: What we learned though was that there were a few things that really rose to the surface.
• 7:49
  SPEAKER_01: The things that we were hearing from our membership were concerns for professional practice.
• 7:54
  SPEAKER_01: And what happened is within their organizations, based on the individual needs of the organizations and the volume of patients and all of their concerns, there were necessary changes that needed to take place.
• 8:05
  SPEAKER_01: But nurses started contacting us and they were concerned about practicing outside the established standards of practice.
• 8:12
  SPEAKER_01: And some examples, this is old news, some of this now, but it's still people still struggle with some of this.
• 8:18
  SPEAKER_01: Placing the infusion pumps outside of the patient's room.
• 8:21
  SPEAKER_01: There were reasons why this seemed to be a good solution.
• 8:25
  SPEAKER_01: At the front end of this, we really needed to save PPE.
• 8:28
  SPEAKER_01: We needed to limit clinician exposure.
• 8:30
  SPEAKER_01: And having the infusion pumps away from the room also meant for the clinician, I can't assess that patient.
• 8:36
  SPEAKER_01: I can't assess that vascular access device.
• 8:38
  SPEAKER_01: There are things I can't see.
• 8:40
  SPEAKER_01: And that was unnerving for them.
• 8:42
  SPEAKER_01: There were changes in administration sets and needing to conserve supplies and changing tubing sets less frequently, performing dressing changes less frequently due to product shortages in some cases, but sometimes it was really staffing shortages in the home care settings, you know, where we couldn't get there on time in ways that they had previously been able to.
• 9:04
  SPEAKER_01: Some concerns also voice were like extending the periods of between flushing their vascular access devices, and they would reach out to us and ask us what is safe, what should we do?
• 9:14
  SPEAKER_01: Another concern, and we have heard this all along, is the concern for personal safety.
• 9:21
  SPEAKER_00: So many of us in many different areas of medicine, and especially healthcare epidemiology and infection prevention communities also have made some rapid changes in how we typically would practice.
• 9:32
  SPEAKER_00: For example, to conserve TPE, many have shifted away from contact isolation for patients with MERSA, for example.
• 9:40
  SPEAKER_00: Oh, yes.
• 9:41
  SPEAKER_00: Some con like difficult conversations to have.
• 9:44
  SPEAKER_00: How have those conversations gone?
• 9:46
  SPEAKER_01: Well, it's hard.
• 9:47
  SPEAKER_01: And this is really the challenge.
• 9:49
  SPEAKER_01: We've been talking about the effects on the clinician, and clinicians have been put in situations where they work in a way that is not usual.
• 9:57
  SPEAKER_01: So when we find that clinicians are being asked not to use PPE when they're going into patients' room who would normally be on isolation precautions, and we would use a gown and then discard that gown when we're done.
• 10:09
  SPEAKER_01: That's a hard conversation to have.
• 10:11
  SPEAKER_01: Clinicians were frustrated with the volume of change.
• 10:14
  SPEAKER_01: They were frustrated with the fact that for something that they would have been disciplined for before for negligence, now they're being asked to do it.
• 10:23
  SPEAKER_01: There's confusion, certainly COVID-19 patients and all of the requirements that we had for using PPE, everything that has changed in that realm.
• 10:33
  SPEAKER_01: But their concern, they're saying, you know, COVID-19 is not the only concern.
• 10:38
  SPEAKER_01: We have all of the same infection control concerns.
• 10:41
  SPEAKER_01: We have been doing this for years.
• 10:43
  SPEAKER_01: And I think the bottom line was just give us what we need to practice safely for ourselves and for our patients.
• 10:49
  SPEAKER_00: You were talking about some additional concerns for personal safety kind of related to this.
• 10:54
  SPEAKER_01: Just exactly what we just talked about.
• 10:56
  SPEAKER_01: They indicated that they felt that they were not always able to protect themselves with the acceptable barriers, masks, face shields, and gowns.
• 11:03
  SPEAKER_01: Now I believe our product availability has improved and continues to improve.
• 11:08
  SPEAKER_01: I know organizations have ramped up and vendors are doing everything they can to supply us with those needs.
• 11:15
  SPEAKER_01: We can talk a little bit later about unraveling all those big changes and then going back to what is standard practice.
• 11:22
  SPEAKER_01: And we'll do that.
• 11:23
  SPEAKER_01: I don't know that everyone's out of the woods yet.
• 11:26
  SPEAKER_01: So there are still those conversations.
• 11:28
  SPEAKER_01: And there's also the post-traumatic effect.
• 11:30
  SPEAKER_01: It's kind of like when you're going down the road and you had a car crash.
• 11:33
  SPEAKER_01: The car crash almost is, it just detains you from getting to where you wanted to go.
• 11:37
  SPEAKER_01: You have this trajectory in your head about where you're supposed to be and where you're supposed to go.
• 11:42
  SPEAKER_01: And this disruption is confounding because we know where we need to go, we know where we need to be every single day and how we should practice and having this continual disruption creates a set of other symptoms and that could lead to some mental health challenges and maintaining our well-being.
• 11:58
  SPEAKER_00: With some of these struggles and trying to support individual clinicians who are struggling with this, what is the role of INS in advocating for members of its organization, particularly if there are concerns raised about feeling supported by an individual clinician's perhaps employer or other organization?
• 12:17
  SPEAKER_01: That's an excellent question.
• 12:19
  SPEAKER_01: There is a place between the organization such as INS and then the due respect that's to the healthcare facility.
• 12:27
  SPEAKER_01: Only that specific health care facility understands the limitations that the pandemic has created, the shortage of supplies, the volume of patients, and the reduction of staff members that has occurred.
• 12:41
  SPEAKER_01: So each organization is put into a place where they need to get all hands on deck, make the best decision possible.
• 12:49
  SPEAKER_01: So we would support each individual healthcare organization to make the best and safest determination possible.
• 12:56
  SPEAKER_01: We certainly want to support our nurses.
• 12:58
  SPEAKER_01: We certainly want to give the ability to not only tell their story, but also have some tools.
• 13:03
  SPEAKER_01: And what we're finding right now, and what we hear again and again, is nurses have emptied themselves out.
• 13:09
  SPEAKER_01: Providers have emptied themselves out.
• 13:11
  SPEAKER_01: And what we're hearing right now is about the exhaustion and fatigue and learning how to reestablish their personal strength, their mental wellness, their rest.
• 13:21
  SPEAKER_01: We know that there are sleep disturbances.
• 13:24
  SPEAKER_01: So in addition to having very challenging clinical situations now, now we find that there are other situations that are as a result of COVID-19 and and all of the the changes that have come into the home even.
• 13:38
  SPEAKER_01: What we've done is we have offered as many resources as possible and we continue to put those out there.
• 13:44
  SPEAKER_01: I'm gonna tell a story right now.
• 13:46
  SPEAKER_01: It's kind of a story of how tough it was, but the resiliency of the clinician.
• 13:52
  SPEAKER_01: And I do have permission to share this.
• 13:54
  SPEAKER_01: I'm on the front lines with nurses at the bedside caring for patients with COVID-19.
• 13:59
  SPEAKER_01: At the beginning of the pandemic, all I could do was cry on my way to work and pray for my safety, my family, our leaders, my coworkers, and that what we are being directed as far as correct PPE equipment would be enough to keep us safe.
• 14:14
  SPEAKER_01: Weeks later, I find that I'm no longer crying, but I look at the courage and take pride in our profession.
• 14:21
  SPEAKER_01: At the bedside, I work alongside nurses.
• 14:24
  SPEAKER_01: They look to me for guidance and providing the best care for these patients.
• 14:28
  SPEAKER_01: The lack of supplies for tubing, gowns, cleansers has us working with engineers within our organization and to create these supplies that we don't have.
• 14:37
  SPEAKER_01: I cannot help but think of all the exciting things that are happening with infusion therapy and how I look forward to hearing about the challenges and triumphs from our infusion community.
• 14:48
  SPEAKER_01: So beginning of her story, she's crying on her way to work every day.
• 14:51
  SPEAKER_01: She's frightened.
• 14:52
  SPEAKER_01: And toward the end of her story, she said, This thing is turning around.
• 14:55
  SPEAKER_01: We are finding, just as everyone else, humans are infinitely creative.
• 15:00
  SPEAKER_01: We have the ability to look at things in new ways, to face these challenges, find the safest way to do things.
• 15:06
  SPEAKER_01: Might not be perfect, but we're learning so fast as we go.
• 15:09
  SPEAKER_01: And knowing we have so much now that is going to inform practice going forward.
• 15:14
  SPEAKER_00: Yeah, we've talked a little bit about this.
• 15:17
  SPEAKER_00: How has you been making changes to practice?
• 15:19
  SPEAKER_00: And if so, what is driving those?
• 15:22
  SPEAKER_00: Or conversely, what have you decided to not change?
• 15:25
  SPEAKER_01: This is a very challenging conversation, and I am thankful for the opportunity to talk about this.
• 15:31
  SPEAKER_01: When I first told a little bit about INS, what I said was we author and produce the infusion therapy standards of practice.
• 15:39
  SPEAKER_01: A real serious challenge that we have faced is not changing the standards of practice in the midst of COVID-19.
• 15:47
  SPEAKER_01: So we've had some emails, we've had some conversations, we've had phone calls that said, during this time, wouldn't you change a standard so that because what they're looking for is they're looking to have someone tell you, it's okay to do what you have to do right now.
• 16:01
  SPEAKER_01: And we say that it is okay to do what you have to do right now.
• 16:05
  SPEAKER_01: Work with everybody in your organization, put the best plan together.
• 16:09
  SPEAKER_01: But standards are really very implicit and they are based on the best evidence possible.
• 16:14
  SPEAKER_01: So when someone says, could I do this thing that I always do on the seventh day, could you tell us how long we could extend that?
• 16:22
  SPEAKER_01: Could we do it 10 days later?
• 16:25
  SPEAKER_01: Can we do it in 12 days?
• 16:27
  SPEAKER_01: And I'm just pulling a number out of the air here.
• 16:29
  SPEAKER_01: Just by doing that, it kind of tells us how impractical that is because we don't have evidence to support a change and say, oh, well, under this circumstance, we're going to we're going to change a national standard.
• 16:42
  SPEAKER_01: We can't do that.
• 16:43
  SPEAKER_01: But what we do do is just what I've said, we know that organizations have really had a challenge experiencing scarcity, depletion of PPE, healthcare supplies.
• 16:54
  SPEAKER_01: We know that there have been the challenges with staffing, and this is when everybody needs to get together on that interprofessional team, prepare the modification of practice, educate all the clinicians on what those changes are going to be, what the new practice steps will be, the desired effect of that change, and the expected duration of that modification.
• 17:17
  SPEAKER_01: Communicate it broadly, and then communicate it when it's appropriate, however it's appropriate with the patients regarding what to expect during their healthcare experience.
• 17:27
  SPEAKER_01: And then monitor those effects of the practice changes.
• 17:31
  SPEAKER_01: What's really important right now is, and we're going to find this, we're going to see really good record keeping and data that we've had all the way all along is going to be so important because, just for instance, just bringing those pumps out of the room and not being able to assess the vascular access devices or other things, it would be good to know.
• 17:50
  SPEAKER_01: What was the infiltration and extravagation rate?
• 17:52
  SPEAKER_01: What was your phylitis rate before this pandemic, before we made these changes, and what is it now?
• 17:59
  SPEAKER_01: What was the effect?
• 18:00
  SPEAKER_01: What can we learn from this?
• 18:01
  SPEAKER_01: And collect that data whenever possible to identify the impact of the changes that were made.
• 18:07
  SPEAKER_00: I know many people in SHA have been dealing with some similar situations where now they're coming out with papers and manuscripts describing some of them, their experiences, using their data that they've been collecting, looking at what has happened when they've changed their practice to face these new realities.
• 18:24
  SPEAKER_00: It is possible that standards might change based on new data.
• 18:28
  SPEAKER_01: Absolutely.
• 18:30
  SPEAKER_01: So now we're going to look at what opportunities are there for individuals working in healthcare to work together and handle the pandemic long term.
• 18:39
  SPEAKER_01: So let's talk about that.
• 18:40
  SPEAKER_01: I know we only have a few more minutes to go, so let's kind of dig in there.
• 18:44
  SPEAKER_01: There are so many opportunities, not only for individual clinicians, but for organizations working to manage the safest practice.
• 18:52
  SPEAKER_01: Certainly, bedside clinicians, infection prevention personnel, we all need to work in tandem.
• 18:58
  SPEAKER_01: We need to get together, but go beyond that.
• 19:00
  SPEAKER_01: Laboratory personnel, supply chain managers, practice experts, all employed in that same healthcare setting, they have to come together to determine best practice for this period of time.
• 19:11
  SPEAKER_01: We also need to intentionally plan the transition back to standard practice once the pandemic recedes.
• 19:18
  SPEAKER_01: And now we really don't know the timing of all of this, but it's essential to keep our eye back on that fixed point.
• 19:25
  SPEAKER_01: We know where practice should rest right now.
• 19:28
  SPEAKER_01: And it needs to be just the period of time that it needs to be to get us past this point.
• 19:33
  SPEAKER_01: Throughout the pandemic, the importance of our national organizations has been so evident.
• 19:38
  SPEAKER_01: It's amazing for us to note the volume of critical information that's been provided, the rate that new information has been shared, and how invaluable this information has been to not only the public, but to healthcare clinicians working on the front lines of care.
• 19:56
  SPEAKER_01: And going forward, we really hope that ongoing collaboration amongst professional societies and our national organizations continues.
• 20:05
  SPEAKER_01: We know it's essential.
• 20:06
  SPEAKER_01: And in the midst of this really tragic event and this tragic set of circumstances, we've rediscovered the importance of working together.
• 20:14
  SPEAKER_01: So we really want to share data, share information, learn from one another, and not to lose this momentum or the benefits that we've gained through this collaboration.
• 20:25
  SPEAKER_00: I think that's an excellent place to kind of end this conversation.
• 20:29
  SPEAKER_00: And thank you so much for collaborating today on this podcast.
• 20:33
  SPEAKER_00: In closing, thank you again to our speaker, Don Barents, for joining us today and sharing your perspectives and experiences.
• 20:40
  SPEAKER_00: And the sincere thank you from Shea to all healthcare personnel for all that you're doing to respond to COVID-19.
• 20:48
  SPEAKER_00: A reminder: this podcast can be accessed on Shay's Online Education Center, Learning CE, under the Rapid Response Program.
• 20:55
  SPEAKER_00: You will also find additional resources such as the recorded webinars, healthcare facility outbreak around this, and the SHAY COVID-19 town halls, as well as the additional podcast series, COVID-19 updates what we know now, which is released every Thursday.
• 21:09
  SPEAKER_00: And I really encourage everybody to go check those out and participate in the town halls.
• 21:13
  SPEAKER_00: They've been great.
• 21:15
  SPEAKER_00: This concludes this episode of the COVID-19 Allies and Infection Prevention Podcast series.
• 21:20
  SPEAKER_00: Thank you for tuning in.