The Infusion Nurses Society’s (INS) Standards of Practice set the benchmark for infusion administration and care of various access devices, including intravenous, subcutaneous, intraosseous, and intraspinal devices. Recognized globally, these Standards are the gold standard for evaluating the quality of practice, service, and education in infusion care. The INS recently shifted its revision cycle from every five years to every three, reflecting the rapid pace of new evidence and emerging trends in the field.

In an interview with Lisa Gorski, MS, RN, HHCNS-BC, FAAN—Chair of the INS Standards Committee (2013-2021) and Co-Chair of the 2024 committee—she emphasized the influence of mandatory reporting of central line-associated bloodstream infections (CLABSIs) on practice. According to Gorski, this led to increased reliance on midline and peripheral catheters, resulting in unintended complications like infiltrations and extravasations, which are currently not required to be reported.

Now, with the potential rise of new quality metrics such as hospital-onset bacteremia and fungemia (HOB), the Standards are evolving to address these issues. For example, there are ongoing studies examining the administration of vasopressors via midline catheters.

The new 2024 Infusion Therapy Standards offer actionable strategies for clinical teams, including:

• Collaborative rounding
• Assessing gaps in practice
• Using audit and feedback to drive improvements

But for many teams, getting started can be the hardest part. We spoke with Lisa Gorski and Michelle DeVries, MPH, CIC, VA-BC, CPHQ, FAPIC, members of the 2024 INS Standards Committee, who offered insights on implementing these strategies effectively.

Engaging an interprofessional team is essential for optimal patient outcomes. Each discipline brings unique insights, and working together ensures comprehensive care. As Michelle DeVries noted, “A kind of magic comes out when we invite all perspectives to assess patient vascular access status and make recommendations. We can do so much more working collaboratively than working at odds with each other.”

The Standards provide guidance on forming this team, which should include leadership, local champions (e.g., vascular access specialists), infection preventionists, quality and safety clinicians, and contracted specialists. More information on establishing collaborative rounding can be found in resources here.

Identifying gaps in practice is the first step to improvement. According to DeVries, choosing an issue that everyone agrees needs attention is crucial for initial success.

For example, when evaluating intact dressings, consider these steps:

• Review quality and safety indicators like CLABSI or HOB data, along with any adverse events and EMR (Electronic Medical Record) data.
• Examine process-of-care data, such as the number of dressings changed prematurely or the proportion of intact dressings.
• If no process data are available, organize a small group (e.g., vascular access, infection prevention, bedside unit representatives) to assess patients’ dressings and apply INS Standards definitions for intact vs. non-intact dressings.
• Review findings to define quality improvement goals and metrics for success.

Audit and feedback play a critical role in confirming gaps in practice, understanding the problem’s magnitude, and measuring the success of changes. Consistent data definitions are essential to accurately track performance.

“When we only measure outcomes like CLABSI rates, we have no idea what’s helping or hindering our progress. Identifying and defining process measures is a critical part of this space,” said DeVries.

The INS Standards offer guidance on process data definitions, particularly for intact dressings. Eloquest Healthcare’s data collection spreadsheet can ease point-prevalence audits—ask your representative for more information.

One emerging trend highlighted in the 2024 Standards is expanding surveillance to include hospital-onset bacteremia and fungemia (HOB) as a broader quality metric. While currently proposed as a voluntary measure supported by the Centers for Disease Control and Prevention (CDC), there is potential for this to become a mandatory reportable metric. The National Quality Forum (NQF) recently released a playbook to support this, signaling a shift toward more inclusive surveillance of hospital-onset infections.

The 2024 Standards of Practice are designed to help healthcare teams navigate the complex landscape of infusion care. By implementing strategies like collaborative rounding, assessing gaps, and using audit and feedback, teams can drive improvements and achieve better patient outcomes. As the field continues to evolve, staying aligned with these Standards will be critical for success.

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Eloquest Healthcare is committed to providing solutions that can both improve patient outcomes and reduce unnecessary costs. We work with your institution to perform a bedside audit evaluating vascular access device sites to assess infection risk and quality improvement. Request a Vascular Access Device Site Audit today!