1. Alexander, Mary MA, RN, CRNI(R)

Article Content

INS has been informing you about the new Centers for Medicare & Medicaid Services (CMS) rule on healthcare-associated infections for more than a year now. CMS has ordered that hospitals no longer be reimbursed for infections acquired in the course of a patient's hospitalization. Given this challenge, hospital administrators are now reviewing their budgets and developing solutions for improving patient outcomes. But this rule also presents new opportunities for infusion nurses to build Infusion Teams, whose skill and expertise can reduce the number of catheter-associated infections and increase positive patient outcomes.

Figure. Mary Alexand... - Click to enlarge in new windowFigure. Mary Alexander, MA, RN, CRNI(R), CAE, FAAN INS Chief Executive Officer

As we know, nearly all hospitalized patients receive some form of infusion therapy during their stay. Some patients continue receiving infusion therapy after discharge, either at home or in an alternate care setting. The most effective way to maximize a patient's ability to receive infusion therapy for the length of the prescribed treatment is to implement Infusion Teams in healthcare organizations. Infusion Teams employ expert infusion nurses who perform procedures efficiently, thereby reducing labor and material costs while decreasing the average length of stay and the incidence of infusion-related complications. The generalist nurse spends more time and uses more materials than the infusion nurse performing similar procedures. Therefore, the infusion nurse is more resourceful and productive in performing these procedures, leaving more time for the generalist nurse to attend to other aspects of patient care. Because the infusion nurse is considered a clinical expert, the healthcare organization is seen as adhering to professional and legally recognized standards of practice.


Cost is an obvious and critical element in implementing and maintaining an Infusion Team. The Infusion Team must be established as an important and essential asset to the healthcare organization. It must be well-managed, have documented advantages, provide cost-effective services, thereby increasing revenues, and improve patient care outcomes. Infusion Teams also take on a number of responsibilities beyond basic venipuncture. While each healthcare organization will determine the precise role and responsibilities of the Infusion Team, such duties should include:


* Development of organization-wide infusion nursing policies and procedures, in compliance with national standards and practice guidelines.


* Patient assessment, initiation of infusion therapy, and monitoring of patient response to therapy.


* Development and provision of infusion education for nursing and medical staff.


* Collaboration with performance improvement and risk management departments in the development of healthcare organization-wide and self-monitoring responsibilities; development of programs for the validation of infusion nursing activities.


* Collaboration with the infection control department to monitor and document catheter-associated complications data.



In 2002, the Centers for Disease Control and Prevention (CDC) published the "Guidelines for the Prevention of Intravascular Catheter-Related Infections," which stated: "[horizontal ellipsis]Specialized 'Infusion Teams' have shown unequivocal effectiveness in reducing the incidence of catheter-related infections and associated complications and costs[horizontal ellipsis]."1 A dedicated autonomous Infusion Team will provide consistency in infusion care and appropriate infection prevention measures because its members are more likely to be familiar with national standards of practice and guidelines, best infusion practices, and correct use of infusion-specific equipment. By employing such specialized nurses, the healthcare organization will see increased patient satisfaction, achievement of anticipated outcomes, and lowered patient morbidity and mortality rates.


It is not always obvious to administrators why an Infusion Team is cost-effective. You might have to present a justification for an Infusion Team at your healthcare facility. You will have to work with a multidisciplinary committee, collect data, project budgets showing cost savings, and write and present your proposal. (INS offers a module with step-by-step instructions on how to validate a team-the Infusion Therapy Team Implementation Module.2 Visit the INS online store at


In patient satisfaction surveys, the 2 areas that patients typically comment on are the quality of food and their IV experience. Infusion nurses play a key role in ensuring that patients have a favorable experience despite the invasive nature of infusion therapy and any fear or pain that may be associated with it. Confidence in our technical skills, combined with calming reassurance during patient interactions, alleviates most anxieties, however.


As key members of the healthcare team, we need to continue to articulate the cost-benefit of infusion teams by stating our business case to administration, demonstrating our knowledge and clinical expertise to our colleagues, while continuing to deliver patient-focused, results-oriented care that has become our hallmark of excellence.


Mary Alexander, MA, RN, CRNI(R)




1. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recommendations and Reports. 55(RR-10); 2002. [Context Link]


2. Infusion Nurses Society. Infusion Therapy Team Implementation Module. Norwood, MA: INS; 2005. [Context Link]