From Institutional Change to Broader Advocacy- My Journey in Policy Understanding

From Institutional Change to Broader Advocacy- My Journey in Policy Understanding

Hello,

Thank you for sharing your post. In ICUs, physicians generally prescribe vasoactive medicines while the preparation, initiation timing administration, titration, and weaning of the same are under the nurses’ management. Once the preparation of the vasoactive infusions is complete, the time it actually is initiated or commenced is dependent on the prioritization by the nurse regarding the patient’s care and also on the organizational factors such as intravenous access suitability, limitation of the workforce, and equipment availability.

Because of the vasoactive medication’s short half-life, the medications are often administered to the patients as continuous infusions. The patients are those who are hemodynamically compromised and unable to have stable cardiac function or blood pressure because of cardiac failure, trauma, sepsis, or other autonomic dysfunction (Nogueira et al., 2015). Although vasoactive medication is critical in the maintenance of perfusion to vital organs such as the heart and brain, among others, they are also known to contribute to complications in patients such as necrosis, limb ischemia, long-term peripheral neuropathies, stroke, and cardiac arrest (Hazardous Substances Data Bank, 2010). This potential for risk is an indicator for nurses to practice the safe management of drugs.

That said, some studies have shown that providing education and also standardizing practices can support nursing practice in vasoactive infusion preparation while reducing medication errors risk (Jung et al., 2014; Melo et al., 2016; Tan et al., 2017). Additionally, Häggström et al. (2017) concept analysis on the way that nurses learn the management of vasoactive medications indicated the skills that are specifically needed when titrating vasoactive infusions, and these included the ability for technological data analysis and evaluation, adaptation to changing situation on the clinical setting and remaining calm throughout the process. Further, the researchers identified the practical and theoretical knowledge that was needed to encourage the development of critical thinking skills necessary for safe clinical practice development when nurses are learning how to manage vasoactive medications.

References

Jung, B., Couldry, R., Wilkinson, S., & Grauer, D. (2014). Implementation of standardized dosing units for i.v. medications. American Journal of Health-System Pharmacy, 71, 2153–2158. https://doi.org/10.2146/ ajhp140046

Melo, E., Cavalcante, H., Marques, A., Ferreira, A., Ferreira de Abreu, M., Lima, V., & Garces, T. (2016). Nurses on knowledge of vasoactive drugs used in critical patients. Journal of Nursing UFPE On-line, 10, 2948–2955

Tan, S., Said, M., Rahman, R., & Taha, N. (2017). The effect of education intervention on parenteral medication preparation and administration among nurses in a general intensive care unit. Journal of Pharmacy Practice and Research, 47, 8–15. https://doi.org/10.1002/ jppr.1203

Häggström, M., Bergsman, A., Månsson, U., & Holmström, M. (2017). Learning to manage vasoactive drugs–A qualitative interview study with critical care nurses. Intensive and Critical Care Nursing, 39, 1–8. https://doi.org/10.1016/j.iccn.2016.09.002

Hazardous Substances Data Bank (2010). Bethesda, MD: U.S National Library of Medicine. Retrieved from https://toxnet.nlm.nih.gov/ newtoxnet/hsdb.htm

Nogueira, L., Padilha, K., Silva, D., Lança, E., de Olivera, E., & de Sousa, R. (2015). Pattern of nursing interventions performed on trauma victims according to the Nursing Activities Score. Revista da Escola de Enfermagen da USP, 49, 28–34.

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

Discussion Response

REFERENCES WITHIN 5 YEARS

I learned a great deal throughout these last few weeks. I, unlike many of the other students in this class, never had a class on policy or political advocacy. I have had some experience with challenging and changing policies while I was a Quality Director, but only at the institutional level. I really hadn’t given much thought to policy beyond that until this class. It was eye-opening to participate in this project and witness how this works first-hand.
In addition to myself, the members of my group are Jayahmie Tolentino, Lawrence Umaming, and Susan Vasquez. We interviewed nurse leaders from a few different national nursing organizations. We decided to complete our project on policy advocacy at the regulatory level, which affects every institution nationwide. We chose a policy initiative championed by the American Association of Critical Care Nurses (AACN), the ambiguity of regulations surrounding vasoactive medication titration in critical care units (AACN, 2020). It is not uncommon in critical care units for patients to be managed on vasoactive medication. In the case of a patient becoming hemodynamically unstable, these medications need to be titrated often and in a hurry. After hearing from nurses in the field and examining the published evidence, the AACN found that because of the way the regulations were written regarding medication titration order sets and documentation requirements, critical care nurses found themselves in a bit of an ethical dilemma (Davidson et al., 2019). They would either have to titrate to the desired effect and then call the physician for the appropriate order to match where they ended up (which is essentially falsifying charting) or wait until they spoke to the doctor directly causing a delay in care (which is morally wrong) (2019). The AACN then reached out to The Joint Commission (TJC) and developed a collaboration to clarify the regulatory language (AACN, 2020). The resulting policy change allowed nurses to stay within the regulations but also treat their patients effectively in an emergency.

References:

Discussion Response

American Association of Critical Care Nurses. (2020). Expectations for implementing
medication titration orders. https://www.aacn.org/nursing-excellence/nurse-stories/expectations-for-implementing-medication-titration-ordersDavidson, J. E., Marshall, M. F., & Watanabe, J. H. (2020, January). Policy impact: When policy fails. Nursing Forum (Vol. 55, No. 1, pp. 37-44).