Milwaukee VA Medical Center
Nurse scientist co-authors standards manual
When someone says, “I wrote the book on it,” referring to some area of expertise, that person is usually just blowing smoke.
But when it comes to infusion therapy, Milwaukee VA Medical Center nurse scientist Mary Hagle literally did write the book on it.
The latest edition of “Infusion Therapy Standards of Practice” includes Hagle as one of 11 co-authors, and her research is cited in a number of entries.
“It’s a labor of love,” Hagle said of working on the manual, which she does for no pay and on her own time. “This is a professional contribution, and a lot of us do it on our own time. It’s a privilege and an honor.
“We want things done at the right frequency and for the right reason. We really look at the evidence and what’s needed to keep the patient safe.”
Infusion therapy is the act of giving a patient fluids or medication directly into their veins – most everyone knows it as getting an IV.
She said about 80 percent of patients admitted to a hospital get infusion therapy of some sort, and that’s been the case for many years.
However, as medicine continues to grow and evolve, so too does infusion therapy. Researchers, nurses and physicians are continually examining standard practices, identifying new ways to make the practice better while also looking to decrease adverse incidents.
“Every patient who requires infusion therapy has unique circumstances, but common goals,” writes Clair M. Rickard in the foreword to the manual. “All patients desire safe, effective and comfortable treatment, delivered in a caring and respectful way.”
It’s important to note that Rickard is from Brisbane, Australia, because the manual isn’t just for the United States but for the worldwide health community. And it contains contributions from health-care workers in many other countries besides the United States.
“They’re doing great work (in Australia),” Hagle said, noting she worked with one of the Australian teams. “You get different perspectives.”
“Infusion Therapy Standards of Practice” is revised every five years, and Hagle served as a co-author on the 2011 and 2016 revisions as well.
It serves as a valuable resource, akin to a thesaurus for writers or car manuals for mechanics.
“Those standards are integrated into our policies and procedures … as part of our practice,” she said, noting nurses can access the manual electronically and quickly see the evidence behind a recommended practice.
Hagle spent more than 20 years as a clinical nurse specialist in cancer care, and as part of the Oncology Nursing Society, she developed guidelines for the administration of chemotherapy.
That brought her to the attention of the Infusion Nursing Society and work on the manual in 2011.
“They asked me if I would like to participate, knowing my cancer background,” she said, noting that at a previous hospital she was asked to revise the IV policies for the four hospitals within that system. “I knew I was making things better for patients at all four hospitals,” she said. “I felt gratified then that I knew all nurses had the best evidence, and we were providing the best care.”
Over her career, Hagle has transitioned from bedside nurse to clinical nurse specialist to nurse scientist. But she still finds time to connect with patients while also working to ensure best practices for nurses and patients.
“I love working with patients,” she said. “As a bedside nurse, it’s you and the patient. As a clinical nurse specialist, I’m supporting that staff nurse, that bedside nurse. And I loved doing that – teaching newer nurses, updating policies and consulting with nurses on problems.”
So what’s new in infusion therapy? Hagle said one of the major changes is how long a peripheral IV – typically placed in the arm or the back of the hand – can remain.
Originally, it was recommended that those IVs be replaced every two days. Gradually, that length of time was increased to four days.
But now, Hagle said evidence points to leaving those IVs – especially those placed in an arm -- in place for as long as needed, or until the patient goes home.
“Most of them stay in anywhere from three to seven days. In the literature, they’ve been in as long as 10 to 12 days,” she said. “That’s good for our elderly patients who have such frail arms and veins. If we get a good IV, we want to keep it in.”
“We want things done at the right frequency and for the right reason. We really look at the evidence and what’s needed to keep the patient safe.”Mary Hagle
Hagle noted that IVs are constantly checked – every eight hours, at a minimum -- and are changed if warranted by problems or adverse reactions.
But the fewer pokes, the better, she said.
“Each time we do a stick, you’re opening up another hole for an infection and bacteria to crawl in,” she said.
Work informs research
Besides reviewing the research of others, Hagle uses her own work in the Milwaukee VA Medical Center to further infusion therapy research.
She said she often consults with the hospital’s IV team or new nurses to learn about questions and concerns.
“I can bring that forward to my co-authors, or I’ll tackle it myself, which I’ve done numerous times,” she said. “My work here with nurses influences questions we might look at for the standards.”
In fact, Hagle said she recommended Milwaukee VA nurses who are experts in infusion therapy to assist as reviewers for the manual.
Hagle said having her name on the book is a big responsibility, saying she often gets emails, which can lead to new research or practices.
“Being able to improve practice based on evidence – that’s what my whole career has been about,” she said.
In addition, she takes pride in representing VA.
“It’s important to have VA represented,” she said. “We have over 70,000 registered nurses and 140 medical centers. That’s a lot of patients we touch, considering 80 percent of our patients get an IV. We represent a major population that we need to keep safe.”