The Art and Science of Infusion Nursing The Art and Science of Infusion Nursing
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Copyright © 2016 Infusion Nurses Society Journal of Infusion Nursin
M E T H O D O L O G Y F O R D E V E L O P I N G
T H E S T A N D A R D S O F P R A C T I C E
Role of the Standards of Practice
Committee
The Standards of Practice Committee brought together a
group of professional nurses with a wealth of clinical
knowledge and expertise in all the domains of infusion
therapy. They initially met to review and agree on the
evidence rating scale and to discuss methods and sources
of searching for evidence. They also agreed on how to
evaluate types of evidence. Throughout the Standards
review and revision process, the committee met regularly
by phone, reviewed each standard in detail, and came to
consensus on the final strength of the body of evidence
rating for the final draft of the Infusion Therapy
Standards of Practice . This draft then was sent to over 90
interdisciplinary reviewers who are experts in the field,
comprising all aspects of infusion therapy. Sixty reviewers
provided in excess of 790 comments, suggestions, refer-
ences, and questions. The committee addressed each com-
ment and made revisions to the standards, seeking addi-
tional evidence as needed. Each standard had a final
review by the committee for agreement on the content,
evidence, recommendation, and rating.
The standards are written for clinicians of multiple
disciplines with various educational backgrounds, train-
ing, certification, and licensing, including licensed inde-
pendent practitioners, because infusion therapy may be
provided by any one of these individuals. The premise is
that patients deserve infusion therapy based on the best
available evidence, irrespective of the discipline of the
clinician who provides that therapy while operating
within her or his scope of practice.
Searching for Best Evidence
A literature search was conducted for each of the stand-
ards of practice using key words and subject headings
related to the standard. Searches were limited to
English-language, peer-reviewed journals published
between 2009 and July 2015. Databases included, but
were not limited to, Cochrane Library, Cumulative
Index to Nursing and Allied Health Literature
(CINAHL), MEDLINE, PubMed, and Web of Science.
The references of retrieved articles were reviewed for
relevant literature.
Additional sources of evidence included, but wer
not limited to, the Web sites of professional organiza
tions, manufacturers, pharmaceutical organizations
and the United States Pharmacopeia (USP). US site
included the US Department of Health and Huma
Services for national centers, such as the Agency fo
Healthcare Research and Quality (AHRQ), th
Centers for Disease Control and Prevention (CDC)
and the US Food and Drug Administration (FDA); an
the US Department of Labor (eg, Occupational Safet
and Health Administration [OSHA]). Classic paper
were included as needed. On occasion, textbook
served as sources of evidence when clinical researc
and scholarship are widely accepted, such as fo
anatomy and physiology. Because standards of prac
tice are written for all health care settings and al
populations, evidence was included for each of thes
areas as available.
Evaluating Evidence
Each item of evidence is evaluated from many perspec
tives, and the highest, most robust evidence relating t
the standards of practice is used. Research evidence i
preferred over nonresearch evidence. For research evi
dence, the study design is the initial means for ranking
Other aspects of evaluation of quality include sufficien
sample size based on a power analysis, appropriate sta
tistical analysis, examination of the negative cases, an
consideration of threats to internal and external validity
Research on research, such as meta-analyses an
systematic reviews, is the highest level of evidence. Onl
specific study designs are acceptable for a meta-analysis
and with its statistical analysis, this is the most robus
type of evidence. Single studies with strong researc
designs, such as randomized controlled trials (RCTs)
form the basis for research on research or a strong bod
of evidence when there are several RCTs with simila
findings. Other research designs are needed as well fo
a developing area of science and often before an RCT
can be conducted. A necessary and foundational stud
for learning about a question or a population is th
descriptive research project, but because of its lack o
research controls, it is ranked at a low level of evidenc
for clinical practice.
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