Leading Change for Safe IV Infusion Practices
Summary
Through the RNAO Advanced Clinical Practice Fellowship program, I had the opportunity to develop my leadership skills through the process of leading organizational change and mobilizing a change team within SickKids to support evidence-based practices for IV infusion safety. At SickKids, IV infusion safety is an organizational priority aligned with the strategic direction of ensuring quality and accountability in everything we do. Further, in partnership with Solutions for Patient Safety, SickKids has the goal of eliminating preventable harm, including those caused by adverse drug events (ADEs). The ask for this project stems from recommendations from the analysis of safety events related to the inversion of IV infusions that caused patient harm. The project focused on evaluating current best practice. As a Clinical Nurse Specialist in Interprofessional Practice, I undertook the challenge of leading this project in collaboration with -practices that guide IV infusion safety. Using literature and benchmarking, an evidence-based practice bundle was developed that includes a process for IV-line setup and pump programming, IV-line tracing, IV-line labelling, and the use of tools that support task sequencing in the procedure.
Outcomes
During the fellowship, I was not only able to learn about the change management process, but also the leadership skills needed to support the work and, more so the change. The fellowship was centered around the work of this project, but truly focused on my professional development as a nursing leader and afforded time for self-discovery that would not have otherwise been possible. The fellowship allowed me to embark upon a journey of personal and professional development as I grow and hone my leadership skills as I embody the role of a Clinical Nurse Specialist at SickKids. Through each task that was needed to carry the project forward, I was able to learn about what it means to be a change leader by building relationships and collaborating with stakeholders and understanding readiness for change. I was able to evaluate and describe how local pilot findings can be applied to inform scale and spread for systems-level change. This required connecting with stakeholders, subject matter experts, and hospital leaders for endorsement, and as a result, I have continued to increase my confidence in connecting with key stakeholders. As I progressed through the goals, I was able to deepen my knowledge as a change leader, further developed my knowledge of quality improvement methodology and continue to strive to be effective in change leadership by developing a proposal for the spread of this change across the organization.
The practice change associated with the fellowship has affects for nursing practice, for patient outcomes, and overall metrics for safety and quality for the organization. The practice bundle supports safer IV infusion practices for nurses and better outcomes for patients. However, change readiness has been crucial throughout the process recognizing and balancing the pressures on bedside nurses with the need to align with best practice. The project will continue beyond the fellowship as the implementation of the practice bundle moves across the organization. Evaluation and monitoring measures have been developed into the project plan which will support assessment of a sustained practice change.
Overall experience
Building strength in myself as a leader has shed light on how I have changed from the mindset of a staff nurse to that of a leader with expertise in evidence-based nursing practice. Reflecting on the experience of the fellowship allowed me to genuinely see the growth I have already had during my nursing career. I will be forever grateful for the learning experience that the RNAO Advanced Clinical Practice Fellowship has provided me. Without the allotted time and support of my mentor, Connie Cameron, I would not have been able to dedicate myself so deeply in the journey of leading change. The leadership within the Collaborative for Professional Practice at SickKids continues to support this work as it evolves and investing in me as a nursing leader as the road does not end here.
