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Erik Samarpan
Standards of practice

What is the definition of Standards of Practice? It seems confusing. INS and CDC have published standards. AVA and ONS have positions and guidelines. Institutions have policies that define practice.

Does anyone have suggestions to assist with clearing this up for me?

An example of an area of confusion is with lab draws from PICC's. I have read that coag's can not accurately be measured from a specimen collected from PICC lines, even with excellent flushing technique. If organizational policies simply state that labs can be drawn from PICC lines, does this policy create a conflict with "established standards"?

You can find the answers in

You can find the answers in the chapter on Legal Aspects of Infusion Nursing in Infusion Nursing- An Evidence-Based Approach. Also the chapter on Quality Management in the same book.

A standard is a legally authoritative statement promulgated by the profession. Attorneys regard standard of care as what any reasonable and prudent nurse would do in the same or similar situation. Standard of care is the authoritative statement about what the patient should expect from the care. Standard of practice is what the nurse will perform. For any standards statements, there are no shades of gray. It is either a yes or no for compliance with a standard.The Infusion Nursing Standards of Practice includes the standard statement and practice criteria to provide additional information about meeting the standard. ANA and other organziations write standards.

Guidelines are different. This is a recommended process of care for a defined group of patients. CDC writes guidelines, not standards.

A position paper is the official position of an organized group of professionals.

All of these documents are based on evidence. Guidelines are usually graded or ranked according to the strength and type of evidence.

All documents should be used to create policies and procedures. All documents are used in a legal case.

Your example is a good one but your approach is not evidence-based. The studies show that any catheter, not just a PICC, that has been exposed to heparin of any dose will not yield a blood sample where correct values on coagulation tests can be obtained. Your written policies and procedures should reflect these studies as well as the published standards and guidelines. So yes, your policy would be in conflict with the published documents and other forms of evidence. This will be a problem clinically because treatment will not be based on accurate data. If this produces a serious problem for the patient, they can bring a lawsuit. The merits of the case would be determined by experts hired to review it. If not settled, it goes to a jury trial where the jury decides which experts to believe. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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