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Table 2 Stakeholder Perspectives from the Organizational Ethics Consult.

From: Self-injecting non-prescribed substances into vascular access devices: a case study of one health system’s ongoing journey from clinical concern to practice and policy response

Patient Stakeholders

• Identify personal experience with self-injection of non-prescribed substances into vascular access devices (SIVAD), but an incomplete awareness of risks, and interest in more education

• Endorse benefits of SIVAD that may not be valued by healthcare providers (e.g. avoiding “high risk” venipuncture, better management of drug withdrawal, and stabilizing substance use disorder enabling completion of medical treatment)

Nursing Stakeholders

• Indicate SIVAD harm reduction appears “common sense” and patient-centered

• Some already engage in SIVAD harm reduction, while others are uncertain and desire more education and organizational guidance and support

• No nurses interviewed expressed objection to SIVAD harm reduction but noted that some nurses will object based on moral or philosophical grounds, or because of lack of experience or evidence

Physician Stakeholders

• Desire organizational support should a legal challenge arise following an adverse event

• Infectious Diseases physicians endorse experience with infectious complications of SIVAD

• Some believe that SIVAD should prompt vascular access device removal and switch to oral antibiotics

• Some believe that shared informed decision making would be helpful in patients who SIVAD

Risk Management and Professional Practice

• Documenting a discussion on anticipated risks of SIVAD would satisfy the need for informed consent, and could mitigate legal risk to individuals and the organization

• Legal liability coverage for nurses is provided by the organization

• Harm reduction interventions are within nursing scope to provide