UCSF ADVANCED PRACTICE NEWSLETTER
August 2019
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CELEBRATING PROFESSIONAL
NURSE PRACTITIONERS
NURSE ANESTHETISTS
PHYSICIAN ASSISTANTS
NURSE MIDWIVES
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WE ARE MOVING AWAY FROM THE TERMINOLOGY, ADVANCED HEALTH PRACTITIONERS FOLLOWING A DECISION BY THE NOW APP ADVISORY BOARD. ALL THE UCs IN OUR SYSTEM USE ADVANCED PRACTICE PROVIDERS AS DOES BCHO AND MOST OF THE UNITED STATES. WE WANT TO ALIGN UCSF HEALTH WITH ALL THOSE SYSTEMS. WE HAVE ASKED FOR LANGUAGE TO BE SLOWLY CHANGED TO APP FROM AHP AS A RESULT OF THE DECISION.
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IN THIS ISSUE
Highlighting APP Practice at UCSF Health
Krista Kuchta, PNP BCHO
APP UPDATES
Maternal Health Article
APP Practice Legislative Change in Hawaii
NP and PA Friendly States
Expectations for for PA Faculty Degrees
Links to other UCMC's APP Practice
First Ever UCSF Health APP Grand Rounds
Cultivating Moral Resilience - Sign Up
Asian Health Symposium - Sign Up
NPS Data Sharing
Inpatient Documentation Workflow and Workflow Compliance
APP Academic Stipend
BRN Important Updates
Medi-Cal SPA Time Study for Ambulatory Providers
UCSF APP Chatter Instructions
New AHP AHA Re-Certification Workflow
Schwartz Rounds
GME Grand Rounds
New APPs to UCSF Health for the 9th Cohort in 2019
Advisory Board Minutes - June 2019
California Healthcare News
UCSF Health Events Calendar
Center for the Enhancement of Communication in Healthcare
True North Metrics
APP Students at UCSF Health
Sharing your Expertise across the State and Nation
Caring for the Caregiver
SON Preceptor Opportunities and UCSF Health Preceptor Training
RECOGNITION, PUBLICATIONS, AND PRESENTATIONS
Ryan Wilson, PA and Elliazar Enriquez, LVN
Mary Lesh, NP
RESOURCES
Fun Discounts for UCSF Employees
Pager Box Update
2018/2019 AHP Advisory Board
Required Training in LMS
Face Card Process
How To Correct The Staff Directory
APP Resource Manual Link
Adding New Privileges
Scope Of Practice Details
Licensing and Certification Responsibilities
CURES Sign Up for Scheduled Medication Prescribing
BRN Link
DEA
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HIGHLIGHTING THE ADVANCED PRACTICE PROVIDERS
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Article by: Krista Kuchta, ACPNP at BCHO
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Hello from BCH-Oakland! For those of you who have not had the opportunity to visit us here in the East Bay, we are excited to share more about our hospital and our amazing team of over 100 Nurse Practitioners and PAs that call BCH-O their clinical home.
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Welcome all the advanced practice providers at BCHO to the broader APP community at UCSF Health
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Children’s Oakland was originally
founded in 1912 by East Bay women's groups with over 100 years of service as an independent, free-standing, not-for-profit pediatric Hospital. We have had many different names over the years but we are proud to now be united with our UCSF Mission Bay Colleagues to serve the pediatric patients throughout California.
BCH-Oakland maintains its original mission that no child is ever turned away because of inability to pay. We are one of the busiest pediatric medical centers on the west coast with more than 200,000 outpatient visits and, on average, provide comprehensive care for over 10,000 inpatient admissions yearly. Some of our unique service populations include: being a state-designated referral center for high-risk newborns in Alameda and Contra Costa counties, Child Development and Mental Health ambulatory services, nationally recognized Cancer & Blood Diseases Center, and BCH-Oakland is one of only five ACS verified Level 1 pediatric trauma centers in California. Our APPs are utilized in all these clinical practices and specialize in over 20 other pediatric sub-specialties that serve in the hospital and clinic settings.
Our recent affiliation with UCSF has afforded our APPs the opportunity to cross campuses and serve patients on both sides of the bay. We look forward to our continued APP collaboration in growing our practice, expertise, and access to care.
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Opinion |
July 7, 2019
Maternal health matters after birth. We need ‘fourth trimester’ care - Perspective
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By Esther Laury, for the Inquirer
Courtesy of Esther Laury
Pregnancy should be a joyous occasion. Yet the experience of pregnancy for a woman can be wrought with great concern for herself, and for her growing fetus. Since childbirth is when the frequent maternity care and the frequent appointments end, health-care professionals and women alike have rising concern about what happens to women during the postpartum period.This is a story of my first pregnancy. It is also a call to action for additional increased assessments of women during the postpartum period.
As a first-generation college student, I’d earned a Ph.D. in nursing science, married a wonderful man, and was on the cusp of a budding career. I’d done it: I’d accomplished the American Dream.
Then I learned I was pregnant. What lay ahead was the wonderfully transformative and empowering journey of motherhood – as well as the alarming disappointment of navigating the U.S. health-care system.
Traversing the health-care system should have been a cinch. I am a Ph.D.-prepared nurse, with knowledge about disparities in care. I was also diagnosed with multiple sclerosis 15 years ago, so I have years of experience in navigating the health-care system. My expectations of care and the reality of the care I received were grossly incongruent, because of the current policies that shape how and when women receive postpartum care.
After my child was conceived, I received nine months of meticulous prenatal care. During this time, I felt special and appreciated as a woman. After my son was born, we received round-the-clock care in the hospital.
Then we were discharged. Discharge marked the end of meticulous care for me.
Swollen legs, extreme abdominal cramps, high blood pressure, limited access to care, and unanswered questions colored my postpartum experience. I did not feel special anymore. I felt confused, abandoned, and scared. All the meticulous care once lavished on me had disappeared. Now, I was fearful of a deep vein thrombosis and possible postpartum onset of preeclampsia.
Anxious for help, I called my obstetrician’s office several times to schedule an appointment, but was denied, because I did not have signs and symptoms of a uterine hemorrhage. Instead, I was told to go to the emergency room. I have multiple sclerosis, had given birth less than a week prior, and wanted to be seen by someone who knew me. But I was also desperate. So I went to the emergency room, where I finally received the care I so badly needed.
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After several diagnostic tests, I was diagnosed with a urinary tract infection and received antibiotics. I went home relieved but frustrated. I’d received the attention that I needed and deserved, but I had been essentially ignored by my obstetrician’s office.
My experience is not rare, particularly among black women. Today, 18 in 1,000 who give birth in the United States
die due to a pregnancy-related issue. Pregnancy-related death among black women is 3.2 and 2.2 times higher than among white women and women of other races, respectively. As a black woman with a chronic illness who was experiencing abnormally high blood pressure and an undiagnosed urinary tract infection resulting in extreme pain, I had plenty of cause for concern
The assessment of pregnant women is a regular occurrence. Postpartum care is less frequent than prenatal care. Women with uncomplicated pregnancies are assessed approximately six weeks after birth. That single assessment marks the
beginning and end of their outpatient postpartum care.
Perhaps, as Widener University’s Tiffany M. Montgomery and I
argue in this month’s Nursing for Women’s Health journal, it is time to view the first six weeks of the postpartum period in the same manner as the prenatal period. To decrease complications in the early postpartum period, the American College of Obstetricians and Gynecologists recommends that care in the fourth trimester include:
1. Regular ongoing care instead of the traditional single postpartum visit.
2. Care that is individually tailored for each woman.
3. First postpartum visit within three, not six, weeks of birth.
4. A final comprehensive postpartum visit no more than 12 weeks after birth.
Women should know they are not alone in their postpartum recovery. They should know that maternity health-care providers are just as committed to women’s healthy postpartum recoveries as they are to women’s healthy pregnancies and healthy deliveries. For the sake of social justice and decreasing the significant racial disparities in maternal mortality and morbidity, health-care providers must realize the importance of fourth-trimester care.
– Esther Laury, Ph.D., R.N., is an assistant professor at Villanova University.
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July 18, 2019
Hawaii Legislation Repeals Physician Chart Reviews for Practicing PAs
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Which States Are the Most NP- and PA-Friendly?
Posted on: July 18, 2017
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The American
healthcare system
is complex. It has plenty of benefits for those who want to practice medicine, but it also comes with its fair share of roadblocks and hurdles. The system gets even more complicated to navigate when states’ rights and the resulting variety in licensure requirements and regulations are factored in. This is especially true in regards to the rights and responsibilities of nurse practitioners (NPs) and physician assistants (PAs)
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Expectations for PA Faculty: Will a Doctorate Degree Be Necessary?
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WHAT IS GOING ON AT THE OTHER UCs in California
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A UC wide Advanced Practice Leadership Strategy Committee was formed a couple years ago to create a dialogue and share common processes that were more mature at some health systems than others and support each other in our collective efforts. The Committee includes members from all professions as well as senior leadership and advanced practice faculty and administrators. The following logos are links to activities at each campus that may relate to advanced practice. These may include conferences and grand rounds. You will note that some are more mature in their online presence.
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SAVE THE DATE
FOR THE FIRST INAUGURAL ADVANCED PRACTICE GRAND ROUNDS AT UCSF HEALTH ON OCTOBER 3rd 2019.
IT WILL BE LIVE STREAMED SO PROVIDERS CAN ATTEND AT MB AND PARNASSUS AND MZ CAN JOIN AS WELL. IT WILL BE FROM 12NOON TO 1P. LIGHT REFRESHMENTS WILL BE SERVED FOR THOSE IN ATTENDANCE AND WILL BE RECORDED FOR FUTURE REVIEW.
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The CME and Education Time Utilization Survey for UCSF Health APPs Results are below and information about what you are entitled to and how to use.
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Questions and Answers:
You get 40 hours per year for paid education time that is coded in HBS as EDU but it is based on percentage appointment, so prorated.
EDU is different than required education such as online modules and AHA certification which are not from your education time and coded in HBS as INHOUSE EDUCATION.
There is no common CME reimbursement across clinical service lines. You must communicate with your service to know if anything is available.
The onboarding series are required and coded as INHOUSE EDUCATION and not regular clinical time.
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Cultivating Moral Resilience in Response to Moral Adversity
Thursday September 5th
h
, 2019 from 6:00pm to 8:00pm
(Dinner served at 6:00pm, program begins at 6:30pm)
Mission Hall – Room 1401
Provider approved by the California Board of Registered Nursing, Provider Number CEP 12980 for 1 contact hour
Target audience:
Ambulatory Care & Cancer Center professionals but all are welcome to attend.
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8
th
Asian Health Symposium – Open for Registration Now!
October 10-11, 2019
For primary care clinicians, especially those who provide
care to Asian patients – Please register immediately!
Date
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October
10 - 11, 2019
(Thu and Fri)
Time:
8:00am – 5:00pm
Place
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San Francisco Marriott Fisherman's Wharf, 1250 Columbus Ave, SF, CA
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2019 Net Promoter Scores for UCSF Health as a "Place to Work" and "Place to Come for Care"
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Despite our many advances and improvements, we continue to have more work ahead to create an engaged and supported AHP workforce. For 3 years we had steady improvement of engagement scores but we slipped a little in 2019. The adjacent slide is a high level snapshot of the data for all West Bay AHPs and I will be sharing more detailed information by service soon. I might refer to this as the plateau of my 3 year tenure. You will see the data for BCHO AHPs added for the first time.
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Updates regarding Inpatient Documentation and APEX revision to Ambulatory Documentation
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We are going to pilot a change in the current dot phrase appearance in a couple Pediatric settings first then share the new workflow with all the inpatient settings and finally move to ambulatory last, given we have an ambulatory workflow that generally works. The Office of the President Audit Office is going to scrutinize our utilization of compliant workflows. I ran a report for the month of June 2019 and we had 2436/12559 total AHP encounter types that were not compliant. This is about 19% non-compliance and we need to get to between 5 -10% compliance. Admittedly the report likely has some flaws but I request that every AHP provider please attempt to incorporate the current smart phrase into all encounter types
in ambulatory settings. We will start reaching out to providers to remind them to use the smart phrase.
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I wanted to prepare you a change in documentation that will provide greater clarity to coders for independent work and capture all the inpatient work AHPs provide, that remains primarily hidden from view. It is important for AHP providers of care, to document their care visibly. This workflow will resolve hidden clinical care. You will continue to be able to incorporate into your template notes as is current practice. The choices of shared or independent visit types will be clearly identified boxes rather than a drop down. It will also provide an option to choose critical care documentation or not. We have a poor history of capturing billable critical care activity by all providers, which can occur in any clinical location, including ambulatory settings. It will work in any note type and is called a Smart Block.
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You must be compliant with the current
ambulatory
documentation workflow until the change occurs. Please use the dot phrase ".ahpvisittype" We are being audited by the Office of the President and will be monitoring starting this month
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The UCSF Health Office of Advanced Practice has 15 supported stipends to offset the cost of AHPs presenting at an academic conference in their specialty. Podium/poster/panel presentations will be eligible. Other requirements listed in link below.
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Jessica Brennan, NP
Lissa Gray, NP
Ada Edwards, NP
Alisa Yee, NP
Sarah Kabatt, NP
Gabriel Schwartz, NP
Mary Lesh, NP
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Maura O'Day, NP
Onica Kuch, NP
Claire Parker, NP
JacklinTong, NNP
Annika Erlich, NP
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UPCOMING BRN CHANGES AND PA BOARD EXISTING RULES
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Did you know that it is your legal responsibility to ensure the BRN has your most current contact information as a licensee of California. Please update your profile to avoid a fine.
The BRN is moving to an electronic communication strategy with its licensees. The letter to remind you about a license has ended and they are moving to a post card to remind you to update your contact information and will be moving over the next year to an email notification series to remind you to renew your license. This will occur at 90/60/30 days. You will receive no other notifications.
This is a move to reduce paper communication and waste recovery.
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HOW TO UPDATE YOUR CONTACT INFORMATION.
Follow the instructions provided, as you do it through the same process as renewing your license but choose the contact information option.
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UCSF HEALTH APP CHATTER
Our goal is to promote efficient and cohesive communication among APP's across UCSF Health. APPs are encouraged to join the "UCSF APPs" Chatter group in effort to better facilitate sharing of information and connect with other APPs. Please see the instructions so you don't miss this opportunity to keep up with other APPs at UCSF Health.
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AMERICAN HEART ASSOCIATION CERTIFICATION WORKFLOW FOR APP PROVIDERS RENEWING THEIR BLS, ACLS PALS THROUGH SAFETY TRAINING SEMINARS
They have a list of authorized APP providers. All others will be denied.
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Schwartz Rounds offer healthcare providers a regularly scheduled time during their fast-paced work lives to openly and honestly discuss the social and emotional issues they face in caring for patients and families. The focus is on the human dimension of patient care. Clinicians and staff have an opportunity to share their experiences, thoughts and feelings on thought-provoking topics drawn from actual patient cases. The premise is that health care providers are better able to make personal connections with patients and colleagues when they have greater insight into their own responses and feelings
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GME Grand Rounds - inter-professional opportunity to share experiences.
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IMPORTANT
Ambulatory APP Providers ONLY
Please complete the LMS module for this training to be included in the next time study. You will not be included in the dates listed below if you did not complete in the LMS system. Your participation will ready us for the next request from Medi-Cal.
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The dates are randomly selected and to gain this valuable source of revenue, the time sheets must be completed and returned after signature in blue ink in a timely manner. We must have an 85% participation rate.
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The following training link provides information that ALL ambulatory APPs must review to be included. ONLY APP providers that completed the LMS module will receive a link to the TIME SHEET when the next date is announced.
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APP NEW HIRES COHORT 9 2019
Please welcome these new APP professionals
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STARTING APP Cohort 9 for ONBOARDING July 2019
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THEY ARE A GROUP OF NP AND PA PROVIDERS COMING INTO MANY DIFFERENT CLINICAL SPECIALTIES ACROSS THE UCSF HEALTH ENTERPRISE AND OUR AFFILIATE PARTNERS.
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APP ADVISORY BOARD MINUTES
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CALIFORNIA HEALTHCARE NEWS
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A COUPLE ARTICLES RELEVANT TO ADVANCED PRATICE. YOU CAN SUBSCRIBE IF YOU WISH.
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Enhancing Relationship Centered Communication Skills Professional Development for Clinicians
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UCSF HEALTH UPDATES REGARDING TRUE NORTH METRICS
Includes an article on price transparency.
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For more information, contact Mitchel Erickson, NP Director of Advanced Practice
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ALL APP STUDENTS AT UCSF HEALTH FACILITIES
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All preceptors are required to ensure all students from ALL educational institutions have been vetted by UCSF prior to any educational activities, including employees. UCSF has many parts of the organization involved in this process. Their school needs an affiliation agreement with UCSF, they need health screening to be completed, they require online training for Health and Safety and APEX, and sign a HIPPA form.
Laura Frahm, RN in INEX is leading the effort to improve the on-boarding of all students and is building a portal that all schools and students must work through.
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WANT TO SHARE YOUR EXPERTISE WITH AHP COLLEAGUES ACROSS THE STATE, THE NATION, OR THE WORLD?
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MORE INFORMATION AND TO BE A PEER SUPPORTER, EMAIL THE FOLLOWING LINK.
Other Resources
:
1.
Mindfulness Mediation
2.
Gratitude Mediation
3.
Loving Kindness Meditation
4.
1-Minute Meditation (for the super-busy)
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Are you a Clinical Preceptor?
Are you interested in precepting or becoming volunteer clinical faculty?
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Presentations, Publications, Recognitions, and News
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Pathways to Weight Loss Surgery Clinic Poster Presentation:
Ryan P. Wilson, PA-C, MSPAS, MPH; Elliazar Enriquez, LVN
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Eli and I are proud to share with you all the exciting news that our Pathways to Weight Loss Surgery Clinic Poster Presentation was chosen as one of the “Top Posters” of the UCSF Health Improvement Symposium for 2019 and Ranked as one of the “Highest Ranked Improvement Initiatives” of the over 210 posters presented this year!
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She spoke at the International Thrombosis and Hemostasis Society in a presentation entitled: Musculo-skeletal Ultrasound - Professional Approach to New Therapies. Her travel was supported by the APP Academic Stipend
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Her presentation had other collaborators.
Patricia Tobase PT, DPT, OCS (Physical Therapy), Andrew Phelps MD (Pediatric Radiology) and Mary Lynch, NP Faculty in the UCSF SON.
Historically management of bleeding episodes in patients with hemophilia/bleeding disorders has been subjective, determined by pain and range of motion assessments- now being able to tailor treatment based objectively and guided by US findings. We have found in kids other causes for their c/o pain verses bleeding and also shorter treatment courses in some cases.
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RESOURSE INFORMATION AND LINKS
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UCSF EMPLOYEE DISCOUNTS AND BENEFITS FOR WORK, LIFE, AND FAMILY
Six Flags - when buying tickets enter promo code UCSF
California Academy of Sciences - when buying tickets for 20% off use promo code UCSF
SF Zoo - use discount code 75001 for $3 off adults, $2 off children with one free train or carousel ride for each ticket
Monterey Bay Aquarium - discount using Store Name UCSF1002
Travel discounts - hotels, packages, cruises. Register for UCSF Passport Discounts, search UCSF Get Away Today
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UPDATING YOUR PAGERBOX CONTACT INFORMATION IS IMPORTANT
In order for other providers to reach you or contact you outside the messaging feature in apex, pagerbox is another mechanism to utilize. This is an internal system and not available to patients. If you do not have a pager, please consider adding your contact information to the pagerbox system. You are only required to respond to pagerbox messages during your normal working hours. All Pagerbox services are now managed by UCSF IT Services.
Feel free to let me know of any problems.
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2018/2019 APP ADVISORY BOARD
Feel free to reach out to them through global Outlook
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Alisa Yee, NP
Willie Ching, CRNA
Shelley Gierat, CRNA
Jeremy Graham, NP
Jennifer Kerney, NP
Laura Kirk, PA - Chair
Maura O’Day, NP
Brandon Sessler, PA
Stacy Wong, NP
Eliana Agudelo, PA
Dana Morgan, PA
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Laura Weil, CNM
Annette Carley, NP
Gerri Collins Bride, NP
Tracy Curtis, PA
Mitch Erickson, NP
Lissa Gray, NP- Co-chair
Rebekah Kaplan, CNM
Danielle Krieger, NP
Tara Valcarcel, NP
Stacie Rohovit, NP
Michelle Klosterman, NP
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Check for any Required Training
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THE APEX SMART PHRASE FOR AMBULATORY AND EMERGENCY DEPARTMENT ENCOUNTERS
This phrase MUST be present in ALL encounter notes. ONLY this phrase will work to capture your wRVU attribution. The billing logic was designed for ONLY THIS DOT PHRASE (.ahpvisittype)
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FACE CARDS FOR APP PROVIDERS
Use the following web-link to complete the ordering process. The instructions are self explanatory. You do not pay but do need to create an account. You may upload a professional photo of your choice or use departmental professional photos for this purpose.
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Making yourself more visible at UCSF Health
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In an attempt to ensure all Advanced Health Providers are visible to the public, your patients, and your colleagues at UCSF, please check and to ensure your working title and contact information are correct. Click the link below and complete the log in process and correct what you can. If your title is incorrect then an additional step will be required as this function is controlled by HR. If you find your title needs to be corrected, email me at
mitchel.erickson@ucsf.edu
with your hire title and I will collect information in batches and forward to the correct person. The "Find a Doctor or staff member" portal update is delayed. UCSF Health is building a new web portal and is challenged with migrating data from the old platform to the new platform. Once ready, we will have capacity to add all the AHPs with photos and CV related data. We have been authorized to develop a dedicated AHP Web portal at UCSF Health. More to come.
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This link will bring you to the UC ME login page. Use the button on the far left at the bottom to access the APP Resource Manual.
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This can be completed at the UC Me page by clicking on REQUEST NEW PRIVILEGE.
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Look up your credentialed standardized procedures: Must be through VPN or UCSF computer.
Look up all the standardized procedures:
OMAG POLICIES
CIDP
FPPE/OPPE
This link will work from a any computer with/without VPN enabled using IE or Chrome.
Click on Professional Organization Links:
All prescribers of Scheduled Medications will need to register and review upon writing Scheduled Prescriptions
IMPORTANT - RELATED TO YOUR DEA LICENSE
If your DEA license was issued in another state, you need to go online to the DOJ website and change the location to California. Your DEA needs to be in the state where you practice as all state laws are different. YOU
DO NOT
HAVE TO PAY FOR DEA LICENSE OR RENEWAL AS YOU WORK FOR A PUBLIC INSTITUTION.
Very IMPORTANT message from BRN: As of Jan 1st, 2016 if you were licensed in California
prior
to March 1st, 2009 you are required to resubmit fingerprints via the new Live Scan Service. If your renewal seems to be in limbo for unclear reasons, this may be why. After Jan 2018, you will no longer receive a card license. Verification if online only.
This information was extracted directly from State organizations and agencies but does not infer any authority as to its content and you are reminded to check with your state authorities regarding statutes of practice in California.
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Renewal Applications Online
REVISED ANNOUNCEMENT REGARDING RENEWAL APPLICATIONS
Starting January 2017, DEA will no longer send its second renewal notification by mail. Instead, an electronic reminder to renew will be sent to the email address associated with the DEA registration. At this time, DEA will otherwise retain its current policy and procedures with respect to renewal and reinstatement of registration. This policy is as follows: If a renewal application is submitted in a timely manner prior to expiration, the registrant may continue operations, authorized by the registration, beyond the expiration date until final action is taken on the application.
DEA allows the reinstatement of an expired registration for one calendar month after the expiration date. If the registration is not renewed within that calendar month, an application for a new DEA registration will be required. Regardless of whether a registration is reinstated within the calendar month after expiration, federal law prohibits the handling of controlled substances or List 1 chemicals for any period of time under an expired registration.
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If you have any suggestions regarding content or additions to the monthly newsletter, please send them to: (submission deadline is 1st of each month)
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