ADVANCED PRACTICE NEWSLETTER
January 2020
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CELEBRATING
NURSE PRACTITIONERS
NURSE ANESTHETISTS
PHYSICIAN ASSISTANTS
NURSE MIDWIVES
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As the Associate Chief of Advanced Practice, in retirement, I will continue to create this newsletter to keep you informed.
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IN THIS ISSUE
Highlighting APP Practice at UCSF Health
APP Collaboration Across Professions and Sites
by Cana Jenkins, NP, Emergency Medicine
Celebrate National CRNA Week
APP UPDATES
Future Vision for UCSF Health
New Dot Phrase Workflow
Update your Licences and Certifications Online via OMAG
Availability of Lab Coats and Uniforms for APPs
New Performance Development/Evaluation Tool for NPs and PAs
Inbox Management Plans
Urgent Need for SON Preceptors
The New UCSF Health APP Website
The Women of UCSF
The Recognize Application
RECOGNITION, PUBLICATIONS, AND PRESENTATIONS
Tom Farley, NP Manager of Adult APP Critical Care Services
Erica Wilson, NP, Supervisor of Adult APP Critical Care Services
Annika Ehrlich, NP Headache Center
Michelle Klosterman, PNP Pediatric GI Services
Laura Kirk, PA Manager in Otolaryngology
TOOLS AND NEWS
Links to other UCMC's APP Practice
BCH/BCHO Monthly Noon Conference at MB
Reminder for Providers regarding Diabetes Supplies Ordering
APP Academic Stipend
ONE GOOD THING
Schwartz Rounds
GME Grand Rounds
Medi-Cal SPA Time Study for Ambulatory Providers
New APPs to UCSF Health for the 10th Cohort in 2019
Advisory Board Minutes - October 2019
California Healthcare News
UCSF Health Events Calendar
Center for the Enhancement of Communication in Healthcare
New APP AHA Re-Certification Workflow
True North Metrics
APP Students at UCSF Health
Sharing your Expertise across the State and Nation
Caring for the Caregiver
RESOURCES
Fun Discounts for UCSF Employees
Pager Box Update
2019/2020 APP Advisory Board
Required Training in LMS
Face Card Process
How To Correct The Staff Directory
APP Resource Manual Link
UCME and OMAG Resources
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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APP Collaboration between CRNAs, NPs, and PAs from UCSF Health and the VA
by Cana Jenkins, NP Emergency Medicine
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Many thanks to the staff at the VA SIM Lab:
Rich Fidler, PhD, MBA, CRNA, NP - Director, Interprofessional Healthcare Simulation Programs; Director, Fellowship in Advanced Clinical Simulation, Senior Nurse Anesthetist
Mary Sturgeon, DMD - Simulation Fellow
Natasha Fetanatnia, RN - Graduate Nursing Student MSN Candidate 2020
Pamela Minasian, RN - Graduate Nursing Student MSN Candidate 2019
Michele Wu, RN, BSN - Volunteer
and Mercy Vigil, UCSF Health CRNA
for making this collaboration possible.
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Intuitively and empirically, it is known that good teamwork with other healthcare professionals is essential for optimal patient care. However, despite a wide range of activities, in most hospitals the main interface between the Emergency Department and the Department of Anesthesia occurs solely during the management of a critically ill patient’s airway. There is rarely time to establish rapport, much less network during these crisis situations before we unceremoniously return to our respective areas of the hospital.
This is why it was a rare treat for me to attend a continuing education dinner in January of 2019 with many CRNA’s and other Anesthesia Providers at UCSF Health. Over wine and dinner, we were able to discuss the nuanced role of the APP in both Emergency Medicine and Anesthesia and to share stories from the bedside.
I was introduced to Mercy Vigil, a seasoned CRNA with a longstanding passion for providing excellent peri-operative care. She offered to come and lecture to our ED APP group about rapid sequence intubation, and to facilitate a simulation lab to practice tracheal intubation.
Our group met together with both Mercy Vigil and Rich Fidler on November 23rd, 2019 at the simulation lab at the VA Hospital in San Francisco. We were provided didactic instruction, followed by hands on time in the simulation lab to practice a myriad of critical airway scenarios. The simulation mannequins were eerily realistic and could moan, blink their eyes, yell at us, and even get angio-edema.
Our group was thrilled to be given this cross training opportunity. Going forward, we will be shadowing UCSF CRNA’s in the OR and will continue to learn from our colleagues. Our shared encounter reminded us of the rich collaboration that the APP group at UCSF fosters.
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HELP US CELEBRATE NATIONAL CRNA WEEK AT UCSF HEALTH
UCSF Health CRNAs provided anesthesia services to 24,760 patient cases in 2019.
January 19-25, 2020
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Future Plan for UCSF Health
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Over the past 2 years, we have asked all ambulatory APP providers or APP providers who are engaged in a proportion of ambulatory services to use a dot phrase in their documentation
(.ahpvisittype). Your participation in this effort was very appreciated. Engaging all APP providers has resulted in about an 83% compliance. We have been working in the background to create a similar workflow for inpatient APP providers as well as create an auto-populate process to the note. The purpose of this documentation workflow was to ensure all providers were recognized and allocated the appropriate wRVU values to their daily clinical work. The allocation only references billable work and clearly, we all engage in other patient care that is not billable, wRVUs do not reflect the entire value of the great work APPs engage in every day for our patients but represents a proxy. We are moving to a new dot phrase
(.appnote). I have provided the new TIPSHEETs which is essentially the same workflow as currently exists but looks a little different. If your service does not auto-populate the dot phrase, simply manually type it in as you have been doing. This has already been implemented in Pediatric critical care and Neonatal services and Adult critical care. We have now engaged some ambulatory clinical services. We believe we have an APEX fix to have this automatically embedded in all note types, but we are going to trial in two practice settings first, General Internal Medicine and Rheumatology.
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If all goes well, then we may roll out this automation to all ambulatory services but initially it will be manual insertion. After ambulatory we will follow with the remaining Inpatient Services. The inpatient services will also see a critical care billing opportunity in the dot phrase populated content and you simply select Yes or No. Selecting the co-sign required button for shared visits remains necessary. You can again imbed in your smart text that you have created unique to your specialty but must remove the old dot phrase. No other physician language identifying an attending is needed with this workflow and can also be deleted from any unique smart text template you may have created. Over the past 2 years Emergency Medicine used the ambulatory workflow but will also make the transition to the new dot phrase. You will be alerted to the roll out timing; by the end of January all ambulatory and by mid-February all inpatient and emergency medicine services must move to this workflow. With the new revision of our APEX Updates and the Instance Merge with BCHO we must be completed by March 1
st, 2020.
I appreciate your flexibility as we improve and ease this documentation workflow that recognizes your contributions to patient care.
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NO NEED TO WORK THROUGH YOUR MANAGER OR MEDICAL STAFF TO UPDATE YOUR LICENSE AND OTHER CERTIFICATIONS. GO TO THE EXPIRABLES LINK UNDER RESOURCES AT THE BOTTOM OF THIS NEWSLETTER AND FOLLOW THE INSTRUCTIONS
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UNIFORM AND LAB COAT ALLOWANCE FOR APPs
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You are now entitled to order new uniforms if you wish and new lab coats via Mission Linens. Newly implemented employees and new hires will receive an initial allotment of $250 and an annual stipend allotment of $140 thereafter (stipend amounts vary based on appointment percentage). To ensure that your uniform selection is made to your liking, a uniform fitting is recommended. Please follow this link to self-schedule the Employee Apparel Fitting Appointment.
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- Click on New User/Register
- Register with your Employee ID#:
- Register with your UCSF Email Address
- Begin Shopping
- Be sure to apply your gift card allocation during check out
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NEW PA AND NP ANNUAL PERFORMANCE REVIEW TOOL AFTER 25 YEARS
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Thanks to the efforts of the Performance Evaluation Work Group of the APP Advisory Board including Laura Kirk, PA, Stacie Rohovit, NNP, Danielle Krieger, NP and others.
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UCSF Health Inbox Management
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Thank you for your commitment and tirelessness in providing outstanding care for our patients. We know that “In Basket” work brings a unique, and sometimes daunting, set of challenges. We are writing today to share with you a multi-pronged approach to improving the In Basket experience for FY2020, and to ask for your partnership.
Why focus on In Basket?
· Quality: We want to be responsive to the needs of our patients.
· People: In Basket should be a team sport, shared between clinic management, staff and providers.
· Safety: We need to assure ourselves that all results have been reviewed and acted on.
What will we work on together?
Ongoing management of In Basket.
On February 5, 2020, most In Basket messages (excluding results) will start auto-completing at 60 days (includes refill requests, telephone messages, MyChart messages, staff messages and Cc’d charts).
Click here
for full list of affected messages. Please work with your administrative staff to efficiently route In Basket items.
All our True North Boards will reflect our collective In Basket quality goals.
Reach out to Mitchel Erickson, Associate Chief of Advanced Practice if you are a per diem APP for possible extra hours of review work opportunity to resolve the backlog.
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Are you a Clinical Preceptor?
Are you interested in precepting or becoming volunteer clinical faculty?
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URGENT NEED FOR UCSF School of Nursing FNP PRECEPTORS
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Becca Neuwirth, FNP program clinical co-coordinator, is still in need of preceptors for the quickly approaching Winter quarter (early January to late March). Please contact her if you can help. She welcomes any outpatient NP practice. If you want to precept, but prefer a different program, feel free to reach out as well and she’ll put you in touch with the relevant faculty. She is of course happy for volunteers for other quarters, but is in particular need of more preceptors for Winter 2020.
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LAUNCH OF NEW UCSF HEALTH ADVANCED PRACTICE WEBSITE
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The APP Advisory Board and the Office of Advanced Practice would like you to explore the new Advanced Practice Website. This site continues to be configured for Advanced Practice and the health system. Please be patient.
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UCSF Health Calendar is now on the Advanced Practice website.
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WOMEN OF UCSF
Explore the stories, resources, and events supporting and highlighting the Women of UCSF.
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Please use the UCSF Health Recognize application to tell any staff member or provider how much your appreciate their expertise or support or guidance. It is free and easy and meaningful to the recipient. It functions through MyAccess.
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Presentations, Publications, and Recognition
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Thomas Farley, NP has been the APP Manager in the Adult Critical Care division for many years and is moving into the newly created Director position to support the day to day operations and expand the UCSF Health APP Fellowship Program (currently open to NPs). For the past 5 years, following years of preparation, Tom and Kerry Decker have been managing this program with minimal support while continuing in their respective clinical and administrative positions. Through the support of Sheila Antrum and a recognition of the value the APP Fellowship Program has to our organization in ensuring a stable and clinically prepared APP workforce, we were able to create this opportunity. Tom will shepherd the program into the future by identifying areas of workforce need and maintaining the programs accreditation and working closely with the UCSF School of Nursing for opportunities and opening the fellowship to other professions.
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I would like to share the promotion of Erika Wilson, NP to adult critical care nurse practitioner supervisor. Erika has been a nurse practitioner in adult critical care at UCSF Health for 7 years. During her tenure at USCF Health, Erika has frequently been recognized for her outstanding clinical work. Most recently, Erika played a key role in organizing the first Fundamentals of Obstetrics Critical Care Support Program at Mission Bay in 2019. We are grateful to Erika for embarking on this new expanded role while continuing her expert clinical care.
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Michelle Klosterman, PNP, RD presented at the Pediatric GI conference (NASPGHAN) in Chicago in October and American Pancreas Association conference in Maui, HI in November , 2019
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She is pictured with her poster at the Pediatics GI conference (NASPGHAN) in Chicago in October and again at the American Pancreas Association conference in Maui, HI in November with the assistance of the APP Stipend.
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Annika Ehrlich, NP
UCSF Health Headache Center
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Member Spotlight
January’s Member Spotlight in the American Headache Society, Ehrlich highlights the importance of the Nurse Practitioner’s role in migraine care
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Her leadership and energy will be missed.
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Transition for Laura Kirk, PA
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Dear UCSF APP colleagues,
I have accepted a leadership position in the Office of Advanced Practice at UT Southwestern in Dallas, Texas. I was born and raised in Texas, and it is bittersweet to leave San Francisco, (most especially each of you- my colleagues and community at UCSF!), to return there. My last day at UCSF will be February 12.
Over my 11 year tenure here, the work I have witnessed us do collectively as APP clinicians and leaders to develop our presence, value, and role is immense and will only continue! I look forward to hearing of UCSF APP developments over the months and years to come. And I will deeply miss collaborating in person with you all (or y'all, as we say in Texas). Please do stay in touch –
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ADVANCED PRACTICE AT UC Medical Centers 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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BCH/BCHO Noon Conference
Monthly Education Meeting with light refreshments at Mission Bay
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Reminder Regarding Education and Diabetes Discharge Supplies
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Provider education about how to order correct discharge supplies for patients with diabetes.
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The UCSF Health Office of Advanced Practice Academic Stipend
15 Academic stipends are offered each fiscal year to offset the cost of APPs presenting at a conference in their specialty. Podium/poster/panel presentations will be eligible. Other requirements listed in link below.
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Compliments of Diane Sliwka, MD
One Good Thing
Improving the Work Experience at UCSF
Issue 87
To make our True North "Our People" efforts more visible at UCSF, this communication provides a highlight of one enhancement, story or tip intended to improve the work experience for clinicians and faculty at UCSF Health.
Getting Started with Telehealth
Getting into San Francisco for a patient visit (or work) is not always easy. For patient visits that don't need a hands-on physical exam, video visits can now help patients access our care more efficiently and easily. In the five years since video visits first became available at UCSF, they’ve saved patients almost 9 million miles of commuting. As a physician, in addition to performing video visits from your clinical office, you can use telehealth to save on your own commute by offering telehealth visits from home. Learning video below.
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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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AMBULATORY APP Providers ONLY
Please complete the LMS module AT THE LINK BELOW
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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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Timestudies can be scanned or a picture of the timesheet can be emailed to Andrina Ong. They can be processed immediately where inter-campus mail can take a week.
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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 10 2019
Please welcome these new APP professionals
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STARTING APP Cohort 10 for ONBOARDING October 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.
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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 PRACTICE. YOU CAN SUBSCRIBE IF YOU WISH.
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Enhancing Relationship Centered Communication Skills Professional Development for Clinicians
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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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UCSF HEALTH UPDATES REGARDING TRUE NORTH METRICS
Includes an article on price transparency.
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For more information, contact Mitchel Erickson, NP
Associate Chief 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 APP 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.
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RESOURSE INFORMATION AND LINKS
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UCSF HEALTH EMPLOYEE DISCOUNTS AND BENEFITS FOR WORK, LIFE, AND FAMILY
IMPORTANT LINKS:
Six Flags
- when buying tickets enter promo code UCSF
Tickets
California Academy of Sciences
- when buying tickets for 20% off use promo code UCSF
Tickets
SF Zoo
- use discount code 75001 for $3 off adults, $2 off children with one free train or carousel ride for each ticket
Tickets
Monterey Bay Aquarium
- discount using Store Name UCSF1002
Tickets
Travel discounts
- hotels, packages, cruises. Register for UCSF Passport Discounts, search UCSF Get Away Today
Site for information
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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
Mercy Vigil, CRNA
Shelley Gierat, CRNA
Jennifer Kerney, NP
Laura Kirk, PA
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
Lissa Gray, NP - Chair
Danielle Krieger, NP
Tara Valcarcel, NP - Co-Chair
Stacie Rohovit, NP
Michelle Klosterman, NP
Ryan Wilson, PA
Samantha Shenoy, NP
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Check for any Required Training
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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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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: They will no longer alert you via mail regarding license expiration. They will only contact you via email. It is your regulatory responsibility to ensure your contact information is accurate and up to date and you can be fined. 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 to the DEA
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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