ADVANCED PRACTICE NEWSLETTER
October 2020
Ivette Becerra-Ortiz, DNP, NEA-BC, CPNP-PC Associate Chief of Advanced Practice &
Shelley Gierat, CRNA Chair of APP Advisory Board Communications Committee
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CELEBRATING
NURSE PRACTITIONERS
NURSE ANESTHETISTS
PHYSICIAN ASSISTANTS
NURSE MIDWIVES
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IN THIS ISSUE
Highlighting APP Practice at UCSF Health
Christopher Acebedo,DNP, ACNP-BC, CCRN
Adult Infusion Center at UCSF Mission Bay
Christopher along with coauthors were selected as the winners of the 2019-2020 Urologic Nursing Patricia Bates Novice Literary Excellence Award for their article entitled, “Discharge Opioid Prescribing Guideline for the Urologic Surgery Patient Population”
Christopher currently works in the Adult Infusion Center at UCSF Mission Bay. He diligently works towards the advanced practice clinicians’ role in the provision of quality patient care among the acutely and the chronically ill. As a seasoned clinician, his professional goal is to leverage his extensive clinical experience in directing his career towards oncology practice. He aspires to assist patients and families in achieving the highest level of health in spite of cancer diagnosis and support the oncology patient population in their journey towards wellness. Christopher is a board-certified adult advanced practice provider with extensive experience in patient management in the acute care setting, clinical education, care coordination, and translation of evidence into practice.
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UPDATE: NP AND CNM PRACTICE AUTHORITY
September 2020 both bills AB 890 (NP practice authority bill) and SB 1237 (CNM practice authority bill) have been signed by CA Governor Newsom allowing NPs and CNM’s. Under a series of compromises pushed by several lobby groups, the final bill allows nurse practitioners and certified nurse midwives to practice without physician supervision, but only after working under a physician’s supervision for a designated number of years.
We are working within the five UC Health Centers, state authorities (CA Board of Nursing), among other stakeholders to interpret the details of the bill and implement the operational changes. Furthermore, I have shared with you in the past that we are in the process of creating an APP Governance structure at UCSF to assist us in moving forward this (among other) regulatory changes at UCSF that impact APP scope of practice and patient clinical outcomes.
CONGRATULATIONS!!!…and more to come
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Join us in Celebrating
NATIONAL
Physician Assistant
WEEK
OCTOBER 6, 2020- OCTOBER 12, 2020
"PAs are Essential"
Every year from October 6-12, we celebrate National PA Week, which recognizes the PA profession and its contributions to the nation’s health.
Before it was a weeklong event, National PA Day was first celebrated on October 6, 1987 in honor of the 20th anniversary of the first graduating class of PAs. October 6 is also the birthday of the profession’s founder Eugene A. Stead Jr., MD.
This PA Week is especially significant as it falls during a global pandemic. PAs have stepped up in major ways, including serving on the frontlines of the COVID-19 response. Whatever your specialty or setting, you have put your health at risk every day to care for your patients.
During this challenging time, PAs have not only proven themselves as flexible, adaptable, and collaborative – but also ESSENTIAL. Essential to healthcare. Essential to patients.
https://www.aapa.org
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Dear Members of the UCSF Research Community,
In recent weeks, Chancellor Sam Hawgood, Executive Vice Chancellor and Provost Dan Lowenstein, Vice Chancellor Renee Navarro, Deans of the four schools and Graduate Division, and UCSF Health President and CEO Mark Laret have sent messages expressing their commitment to the UCSF Anti-Racism Initiative. On behalf of the UCSF Office of Research, I write to you to highlight some of the important work that is underway and new efforts being developed to address systemic racism in the context of our research enterprise.
Systemic racism, particularly anti-Black racism, is deeply embedded in biomedical and health research in the United States. The infamous Tuskegee syphilis study conducted by the U.S. Public Health Service and the exploitation of Henrietta Lacks in the development of the HeLa cell line are but two of the most egregious examples. At UCSF, we have not done enough to overcome this legacy and earn the full trust of people of color in our research and scientific programs. Among the ranks of our research faculty, trainees, and staff, Black, Latinx, and Indigenous and Native people remain extremely underrepresented.
The Office of Research is strongly committed to support concrete initiatives aimed at implementing transformational changes in health equity and racial justice in research. I am writing to share information about some of the anti-racism work already being conducted by stakeholders across the UCSF research community that lays the foundation for a comprehensive strategy, and to announce several new actions being launched by the Office of Research and our partners.
Establishment of UCSF Office of Research Task Force on Equity and Anti-Racism in Research
One important new action is establishing a Task Force on Equity and Anti-Racism in Research, reporting to the Vice Chancellor of Research, with an initial remit to focus on anti-Black racism. The core leadership of the task force will consist of faculty members instrumental in developing a Proposal for the UCSF Research Response to Racism, presented to me, EVCP Lowenstein, and other campus leaders on August 3:
- Malcolm John, MD, MPH (School of Medicine and Health Equity Council, UCSF Health)
- Monica McLemore, RN, PhD, FAAN (School of Nursing)
- Tung Nguyen, MD (School of Medicine and Clinical and Translational Science Institute (CTSI))
- Jason Sello, PhD (School of Pharmacy and UCSF Office of Diversity and Outreach)
- George Taylor, DMD, MPH, DrPH (School of Dentistry)
I am in the process of identifying additional individuals to serve on the task force, to ensure representation of other key sectors, such as the Graduate Division, basic science programs, staff, trainees, and community members.
The task force will steward implementation of recommendations for immediate action from the Proposal for the UCSF Research Response to Racism; develop a plan to vet, refine, and address the 6- and 12-month recommendations; and work on behalf of the Office of Research to align and create synergy among the many activities tackling equity and anti-racism that are in process within the UCSF research community and broader campus.
Aligning diverse activities and efforts
Examples of existing activities within the research enterprise include:
- The interdepartmental basic science committee for faculty recruitment formed two years ago by eight basic science departments in three schools, which has made meaningful progress in successful recruitment of scientists from underrepresented groups;
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Intensified anti-racism programs in the Graduate Division including curricular reforms, professional development, and increased recruitment of graduate students and postdocs from underrepresented groups;
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The efforts of the Differences Matter Research Action Group for Equity (RAGE) to increase the diversity of our scientific workforce and research participants;
- The Accelerating Systematic Stakeholder, Patient, and Institutional Research Engagement (ASPIRE) project collaborating with the CTSI Community Engagement Program to strengthen the role of Black community members and other communities of color in the design and conduct of research, including recently establishing a UCSF-wide COVID-19 Research Patient and Community Advisory Board (PCAB); and
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Several initiatives underway by the Precision Medicine Platform Committee, Population Health and Health Equity Program, student groups, and others to scrutinize the misuse of racial classifications in research and promote understanding of race as a social construct that has important biological and clinical consequences.
In addition to considering how to best align these many valuable existing activities in the research enterprise, the task force will facilitate coordination with Vice Chancellor Navarro and campuswide programs from the Office of Diversity and Outreach and Center for Community Engagement’s Anchor Institution Initiative.
Implementing two immediate task force recommendations
The following steps are being taken to implement two of the recommendations for immediate action:
Pilot funding for research directly addressing systemic racism and police violence
The CTSI is dedicating funding to support pilot studies investigating racism and its effects on health, including issues such as the impact of police killings of Black people on community wellbeing. We are in conversation with other intramural funding sources to generate matching funds for this pilot program.
Implementing the engagement of racially and ethnically diverse patient and community advisory boards as an expectation for all COVID-19 clinical and population health research
Profound inequities in the coronavirus pandemic’s toll on communities of color and low-income communities and the current underrepresentation of people of color in COVID-19 research make it essential to engage community members as partners in the conduct of COVID-19 research to achieve scientific validity and impact. Although many UCSF researchers have successfully adopted participatory models for COVID-19 studies, the Office of Research is affirming an expectation for community engagement in all UCSF COVID-19 clinical and population research. To make the right thing to do the easy thing to do, CTSI is augmenting funding for the UCSF COVID-19 Patient and Community Advisory Board to ensure capacity for prompt, free consultations for all COVID-19 clinical and population research studies that do not already have a study-specific community advisory group (request a PCAB consultation online and click the orange box). The UCSF Human Research Protection Program will be adding an item for protocol submissions asking about community engagement plans and if assistance is needed. We are starting by setting an expectation for patient and community engagement in COVID-19 related research, with a vision of soon extending this expectation to all clinical and population research.
We will communicate about additional future actions as the task force works with the Office of Research to refine and implement additional strategic action plans. We know that this is just the beginning of our work, and that we must invest in sustained, systemic efforts to achieve our goal of dismantling structural racism.
Sincerely,
Lindsey A. Criswell, MD, MPH, DSc
Vice Chancellor of Research
Professor of Medicine and Orofacial Sciences
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Organizational and Leadership Initiatives Around Anti-Racism & Health and Social Welfare for Under-resourced Communities
Manager/Supervisor Resources for leading through the pandemic, fiscal health, and racial justice:
· Action Labs – create a plan for your unit on each of these organizational priorities. Access resource guides and consultation with LOD
Resources for all staff for engaging in anti-racism work:
Resources for all staff on navigating the COVID-19 crisis, increasing fiscal health, and racial justice:
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Advanced Practice Provider Advisory Board
Organizational Chart
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2020 UCSF HEALTH EXCEPTIONAL APP AWARD
CALL FOR NOMINATIONS
Submissions are due no later than
Friday, October 23rd, 2020
UCSF Health will recognize its Advanced Practice Providers (APP) with the Exceptional APP Award at the 2020 Annual Honors and Awards Celebration in November. APPs will be chosen for their demonstration of UCSF Health’s PRIDE values: Professionalism, Respect, Integrity, Diversity and Excellence.
FAQs
Who is eligible?
Any practicing UCSF Health Nurse Practitioner, Physician Assistant, Nurse Anesthetist or Nurse Midwife, who has not been a past recipient AND whose primary site of practice is UCSF Health, may be nominated for this award.
Who can nominate?
Any UCSF Health employee may submit and/or second a nomination. All nominations must be seconded. Multiple nominations for individual APPs is acceptable
2019 Exceptional APP Award recipients : Iyer Gautham and Brandon Sessler
Please note, submissions are due no later than Friday, October 23rd, 2020.
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MENTORSHIP
Mentorship is the process whereby an experienced individual (the mentor) advises, guides, and supports another individual (the mentee) in the development and examination of their own ideas, learning, and personal and professional development.
Are you interested in being an APP mentor? Please complete the following survey from the APP Mentorship Committee:
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DELINQUENT OPEN ENCOUNTERS
Friendly reminder that notes need to be signed/completed ideally within 24 hours of the encounter and no later than 14-days from the encounter.
For providers who have open encounters that go beyond 14 days, your Medical Staff privileges will be suspended
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UCSF HEALTH ADVANCED PRACTICE WEBSITE |
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ADVANCED PRACTICE GRAND ROUNDS
Climate Change
and
Impacts on Health
Barbara Sattler, RN, MPH, DrPH, FAAN
Professor University of San Francisco and an international leader in environmental health
October 22, 2020
12-1:00 pm
please click link below to register
Co-sponsors:
Office of Sustainability and Education
Committee of the UCSF Health Advanced Practice Advisory Board
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Nursing Leaders please join our Greater SF ACNL Chapter meeting on October 13, 2020
Join by scanning the QR code on the flyer or clicking the hyper link below
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One continuing education credit can be earned by attending Nursing Grand Rounds, which are free to attend.The upcoming schedule is as follows:
Nov. 9, Nursing Grand Rounds: Presented by Alicen Kershaw, NP (topic TBD).
Meets from 8 to 9 a.m. in OPC Auditorium
AND
Pediatric Emergency Medicine (PEM)
will be hosting a virtual CME course on
pediatric urgencies and emergencies on October 16-17, 2020
Almost all of the speakers will be PEM faculty from San Francisco-based group and the Oakland-based group and we'll be talking about how to manage common pediatric urgencies in outpatient
We are offering a $50 rebate on the registration fee for any of our DEM APPs (any site). Please email me at: carol.chen@ucsf.edu if you are interested in registering or with any questions.
Please check out the website below for more information.
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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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UCSF DNP PROGRAM
Applications are open from July 1, 2020 through Nov. 15, 2020 for
Spring 2021 entry
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AMBULATORY PROVIDER SELF-CODING |
Sent on behalf of Josh Adler, MD, Susan Smith, MD and
Ivette Becerra-Ortiz, DNP
Thank you for your commitment and tirelessness in providing outstanding care for our patients.
We are writing to ask for your partnership on a new initiative designed to improve the transparency and feedback of our coding process, and to support UCSF’s financial recovery.
Because CMS has simplified the coding rules for in-person visits effective January 2021, and for video visits effective immediately, UCSF has decided to implement self-coding for Evaluation and Management (E&M) codes. This change will align UCSF with most AMCs and enable us to substantially reduce the cost of external coding. Key program components are outlined below.
1. During Fiscal Year 2021, all FPO physicians and APPs will transition to E&M self-coding.
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Phase 1: E&M 2021 Guidelines (CPT Level/Family – level of service, new vs. established, prolonged visits, consults), Diagnosis coding, Modifiers, HCC
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Phase 2 considerations: In-clinic procedures and/or Inpatient subsequent care days
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Out of Scope: All OR, Inpatient admit day, discharge day, and critical care coding
2. The Steering Committee prioritized practices based on criteria such as simplicity of CPT code sets and current coding accuracy. We will begin transition to self-coding in September 2020 with the initial practice.
3. A standard education, auditing and provider feedback model will support this transition.
- Providers will attend an initial training and then begin self-coding; all charges will be reviewed by a coder until a Compliance audit is cleared with >90% accuracy
- Each provider will receive a report outlining audit findings
- Ongoing education and auditing will support the provider experience
4. We will track financial, quality and provider experience metrics and evolve the program based on feedback from our providers, operations teams and learnings from peer AMCs.
Please take a couple of minutes to complete this questionnaire so we can better understand your current experience with coding and any concerns.
Thank you for engaging with this important effort – we welcome your questions and feedback.
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ONE MONTH LEFT TO GET YOUR FLU SHOT |
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Dear UCSF Community,
With the first flu patient admissions already underway in our medical center, we want to draw your attention to an important and looming deadline.
As you are aware, UC President Michael Drake, MD, has strongly encouraged universal flu vaccines for the entire UC community by Oct. 31, 2020, and is requiring all students, faculty and staff living, learning or working on any UC site to have a flu vaccine effective Nov. 1, unless they have an approved medical exemption, or disability or religious accommodation.*
We ask for your support to help keep our frontline care providers and all other faculty, staff, learners and patients healthy this fall. So far, more than 60% of our UCSF Health employees have received their influenza vaccines, along with 35% of our Campus employees. During the next few weeks, we will need to vaccinate 19,000 additional members of the UCSF community.
There are numerous options available for you to get your vaccine, including on-site flu clinics, Occupational Health clinics, your primary care provider and most pharmacies. Please visit the Occupational Health Services web site for a full list of on-site clinic locations and dates, as well as additional free options for members of UC health plans. For additional guidance, including how to submit outside documentation and a manager’s toolkit, please visit the Flu Vaccination FAQs page.
It has never been more important to get a flu vaccine. In addition to the personal risk of contracting either the flu or COVID-19, the impact of even a normal flu season on our health system could be overwhelming if it coincides with a COVID-19 surge. Your vaccination can benefit you, your colleagues and your surrounding community.
On behalf of every member of our UCSF community and the patients we are privileged to serve, thank you for doing your part and getting your flu shot.
Sincerely,
Josh
Josh Adler, MD
Chief Clinical Officer, UCSF Health
Vice Dean, Clinical Affairs, UCSF School of Medicine
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Rubi Hickson, CCNP
&
Heather Roff, CCNP
Neurocritical Care Society
Annual Conference
2020
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Rubi and Heather were both accepted for poster presentation at the Neurocritical Care: Research to Recovery 18th Annual Meeting. The Neurocritical Care Society is an international, multi-disciplinary organization whose mission is to improve outcomes for patients with life-threatening neurological illnesses. Their poster presentation topics include Cerebral Malaria in Non-endemic Areas: Case Report and the UCSF Critical Care Comfort Huddle Project.
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Erin Gasser, Critical Care Medicine NP, published an article “ Systemic Lupus Erythematosus and Critical Illness” in the fall quarterly AACN Advanced Critical Care Journal this month.
ABSTRACT: Systemic lupus erythematosus is a chronic autoimmune disorder that causes a wide range of mild to life-threatening conditions that require hospitalization and critical care. The morbidity and mortality of systemic lupus erythematosus are associated with the organ system damage caused by intermittent or chronic disease activity and with the complications of long-term and toxic immunosuppressant medication regimens. This article reviews the epidemiologic, clinical, diagnostic, and therapeutic information essential for critical care clinicians who provide care to patients with systemic lupus erythematosus.
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Acknowledgments
APPs on the Education Committee
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Lisa Hartmayer, NP
In her first year as a member and chair of the Grand Rounds subcommittee, Lisa has taken her role in stride by implementing unique ideas for APP Grand Rounds and devoting hours of planning and organizing!
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Emily Yee, NP
Continuing her commitment as a member of the Education Committee for 2 years, Emily took on the herculean task of adapting the Stipend subcommittee documents and is heading the advertising subcommittee for Grand Rounds. She frequently volunteers to take minutes at the meeting and is always the first to step up for any committee task!
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Nick Carvelli, NP
Has been instrumental in his second year as a member of the Education Committee and headlines the IT subcommittee for Grand Rounds, which has been vital in pivoting to a webinar format!
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SOME ARTICLES ARE RELEVANT TO ADVANCED PRACTICE. YOU CAN SUBSCRIBE IF YOU WISH. |
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For more information, contact
Ivette Becerra-Ortiz, DNP, NEA-BC, CPNP-PC
Associate Chief of Advanced Practice
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ALL APP STUDENTS AT UCSF HEALTH FACILITIES |
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. |
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WANT TO SHARE YOUR EXPERTISE WITH APP COLLEAGUES ACROSS THE STATE, THE NATION, OR THE WORLD? |
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APP OPEN FORUM
If you missed the APP Open Forum September 24th please click OPENFORUMRECORDING for the recording and click on OPENFORUMSLIDES if you would like to view the presentation
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I am here to support and advocate for APP's
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Senior Operations Analyst |
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