A PRN Update  March 2018

Page one message from Jessica Estes, President

What YOU Don’t Know CAN Hurt You

As a member of our professional association, would you have considered this column title a great subject for a CE program?   In the last few months, gathering information and intel for the preparation for SB 89, trying to gain full practice authority in Kentucky, it has become apparent all professions have members who are not well versed on prescribing rules and regulations, and all have some bad actors.  Across the nation, we are seeing skyrocketing numbers of opiate addictions and deaths.  We are seeing a larger than ever population with poor coping skills and major mental health issues.  For the first time in decades, we have seen maternal death rates rise and average life expectancy decrease, in part because of substance abuse.

As APRNs our first question should be, “why are these things occurring?” Our second question should be, “how can we help?”

When we look at the number of opiate addictions we are also seeing a correlating rise in regulations that are geared towards over-prescribing.  The trend is to blame prescribers for the number of opiates that are being written.  We have more tools than ever to look at our own prescribing patterns and we should be using them.  We should be running self-KASPER reports and making sure we are consistent with recommended clinical practice.   We also need to look at the prescribing practices of our peers.  I am certain if we were asked, we could all think of someone whose practices aren’t evidenced based and perhaps are concerning.   Are we reaching out to our colleagues and expressing our concerns?  Are we educating our patients on risks?  For example, when was the last time you told a patient that driving a car while using pain medications could result in a DUI?  What about looking at your own KASPER reports and making comments on how and why you have written controlled substances?  Can you justify all of the scripts that you continue to write?

Controlled substance prescribing has a national stage that isn’t likely to change for a while.  We have to be the best at making sure we are prescribing in a safe and effective manner.  We have to be able to clearly document our reasons and rationale for what we do.  We also have to be the best at educating patients on risk.  If you are unsure or unclear on how you should be auditing yourself or how you can address concerns about your peers, please start reaching out.  Your Coalition and Association Boards will help you find the appropriate resources so that we can provide the highest quality care for Kentucky residents. 

In the upcoming months you will see my title again – “What YOU don’t know CAN hurt you.”  

Conference is only 2 short months away – come and visit me at the President’s table. 

I would LOVE to say I shook hands and met every conference attendee! 

From the president - December 2017

I hope this newsletter finds you all well and preparing for the upcoming holiday season.  Every year, it feels like I just finished Christmas shopping – when all of a sudden, I need to start again!   Each time it happens – I wonder why I never notice the passage of time until some major event sneaks up on me.

Every newsletter publication is much like Christmas – the time slips away and suddenly, I am trying to decide on my topic.  This time – the topic was easy! We have started the negotiation process for the removal of the CAPA-CS.  We know where our opposition stands.  With that information – we have developed a plan.  But with that plan we need your help. We know the biggest concern with prescribing in Kentucky is related to opiates and the prevalence of addiction.  We know patients in Eastern Kentucky and Northern Kentucky are losing lives related to the issue.  We know the only way to combat the problem is appropriate treatment and early intervention.  We also know the first line of action is to ensure that we are taking appropriate care when prescribing controlled substances. 

As a prescriber I would ask that you look at your practice and ask the following questions:

• Have I run my reverse KASPER and what does it look like? 
• How do I compare to other prescribers?
• How many of my patients have been on opiate medications long term? 
• What about benzodiazepines?  Sedatives? 
• When did I last try a GDR? 
• Have I documented that I tried other interventions before using these medications?
• Do I have a process in place for random drug screening, and for pill counts when appropriate? 
• Have I documented that I’ve counseled the patient on the risks of dependence and tolerance?

I know APRNs have shown over the years they are safe and effective prescribers, but I also know sometimes it helps to have a reminder of the things we need to safeguard. 

Thank you for all you do for the residents of Kentucky, and for being one of my five.  They say every person should have at least 5 people they can call who will show up at any time to help.  I am fortunate to have far more than 5.   

Jessica Estes DNP APRN   President@kcnpnm.org

COALITION News - December 2017

Click to view/download PDF

From The President - October 2017

Jessica L. Estes DNP, APRN - President@kcnpnm.org

October 2017 Issue of Coalition News

From the president - February 2017

In a world of smartphones and social media, it sometimes feels like we are “always on,” “always informed,” and “always connected”—but nothing could be further from the truth for APRNs who are not members of the KY Coalition of Nurse Practitioners and Nurse Midwives. We live in an ever-shifting practice climate from the federal, state, and even local level, and just when you think you’ve caught your balance, it’s time for things to shift once more.

At the federal level, the promised repeal and replacement of the Affordable Care Act will likely change not only how we treat our patients, but also how we will be reimbursed for that care. As our state considers waiving the expansion of Medicaid, opting for a new way of doing business with those beneficiaries will present challenges you may not be able to foresee. And as always, fighting for our autonomy and breaking down the barriers and restrictions on our practice are ongoing at the local level, from the hospital doors to our own practices.

For these reasons and many more, there’s never been a more important time to be a member of the Coalition. KCNPNM has become a trusted and recognized stakeholder at the state level and through our partnership with AANP, we have a finger on the pulse of all things federal as well. We are the premier “trade organization” for KY’s 4,000+ advanced practice nurses, and we believe that the continuing education, advocacy, and network opportunities afforded by membership are second to none! Membership benefits you because it allows you to know as soon as regulatory or statutory changes affecting your practice are being considered—usually long before they are even voted on or approved by legislators because we are at the table for you when these discussions are happening.

Your membership helps the Coalition participate in those high-level meetings, which in turns helps keep you informed and up to date on practice, billing, reimbursement issues, as well as educational requirements. We work closely with the KY Board of Nursing to make sure our members are protected from the potential pitfalls of practice. We believe that no one works harder FOR YOU to elevate your role as an independent clinical decision maker, and we are fighting BESIDE YOU for independence in prescribing, but we can’t do it WITHOUT YOU. So please help us help you by joining or renewing your membership today.

Together, WE CAN!

Wendy T. Fletcher, DNP, APRN - President@kcnpnm.org

 You can expect this in the mail within a few days, but if you can't wait:

Coalition News Feb 2017

January 27, 2012

CONFERENCE Incredible learning sessions, bowling for charity, Pajama Party, great workshops, awards banquet, shuttles to downtown Louisville, and more more more! Toward Excellence in Advance Practice Nursing is yourTICKET TO THE FUTURE Professional Development Hone your leadership skills as you advance the profession. Nominations will be accepted for President-elect, Vice President, At-large board members, Nominations Committee and Student Rep to the board. More information and online nomination

Great Success in Frankfort!   Nearly 200 APRNs and students met with their legislators yesterday in Frankfort. Many of the elected officials were surprised to learn that Kentucky APRNs are not required to be supervised by MDs. This is one example of why it's so important for your legislators to hear from you. Watch your email next week for new developments. KET Special on Rural Health Airs Feb.6 Tune in as one of our members from Phelps, Kentucky is featured in this important show.

July 25, 2011

Experts work on iPhone-based glucose monitoring app Researchers at Northeastern University in Boston are developing an iPhone application designed to monitor blood glucose levels in patients with diabetes without the standard finger-pricking. The technology makes use of fluorescent nanoparticle solutions injected into the skin and an iPhone in a modified case that tracks changes in the level of fluorescence, revealing the amount of sodium or glucose present... READ MORE at MobilHealthNews Kentucky to Implement More Stringent Criminal Background Checks for Caregivers The Centers for Medicare and Medicaid Services is charged with administering the National Background Check Program (NBCP), created under Section 6201 of the Patient Protection and Affordable Care Act. This agency is under the US Department of Health ... READ MORE at iSurf Muhlenberg.com Pediatric Abusive Head Trauma CE During the 2010 Kentucky Legislative Session, the Nursing Continuing Competency requirements were amended to include a requirement for all nurses to participate in a one-time educational program on pediatric abusive head trauma or "shaken baby syndrome”. By mandate, the Board is requiring all present and future licensees to complete a one-time training course of at least one and one-half (1.5) hours covering the recognition and prevention of pediatric abusive head trauma. Nurses licensed before July 15, 2010 must complete the course by December 31, 2013. Nurses licensed on or after July 15, 2010 must receive the education within three (3) years of their initial licensure dates or by December 31, 2013, whichever is later. This CE will be offered as a part of KCNPNM’s 2012 conference.

Lexington: Most Inactive City in the Nation If sitting on your bum was award winning, Lexington, Kentucky would get a medal. Men's Health Magazine names it the most inactive city in the nation. Men's Health Magazine ranked 100 cities to see which is the most sedentary and which is ...READ MORE at kypost.com Be careful: Copying, pasting can create false EHR data Relying on copying-and-pasting materials within a patient's electronic health record (EHR) could lead to the insertion of false information in the record, concludes a group of researchers from Brigham and Women's Hospital in a recent issue of the Archives of Internal Medicine. "Previous research has shown that copying and pasting fragments of notes is common in EMRs. However, it was not knownWorse, yet, more than half of Americans a... READ MORE at FierceEMR PharmaNews Bristol/Pfizer stroke prevention data wow market A blood thinner developed by Bristol-Myers Squibb Co and Pfizer Inc proved superior to and safer than warfarin in preventing strokes in patients with dangerously irregular heart rhythms in a key… READ MORE at Reutuers New use for Lyrica? FiercePharma As Motley Fool notes, the Pfizer drug just passed a trial for neuropathic pain after spinal cord injury. No detailed data was released, but beating out placebo at reducing pain may just nab Lyrica another use. And another use can only be a good thing ... READ MORE at FiercePharma

Kentucky Coalition of Nurse Practitioners & Nurse Midwives

1017 Ash Street - Louisville, KY 40217 502.333.0076

Advanced Cardiac Risk Assessments Once again Kentucky APRNs will demonstrate their skills, care, and compassion by providing in-depth "advanced” cardiac risk assessments to the public during KCNPNM’s Conference. Volunteers will conduct advanced cardiac history, vital signs, full lipid testing and EKGs. We still need workers, especially "morning” people – for the 6:30 shift. Thank you Dottie Baker for coordinating this effort. Read more and sign up. Sock it to 'em! Socks and underwear for men and boys sought. Last year’s Panty Raid was a huge success, and you have to admit, a whole lot of fun. KCNPNM conference attendees filled several large containers with new bras and panties that were donated to a Covington shelter for women and children. This year, we take care of the men. Get out to the store and fill your basket with nice, new underclothes for men and boys. Bring items with you to conference and look for the Sock it to ‘em barrels near the registration desk. Donated goods will go to the Pike Street Homeless Clinic in Covington. Thank you Julie Ossege, Joan Zieglemeyer and Northern Kentucky area members for making these arrangements. Nurses Win Trust Nurses Win Trust, Leadership Next? Read this reprint of a blog written by HealthLeaders Media editor, Rebecca Hendren, in which she writes, "It's no surprise to anyone in the profession that the general public trusts nurses …. .” The Future of Nursing: Campaign for Action The Future of Nursing: Campaign for Action is continuing to build momentum to transform health care across the nation following this winter’s National Summit to launch the Campaign. The Campaign for Action is a collaboration created by the Robert Wood Johnson Foundation (RWJF) and the AARP Foundation to ensure that all Americans have access to high quality, patient-centered care in which nurses contribute as essential partners in system-wide transformation. With significant collaborations from diverse sectors in health care, including physicians, nurses, insurers, consumers, business, government, foundations, academia and health systems, the Campaign is building action to support a transformed health care workforce through the implementation of the recommendations in the Institute of Medicine’s landmark report The Future of Nursing: Leading Change, Advancing Health. Visit the Future of Nursing: Campaign for Action to learn more. Read the Institute of Medicine’s report The Future of Nursing: Leading Change, Advancing Health. 23rd Regional Conference Toward Excellence in Advanced Practice Nursing April 19-22, 2011 Northern Kentucky Convention Center Covington, Kentucky Program Info and Registration

Medicaid cuts rescinded Gov. Beshear on Friday line-item vetoed all spending cuts to state government and all reporting requirements contained in a Medicaid budget fix passed by the legislature Thursday night. The move means Beshear can implement his original plan to fix a hole in the Medicaid budget. He will transfer $166 million from next fiscal year to the current fiscal year, then plans to make up the difference in the second year of the budget through a series of cost-saving initiatives, including managed care plans. On March 25, the Cabinet for Health and Family Services, Department for Medicaid Services (DMS), rescinded all actions described in the public notice issued March 11, 2011, related to changes in Medicaid provider reimbursements. Read more. Medicare and Medicaid Innovations With the goal to provide better care and better health, at reduced costs, Medicaid and Medicare hope to improve. A new Innovation Center will accomplish these goals by identifying, testing and spreading new models of care and payment. Improve individual patient experiences of care along the Institute of Medicine’s six domains of quality: Safety, Effectiveness, Patient-centeredness, Timeliness, Efficiency, and Equity. Encourage better health for entire populations by addressing underlying causes of poor health, such as physical inactivity, behavioral risk factors, lack of preventive care and poor nutrition. Lower the total cost of care resulting in reduced monthly expenditures for each Medicare, Medicaid or CHIP beneficiary by improving care. Innovations HIV/AIDS module free and online Meeting Your HIV/AIDS Licensure Requirement Is Now Easier, Online and Free. The Cabinet for Health and Family Services is pleased to announce the release of a free online HIV/AIDS module. This Web-based, self-paced study module discusses many facets of HIV/AIDS: medical aspects, epidemiology, transmission, prevention, treatment, OSHA and CDC recommendations, attitudes and behaviors, services available, reporting requirements and other legal issues. A post test is included to access the certificate of completion required by licensure boards. Participants can access the course by visiting the TRAIN website ( https://ky.train.org )and selecting Course ID: 1021131 with the title HIV/AIDS Professional Education in KY... Making It Count - Online Module - 1021131. This educational program has been developed in cooperation between the Cabinet for Health and Family Services and a Kentucky Board of Nursing (KBN) approved provider for continuing education. KBN approval of an individual nursing continuing education provider does not constitute endorsement of program content. The KBN recognizes this course to meet the mandatory HIV/AIDS CE requirement to be earned each 10-year period for license renewal. RN earning period from Nov. 1, 2002 - Oct. 31, 2012.

Each Doing Our Own Part Many of you may have taken the time to consider the questions posed on KCNPNM nomination questionnaire. Fourteen of you went a step further, answered those questions about your experience and vision, and completed the nomination form. Six of those 14 will be elected to serve the Coalition in mostly thankless positions. These are not the power-hungry, they simply are choosing to serve. They will join those with time still remaining in their terms and lead this organization through the next few years. Please take 5 minutes to review the candidate biographies and vote. Elections close Thursday, March 24, 2011. Ballot for ACTIVE/RETIRED members Ballot for STUDENT members You must be signed in as a member for these links to work. Membership lapsed? Click here to renew

Network with APNs from Across Kentucky, Across the Region, and, Yes, Across the Atlantic! You read it right, KCNPNM’s conference Toward Excellence in Advanced Practice Nursinghas drawn registrants from all corners of Kentucky, bordering states, and eight people from a small country on the west coast of Africa called Togo. So, if you’re on the fence, might this information help you make up your mind to attend? After all, it is just a drive across the state, right? Who would have thought at KCNPNM’s first conference 22 years ago that we’d go from a small state conference, to a regional event, to drawing people from overseas?Those original planners had tremendous foresight and vision, especially in regard to sessions and speakers selection. You get hand selected topics, hand selected speakers with well-thought variety for those just entering practice, those looking to build on expertise, those looking to improve their positions and those interesting in sharing their experience. Join the 458 people already registered! Click for Program Information

Legislative Update There are only a few more days left in this legislative session. If you haven't been calling, now is the time! Ask your Senator (and all Senators on the Judiciary Committee) to support HB 282. If passed, this bill will remove the requirement for the collaborative prescribing agreement for non-scheduled drugs (CAPA-NS). Legislative Message Line 1 800 372 7181 .... Yes HB 282 For talking points and background, etc. Visit our members only Legislative Page CONFERENCE Early Registration ends March 25th Toward Excellence in Advanced Practice Nursing April 19-22, 2011 Northern Kentucky Convention Center Conference and Hotel Info FOR YOUR BENEFIT: www.kcnpnm.org Mouse over the new horizontal menu for fewer clicks to popular pages. If you're looking for a job, Click Add/Edit Resume' and make yourself "searchable by the employers and recruiters registered with our site.

Health, United States This updated report presents national trends in health statistics on such topics as birth and death rates, infant mortality, life expectancy, morbidity and health status, risk factors, use of ambulatory and inpatient care, health personnel and facilities, financing of health care, health insurance and managed care, and other health topics. http://www.cdc.gov/nchs/hus.htm Encourage Screening, Save Lives! Colon cancer is the second leading cause of cancer deaths in the U.S., but it doesn’t have to be. Colon cancer is one of the most preventable forms of cancer, and one of the most treatable when caught early. According to recent statistics, Kentucky ranks worst in the nation for colon cancer mortality. What makes that statistic so frustrating to healthcare providers is that when colon cancer is detected early, it can be successfully treated in more than 90% of cases. Simply put, screening saves lives. March is National Colon Cancer Awareness Month! You can help spread awareness about the life saving benefits of colon cancer screening by participating in Dress In Blue Day on March 4, 2011, and encouraging your patients, colleagues, friends and family to be screened. A provider screening tip sheet has been prepared for easy reference when making screening and surveillance recommendations. To learn more, please visit the Colon Cancer Prevention Project or call toll-free (800) 841-6399. Proposed Bylaws Changes

We hate SPAM as much as you do, really!! Please don't mark our messages as SPAM. When you do, you affect the receipt of our mail to all members with your internet service provider. Therefore, if you use Hotmail, all Hotmail users have our emails blocked. We hear time and again that the reason APRNs join the organization is for timely, pertinent information. However, we want to be careful to respect your wishes. If you don't want to receive a certain kind of communication from us, let us know by email (kcnpnm@kynp.org), phone (502.333.0076) or sign in and edit your profile. But, PLEASE PLEASE PLEASE don't mark us as SPAM. CONFERENCE Registration is now open! Toward Excellence in Advanced Practice Nursing April 19-22, 2011 Northern Kentucky Convention Center Program Information Hotel Info and Reservations Exhibitor & Sponsor Information

HB 282 Passes out of Committee!! Thank you APRNs that called your representatives and committee members. Let's celebrate this small success, just for a minute and watch email (or cell phone if you've signed up for text alerts) for next steps to remove the requirement for the CAPA-NS. Develop Your Leadership Skills There are some things that are best learned from experience. On the "job" experiences are much more valuable when it comes to developing leadership skills, perhaps like some aspects of nursing? Leadership traits A vision for the group and a sense of mission for its operations A positive attitude toward change Effective communication skills The ability to see difficulties and obstacles as challenges and opportunities Able to create and maintain and foster group cohesion Willing to share responsibility and authority Desires to be more than a manager -- seeks to be a leader Learn more about openings on the KCNPNM board of directors. Duties, responsibilities, and benefits.

January 13, 2011

Kentucky APRNs: Passionate and Committed Are you passionate and committed to the cause of practicing to the full extent that your education and training has prepared you for? The Coalition Legislative Task Force, Governmental Affairs Committee, and Board of Directors have been working diligently, sometimes behind the scenes, sometimes right out in front on this and other issues. Allow us to keep you informed and ask for your involvement. Here’s how: Make sure we have accurate information by editing the following sections of your profile: 1.Contact Information (here you’ll see your address and nine digit ZIP code) 2.Additional Information (use the box below to determine your KENTUCKY house and senate district NUMBERS. 3.My Communications Preferences (would you like updates by text?) STEP ONE: Sign into www.kcnpnm.org (if you can’t remember your password, reset it online and be directed to a log in page that contains your username) or call the office STEP TWO: Mouse over Member Resources, mouse over Manage Profile, CLICK Edit Profile STEP THREE: Scroll down to your contact information to view your NINE digit ZIP code. STEP FOUR: In a new browser tab (CTRL-T), visit VoteSmart.org In the search box at the top of the page, enter your 9 digit zip code and click GO. Scroll to find the results for STATE LEGISLATIVE, look for House and Senate district NUMBERS STEP FIVE: Return to your profile and under Additional Information, enter the numeric results for Kentucky House and Senate Districts . Out of state members - enter 999 Thank you, it’s worth your effort!

APRN: National Standard for ALL advanced practice nurses As new questions arise, our FAQ page is being constantly updated. Click the link below, or locate it at any time in news section of website or by using SITE SEARCH – APRN. Since this information is so timely, the link is also at the bottom of our home page. ARPN FAQ Listen and Report Can you listen and take note of main concepts of a discussion? Are you organized when it comes to important records and documents? Are you willing to serve your professional association?If you answered yes to any of these questions, please consider nominating yourself to serve as Secretary or At-large member of the board of directors. More information about responsibilities and benefits. News About You This week Kim Evans APRN, celebrated the grand opening of her Integrative Medicine Practice in Louisville, KY. Kim works with six other wellness practitioners offering, yoga, nutritional counseling, amma therapy, quantam feedback and life coaching, massage threapy and counseling. Kim says, "This has been a dream come true and we are quite excited to have everyone in FOR YOUR BENEFIT: www.kcnpnm.org Mouse over the new horizontal menu for fewer clicks to popular pages. Click EVENTS for Coalition meetings, events, and workshops/seminars presented by others of interest to nurse practitioners and nurse midwives. CONFERENCE Registration is open! Toward Excellence in Advanced Practice Nursing April 19-22, 2011 Northern Kentucky Convention Center Program Information Hotel Info and Reservations Exhibitor & Sponsor Information

Effective Jan 10, 2011 - It's APRN! As of January 10, 2011 all Kentucky ARNP registrations will become APRN licenses. The Kentucky Board of Nursing (KBN) is in the process of implementing the national Advanced Practice Registered Nurse (APRN) Consensus Model. Many authorities point to the advanced practice role as being essential to providing safe and expert healthcare to individuals across the country. An Oct. 5, 2010, report released by the Institute of Medicine (IOM) recommends a variety of stakeholders - from state legislators to the Centers of Medicare and Medicaid Services to the Congress - to ensure that nurses can practice to the full extent of their ducation and training. The role of the APRN is also essential to Kentucky, particularly as various national healthcare reform initiatives are implemented in the state. The KBN has received a number of inquiries about the proposed changes. Answers to the most frequently asked questions can be found at APRN Consensus Model FAQ CONFERENCE Registration is now open! Toward Excellence in Advanced Practice Nursing April 19-22, 2011 Northern Kentucky Convention Center Program Information Hotel Info and Reservations Exhibitor & Sponsor Information FOR YOUR BENEFIT: www.kcnpnm.org Mouse over the new horizontal menu for fewer clicks to popular pages. Click EVENTS for Coalition meetings, events, and workshops/seminars presented by others of interest to nurse practitioners and nurse midwives.

FEATURE: Four Articles with Diabetes Focus Over 11% of Adult Kentuckians Have Diabetes Worse, yet, more than half of Americans are predicted to have diabetes or be prediabetic by 2020. The cost to the U.S. health care system will exceed $3 trillion if current trends continue. New data recently released from the Kentucky Behavioral Risk Factor Surveillance System also shows Kentucky ranks fourth in the nation in the number of adults diagnosed with diabetes. Click the link to download the findings in a report by UnitedHealth – titled United States of Diabetes: Challenges and Opportunities in the Decade Ahead Diabetes Patient Resource The Kentucky Department for Public Health (DPH) has created a public web-based directory for individuals in need of care and management resources for the treatment of diabetes, linking individuals with doctors, diabetes educators and other resources in their area. Kentucky Diabetes Resource Directory The new website may not contain a complete listing of all Kentucky diabetes resources. Under the new system, diabetes resource providers can add new resources or edit their information on the site. In addition, new diabetes resource categories may be added in the future. Read news release Pregnant Women Lack Sufficient Diabetes Testing Among relevant results, only 19% of women diagnosed with gestational diabetes were tested six months postpartum. And 32% of pregnant women ages 25 to 40 were not being screened for gestational diabetes using a standard and inexpensive lab test. Read more about the Quest Diagnostics study of over 1 million pregnant women in the U.S. at Nurse.com NPs AS EDUCATORS Read how Long Island NPs are educating the public about Diabetes