WNA Monitor August 25, 2017

WNA News

Plantoattendthe4thAnnualNorthwoodsClinicalPracticeUpdate!

Friday,October6,2017NicoletCollege,Rhinelander,WI

Programandregistrationinformationwillbepostedasavailableatwisconsinnurses.org.

Contactmegan@wisconsinnurses.orgwithquestions.

JointheWisconsinAPRNCoalition!TheCoalitionwasformedtoprovideanefficientandeffectivemethodandprocessforassuring

thepassageofTheAPRNModernizationActduringthe2017-2018LegislativeBiennium.JointheCoalitionforonly$50tosupportthepassageofthisimportantlegislation!Learnmorehere.

WNAleadsdevelopmentofWisconsinAPRNCoalitiontoadvancepassageoftheAPRNModernizationAct.

TheWisconsinAPRNCoalitionconsistsofindividualandorganizationalmemberssupportingpassageoftheAPRNModernizationActduringthe2017-18LegislativeBienniumusinggrassrootsadvocacyprinciples.Achievingpassageofthelegislationwilltakevolunteersandfinancialresourcesthatincludelobbyistsupport,creationanddistributionofinformationalmaterials,websitedesignandmaintenance,andaone-dayAPRNLobbyDayattheCapitolonOctober12,2017.Moreinfoontheeventandmembership.

SAVETHEDATE(s)!StartingthisSeptember,WNAishostingavarietyoflearningopportunitiesincludingwebinarsandconferences,culminatingintheAnnualMembershipAssemblyinGreenBayonOctober21.Checkbackinthecomingmonthsformoredetailsonthoseopportunities!FallLearningSymposiumEventPage

KeepalookoutformoreWNAandANAupdatesinthe

Monitoraswellasonthewebsiteandsocialmedia

Nursing Practice, Education, and Research Updates Higher nurse workloads could mean lower hand hygiene compliance.Astudy,publishedintheJournalofHospitalInfection,examinedtheassociationbetweenhandhygienecomplianceandnurseworkloads.Researcherscorrelatedelectronicallymeasuredhandhygienecompliancedata(suchashand-rubactivities)withelectronicallydeterminedworkloaddata(suchasnursingtimeoutput/nursingtimeinput)ataSwitzerland-basedhospital.Theresearchteamalsocalculatedhanddisinfectantuseusingspendingrecordsforoneyear.Readmore.

ANA Seeks Comment on Gender Diversity Draft.TheAmericanNursesAssociationwantspubliccommentonitsproposedpositionstatementNursingAdvocacyforGenderDiversePopulations.ANAis"committedtotheeliminationofhealthdisparitiesanddiscriminationbasedonsexualorientation,genderidentityorexpressionwithinhealthcaresettings,"andinvitesthepublic'scommentsonitsdraft.Deadline:5p.m.ETonSeptember15.Readthestatement.

Understand Unconscious Bias to Promote Health Equity.It'simportantforeveryone,includingandespeciallynurses,tounderstandtheconceptofunconsciousbias.Inafollow-uptoherwebinaronthetopic,CampaigndiversityadviserKupiriAckerman-Barger,PhD,RN,writesaboutthese"beliefs...thatresideoutsideofourawareness,"andhowsuchbeliefscanaffecthealthcareprovidersandthosetheycarefor.Readmore.

NCHWA releases nursing workforce projections and program highlights.TheNationalCenterforHealthWorkforceAnalysis(NCHWA)releasedsupplyanddemandprojectionsforRNs,andlicensedpractical/vocationalnurses(LPNs)in2030.Accordingtothestudy,theU.S.isexpectedtohaveaninequitabledistributionofRNsandLPNsacrossstates.Specifically,sevenstatesareprojectedtohaveashortageofRNsandthirty-threestatesareexpectedtoexperienceashortageofLPNs.NCHWAalsoreleasedaseriesofProgramHighlightsforacademicyear2015-2016,whichsummarizethecharacteristicsandaccomplishmentsoftheBureauofHealthWorkforceprogramsandtheirtrainees.TheSupplyandDemandProjectionsoftheNursingWorkforce:2014-2030reportandtheProgramHighlightsarebothavailableonNCHWA’swebsite.Readmore.

Establishing Clinician Well-Being as a National Priority Burnout Among Health Care Professionals: ACalltoExploreandAddressThisUnderrecognizedThreattoSafe,High-QualityCare.TheUShealthcaresystemisrapidlychanginginanefforttodeliverbettercare,improvehealth,andlowercostswhileprovidingcareforanagingpopulationwithhighratesofchronicdiseaseandco-morbidities.Amongthechangesaffectingclinicalpracticearenewpaymentanddeliveryapproaches,electronichealthrecords,patientportals,andpubliclyreportedqualitymetrics—allofwhichchangethelandscapeofhowcareisprovided,documented,andreimbursed. Readmore.

3 nurses exposed to fentanyl after treating overdose patient at Ohio hospital. ThreenursesatMassillon,Ohio-basedAffinityMedicalCenterfellillandlostconsciousnessaftertreatinganoverdosepatient.Investigatorsbelievethenurseswereexposedtofentanylwhencleaningthepatient'sroom.Thenursesweresuccessfullytreatedwiththeopioidoverdosedrugnaloxone.Fentanylis50to100timesmorepotentthanmorphine.Thedrugissopowerful,individualscanoverdosebysimplytouchingresidualamountsofthesubstance.Readmore.

Are physicians, nurses obligated to protect patients during an active shooter event? Patientsandhospitalstaffhavedifferentperceptionsabouttheriskofactiveshootereventsinhospitals,accordingtoarecentsurveyconductedbytheHartfordConsensus,whichispartofanAmericanCollegeofSurgeons-ledcommitteeformedtoimprovesurvivabilityfrommasscasualtyevents.Learnmore.

Federal Health Policy Updates SAMHSA reports 39% increase in opioid treatment programs since 2003.Thenumberoffederally-approvedopioidtreatmentprograms,whicharequalifiedtodispensemethadoneandbuprenorphineforopioidusedisorders,increased39%between2003and2016,accordingtoanewreportbytheSubstanceAbuseandMentalHealthServices

Administration.Thedata,fromtheNationalSurveyofSubstanceAbuseTreatmentServices,donotincludeprivatephysicianswhoarenotaffiliatedwithasubstanceabusetreatmentprogramorfacility.Readmore.

President signs FDA Reauthorization Act(H.R.2430).ThebillreauthorizesandamendsfourFDAuserfeeprogramsunderwhichcompaniesthatdevelopdrugsandmedicaldevicespartiallypayforpremarketreviewoftheirproducts.Thebillalsoincludesprovisionsintendedtoimprovegenericdrugdevelopmentandhelplowerprescriptiondrugcosts;improvethemedicaldeviceinspectionprocess;andimprovecommunicationaboutabuse-deterrentopioidproducts,amongotherchanges.Learnmore.

CMS proposed rule would cancel three bundled payment models. Theproposedrulewouldcancelthecardiacandsurgicalhipandfemurfracturetreatmentmandatorybundlingpaymentprograms,knownastheepisodepaymentmodels.Italsowouldcancelthecardiacrehabilitationincentivepaymentmodel.TheseprogramshadbeenscheduledtobeginJan.1,2018.TherulealsoproposestorevisecertainaspectsoftheComprehensiveCareforJointReplacementmodel,includingbygivingcertainhospitalsselectedforparticipationintheCJRmodelaone-timeoptiontochoosewhethertocontinuetheirparticipationinthemodel.Learnmore.

CMS launches Hospice Compare website.TheCentersforMedicare&MedicaidServicestodayunveileditsHospiceComparewebsite,whichinitiallyshowshowmorethan3,800hospicesperformonsevenqualitymeasuresrelatedtopatienttreatmentpreferences,managingpainandtreatingsymptoms.CMSplanstoaddpatientexperienceofcaredatatothesitenextyear.ViewtheHospiceComparewebsite.

State Health Policy Updates

Senate health and human services committee holds hearing on expanding EpiPen to individuals.Thelegislationallowingpeoplewithpropertrainingtoadministerdevicesthatcounteractsevereallergicreactionsinemergencies.Thebillwouldallowtrainedindividualstoacquire,maintain,andadministerepinephrineauto-injectorstosomeonetheybelieveisexperiencinganaphylaxis,asevereandpotentiallydeadlyallergicreaction.ItpassedtheAssemblyearlierthisyear.Whilethosewithallergiesoftencarryanepinephrineauto-injector,somepeoplemaynotrealizetheyhaveanallergytoabeestingorothertrigger.WNAhasregisteredinfavorofSB209andAB96.

OCI's approach to cost-sharing reduction payments echoes other states.WisconsinistakingasimilarapproachasotherstateswhenitcomestodealingwiththeuncertaintyoffutureObamacarepaymentstoinsurersthatreduceout-of-pocketcostsforlow-incomeconsumers.Theadministrationalsoplanstomakechangestoitsriskadjustmentmethodologyforstateswherecompaniesincreaseratestoaccountfornotreceivingcost-sharingreductionpayments,whichreduceco-paysanddeductiblesforconsumersmakingbetween100and250percentofthefederalpovertylevel.ThatcouldaffectWisconsin,wheretheOfficeoftheCommissionerofInsurancehasrequestedthatcompaniesfiletheirratesassumingtheywon'treceivethepayments.

Wisconsin hospitals dinged for high readmission rates.Medicarewillpenalize51Wisconsinhospitalsintheupcomingfederalfiscalyearforhavingmoredischargedpatientsreadmittedthanexpectedwithinamonth,accordingtoarecentdataanalysis.About77%ofthe66WisconsinhospitalsthatarepartoftheHospitalReadmissionsReductionProgramwillfacepenaltiesstartingOct.1.TheMedicarereimbursementcutsrangefrom0.02%to2.93%,accordingtodatacrunchedbyKaiserHealthNews.MedicareReadmissionsByState(.csv)

Wisconsin Health Care Best in the Nation.Wisconsinranks#1amongallstatesbasedonquality.Forthesecondtimeinamonth,Wisconsinhealthcarereceivestophonors.TheAHRQqualitymeasuresarecomparedtoachievablebenchmarks,whicharederivedfromthetop-performingstates.AHRQmeasureshealthcarequalityinthreedifferentcontexts:bytypesofcare(suchaspreventive,acute,orchroniccare),bysettingsofcare(suchashospitals,nursinghomes,homehealthorhospice),andcarebyclinicalarea(suchascareforpatientswithcancerorrespiratorydiseases).Theyalsoreportmeasuresbyraceandethnicity.WhileWisconsinshowsstrongoverallperformanceinmostareasof

care,thereisstillworktobedonerelatedtohealthcareequity,includingcareforbothhighandlowincomepopulationsandethnicminorities.Whenmeasuresaresegmentedbyraceandethnicity,theperformanceisaverage.Readmore.

Wisconsin insurers post profitable first quarter. Asuncertaintycontinuestoroiltheindividualmarket,mostWisconsininsurersboostedtheirprofitsduringthefirstquarterof2017,accordingtoaWisconsinHealthNewsanalysisoffilingswiththeOfficeoftheCommissionerofInsurance.DeanHealthPlan,GroupHealthCooperativeofSouthCentralWisconsin,NetworkHealth,UnityHealthInsurance,WEATrust,WisconsinPhysiciansServiceInsuranceandAriseHealthPlanwereintheblackafterlosingmoneyduringthefirstquarterof2016.SowasCommonGroundHealthcareCooperative,whichearned$2.7million,a6.1percentmargin,afterlosing$3.9millionduringthesameperiodlastyearand$36millionoverallin2016.

Patient Safety and Quality Opioid use, misuse, and overdose in women. TheHHSOfficeonWomen’sHealth(OWH)releasedtheFinalReport:OpioidUse,Misuse,andOverdoseinWomen.Thereportexaminesprevention,treatment,andrecoveryissuesforwomenwhomisuse,haveusedisorders,and/oroverdoseonopioids.Thisnewreportseekstoinformfurtherresearchonopioidsandwomen.Readthereport

40% of hospitalized patients could identify at least 1 breakdown in care, often about medications or clinician communication.Whenaskeddirectly,almost4outof10hospitalizedpatientsreportedabreakdownintheircare.Patient-perceivedbreakdownsincarearefrequentlyassociatedwithperceivedharm,illustratingtheimportanceofdetectingandaddressingtheseevents.Readtheabstract.

AHRQ Annual Report Shows More Americans Have Health Insurance and Receive Safer Care, but Gains Remain Uneven Among Minorities.AHRQ’s2016NationalHealthcareQualityandDisparitiesReportshowsthatthequalityofhealthcarecontinuestoimprovegraduallyeachyear,butgainsremainunevenamongminorities.Someofthebiggestimprovementsareinmeasuresof“person-centeredcare,”suchascommunicationbetweendoctorsandtheirpatients,andthesafetyofmedicalcare,suchasfewercomplicationsamonghospitalpatientswhoweretakinganticoagulantsotherthanwarfarin.Thereportalsoindicatesthatfewerpeoplewereuninsured,as11%ofpeopleunderage65wereuninsuredin2016comparedwith18%in2010.However,mostdisparitiesinhealthcarequalitycontinuedtopersist,withnosignificantimprovementsforanyracialorethnicgroups,especiallypeopleinpoor,low-incomeanduninsuredhouseholdsaswellasblacksandHispanics.Learnmore.

Association of changing hospital readmission rates with mortality rates after hospital discharge.Reducinghospitalreadmissionsisamajorpatientsafetypriority.TheCentersforMedicareandMedicaidServicespolicyofnonpaymentforreadmissionsforcertainconditionshasdecreasedtheirincidence.Learnmore.

AHRQ CAHPS Webcast Now Available: Introducing the CAHPS Cancer Care Survey.Thenewsurveymeasurespatients’experienceswithcancertreatmentinoutpatientandinpatientsettings.ThissurveywasdevelopedbytheAmericanInstitutesforResearchandtheMayoClinic,withfundingfromtheAHRQ,theNationalCancerInstitute,andtheCaliforniaHealthCareFoundation.Webcastspeakersdiscussedthepurposeofthesurvey,developmentandadministrationofthesurvey,andhowtoanalyzesurveyresults.IntroducingtheCAHPS®CancerCareSurvey

Antidepressant use up 65% over 15 years. AntidepressantusebyAmericansaged12andolderincreased65%between1999and2014,accordingtoareportreleasedtodaybytheCentersforDiseaseControlandPrevention.Nearly13%ofAmericansreportedtakingantidepressantsinthepreviousmonthwhensurveyedbetween2011and2014,upfrom7.7%between1999and2002.WhiteAmericansandfemalesweremorelikelytoreportantidepressantusethanmalesandpeopleinotherracialandethnicgroups.Oneinfourpeopletakingantidepressantsreportedusingthemfor10ormoreyears.ThefindingsarefromtheNationalHealthandNutritionExaminationSurvey.Viewthereport.

CDC issues national, state-level data on epilepsy.Anestimated1.2%ofAmericans,including3millionadultsand470,000children,hadactiveepilepsyin2015.That'supfrom2.3millionadultsin2010and450,000childrenin2007.Totalestimatesbystaterangedfrom5,900inWyomingto427,700inCalifornia.Abraindisorderleadingtorecurringseizures,epilepsy"posessubstantialindividualandsocietalburdensthatrequireheightenedpublichealthaction,"theauthorssaid."Asacomplexconditionvaryinginseverityandimpact,itaffectspersonsofallagesandracialandethnicgroups,especiallythosewiththelowestincomes."Viewthereport.

Google’s Machine Learning Looks to Improve Predictions in Health Care.Techgiantteamswiththreeuniversitiestoresearchitsabilitytopredictmedicalevents.ThesamemachinelearningtechnologyGoogleusestoanticipatethenextwordinasearchqueryisinteststoadvancepredictivemodelinginhealthcare,andthetechgiantisteamingupwiththreeuniversitiesthisyeartoresearchitsabilitytodoso.Readmore..

Columbia Study Shows Smoking on the Rise Among Pregnant Women with Depression.Morethanone-thirdofpregnantwomenwithdepressionsmokecigarettescomparedto1outof10pregnantwomenwithoutdepression.Learnmore.

National Adult Immunization and Influenza Summit (NAIIS) publishes white paper on lowering the burden of adult disease through vaccination. ThewhitepaperinBecker'sHospitalReviewistitled"LoweringtheBurdenofAdultDisease,OneShotataTime."Thispaperexaminesbarriershospitalsandhealthsystemsfacewhentryingtoincreaseadultimmunizationrates,aswellasopportunitiesforadvancements,suchasdatatransparencyandimmunizationmeasures.Toaccessthispaper,filloutthisshortform,andacopywillbeemailedtoyoutohelpyourhospitalorhealthsystemworktowardbetteradultimmunizationrates.

Opportunities Promoting transformation in care delivery –OnSeptember27,WCMEWwillsponsoraconference,“TheFutureLandscapeofWisconsin’sHealthCareWorkforce,”whereparticipantswillengageontopicsrangingfrompublicpolicytoproviderretentionandtrainingcliniciansforevolvingmodelsofcaredelivery.TheconferenceisdesignedtobringstakeholdersfromacrossWisconsin’sbusiness,government,educationalinstitutionsandnon-profitareastogethertorecognizetheurgentdemandforcreativeandcross-sectorsolutionstohealthcareworkforcechallenges.Registernow.

New AHRQ Publication Highlights Research on Improving Patient Safety and Reducing Medical Liability. Thepublication,entitledAdvancesinPatientSafetyandMedicalLiability,highlightstheresultsfromanumberofplanninganddemonstrationgrantsaimedatimprovingpatientsafetyandmalpracticeoutcomes,aswellastheenvironmentinwhichthoseoutcomesoccur.In2009,AHRQwasaskedbytheU.S.DepartmentofHealthandHumanServicestospearheadthePatientSafetyandMedicalLiabilityInitiative.Activitiesandfindingsfromtheinitiativehavelaidthegroundworkforfuturepatientsafetyandmedicalliabilityprojects.Amongtopicsincludedinthenewpublication:theroleofthepatientandfamilyinsupportingimprovedcareandpatientsafety;theharmfulimpactofinstitutionalsilencewhenpatientharmoccurs;theuseofdifferenttypesofreportingsystems;andimplementationofdisclosure,apologyandofferprograms.Viewthepublication.

Omega-3 Fatty Acids and Cardiovascular Disease.TheseAHRQpublicationscanhelpcliniciansandpatientslearnabouttheeffectsofomega-3fattyacidsonheartdisease.Omega-3FattyAcidsandCardiovascularDisease:CurrentStateoftheEvidencesuggeststhatinhealthypeople,dietaryintakeoffishoilmayhelplowertheriskofCVDdeathandstroke.Inpeoplealreadydiagnosedoratincreasedriskforheartdisease,evidenceshowedfishoilsupplementsdonotlowertheriskoflongertermheartproblems,suchasheartattackandheartfailure,anddeath.Thecompanionpublicationforpatients,Omega-3FattyAcidsandCardiovascularDisease–AReviewoftheResearchforAdultsmayhelpconsumerstalkaboutthebenefitsandrisksofomega-3fattyacids.Learnmore.

Insomnia Disorder. TheseAHRQpublicationscanhelpcliniciansandpatientseffectivelymanageinsomniadisorder,definedasalong-termconditioninwhichapersonhastroublesleepingatleastthreenightseachweekforatleastthree

months.TheclinicalguideManagementofInsomniaDisorderinAdults:CurrentStateoftheEvidencefoundevidencethatcognitivebehavioraltherapyforinsomniacanbeeffectiveandsafeasatreatment.Someshort-termstudiesfoundthatmedicationswerealsoeffectivefortreatinginsomnia,buttheyhavepotentialsideeffects.AlsoavailableisAHRQ’sguideforpatientsaboutmanaginginsomniadisorderthatwillhelpinformtreatmentoptiondiscussionsbetweenclinicians,patients,andcaregivers.Learnmore.

Understanding MIPS: Advancing Care Information (ACI).ACI,whichreplacestheMeaningfulUseprogramisoneoffourcomponentsCMSwillusetomakepaymentadjustmentsunderMIPS.ACIlooksatEHRuseasitrelatestopatientengagementandhealthcarequalityandis25%ofyourMIPSscorefor2017.DownloadthisinfographictolearnmoreaboutACIandanoverviewonscoring.Learnmore.

Part-Time RN Hospital Supervisor

Part-TimeRNHospitalSupervisoratSaintMichael’sStevensPoint–LeadershipOpportunity!

AtMinistryHealthCare,partofAscension,nursingismorethanajob.It’sacareerwhereyourtalentandpassionfordeliveringqualityhealthcaremakesadifferenceforpatients,teammembers,andthecommunity.

WehavearareopeningforanRNHospitalSupervisortooptimizeadmission/dischargeworkflowandmentorandcoachnursingstaffatSaintMichael’sHospital.

Thispositionisapotentialsteppingstonetoamanagementroleandisscheduledinrotatingshiftseverythirdweekend.

Clinical Operations Director

GroupHealthCooperativeofSouthCentralWisconsin(GHC-SCW),Madison,WI,isseekingaClinicalOperationsDirectorresponsibleforeffectiveleadershipanddirectioninthedeliveryofsupportservicesbythePatientCareServices(PCS)staffwhogivenursingandreceptionrelatedpatientcare.Thispositionisessentialforfacilitatingandsustainingprocessimprovementthat

assuresoperationaleffectiveness,clinicalstandardization,fiscalresponsibility,customersatisfactionandongoingclinicalexcellence.TheClinicalOperationsDirectorprovidesdirection,guidance,andsupervisiontotheClinicManagersandmusthaveexcellentcommunicationandorganizationalskills.

Qualifications:

1. Bachelor’sdegreefromanaccreditedcollegeoruniversityinHealthCareAdministration,Business,Nursingorrelatedfieldrequired.Bachelor’sdegreeinNursingpreferred.Master’sdegreeinarelevantfieldisdesired.

2. Five(5)toseven(7)yearsprogressivemanagementexperienceinclinicalpracticesettingrequired.Experienceinsimilarsize/typeoforganization(managedcare)preferred.

GHC-SCWisaleadinginsuranceandhealthcarecooperative.Forconsideration,visitghcscw.com/careers.

AA/EOE

CNS-Unit/Population

Aunitbasedrolethatprovidesleadershipinclinicalpractice,education,professionaldevelopmentandresearchutilizationforpatientcarestaff.WorkscollaborativelyasaleadershippartnerwiththePatientCareManagerandsupervisorstoassureexcellentnursingcareforchildrenandfamilies.Master’sdegreeinnursingrequired.Experienceinprogramdevelopmenthelpful.Preferenceisgiventothosewitheducationandpracticeexperiencein

pediatricacutecare.Threetofiveyearsofexperienceinpediatriconcologypreferred.

Pleaseapplyonlineathttp://www.chw.org/careersandreferencejobid29129