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Practice & policy newsletter

On behalf of the NACNS Board of Directors, I am pleased to announce the creation of the NACNS Practice & Policy Newsletter. The purpose of this newsletter is to keep our membership up-to-date on important information that will have an impact on your CNS practice. The newsletter will contain pearls of wisdom from a variety of sources to help you in your practice. In addition, NACNS is excited to announce a new member benefit – our blast email system. As an NACNS member you are eligible to sign up to receive blast email that will keep you “in the know.” This newsletter (as yet, unnamed) is designed to bring to you helpful clinical information as well as information about your NACNS events and member benefits. There is no cost for this subscription, and I know you will find it incredibly useful. The newsletter is one example of the information you will receive if you subscribe to the blast email system. The NACNS Practice & Policy Newsletter will be published electronically on a quarterly basis. You will receive an email with a link to the NACNS website ( The current issue will be posted, and past issues will be available for your review. I hope you find this publication as helpful as I have! Sincerely, Theresa Murray, RN, MSN, CCRN, CCNS NACNS Vision Paper…………… 1
NACNS Foundation……………. 1
leaders and members over the past year. It NACNS Awards ………………… 2
presents a comprehensive vision of our future. NACNS Conference……………. 2
This document is an essential part of the CNS NACNS Summit………………… 2
Agency Issues
PQRI ……………………………. 3
New Surgeon General…………… 3
FDA – Avandia…………………. 3
CDC – MMWR fatality report…. 4
The CNS Foundation now offers two scholarship AHRQ – Quality Reports ………. 4
opportunities for students pursuing a master's Medicare Physician Payment…… 4
degree or PhD in nursing. The CNS
Foundation Scholarship
has a unique focus on
FDA- New Warfarin Label……… 5
the student’s practice as a CNS and/or the FDA – New Glucose Monitor…… 5
doctoral student’s research which has improved or brought about change in another culture, minority group, and/or with a vulnerable population, and evidence of impact on local, state and/or national
initiatives to improve nursing and health care. The
Dayhoff Clinical Nurse Specialist Scholarship
reflected in the NACNS Statement on CNS Practice has a focus on student’s whose nursing specialty is the field of adult health, adult care including critical care, and any of the medical surgical CNS Researcher of the Year
specialties. The deadline for application for The purpose of the award is to nationally consideration for these scholarships is October recognize an NACNS member for outstanding 30, 2008. To get more information and download professional achievement as a clinical nurse specialist who has conducted original nursing research that has significantly enhanced the science of autonomous nursing practice, patient and family outcomes, and/or health care systems. NACNS awards allow us to honor our colleague accomplished program of research that has clinical nurse specialists and highlight the excellent significantly contributed to advancing the nursing contribution these expert clinicians make to clinical nurse specialist practice, research, education and preceptoring. All nominations are due on October 15, 2007. These awards will be presented at the NACNS 2008 Annual Student abstracts being accepted until December There are four awards that will be given: Clinical Nurse Specialist of the Year
The purpose of the award is to nationally
recognize an NACNS member for outstanding
professional achievement as a Clinical Nurse
Specialist in the three spheres of CNS influence.
The award acknowledges a nurse who
demonstrated CNS competencies and exemplary
practice in patient care, nursing and health care
delivery systems.
CNS Educator of the Year
The purpose of the award is to nationally recognize an NACNS member for outstanding professional achievement as a Clinical Nurse Specialist Educator. The award acknowledges a NACNS hosted a successful Summit on July 26th CNS educator’s commitment to excellence and and 27th in Indianapolis, Indiana. This meeting was attended by about 30 nursing organization implementing the NACNS Statement on CNS representatives. The primary agenda of the Summit was a presentation of the current work of the NACNS Doctoral Competencies Task Force. CNS Preceptor of the Year
The Task Force discussed the work they had done The purpose of the award is to nationally to date analyzing the current master’s level CNS recognize an NACNS member for outstanding competencies from a large number of specialty professional achievement as a Clinical Nurse nursing organizations. The Summit participants Specialist Preceptor. The award acknowledges a we asked to validate the work of the Task Force and provide feedback related to masters and commitment to teach, coach, and mentor CNS doctoral level CNS competencies. This feedback students to achieve CNS competencies in the will be vital to the Task Force as they begin the nurse, patient, and organizational spheres as next phase of their work, developing doctoral level competencies. This work will be shared again Providers are not required to report on all with the NACNS Board of Directors and nursing measures. If 4 or more measures are applicable to community for comment. Many thanks to the the practice, the practitioner must report at least 3 of them correctly for 80 percent of cases (visits or patients, depending on measure). If 3 or fewer measures are applicable to the practice, practitioner must report each of them correctly for 80 percent of the cases (visits or patients, depending on measure). The link to the measures is found at: What is PQRI? On December 20, 2006 President
Bush signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 of Title I authorizes the establishment of a physician quality Where Do I Get More Information? CMS has
reporting system by the Center for Medicare & set up an extensive website with information, Medicaid Service (CMS). CMS has titled the including frequently asked questions and web statutory program the Physician Quality Reporting Initiative (PQRI). PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. The entire quality reporting program for 2007 will be managed through the patient billing for Medicare The Office of the Surgeon General has been vacant since July 2006 when then Surgeon General Richard H. Carmona left office. On May 24, Eligible professionals who successfully report a designated set of quality measures on claims for Holsinger to be the nation’s 18th surgeon general. dates of service from July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, Holsinger is a cardiologist and has been the of 1.5% of total allowed charges for covered secretary for Health and Family Services for the Medicare physician fee schedule services. state of Kentucky as well as chancellor of the University of Kentucky Medical Center. He has a Eligible professionals include physicians;
26-year career with the U.S. Department of podiatrists; chiropractors; dentists; physician Veteran Affairs and has served as undersecretary assistants; advanced practice registered nurses, for health in 1992. Holsinger also served more including CNSs; dieticians; psychologists; social than three decades in the United States Army workers; physical, speech and occupational Reserve; he retired in 1993 as a major general. President Bush noted in his announcement that How Will I Report? Eligible professionals need
among his other duties, Holsinger will focus on not enroll or file an intent to participate for the educating parents and children about childhood PQRI. Eligible professionals can participate by obesity. The Senate Committee on Health, reporting the appropriate quality measure data on Education, Labor and Pensions held a hearing on claims submitted to their Medicare claims his nomination on July 12, 2007. Action on his processing contractor. A NPI number will be What Measure Will I Report On? The 2007
PQRI measures specifications for the 74 measures professionals of a potential safety issue related to Avandia (rosiglitazone). An on-going analysis of safety data for the treatment of type 2 diabetes mellitus using Avandia showed differing rates of ischemic cardiovascular events including heart Work in a facility with an interest in improving attack or heart-related adverse events, some fatal, patient safety? Have a patient safety team or relative to other drugs used to treat diabetes committee? You may want to consider applying mellitus. The clinical studies reviewed to date vary to be a participant with the Patient Safety with respect to their populations, treatment Improvement Corps (PSIC), a partnership with regimens, and length of follow-up. Based on these AHRQ and the Veteran’s Administration. The data, the risk of ischemic cardiovascular events due to Avandia remains unclear. Prescribers providing knowledge and skills to teams of should continue to carefully make individualized hospital and other staff including patient safety treatment decisions for patients with diabetes officers and those responsible for patient safety reporting and analysis as well as intervention Participants eligible for this expanded PSIC program are teams of patient safety officers in large CDC’s MMWR reports on Fatal Injuries hospitals or health care systems, critical access or rural hospitals or health care systems, long term The May 16, 2007 issue of the MMWR reports care facilities or systems, ambulatory centers and that unintentional injury is the leading cause of large clinics, and those responsible for patient death among U.S. children aged 1 – 19 years of safety reporting and analysis as well as age. Statistically, homicide is the second leading intervention initiatives in other relevant cause and suicide is the fourth. Mortality rates organizations such as quality improvement from injury, whether unintentional or intentional, organizations (QIO) and Federal government are particularly high among certain racial/ethnic agencies such as Centers for Medicare and populations. Previous studies have examined Medicaid Services, Health Resources and Services differences in injury death rates according to Administration, Indian Health Service, and race/ethnicity and have consistently documented others. It is anticipated that teams will be that black and American Indian/Alaska Native composed of clinical and/or administrative (AI/AN) children are disproportionately affected. leaders. Note that team participation is a requirement, and an application from a single individual will not be accepted. For more Agency for Health Care Research and Quality (AHRQ) Offers Publication with quality assurance work in your facility? You may Medicare’s physician payment formula known as want to take a look at the new publication the sustainable growth rate (SGR) will call for a 10 available from the AHRQ. The new Health Care percent reduction in provider reimbursement 2008. The last time the schedule SGR reduction directory of over 200 samples of report cards went into effect was in 2002, when a 4.4 percent produced by a variety of organizations. The Medical Association and other physician and other providing comparative information on the quality provider organizations reimbursed under the SGR of health plans, hospitals, medical groups, are working to eliminate this 10 percent cut. individual physicians, nursing homes, and other providers of care. The Health Care Report Card Every year since 2002, this issue has absorbed extensive time by provider organizations in their efforts to eliminate the payment reduction. One of the ways to stop this cycle is to change the sustainable growth rate formula. AMA and other Continuous Glucose Monitoring System (STS-7 provider organizations will be making an effort to System) measures glucose levels every five do just that in 2007. A 10 percent reduction in minutes throughout a seven-day period. This Medicare physician payment reimbursement may additional information can be used to detect have a real impact on the number of providers trends and track patterns in glucose levels that are willing to accept Medicare patients into throughout the week that wouldn’t be captured by their practices. To read AMA’s press release, finger stick measurements alone. However, diabetics must still rely on the finger stick test to decide whether additional insulin is needed. The STS-7 System, manufactured by DexCom Inc. of San Diego, Calif., uses a disposable sensor FDA is recommending a labeling change for placed just below the skin in the abdomen to warfarin (coumadin) that would highlight the measure the level of glucose in the fluid found in opportunity for prescribers to use genetic tests to the body’s tissues (interstitial fluid). Sensor improve their initiation estimate of a reasonable placement causes minimal discomfort and can warfarin dose for individual patients. Testing may easily be done by patients themselves. The sensor help optimize the use of warfarin and lower the must be replaced weekly. An alarm can be risk of bleeding complications from the drug. programmed to sound if a patient’s glucose level These labeling updates are based on an analysis of recent studies that found people respond to the drug differently based, in part, on whether they A three-day version of the device, the STS Continuous Glucose Monitoring System, was approved in March 2006. FDA estimates that 2 million persons start taking warfarin in the United States every year to prevent An estimated 20.8 million people in the United blood clots, heart attacks and stroke. Warfarin is a States—7 percent of the population—have difficult drug to use because the optimal dose diabetes. While there is no known cure, studies varies and depends on many risk factors including have shown that patients who regularly monitor a patient's diet, age, and the use of other and regulate their blood glucose levels have lower incidences of complications associated with the disease. For more information, go to: Patients who take a dose larger than they can tolerate are at risk of life-threatening bleeding. Those who receive too low a dose are at risk of equally dangerous blood clots. Dosing is NACNS Staff -
particularly important at the beginning of therapy, when problems in adjusting the dose can lead to Editor: Melinda Mercer Ray, MSN, RN NACNS complications such as bleeding. Warfarin is the Executive Director: Christine Filipovich, RN, second most common drug – after insulin – implicated in emergency room visits for adverse For questions or comments on this
publication, please contact:
NACNS, 2090 Linglestown Road, Suite 107 - Harrisburg, PA 17110 Phone: (717) 234-6799 Fax: (717) 234-6798 On June 4th, the U.S. Food and Drug Administration today approved a device that measures glucose levels continuously for up to seven days in people with diabetes. While a standard finger stick test records a person’s glucose level as a snapshot in time, the STS-7


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