The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists. The purpose of this publication is to keep our members updated on the NACNS headquarters news; connect our members with fast-breaking clinical news; and update clinical nurse specialists on state and federal legislative actions. If you have any questions or wish to advertise in this publication – please contact Laura Huestis at lhuestis@fernley.com.

 

Featured Headlines

  1. Status Report: Repeal and Replace ACA

Headquarters News

  1. 2018 NACNS Annual Meeting – Austin Here We Come!
  2. NACNS 2017-2018 Webinar Series
  3. NACNS Cost Analysis Toolkit Released
  4. NACNS Provides Comments to ANA Position Statement

Affiliate News

  1. Minnesota Affiliate

Clinical News

  1. Preventing Health Care-Associated Legionnaires’ Disease is a Team Effort
  2. Prescription Opioid Use Among Adults with Mental Health Disorders
  3. Multiply Recurrent C difficile Infection Rates Rise Sharply
  4. CDC: Opioid Prescribing High and Varies Widely Throughout the Nation
  5. Common Antibiotics Help Small MRSA Infections Heal

Federal/State Issues

  1. 2018 National Sample Survey of Registered Nurses to Include CNS Survey Questions
  2. FDA Announces New Policy Steps on Opioid Crisis
  3. Georgia Public Health Official Named CDC Director
  4. Indiana Health Commissioner Nominated to be Surgeon General
  5. Healthy People 2030
  6. Senate Panel Approves Bill Revamping Medicare for Chronically Ill Patients

Resources

  1. NQF Launches Opioid Stewardship Initiative
  2. SAMHSA's Final Strategy on Protecting Our Infants Act
  3. New AHRQ Report on Opioid-Related Hospital Stays

Featured Headlines

1. Status Report: Repeal and Replace AHCA

As we go to press, Senate Majority Leader Mitch McConnell (R-KY) stated that his party’s effort in the Senate to repeal and immediately replace the Patient Protection and Affordable Care Act (ACA) will not be successful. McConnell’s bill, which was drafted largely in secret, was the second Senate attempt titled the Better Care Reconciliation Act of 2017 (BCRA). NACNS had issued a statement from Board President Vince Holly, MSN, RN, CCRN, CCNS voicing the association’s concerns that the proposed BCRA health reforms should prioritize patients, not reduce coverage to patients.

Now with BCRA’s abandonment, McConnell recommends a plan, supported by President Donald Trump, to vote on a straight repeal of the ACA without immediately replacing it with different health care legislation. McConnell noted that a majority of the Senate supported a similar bill in 2015 to repeal the ACA “with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care.”

This proposed repeal likely faces even steeper hurdles than the BCRA replacement bill because few insurers would stay in an exchange that could disappear in two years if no consensus replacement is crafted. To repeal with a delayed replacement has lawmakers quoting from the non-partisan Congressional Budget Office (CBO) January 17, 2017 report on the estimated changes in health insurance coverage and premiums that would result from leaving the ACA’s insurance market reforms in place while repealing the law’s mandate penalties and subsidies. CBO stated that repealing the Description: http://www.fernleyhosting.com/NACNS/2017_7/Page_02.jpgMedicaid expansion and exchange subsidies would cause many insurance markets to implode resulting in an additional 32 million uninsured and premiums roughly doubling, with 75% of the country lacking insurers entirely in the individual market in a decade.

Passing a repeal and delayed replacement effort requires the majority party to gather at least 50 Senate votes — Vice President Mike Pence would break a tie. Yet, Republican Senators still are divided on health care with conservatives seeking to completely roll back the ACA, and moderate Republicans from Medicaid expansion states arguing that repeal is too punitive.

The Senate Majority Leader may wish to defeat a plan in order to begin moving on to other legislative matters, such as the nation’s debt ceiling, the FY 2018 spending bills, and an overhaul of the tax code. Some suggest that even if the Republicans, which control all three branches of government, were to move forward with their agenda, they may have to address stabilizing the ACA’s existing insurance markets.

It is important to note that the instability of the market and driving up insurance prices for 2018 have been exacerbated by Congress’s uncertainty over the ACA, the administration’s refusal to guarantee payment of “cost-sharing” subsidies to health insurance companies, and doubts about enforcement of the mandate for most people to have insurance. However, the death of the individual insurance market appears greatly exaggerated, according to researchers and a financial analysis by Standard & Poor’s. The report shows the insurers “significantly reduced their losses last year, are likely to break even this year, and that most could profit . . . It is the latest evidence that the existing law [ACA] has not crippled the market where individuals can buy health coverage.” Nevertheless, of the 12 million people currently buying their own insurance, about 35,000 people buying insurance in ACA marketplaces in 45 counties could have no carriers to choose from in 2018.

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Headquarters News

2. 2018 NACNS Annual Meeting – Austin Here We Come!

The 2018 NACNS Annual Meeting will be here sooner than you think! It is time to start planning for this excellent conference – the only national conference that focuses on the clinical nurse specialist! Join us from February 28 to March 3 and explore our conference theme – Putting the Pieces Together: CNSs Bridging the Gaps in Health Care at the Renaissance Austin Hotel.

Austin is a beautiful city which holds the official motto as the “Live Music Capital of the World.” If you are in interested in music of any type, this is the city for you. As is the case in many Texas towns, Austin is also known for its hospitality, barbecue and charm!

2018 brings many positive changes for our conference attendees!

NEW: Expanded Program
NACNS conference organizers expanded both the length and breadth of the annual conference in in direct response to evaluations and the growing number of high-quality abstracts that were not previously able to be accommodated. By starting a half-day earlier, opening at 1:30 p.m. on Wednesday, February 28, will allow organizers to accept presentation proposals.

NEW: Additional Workshops
By member request, NACNS is adding four workshops to the conference agenda focusing on: pharmacology, legislative and regulatory advocacy, safety initiatives using medical devices, and infection control, sponsored by NACNS’ work with the NICE Network. These additional workshops are intended to provide attendees with an insider’s view on how to accomplish key projects and allow time to network with the experts.

NEW: More Pharmacology
The traditional NACNS pharmacology pre-conference will still be offered! Three morning pharmacology sessions will be held before the conference begins at 1:30 PM. There will also be a pharmacology workshop during the meeting and additional sessions that qualify for pharmacology CE. Those who attend the pharmacology preconference can still attend all the traditional conference sessions!

NEW: Increased Focus on Quality
The 2018 call for abstracts is based on the NACNS Research Agenda topic areas. Focusing our conference topics in this way will allow CNSs to address the key categories of concerns identified by the NACNS Research Committee and the membership. High priority is also given to pharmacology sessions.

Key dates
Abstracts: The call for abstracts is now open. Click here to submit.
Deadline for Abstract Submission: August 2, 2017
Deadline for Student Poster Submission: December 5, 2017

Registration: Registration for the meeting is expected to open in November.

 

3. NACNS 2017 - 2018 Webinar Series – Look What is Coming in August and September

Three exciting webinars will be held in August and September.

August 15, 2017
Anticoagulation Therapy and Atrial Fibrillation
Pamela Mahaffey, DNP, RN, ACNS-BC
Pharmacology CE
This session will focus on the use of anticoagulation therapy. The speaker will focus on the treatment strategies used for patients at risk for thromboembolic events and the populations at risk for venous thromboembolism. The current guidelines for antithrombotic and anticoagulant use for patients with stroke, atrial fibrillation and deep vein thrombosis will be addressed.

September 6, 2017
Mindfulness for the CNS
Betsy S. Murphy, MS, RN, HNB-BC, C-IAYT
This is a Free Webinar Offered for CNS Week!
This session will discuss what is mindfulness and how the practice of mindfulness can reduce stress in the workplace.  Participants will be guided through a mindfulness practice session as part of this webinar.

September 20, 2017
Getting to the Bottom of Falls
Linda Hoke, PhD, RN, CNS and Rachel Zekany, BSN, RN, PCCN
This session will discuss the importance of a falls program in preventing falls and enhancing patient participation in safety. In addition to highlighting the current best practices in fall prevention the speakers will provide insights from the implementation of a falls program on a unit.

All webinars will be held from 2:00 to 3:00 pm ET. Webinars will be archived and are competitively priced (member: $25.00; non-member: $60.00; and student: $30.00) so that CNSs can stay on top of innovative practice and policies. For more information regarding contact hours, email info@nacns.org.

 

4. NACNS Cost Analysis Toolkit Released

Building on the work of the original NACNS Cost and Outcomes Task Force, the 2016-2017 NACNS Practice Committee developed an invaluable tool for the CNS – the NACNS Cost Analysis Toolkit. Released last month, this toolkit is designed to guide clinical nurse specialists in designing and capturing costs related to CNS-led initiatives to improve patient care and safety. No longer can CNSs rely on informal evaluation of the care we provide, the CNS must take cost savings into account.

Through their direct work with patients and families, nurses at the bedside and hospital and health system leaders, clinical nurse specialists are uniquely prepared to assess, analyze and improve the business of health care while continuing to put the patient first. The CNSs ability to translate value impact in the clinical setting is crucial. Today’s health care landscape is ever-changing. Initiatives to improve patient care and safety must take cost savings into account.

The Cost Analysis Toolkit includes:

  • A checklist describing a Six Sigma process to guide CNSs in a cost analysis change strategy,
  • An extensive literature review with assessment and grading of each articles and direct access to resources ; and
  • A thorough FAQ. Download the Cost Analysis Toolkit today for a small fee, $10 for members and $50 for non-members, and learn strategies to help better describe and quantify CNS contributions to heath care.  

 

5. NACNS Provides Comments on ANA Position Statement: The Ethical Responsibility to Manage Pain and Suffering

The American Nurses Association (ANA) recently closed its public comment period on a position statement, The Ethical Responsibility to Manage Pain and Suffering. This statement addresses the core ethical principles surrounding the management of pain and suffering and builds on the premise that nurses have a duty to relieve pain and suffering. The statement also addresses the opioid crisis and the ethical issues nurses face.

NACNS’ Opioid/Pain Management Task Force reviewed and analyzed the statement and drafted comments in an effort to clarify some of the questions the position statement raised. These remarks, on behalf of the NACNS Board of Directors, were submitted during ANA’s call for public comments.

 

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Affiliate News

6. Minnesota

The Minnesota Affiliate is planning its fall conference on October 27, 2017 at the Radisson Hotel in Roseville. This year’s theme will be Growing Stronger Together – Influence of the Clinical Nurse Specialist. The Minnesota Affiliate welcomes CNSs from across the country to attend, network and learn from each other. CNSs can earn pharmacology credits in some of the sessions.

Susan Sendelbach, PhD, APRN-BC, CCRN received the first annual Mary Fran Tracy Excellence Award for her dedication and exceptional work to improve patients care, nursing and system improvements.

Minnesota NACNS elected a new board to lead the affiliate. They are:

President: Kristin Negley Treasurer: Janice Osborne
President-Elect: Pamela Triplett Student Representative: Ben Hickox
Secretary: Deanna Erickson Past President:Susan Schumacher


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Clinical News

7. Preventing Health Care-Associated Legionnaires’ Disease is a Team Effort

Health care facility leaders can help prevent health care-associated Legionnaires’ disease by developing and using an effective water management program. A team, which can include infection control practitioners, facility managers, hospital administrators, quality assurance staff, or others, should be established to implement the program. These leaders can also work with providers to help them identify cases of Legionnaires’ disease and potential exposure sites. CDC’s updated water management program toolkit helps health care facility leaders identify buildings or devices that are at increased risk for growing and spreading Legionella, while CDC’s updated fact sheet for clinicians describes how to diagnose patients. Access these and other resources at www.cdc.gov/legionella.

 

8. Prescription Opioid Use Among Adults with Mental Health Disorders

Fifty-one percent of all opioid prescriptions in the United States are written for people with anxiety, depression, and other mood disorders, according to a new study that questions how pain is treated. The study found that this population – who also are at increased risk of abusing opioids and of suicide – received more prescriptions than the general population.

Of adults in the study who were diagnosed with mental health disorders, 18.7% use prescription opioids, compared with only 5% of people without those diagnoses.  Researchers analyzed data on 51,891 non-institutionalized adults from the nationally representative Medical Expenditure Panel Survey (MEPS). In the MEPS prescription drug data, the most common oral opioid prescriptions were hydrocodone with acetaminophen, tramadol, and hydrocodone. Opioid users with mental health disorders were likely to be middle-aged, female, white, and unmarried. They received opioids predominantly for musculoskeletal problems, unclassified diagnoses, and undefined non-traumatic joint or connective disease.

Higher opioid use among those with mental health disorders persisted across key variables, including cancer status and various levels of self-reported pain. Differential prescribing may be a function of the patients' advocacy for themselves. It also might be because there is no objective assessment of opioid efficacy.

There are various guidelines suggesting that opioid prescribing should be based on functional outcomes such as activities of daily living and physical function, not on self-reported satisfaction. The study emphasizes the need for careful assessment of prescription opioid use and attention to pain management in individuals with mood and anxiety disorders.

 

9. Multiply Recurrent C difficile Infection Rates Rise Sharply

The incidence of multiply recurrent Clostridium difficile infection (CDI) is increasing at more than four times the rate of CDI in general, according to results of a retrospective cohort study published online in the Annals of Internal Medicine. CDI affects nearly 500,000 individuals annually in the United States, at a cost of more than $5 billion. Recurrence within 8 weeks of initial infection is common, and some patients suffer more than one event.

 

10. CDC: Opioid Prescribing High and Varies Widely Throughout the Nation

According to the latest Vital Signs report by the Centers for Disease Control and Prevention (CDC), opioids prescribed in the U.S. peaked in 2010, then decreased each year through 2015. The amount of opioids prescribed was at 782 morphine milligram equivalents (MME) per capita in 2010 and then declined to 640 MME per capita in 2015, which still is enough for every American to be medicated around the clock for three weeks.

The CDC study shows that half of U.S. counties had a decrease in the MME prescribed per person from 2010 to 2015. In 2015, six times more opioids per resident were dispensed in the highest-prescribing counties than in the lowest-prescribing counties. This wide variation suggests inconsistent prescribing practices among health care providers and that patients receive different care depending on where they live.

The variation from county-to-county also highlights the need for health care providers to consider evidence-based guidance when prescribing opioids, such as CDC’s Guideline for Prescribing Opioids for Chronic Pain.

 

11. Common Antibiotics Help Small MRSA Infections Heal

Two common antibiotics can help hospital outpatients heal from small skin infections involving Methicillin-resistant Staphylococcus aureus, according to a recent study published in the New England Journal of Medicine. Funded by the National Institute of Allergy and Infectious Disease, the study found that clindamycin and trimethoprim-sulfamethoxazole were equally beneficial in treating small skin abscesses after drainage, with a cure rate of 82% - 85% compared with 63% for patients who received a placebo. The authors note that possible antibiotic-related side effects should be taken into account when deciding treatment.

 

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Federal/State Issues

12. 2018 National Sample Survey of Registered Nurses to Include CNS Survey Questions

The National Center for Health Workforce Analysis (NCHWA) has contracted with the Census Bureau to conduct the 2018 National Sample Survey of Registered Nurses (NSSRN). In the 2018 NSSRN, all four APRN roles – including CNSs – will be included in the survey. NCHWA plans to separate the results for each of these APRN roles and report results individually at the national, regional, and state levels. Reporting, however, will depend on the number of APRN respondents to the survey. Gaining the cooperation of those who are sent the NSSRN will be key to ensuring high quality data for the study. As an endorser of the NSSRN, NACNS will be highlighted in all materials sent to the nationwide sample of 100,000 registered nurses.

The Census Bureau currently is seeking public comment on ways to enhance the quality, utility, and clarity of the NSSRN information to be collected in 2018.

 

13. FDA Announces New Policy Steps on Opioid Crisis

The Food and Drug Administration (FDA) recently announced "more forceful steps" it is taking to deal with the ongoing opioid addiction crisis. Looking at all facets of this complex issue and collaborating on various approaches, FDA next steps include forming a new steering committee and asking the public to share their ideas and experiences in online forums and at an upcoming two-day meeting scheduled in July.

The public workshop will address the challenges in using the currently available data and methods for assessing the impact of opioid formulations with abuse-deterrent properties on opioid misuse, abuse, addiction, overdose, and death in the post-market setting. The goal of the meeting is to discuss ways to improve the analysis and interpretation of existing data, as well as the opportunities and challenges for collecting and/or linking additional data to improve national surveillance and research capabilities in this area.

All materials from the public workshop are accessible online, including the FDA issues paper: Data and Methods for Evaluating the Impact of Opioid Formulations with Properties Designed to Deter Abuse in the Postmarket Setting.

 

14. Georgia Public Health Official Named CDC Director

On July 7 Health and Human Services Secretary Tom Price named Brenda Fitzgerald as director of the Centers for Disease Control and Prevention. Fitzgerald is an obstetrician-gynecologist currently serving as Georgia's Public Health Commissioner and president-elect of the Association of State and Territorial Health Officials. Fitzgerald previously served as president of the Georgia OB-GYN Society and as a health care policy advisor for former House Speaker Newt Gingrich (R-GA) and former Senator Paul Coverdell (R-GA).

 

15. Indiana Health Commissioner Nominated to be Surgeon General

President Trump nominated Dr. Jerome Adams, the health commissioner of Indiana since 2014, to serve as the 20th U.S. Surgeon General. If confirmed by the Senate, he would serve a four-year term. Adams replaces Dr. Vivek Murthy, who was appointed during the Obama administration and was unexpectedly dismissed in April before the end of his term.

Adams was confirmed as Indiana health commissioner when Vice President Mike Pence was the state's governor. He is a trained anesthesiologist and currently serves as assistant professor of clinical anesthesia at Indiana University School of Medicine.

As Indiana health commissioner, Adams garnered national attention for his handling of an HIV outbreak in Scott County, a rural community in the state. The outbreak was allegedly caused by people using used needles to inject the prescription painkiller Opana. Adams led the implementation of a needle exchange program to help curb the outbreak. Considering Adams' expertise and experience tackling the opioid epidemic, it's likely he will work to combat the issue as surgeon general if he is confirmed.

 

16. Healthy People 2030

The Department of Health and Human Services (HHS) is soliciting written comments on the Healthy People (HP) 2030 proposed framework, including the vision, mission, overarching goals, plan of action, and foundational principles. Every ten years, through the HP initiative, HHS leverages scientific insights and lessons from the past decade along with new knowledge of current data, trends, and innovations to develop the next iteration of national health promotion and disease prevention objectives.

Since 1979, HP has set and monitored national health objectives to meet a broad range of health needs, encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of prevention and health promotion activities. In order for comments on the proposed framework to be considered, they must be submitted by September 29, 2017.

 

17. Senate Panel Approves Bill Revamping Medicare for Chronically Ill Patients

In bipartisan fashion, the Senate Finance Committee (SFC) advanced legislation aimed at improving care for people with chronic conditions. The bill, S.870 - Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, now will be scheduled for consideration on the Senate floor.

The SFC considers this bill a “transformational” reform to Medicare as it gives a new focus on providing efficient treatment for chronic conditions, in addition to primary care services, hospitalizations, and prescription drugs. NACNS and the APRN Workgroup, one of the coalitions in which NACNS is a member, have been closely following this legislation for nearly two years.

CHRONIC is aimed at reducing costs associated with chronic illness by giving people greater access to telehealth services, promoting care coordination between providers, and expanding value-based payment models. For example, the measure would create a voluntary pathway for people to join accountable care organizations, which could make it easier for providers to coordinate care for those patients. The bill also takes steps to improve care coordination for patients who are eligible for both Medicare and Medicaid and expands an Affordable Care Act pilot program that enables providers to offer primary care services at home to people with multiple chronic illnesses.

 

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Resources of Interest

18. NQF Launches Opioid Stewardship Initiative

The National Quality Forum (NQF) is launching a new initiative to address the nation’s escalating opioid epidemic. NQF’s National Quality Partners (NQP) will bring together experts from NQF’s membership and from across the nation to develop a practical resource to help healthcare practitioners better manage their patients’ pain while reducing the risk of opioid addiction.

NQP will model the new Opioid Stewardship Action Team after other successful efforts to address national healthcare challenges. Last year, NQP issued a playbook to help hospitals strengthen antibiotic stewardship programs and released an issue brief to help providers, communities, and policymakers ensure that the preferences and values of individuals with advanced illness are at the center of their care decisions. Physicians, nurses, consumers, and other Action Team members, will build on current public- and private-sector efforts to address the opioid epidemic, focusing on improving clinicians’ prescribing practices.

In addition to improving clinicians’ prescribing practices, the Action Team will identify strategies and tactics for managing care of individuals who are at high risk of becoming dependent on opioids. The Action Team will also advance quality measures that support prescribers. In 2017, NQF endorsed its first measures that address prescribing opioids at high dosage or from multiple providers among patients without cancer. The NQP opioid stewardship playbook will be available in March 2018.

 

19. SAMHSA's Final Strategy on Protecting Our Infants Act

Congress passed the Protecting Our Infants Act of 2015 to respond to the unmet needs of pregnant women with opioid use disorder (OUD) and to infants born with neonatal abstinence syndrome (NAS). The law mandated the Department of Health and Human Services (HHS) to reduce the gaps in research, to develop guidance of best practice to treat NAS and to coordinate federal efforts.

HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) announced the availability of the updated Protecting Our Infants Act: Final Strategy – 2017. The report includes strategies for:

  • Preventing prenatal opioid exposure – e.g., improving screening for OUD and interventions that prevent misuse of opioids by women of childbearing age:
  • Treating both the mother and the infant – e.g., providing continuing medical education to providers treating infants with NAS; and
  • Providing services for pregnant and parenting women with OUD and their infants – e.g., provide easily accessible, family friendly, treatment for women with OUD.

 

20. New AHRQ Report on Opioid-Related Hospital Stays

According to a new report from the Agency for Healthcare Research and Quality (AHRQ), hospitalizations involving opioid pain relievers and heroin increased 75% for women between 2005 and 2014, a jump that significantly outpaced the 55% increase among men.

AHRQ’s report, which provides the most current national rates on opioid-related hospitalizations and emergency department visits, also includes data illustrating wide variation by state. Among those findings:

 

  • In 2014, opioid hospitalization rates among women were highest in West Virginia, Maryland and Massachusetts.  Each of those states reported rates exceeding 350 hospitalizations per 100,000 people.
  • Among men, the highest hospitalization rates in 2014 were in the District of Columbia, New York and Maryland, each of which reported rates higher than 440 hospitalizations per 100,000.
  • A new AHRQ infographic shows that in three-quarters of the states, opioid-related hospitalization rates were higher among women than men in 2014.
  • The age-group most likely to have an opioid-related hospitalization varied substantially across states.  In 13 states, including California, people 65 years old and older were the most likely to be hospitalized.
  • In all states reporting on opioid-related visits to EDs, the rate was highest among adults age 25-44 years.

 

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The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists.
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