Latest Comments by NRSKarenRN

NRSKarenRN, BSN, RN Moderator 120,864 Views

Joined Oct 10, '00 - from 'RN Spirit from Philly Burb'. NRSKarenRN is a PI Compliance Specialist, prior Central Intake Mgr Home Care Agency. She has '35+' year(s) of experience and specializes in 'Home Care, VentsTelemetry, Home infusion'. Posts: 27,341 (22% Liked) Likes: 13,440

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    You must have 3 hour child abuse course completed (as first time license renewal) and reported to PA BON or your license will not be renewed.
    Regs: Act 31 of 2014 – Initial Training and Continuing Education in Child Abuse Recognition and Reporting Requirements (PDF)


    PA BON list available at link below. Pennsylvania Child Welfare Resource Center offered Free course in past:
    Act 31 of 2014 Child Abuse Recognition and Reporting Continuing Education Providers

    Many hospital/healthcare providers offer free CE via CE Direct--ask your employer /education department if they participate.

    See my link of Free Nursing Continuing Education Programs - 100+ contact hours ... see I need to update for 2017.

    You must complete 30hrs CE prior to submitting license application for if license pulled for contact hour verification and found missing CE, you will be fined and have PERMANENT disciplinary action on your license.

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    AJJKRN likes this.

    New Regulation: General Revisions


    On December 17, 2016, the State Board of Nursing’s General Revisions regulation was published in final form in the Pennsylvania Bulletin. A copy of this regulation can be found at PA Bulletin, Doc. No. 16-2194.

    Amongst the revisions, the new regulation requires that:

    · Candidates for licensure take the licensure examination for the first time within one year of completing their nursing education programs. Express permission must be granted by the Board for candidates to take the examination for the first time after the one-year period. Candidates will first be required to demonstrate that they were prevented from taking the examination by emergency, illness, military service, licensure in another state, or other good cause shown.


    · Licensees notify the Board within 14 days of a change of address.

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    Rose_Queen and AJJKRN like this.

    New Regulation: General Revisions


    On December 17, 2016, the State Board of Nursing’s General Revisions regulation was published in final form in the Pennsylvania Bulletin. A copy of this regulation can be found at PA Bulletin, Doc. No. 16-2194.

    Amongst the revisions, the new regulation requires that:

    · Candidates for licensure take the licensure examination for the first time within one year of completing their nursing education programs. Express permission must be granted by the Board for candidates to take the examination for the first time after the one-year period. Candidates will first be required to demonstrate that they were prevented from taking the examination by emergency, illness, military service, licensure in another state, or other good cause shown.


    · Licensees notify the Board within 14 days of a change of address.

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    herring_RN likes this.

    Getting the first contract @ DCMH signed proving to be difficult, despite Crozer's other 2 hospitals with nursing unions, one of them Crozer's PASNAP unit which STARTED the union 20 yrs ago. Karen


    DCMH nurses threaten 2-day strike over lack of new contract

    The 370 nurses and technical employees at DCMH say they will hit the bricks Sunday and Monday, March 5-6 to protest what they claim is unfair treatment by the hospital’s new owner. The group won the right to unionize nearly a year ago under the former owner, Crozer Keystone Health System.

    In July 2016, the hospital was acquired by Prospect Medical Holdings Inc., a subsidiary of the hedge fund Leonard Green & Partners. They two sides have been unable to reach a deal on a new contract.

    The DCMH workers, who are now members of the Pennsylvania Association of Staff Nurses & Allied Employees (PASNAP), allege the company has steadfastly refused to talk about guaranteed patient safety through safe staffing practices.

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    Excellent article about improving social determinants of health for the chronically ill, "super utilizer" patients that take up 25% of resources. Providing food cupboards, transportation, social services to get home repairs made, paying electric bill for summertime use of air conditioner for COPD patient (as my health system did) helps to improve clients overall health while reducing rehospitalization rate and insurance costs.

    USA Today
    Feb. 17, 2017
    Jayne O'Donnell

    Hospitals target nutrition, other social needs to boost health

    ...Six months after getting free healthy groceries every week through the Geisinger hospital near his rural Pennsylvania home, Shicowich has cut his blood sugar level from nearly 11 to close to a normal level of 7. The 6' 5" former high school track team competitor has lost 35 pounds but is still nearly 200 pounds from his target weight of 250 pounds.

    The Geisinger Health System is on its way to making its own numbers. On March 1, Geisinger plans to expand its five-patient pilot project to 50 more of its sickest and highest-cost diabetes patients. So far, all of those participating in Geisinger’s Fresh Food Pharmacy have lost weight, lowered their body mass indices, decreased their use of medication, lowered their cholesterol and improved their hemoglobin A1C levels, says Andrea Feinberg, an internal medicine doctor who is "clinical program champion."

    Geisinger is what's known as an accountable care organization, which makes it fully responsible for the insurance and all health costs for their patients. They employ the doctors and own the hospitals and insurance company. The better-known Kaiser Permanente is another example. That means unlike other hospitals, their profits aren't based upon patients' visits and treatments.

    It is no coincidence that the health systems and hospitals that are doing it the best have aligned their incentives more closely to the health of their patients," says Joshua Sharfstein, a pediatrician who is a former secretary of health for Maryland and top Food and Drug Administration official. "It's very hard to ask a hospital that’s getting paid for every preventable admission to invest in ways that would eliminate those admissions."....

    I've been watching news articles about Dr. Jeffrey Brenner's development of Camden Coalition of Healthcare Providers
    Our coalition members share information through the Camden Health Information Exchange (Camden HIE). With relevant, real-time data, our cross-disciplinary care teams connect quickly with people who have high rates of hospitalization and emergency room use, and help them address their complex needs.
    Since 2002, we’ve been demonstrating that human-centered, coordinated care, combined with the smart use of data, can improve patients’ quality of care and reduce expensive, ineffective inpatient stays and emergency room visits. And that’s better for everyone...

    We identify patients with frequent hospital admissions using real-time data from the Camden Health Information Exchange. Staff members meet patients at the hospital bedside to offer them the opportunity to participate in our care coordination services. Enrolled patients work with a community-based team of nurses, social workers, community health workers, and health coaches for about 90 days.

    Our care teams empower patients to address not only medical issues, but also behavioral and social barriers to wellness. The team links patients to resources throughout the community, including primary care, transportation, housing, and other wrap-around services. Team members accompany patients to their appointments while helping patients gain the skills and support they need to avoid readmissions.
    They are now expanding with a "Housing First" program for the homeless.

    'Housing First' Pilot Shows How It Can Help Improve Health of NJ's ...

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    Information on these programs found in Allnurses Pennsylvania Nursing forum.

    Be aware the Philadelphia job market is extremely tight due to yearly flood of new grads. Expect to take ~ 6 months to obtain first position unless apply beyond 5 county Philadelphia area. Best wishes in finding a program that fits you.

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    Icooka4u and AJJKRN like this.

    What a nightmare....All in the name of opiod addiction prevention.... what a nightmare for NJ home health nurses for patients with new acute pain due to fracture, new cancer DX, post surgery, Sickle cell crisis..... will just drive up ER business. Fifteen day limit would be more reasonable. Some PCP in Philly/NJ area have 30+ days before patient can get appointment post hospitalization! Karen

    Philadelphia Inquirer
    Jan 19, 2017
    Andrew Seidman

    Christie set to impose pain pill limits despite N.J. doctors' objections


    TRENTON - Gov. Christie wants to tackle opioid addiction by limiting the number of pills physicians can initially prescribe - an idea experts say could reduce excess supply but may cause some pain patients to go days without medication.

    Christie, a Republican serving the last year of his second term, last week ordered new rules that would limit doctors to writing initial prescriptions for five days' worth of opioid-based medications, down from 30.

    The regulation would apply to patients with acute pain, such as a broken wrist, not those with chronic pain. Following a consultation, either by phone or in person, doctors could prescribe more opioids, such as oxycodone and fentanyl, to acute-care patients....

    ...Half of those who abuse the drugs report getting them from a friend or relative, according to 2013-14 National Survey on Drug Use and Health.

    "Many prescriptions may be written for clinically appropriate purposes and still inadvertently contribute to the epidemic because they go unused and ultimately are given or sold to friends or family members," he said

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    Will be interesting if they allow facetime -- issue is SECURE connection, ability to clarify orders provided, able to verify clinician giving orders. What if wife or significant other involved in healthcare picks up cellphone and texts orders without provider being even aware...

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    vampiregirl and txbornnurse like this.

    Most ECF = Extended Care Facility receive that patient with a decubitus ulcer already developed or identified from inpatient stay at a hospital.

    Case #1: Family member had cardiac arrest post anaphylatic reaction to IV Vancomycin, spent 6weeks intubated in ICU went into rapid A fib anytime turned or BP plumeted. Had redness R buttocks pinpoint opening when finally stabalized sent to telemetry. Upon getting to SNF, wound had opened to stage 3; rehospitaled another facility, now stage 4 with severe protein calorie malnutrition. Discharged to Home care where we used wound vac and decub closed after 6 months including 2 further short hospitalizations.

    Case#2: Healthy father with dementia had 2 episodes diarrhea 1 week apart: sudden onset high temp, confusion, inability walk shows up in ER with Stage 2 gluteal fold decub as unable to properly clean backside. Healed with home care intervention. Stage 2 reoccured as health deteriorated, on Hospice as only wanted to sit, unable to ambulate.

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    ICUman and Susie2310 like this.

    Found at Medscape Medical News
    Ken Terry
    January 06, 2017


    Use of Secure Text Messaging for Patient Care Orders Is Not Acceptable


    Joint Commission Reinstates Ban on Order Texting


    Citing patient safety and workflow issues, the Joint Commission last month restored its ban on the texting of orders in hospitals after consulting with the Centers for Medicare & Medicaid Services (CMS).

    In the December issue of its Perspectives newsletter, the Joint Commission, which accredits hospitals and other healthcare organizations, said that computerized physician order entry (CPOE) should be the preferred method for submitting orders, "as it allows providers to directly enter orders into the electronic health record (EHR). CPOE helps ensure accuracy and allows the provider to view and respond to clinical decision support (CDS) recommendations and alerts."
    If CPOE isn't available to the practitioner at the time of the order, a verbal order is acceptable, the Joint Commission said. Verbal orders should be infrequent and not used for the convenience of the practitioner, the body noted.
    According to the Joint Commission, the impact of secure text orders on patient safety remains unclear, for the following reasons:

    • Placing the burden of entering orders from texts on nurses may increase the burden on them and adversely affect their ability to provide care.
    • Transmission of a texted order, unlike a verbal order, does not allow for real-time clarification and confirmation of the order.
    • If a CDS recommendation or alert is triggered during the order entry process, the nurse would have to contact the ordering practitioner for additional information, which could result in a delay in treatment....
    See JCAHO pdf Clarification: Use of Secure Text Messaging

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    Skilled Nursing Facilities and Assisted Living tend to staff 8hr shifts/5x wk with every other weekend rotation with set schedule Most hospitals in Philadelphia area have 3 -12hr shifts/wk and schedule in 6-8wk blocks of time, many have self scheduling where you can quest shifts you desire to work in 2 week increments. Some facilities require alternating days and nights while others staff all days or all night 12hr shifts.

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    Posting in allnurses Nursing in Canada forum is best chance for advice.

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    Libby1987 and nursel56 like this.

    I am one of the QA nurses staff love to hate. Under Medicare payment is based on FUNCTIONAL deficits listed on the OASIS which needs to match the 485 plan of care. Incontinence IS a functional deficit, can lead to falls and should be listed on every client. I add functional deficit answers to about 90% charts i review.

    I highly suggest you attend an OASIS training workshop or at least check out OASIS Answers website for CMS Q+A sections to understand CMS guidance on answering questions. In speaking with my manager, since I attended a Blueprint for OASIS Accuracy workshop, my clients functional scores have improved as reflected at discharge along with agency's functional scores above state average as reported on CMS website.

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    Once you have been disciplined by BON for working with lapsed license requirements in this case mandatory Continuing Education requirements, it is there permanently.


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