ADVANCED PRACTICE PROVIDERS NEWSLETTER
Highlighting APP Practice at UCSF Health
January 2022
Roseanne "Rosie" Krauter, FNP-BC, CORLN, RN, MSN

Roseanne “Rosie” Krauter joined the Office of Advanced Practice Providers as the new Associate Director of APP Clinical Systems on Monday, January 10, 2022. Rosie will work collaboratively with all UCSF Health departments, clinic areas, and sites to ensure alignment among all areas for patient care and Advanced Practice support and advocacy.
Clinical informatics will be used to empower APPs and foster collaboration in the shared goal to deliver excellent patient care.

Rosie began her practice at the Stanford Ear Institute and joined UCSF Health in the Otolaryngology Head and Neck Surgery Department in 2015. She was part of the NPIII cohort in 2017 and later became an Advanced Practice Provider Supervisor. Rosie is an Assistant Clinical Professor with the UCSF School of Nursing. She also serves on the APP Onboarding Committee and the Program for Interprofessional Education Clinical Committee.

In her supervisory work, Rosie found that data can powerfully demonstrate the importance of APPs. Outstanding patient care and large revenue streams became readily apparent and actionable through creation of a novel database that tracked APP charges, work relative value units (wRVU), and patient satisfaction scores. Clinical informatics were also utilized in response to a 14-fold increase in patient advice messages over a three-year period. An automated triage process was designed to separate the administrative versus medical inquiry messages for appropriate routing and improved response times.

Having grown up in the Bay Area, Rosie is fortunate to have family and a close-knit group of friends nearby. Rosie also enjoys camping and hiking with her husband Kevin and spry 12-year-old dog Sierra.
Shelley Gierat, CRNA
Shelley Gierat is a Senior Nurse Anesthetist with over a decade of experience. She received her BSN at San Diego State University and MSN at University of Southern California.

In addition to her full-time position as part of the anesthesia team, she served as an APP advisory board member for the past 3 years and as the Chair of the APP Communication and Outreach Committee for the past year--whose main oversight was to create and maintain the monthly APP newsletter. She contributed greatly to highlighting APP practice at UCSF Health.


NP's Starr Tomlinson and Kristopher Jackson, PhD

Hepatobiliary surgery NP Starr Tomlinson and Orthopedic Surgery Oncology NP Kristopher Jackson co-authored two chapters in the newly released Wolters Kluwer Textbook "Essential Procedures: Acute care". The chapters were on Paracentesis and arterial line insertion. Kristopher also authored an additional chapter on arthrocentesis. In December, 2021 he defended his dissertation on "Advertised Health and Risk Taking Behaviors of Internet-Based MSM Sex Workers in the United States" for his Ph.D studies from University of New Mexico College of Nursing. The project examined patterns in advertised risk taking behavior among MSM sex workers in the US through the lens of hegemonic masculinity, but also demonstrates the potential value of Internet-based data collection in health-related research, particularly among researchers interested in hidden populations or stigmatized behaviors.

CRNA's Gloria Lai and Sarah Zhang

CRNA's Gloria Lai and Sarah Zhang published their manuscript in the December edition of the American Association of Nurse Anesthetist Journal.The article is entitled
 
α2-Adrenergic Receptor Agonist, an Attractive but Underused ERAS Component in ​Improving Fast-Track Recovery and Surgical Outcomes

Zhang SJ, Lai G, Griffis CA, Schiltz M, Aroke EN. α2-Adrenergic Receptor Agonist, an Attractive but Underused ERAS Component in Improving Fast-Track Recovery and Surgical Outcomes. AANA J. 2021 Dec;89(6):529-537. PMID: 34809759.

Jessica Brennan, NP


Pediatric kidney transplant NP, Jessica Brennan, was part of the team that helped with a living-related donor (mother to child) kidney transplant. The story was featured on KPIX Channel 5. UCSF has the largest waiting list in the country with well over 4,500 candidates waiting for a kidney transplant. For full story coverage, click here. Jessica belongs to the American Society of Transplantation where she serves on the advanced practice providers committee, and the International Pediatric Transplant Association.
Sara Miller MPH, FNP


Sara Miller is an NP in the Department of Hepatology and liver transplant and cares for patients with a wide variety of liver disease and those who are waiting liver tranplant. She will be giving a lecture on "Health Disparities in Liver Transplanation" at the GI Grand Rounds on January 12, 2022. MeetingID: 979 2391 6374 Password:133521. In 2020, Sara was identified as one of the "40 under 40: Rising Nurse Leaders" from the UCSF School of Nursing, as she is under the age of 40 and making signficant contributions in health care. She also currently serves as member on the APP Justice Equity and Inclusion committee.
Inpatient News



PRN Pain Order Set Administration Guidelines
Effective 2/2/2022



What: The PRN pain medication order sets will be changing. Revisions will guide nurses' PRN medication administration based on a revised decision-making process. This is based on regulatory findings of inconsistencies between RN pain assessments and subsequent PRN pain medication administration
Who: Nurses on adult and pediatric inpatient units, emergency department and infusion centers
Why: This update follows evidenced-based guidelines for safe and high-quality patient care. Benefits to this approach are fewer adverse side effects (including opioid-induced respiratory depression) and reduced opioid requirements.
How: Orders favor administration of PO before IV starting with the lowest dose in the range (whenever possible). Instead of administering PRN pain medication based on mild/moderate/severe, or a numeric rating scale, PRN pain orders will soon include an individualized, multimodal approach. Examples may include:
  • First-Line: options may include PO non-opioids or PO opiod for patients already on scheduled non-opioids
  • Second-line: adjuvants (e.g., gabapentinoids, alpha 2 agonists, antidepressants, muscle relaxants)
  • Third-line: Opioid PO or IV
  • Breakthrough/emergent pain: medications to treat acute pain that is not relieved by existing PRN or schedule pain medication orders. Considered to be emergent pain relief which supersedes the first, second, or third-line therapy options.
  • Procedural pain: Medication given prior to activity known to induce pain (e.g., complex dressing changes, ambulation, drain removal, etc)

Be on the lookout for updated adult pain order panel and new pediatric pain order panel

Lab Stewardship
Effective immediately
What: The clinical laboratories are facing an unprecedented staffing shortage up to 30% in certain sections due to covid exposures. Significant delays in routine and specialty testing are anticipated, so we are asking all clinical services to critically evaluate all clinical laboratory testing to reduce to that absolutely essential for clinical care
Who: All providers
Why: Many core clinical services are struggling with staffing, and we ask for good resource stewardship in all areas (e.g. radiology, rehab services, etc)
How:
  • Re-evaluate all standing orders, avoid routine daily orders and decrease frequency of serial labs
  • Order CBC only, instead of CBC with differential
  • Avoid repeating labs that won't generate an action (e.g., daily albumin)
  • Avoid repeating labs that are normal on admission and you don't expect to change
  • Defer all non-essential testing
  • Please avoid phone calls to the lab to check on result
APP Education Committee News
Integrated Chinese Medicine:
How to Engage the Medical Team in Whole Patient Care for Cancer Support
Presenter: Misha R. Cohen, OMD, L.Ac.
Clinic Director & Practitioner Chicken Soup Chinese Medicine

Sponsored by San Francisco Bay Area Oncology Society (BAONS)
one free CEU provided

Thursday January 20, 2022 6:40pm-8:00pm
(lecture starts at 7pm)

RSVP at https://www.surveymonkey.com/r/KNCH5C9 and then you will be sent the Zoom event information

If you have questions: email [email protected]
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Academic & EBP Immersion Program Stipends

Academic stipends are available to offset the cost of APPs presenting at a conference in their specialty. Podium/poster/panel presentations will be eligible.
EBP stipends are to support a virtual or in-person attendance at the FULD Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare.he APP E
d ractice in ursing and Healthcare.
APP Standards & Compliance Committee News
**ACTION REQUIRED** How important do you think coding is to being an APP at UCSF?
Not at all
Somewhat
Very important
The Coding Corner
Do you ever wonder why Diagnosis Coding matters?

Do you ever wonder what is the basis of choosing an appropriate diagnosis code?
Do you ever wonder what HCCs and risk capture mean?

Click on this 15 minute video to get answers to all of the above and learn how to use APeX for Diagnosis Coding

For more coding tips/FAQs


** ACTION REQUIRED *** see poll
Daily Health Screener
now has expanded functionality
The daily health screener has more functionality than ever before. You can receive guidance and hotline messaging through the "RETAKE SCREENER" if

a. new symptoms develop...to guide testing option
action: stay home/leave work
b. new report of high-risk exposure
action: go to work/stay at work
c. receive positive COVID test result
action: stay home/leave work
d. receive negative COVID test result
action: complete attestation in Daily Screener and Return to work
Professional Development News
New APPs who joined the UCSF workforce
Austin Agelidakis, NP GU Medical Oncology
Trese Biagini, NP Neurology/Neurovascular
Anne Marie Destruel, NP Neurosurgery
Malory Eichman, NP Adult Electrocardiology
Fielding Elliot, NP Adult ICU
Desirae Exendine, NP Neonatal
Anna Hoffman, NP Integ Pain and Palliative Care
Sang Lee, NP Heart and Vascular Center/Adult Cardiac Stress Lab
Jamie Martin, NP Peds/Neonatal
Megan Stephenson, PA OrthoSpine
Ana Trejo, NP CT surgery
Mentor and Mentee
Stuck in a rut? It can be easy to feel this way once you've been in your career for a while. Mentoring can help you expand your perspective, become a better leader, build community, exercise emotional intelligence and challenge yourself. Whenever you teach or provide guidance to someone else, it can help reignite your own career motivation.

Do you feel as if you need a mentor? Enroll in the program to be matched up with an APP who can speak from experience or point you in the right direction.

If you have questions, please reach out to [email protected]


APP Mentee Application

Teach for UCSF Certificate Program

Improve the quality and depth of your teaching skills
APP Job Corner
Each month you will find the most up to date list of all UCSF Health APP open positions. Refer a colleague and if that colleague is hired, then you may be eligle for a referral award. For more info: referral program
There are over 100 available positions
Wellness News
Useful Wellness and Mental Health Apps

Articles tell us what to do, but apps help lead us and remind us to practice self-care every day. Below are apps UCSF recommend, and many have been shown to be effective in evidence-based research. These high quality apps have been made available to UCSF, with some also free to the general public.
The Stress Free UC Study found that Headspace, used daily for just 10 minutes, reduced stress in a meaningful way and the benefits lasted for two months after stopping use. Headspace can be done in the morning or evening, alone or with family, or anytime you need to take a break.

Please consider trying one of these apps.
Meditation and relaxation
  • Headspace: Two-week free trial for the general public.
  • Calm: Seven-day free trial. A meditation, sleep, and relaxation app that also provides resources specifically for coping with COVID-19 anxiety.
  • Stop, Breathe & Think: Always free, and for kids too.
  • Insight Timer: Always free. This is not a daily app, but rather a great library where you can search for various types of meditations and lengths by excellent teachers.
  • 10% Happier: Free and paid options available. Health care providers can use redemption code HEALTHCARE to unlock all content.
  • UCLA Mindful App: Free and has meditation by Diana Winston.
  • Mindfulness Coach: Mindfulness Coach 2.0 was developed to help veterans, service members, and others learn how to practice mindfulness. The app provides a gradual, self-guided training program designed to help you understand and adopt a simple mindfulness practice.
  •  
Coping with stress and anxiety
  • Sanvello: Clinically validated techniques for reducing stress and treating anxiety and depression (free premium access during COVID-19 pandemic).
  • Happify: Some free content, including stress reduction and cognitive techniques to address anxiety.
  • MindShift CBT: Free content, including cognitive behavioral therapy strategies to address general worry, social anxiety, and panic.
  • PTSD Coach: Created by VA’s National Center for PTSD and the Department of Defense’s National Center for Telehealth & Technology. This app provides you with education about post-traumatic Stress Disorder (PTSD), information about professional care, a self-assessment for PTSD, opportunities to find support, and tools that can help you manage the stresses of daily life with PTSD.
  • PTSD Family Coach: In conjunction with PTSD Coach, the PTSD Family Coach app is for family members of those living with PTSD. The app provides extensive information about PTSD, how to take care of yourself, how to take care of your relationship with your loved one or with children, and how to help your loved one get the treatment they deserve.
  • Mothers and Babies Online Course: Available in both English and Spanish, this online course teaches skills to manage changes in how you feel. Designed for pregnant women, new mothers, and those who want to support them.
  • COVID Coach: Created for everyone, including veterans and service members, to support self-care and overall mental health during the coronavirus pandemic.
  •  
Insomnia
  • CBT-i Coach - Free cognitive behavioral therapy for insomnia, available for iOS and Android.

**Action Required**

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Do you have questions about your APP practice?

Email the Office of Advance Practice Providers: [email protected]



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Ivette Becerra-Ortiz DNP, MPH, NP, RN, NEA-BC, C-PNP
Chief of Advanced Practice Providers
Alisa Yee, MSN, ACNP-BC
Associate Director of Advanced Practice Providers
Brandon Sessler, MMS, PA-C Associate Director of APP Professional Practice
UCSF Health PRIDE Values Professionalism • Respect • Integrity • Diversity • Excellence