Using the Appeal Process to Advocate for Medicare Beneficiary Rights
Transcription
Using the Appeal Process to Advocate for Medicare Beneficiary Rights
Network • August/September 2006 Volume 23, Number 4 Using the Appeal Process to Advocate for Medicare Beneficiary Rights Paul Nathenson, MPA BSN RN CRRN Many fiscal intermediaries (FI) use local coverage determinations (LCDs) to make payment determinations for Medicare beneficiaries for care in inpatient rehabilitation facilities (IRF). An FI is a private insurance company that is hired by Medicare to administer and review payment considerations for Medicare beneficiaries cared for in IRFs. The LCD is issued to IRFs by the FI regarding medical necessity as a basis for denial for coverage. In the mid 1980s the Centers for Medicare & Medicaid Services (CMS) (then the Health Care Financing Administration), set forth eight criteria that must be met to determine medical necessity: • The patient must require and receive close medical supervision by a physician with specialized training or experience in rehabilitation. • The patient must require and receive 24-hour rehabilitation nursing. • The patient must require and receive a relatively intense level of rehabilitation services. • The patient must require and receive a multidisciplinary team approach to delivery of the program. • The patient must require and receive a coordinated program of care. • The patient must have a likelihood of significant practical improvement. In This Issue President’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Evidence-Based Rehab Nursing . . . . . . . . . . . . . . . 3 ARN Conference Preview . . . . . . . . . . . . . . . . . . . . . 4 Bedside Meds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Antidepressant Update . . . . . . . . . . . . . . . . . . . . . . . 7 Prepare for the CRRN Examination . . . . . . . . . . . . 9 ARN-CAT Assessments . . . . . . . . . . . . . . . . . . . . . 11 ARN Calendar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 • The patient’s goals must be realistic. • The rehabilitation program must be of an appropriate length. The fiscal intermediary has authority over the redetermination, but it must be completed by someone other than the person handing down the initial denial. Between the changes in qualifying conditions found in the 75% Rule and the medical necessity criteria of the LCDs, IRFs have become increasingly constrained in the type of patients they can accept for inpatient rehabilitation. The bottom line is that Medicare beneficiaries, who have a right to receive inpatient rehabilitation, will be increasingly denied access to such care. In order to advocate for persons in need of inpatient rehabilitation services, IRFs will be forced to appeal cases denied by FIs. The appeal process has become increasingly difficult with an additional level of review that has been inserted called qualified independent contractors (QICs). The appeal sequence begins with redetermination, reconsideration, Administrative Law Judges (ALJs) hearing, and Medicare Appeal Council (MAC). After these four levels of appeal are exhausted an appeal can then be made to federal court. The FI has authority over the redetermination, but it must be completed by someone other than the person handing down the initial denial. The reconsideration level is processed by the QIC, which should include a review by a physician, but there is no requirement for the physician to have PM&R experience. Any evidence not submitted to the QIC will not be allowed for review at subsequent levels of appeal. The appeal process continues to the level of an ALJ if the QIC does not overturn the denial. The ALJ hearing now allows CMS and the FI to participate by filing a position paper or presenting testimony. CMS and the FI can only fully participate in the hearing if they agree to enter as parties in which case they may cross examine and call witnesses. The final administrative level of appeal is at the MAC level. After all administrative levels are exhausted the last resort is an appeal in federal district court. It is more important than ever to push the appeal process not only to advocate for the rights of Medicare beneficiaries but to ensure the survival of IRFs. Although the process and timeliness of the appeal process must be known by the IRF, the basics of the eight criteria from CMS, ruling 85-2, must be integrated at each level in the rehabilitation continuum from pre-admission throughout the inpatient stay. Documentation of the eight criteria must occur throughout this continuum and must be recaptured during the appeal process. Suggested Reading Thomas, P. W., & Connelly, R. S. (2005). Patient protections and managed care reform: Successfully appealing Medicare coverage denials under the new procedures. AMRPA Magazine, 12, 8–11. ARN Annual Conference October 4–7, 2006 Chicago, IL Register at www.rehabnurse.org PRESIDENT’sMESSAGE PRESIDENT’s MESSAGE Leading the Call to Action Stephanie Davis Burnett, MSN RN FNP CRRN What constitutes a leader? There are all sorts of leaders. You may have already cast your vote for your favorite local official or your ARN leader of choice for next year, and I will have already attended ANA’s House of Delegates, representing you among leaders of all the various nursing organizations and groups. But, in keeping with this year’s ARN conference theme “A Call to Action,” I wanted to discuss the role of leadership in the response to that call. We, in our nursing community, think of “leader” when we think of nurses in executive or management roles, or even when we think of officers and board members of a specialty organization. But, what about the leadership involved in so many other roles: staff nurses, educators, and clinical specialists? To lead is to show the way, to guide, direct or cause to follow by persuasion or influence according to Webster’s. Trust and pride are two elements essential for organizational success. However, because of the massive changes that exist within an organization’s environment, it is difficult to establish trust and pride. Change in personnel and leadership can lead to erosion of trust and pride because of fluctuating leadership. Jim Collins, author of Built to Last and Good to Great, wrote “great organizations are built by those who make sure that they have the right people on the bus...before they figure out where to drive the bus.” In other words, they think first about “who” then “what.” Greatness is “largely a matter of conscious choice, and discipline.” Effective leaders ensure that the group or organization has the right people in the right positions. Effective organizations ensure that their core unchanging values are clear. There are many issues affecting healthcare delivery these days (e.g., access to care, limited resources, issues of quality). Will nursing leadership gain the recognition it deserves? If nurses don’t take the lead in today’s healthcare environment with its many nursing challenges, who will? Will nurses seize the opportunity to offer and take the lead that they rightly deserve and in many instances have rightfully gained to date? Will nursing answer the “call to action?” Recently, the Scope of Practice Partnership (SOPP) coalition was formed by the American Medical Association (AMA) to assist various physician organizations facing scope of practice challenges. At its November 2005 interim meeting, the AMA House of Delegates adopted Resolution 814, “Limited Licensure Healthcare Provider Training and Certification Standards.” This resolution states that the AMA and SOPP will study qualifications, education, academic requirements, licensure, certification, independent governance, ethical standards, disciplinary processes, and peer review of the limited licensure healthcare providers, and limited independent practitioners, as identified by the Scope of Practice Partnership and report back at the 2006 Annual Meeting. Studies prove that “limited licensure healthcare providers,” which one assumes includes nurses, provide necessary and valuable service in the provision of health care; some would say, better and more desired care in many instances, especially during this time of challenging healthcare needs and limited availability. Yet the AMA resolves to assess qualifications of other professionals providing a necessary service? Is this truly a concern for the standard of care or is this the reaction of a group being threatened? ARN seeks to be in a position, to lead, to influence, and to take action, by taking an active role in the nursing community leadership. ARN is one of 24 healthcare organization groups that formed a Coalition for Patients’ Rights to ensure that the growing needs of the health system can be met and that patients have access to quality healthcare providers of their choice. In the rehabilitation arena, as you know, with issues of prospective payment and limited resources already, negative actions may prove devastating for many in need of services. ARN seeks to ensure that our core values, as rehabilitation healthcare providers and as an association, are not jeopardized, answering the “call to action.” I challenge each of you, as leaders, to participate in evidenced-based practice and legislative involvement, and become even more involved in ARN. Stephanie Burnett is the hospital education coordinator at the University of Alabama at Birmingham Medical Center. Association of Rehabilitation Nurses 2005–2006 Board of Directors PRESIDENT Stephanie D. Burnett, MSN RN FNP CRRN PRESIDENT-ELECT Terri Sue Patterson, MSN RN FIALCP CRRN SECRETARY/TREASURER Donna Williams, MSN RN CRRN-A DIRECTORS Karen A. Cervizzi, MSN RN CNA CRRN Debra Dzenko, BSN RNC CCM CRRN Sharon Duffy, MS RN CRRN Donna P. Jernigan, MS BSN RN CRRN Meg A. Munger, MN RN CCM CRRN Cyndi A. Murphy, MBA RN CRRN Karion Waites, MSN RN CS-FNP CRRN Susan C. Wirt, RN CCM CLCP CRP CRRN RNF CHAIR, ex officio Cynthia S. Jacelon, PhD RN CRRN-A ARNNetwork • August/September 2006 The Association of Rehabilitation Nurses (ARN) is an international organization of professional nurses who assist individuals with disability or chronic illness in the restoration and maintenance of maximal health. ARN has nearly 6,000 members and more than 65 chapters. ARN’s purpose is to promote and advance professional rehabilitation practice through education, advocacy, collaboration, and research and to enhance the quality of life for those affected by disability and chronic illness. Copyright © 2006 by the Association of Rehabilitation Nurses. ARN Network (ISSN 1075-5764) is published 6 times a year by the Association of Rehabilitation Nurses, 4700 W. Lake Avenue, Glenview, IL 60025-1485, 800/229-7530, 847/375-4710, e-mail [email protected]. Request permission in writing to reprint or copy articles. Letters and suggestions should be addressed to the managing editor. The association reserves the right to accept, reject, or alter all editorial and advertising material submitted for publication. Advertising published in the newsletter does not imply endorsement of products and services. Classified rates available. Call Mary Telios, National Sales Manager, at 800/229-7530, 877/734-9384. ARN Network is indexed in the Cumulative Index to Nursing & Allied Health Literature. New! Evidence-Based Rehabilitation Nursing: Common Challenges and Interventions This new publication is an updated version of the popular Twenty-One Rehabilitation Nursing Diagnoses: A Guide to Interventions and Outcomes. Evidence-Based Rehabilitation Nursing: Common Challenges and Interventions addresses 13 patient problems including: pain, falls, pressure ulcers, bowel, bladder, mobility, cognition, safety awareness, knowledge deficit, behavior management, depression, self-care deficit, and swallowing. tion Nursing: ed Rehabilita Evidence-Bas erventions llenges and Int Common Cha Related or suggested nursing diagnoses, disease states, and nursing interventions are also highlighted. This is an excellent resource for nurses who are involved in planning and delivering rehabilitation care in any setting. It reflects the current state of best, and evidence-based practice in rehabilitation nursing. This publication will be available for purchase in October. To order a copy contact ARN at 800/229-7530, or order online at www.rehabnurse.org. If you attend the ARN conference, copies will be available at the bookstore for purchase. Rehabilitation Center Nursing Leadership Opportunity at… T H E M O U N T S I N A I H O S P I TA L Warren Barr Pavilion, the premier Subacute Rehab/Skilled Facility in Chicago’s Gold Coast, is seeking energetic, passionate and dedicated nurses to join our team. We embrace people as our most important resource, and caring for our residents and families is our first priority. • Subacute Rehab Manager • Subacute Nurses Come join our team to work on our newly remodeled Subacute Unit opening Summer 2006 Our beautiful facility is conveniently located within walking distance of the Magnificent Mile - Michigan Avenue. We offer generous compensation as well as excellent benefits including choice of health & dental plans, 401(k) with employer contribution, tuition assistance, short/long term disability, on site parking and more! Qualified candidates will have experience with rehabilitation/subacute nursing. Candidates should send resumes to: Warren Barr Pavilion Attn: HR Director 66 W. Oak Street, Chicago, IL 60610 • Fax: 312-337-5041 Phone: 312-705-7121 • [email protected] Drug-Free Workplace/Equal Opportunity Employer I N N E W YO R K The Mount Sinai Hospital is the recipient of the prestigious Magnet Award for nursing excellence, the first full-service hospital in Manhattan to earn this designation from the American Nurses Credentialing Center. CLINICAL NURSE MANAGER - REHABILITATION Full time. NYS RN license, an MSN, progressive leadership and relevant clinical experience required. The Mount Sinai Hospital, one of New York’s most prestigious academic health science centers, has a unique opportunity for an experienced Clinical Nurse Manager to direct nursing practice on its 25-bed Brain Injury Rehabilitation Unit. Mount Sinai has the national distinction of being one of only five Centers in the country awarded dual NIDRR Model System Program designation for both its Traumatic Brain Injury and Spinal Cord Injury programs. Another day, another breakthrough. Please send your resume and cover letter, indicating position of interest, to: The Mount Sinai Hospital, Nursing Recruitment, Box 1166, One Gustave L. Levy Place, New York, NY 10029. Email: [email protected]. Fax: (212) 860-6631. We are an equal opportunity employer and foster diversity in the workplace. (212)241-9061/(866)SinaiRN (outside of NYC) www.mountsinai.org/nursing August/September 2006 • ARNNetwork 2006 ARN Conference Paper and Case Study Sessions ARN 32nd Annual Educational Conference October 4–7, 2006 / Chicago, IL The Palmer House Hilton Thursday, October 5, 2006 10–11:30 am Session 601 “Red Alert” Your Patient Has Fallen Marcia Grandstaff LiftRight: Reduce Workplace Injuries Through a Successful Safe Patient Handling Program Michelle Camicia The Monkey’s Cage Tammy Fandrich Searching the Literature for Evidence Anne Deutsch Session 602 Nurse to Patient Ratios: The Massachusetts Experience Debra Frost A Call to Action to Improve the Quality of Patient Care Through Diagnostic Teams and Transitioning from a Team Model of Nursing Care to a Modified Primary Nursing Model Aloma (Cookie) Gender Strengthening the Link Between Nursing and Therapy: A Model for Unlicensed Assistive Personnel Karen Liszner Development of a Rehabilitation Acuity Measurement Tool Donna Loupus Session 603 Chronic Pain: A Multidisciplinary Approach Part 1 Linda Toelke Chronic Pain: A Multidisciplinary Approach Part 2 Linda Toelke Multi-Modal Pain Management Following Limb Loss Janet Frazier PANDA: How to Outwit, Outlast, Outplay Pain Sharon Harton 3:45–5:15 pm Session 701 From Acute Care to Where? Demystifying the Process of Referring Patients to Post-Acute Care Kathleen Grace FY 2006 Final Rule: An Analytical Look at the Changes in the Inpatient Rehabilitation Payment System Donna Elsenheimer FIM™ Rating Accuracy: How Do Rehabilitation Nurses Compare to Other Disciplines? Donna Elsenheimer Cultivating Multidisciplinary Clinical and Business/Financial Best Practices Within Inpatient Rehabilitation Facilities Kathleen Ruroede Session 702 The Consulting Conundrum: Advanced Practice Nurses in Rehabilitation Kristen Mauk The Rehabilitation Nurse as an Expert Witness Debra Dzenko The Entrepreneurial Side of Rehabilitation Nursing Debra Dzenko A New Model in Outpatient Cardiac Rehabilitation Nancy Nathenson Session 703 Understanding Family Member’s Anxiety After Traumatic Brain Injury: From Intensive Care Unit Through Acute Hospitalization and Inpatient Rehabilitation Maria Jinky Valdez TBI and Substance Misuse: “Integrating Recovery” Mary Pat Murphy Disaster Preparedness for Persons with a Disability Gema Morales-Meyer Surviving Suicidality, A Call to Action: Essential Risk Assessment and Interventions for Rehabilitation Nurses Helen Carmine Session 704 CARF Stroke Specialty Certification...One Rehab’s Journey from CHIRP to Stroke Specialty Certification Bernadette Anderson Session 604 Multiple Births with Multiple Disabilities: A Pediatric Case Study of the Unique Rehabilitation Needs of Twins and Quadruplets Terrie Sue Patterson Stroke Survivors’ Responses to Discharge Instructions VaLinda Pearson Wheeling into Life: Wheelchair Sports and Rehabilitation Jane Thomas New Rehabilitation Therapies for Neurological Disorders: Body Weight Supported Treadmill Training and Constraint Induced Movement Therapy Ellen Barker ARNNetwork • August/September 2006 Clinical Trial of Water Protocol for Dysphagia Patients Highlights Crucial Role of Rehabilitation Nurses Lisa K. Tews Friday, October 6, 2006 10:15–11:45 am Session 801 Fighting the War for Ventilator Independence Donna Mack A Pregnant Pause: Addressing the Needs of the Pregnant Traumatic Brain Injured Client Sylvia A. Duraski Saturday, October 7, 2006 8:30–10 am Session 901 Cardiac Rehabilitation—Men vs. Women—Is There Really a Difference? Shirley E. Ackerman The LTAC Rehabilitative Challenge Cheryl Bartlett The Long Journey Home: Helping Families Return Home After Pediatric Spinal Cord Injury Patricia A. Mucia Piloting a Home-Based Telehealth Intervention for Veterans with Stroke and Their Caregivers Barbara Lutz Experiences with Using the Adaptive Crawler™ with Infants with Spina Bifida Margaret Williams Using Educational Videos on Secondary Conditions of Spinal Cord Injury to Enhance Healthcare Practice Phil Klebine Session 802 The Relationship of Continuity/Discontinuity, Functional Ability, Depression, and Quality of Life over Time in Stroke Survivors Janet Secrest Problems Reported by Caregivers of Stroke Survivors During the First Year of Caring Linda Pierce Session 902 Rehabilitation Nurses Use of Spiritual Interventions Mary Catherine Gebhardt Whose Space Is It Anyway? Proxemics in Nursing Celeste E. McLaughlin Two as One: Caregivers’ Success Teresa Cervantes Thompson Factors Related to Stroke Caregiver Depression and Anxiety During Acute Rehabilitation Rosemarie King Cultural Considerations that Affect the Hispanic’s Attitude Toward Disability Sally Ann Gutierrez Adverse Events Experienced by Stroke Survivors the First Year Following Hospital Discharge Sharon Ostwald Session 903 Toward Excellence Linda Lee Thomas Session 803 Critical Decision Making: Survival Skills for the Rehab Nurse Manager Linda DuFour Teamwork Has Many Benefits Beverly Ann Crittendon Growing Our Own: A Program to Develop Nurse Leaders Ann Marie LaRocca Promoting the Professional Development of Nurses Kathleen Stevens Session 804 Rehabilitation of a LVAD Patient Jobey Hendel Life Care Planning: Identifying Alternatives of Care and the Rehabilitation Needs for the Medically Complex Patient Jody Masterson Got CRRNs? A Collaborative Approach for CRRN Certification Ann M. Wilson “It Made Me Think” Christie Bartelt Developing the Talent: A Rehab Residency Program Carolyn Sorensen Session 904 Managing Dysautonomia in the Patient with Severe Traumatic Brain Injury Linda Dufour Essentials of Care for the Client in Coma, Vegetative, or Minimally Conscious States Linda Dufour Nurse’s Recognition of Behavioral Indicators of Escalating Aggression in Acquired Brain Injury Elizabeth Archer Behavior Management and Cognitive Retraining in an Acute Rehabilitation Setting Maureen Musto August/September 2006 • ARNNetwork AST-06-001 VAS Ad BW 2/15/06 1:11 PM Page 1 RehabNurse-L Bedside Meds Question … Has anyone problem-solved how to keep patient medications at the bedside and maintain the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards? Responses … … No meds are acceptable at the bedside. Patient-ordered meds or their own meds are identified and dispensed by the nurse who documents each time they are given as per orders and JCAHO standards. … Any bedside meds are kept in a locked box at each bedside. We only keep topicals, eye drops, and ear drops so we don’t have to return them to the cassette for infection control reasons. … Although it is not the case where I am currently employed, I have worked at some facilities which have developed policies which make exceptions for “rescue” asthma medications, which I personally think is a good idea. … Dispensing is within the scope of practice for pharmacists. Administration is within the scope of practice for nurses. Administration of bedside meds, home meds, and self-administered meds are really three separate, but related issues. Administration of bedside meds involves safely storing meds (MM2.20). Administration of home meds has specific criteria for appropriateness and criteria for using home meds (MM2.40). Administration of self-administered meds has to do with safety and accuracy of administration (MM5.10 and MM5.20). … What we do is fill a 3-day supply of meds in the individually labeled bottles. The patient is provided with the medication list or drug info in a folder, and they are supposed to be responsible for calling for their meds. The nurse keeps the meds locked up in a plastic bag with a zip lock. Then she brings it in the room and supervises or assists the patient setting up and taking his or her meds. We have documentation on the medication administration record, nurses notes, and on our care plan for this. Nurse Manager Full-time, days Kaweah Delta Health Care District is one of the most progressive “families” of health care facilities in the San Joaquin Valley. We strive to insure that the community has access to a broad spectrum of health care services. It is our goal to create a seamless, efficient system of health care services for patients in our area. We are currently seeking a Nurse Manager in our Rehabiliation Department. You will be responsible for the clinical and administrative management of a 45-bed acute rehabilitation, CARF accredited unit, with 24-hour accountability for leading and managing a dynamic and committed team with many CRRNs on staff. Day-to-day operations include maintaining an excellent clinical environment, collaborating with therapy disciplines and medical staff, budgeting and fiscal oversight of unit. The patient population for this well-established program is adults with spinal cord injury, traumatic brain injury, stroke, and orthopedic impairments. We are located in Visalia - one of California’s most attractive cities - just a short drive to national parks and coastal beaches. The remarkable combination of affordable housing and a highly professional practice environment make this a great place to balance your work style and your lifestyle. Our benefits include relocation assistance, flexible schedules, highly competitive salary, matching 401(k) and 457 plans. Apply online at www.kaweahdelta.org or e-mail your resume to [email protected] For more information, please call Jane Therrien, Director of Recruitment at (800) 332-2508. EOE. ARNNetwork • August/September 2006 Introducing the Astra Tech Value Added Services Toolkit. A revolution in VALUE. From the company that brought you a revolution in safety, efficacy, and convenience. Specifying the world’s best-documented, most trusted, and most convenient intermittent catheter now brings a wealth of valuable services such as: – – – – – – Prescription Processing Support Customized Prescription Pads Sampling Program Sample Module Program HIPAA Awareness Patient Teaching Materials To find out how to add the value of Astra Tech to your practice, call 877-4-LoFric. From the makers of the new LoFric ® Primo™ catheter. Reliable. Simple. Small. Astra Tech, 21535 Hawthorne Blvd., Ste. 525, Torrance, CA 90503. Toll Free: 877 456 3742, Fax: 310 316 5296. www.astratechusa.com. pharmacology Update Antidepressant Update Cheryl A. Lehman, PhD RN CRRN-A; Creaque V. Charles, PharmD CGP Rehabilitation nurses should be familiar with current medications for depression so that they can better advocate for their depressed patients. Depression Statistics • Depressive disorders affect approximately 18.8 million American adults, or about 9.5% of the U.S. population age 18 and older. • Everyone will, at some time in their life, be affected by depression. • The rate of increase of depression among children is 23%. • Fifteen percent of the population of most developed countries suffers severe depression. 30% of women are depressed. Men's figures were previously thought to be half that of women, but new estimates are higher. • Fifty-four percent of people believe depression is a personal weakness. • Forty-one percent of depressed women are too embarrassed to seek help. • Eighty percent of depressed people are not currently having any treatment. • Ninety-two percent of depressed AfricanAmerican males do not seek treatment. • Fifteen percent of depressed people will commit suicide. • Depression will be the second largest killer after heart disease by 2020 and studies show depression is a contributory factor to fatal coronary disease. • Depression results in more absenteeism than almost any other physical disorder. • A recent study linked rising rates of SSRI prescription with lower suicide rates in the United States (www.medscape.com/viewarticle/536251). Depression in the past has often been thought to be associated with situations such as a death in the family or a new disability diagnosis. It is now thought that situational depression is a combination of situation and genetics. The specific medication selected for depression is based on symptoms and severity, age and comorbidities, allergies, cost, and side effects. Antidepressants alter the way that neurotransmitters work in the brain. Antidepressants must be taken for 3–8 weeks (depending upon the type of drug) before the full therapeutic effect is seen. Several recent scientific publications suggest the possibility of an increased risk for suicidal behavior in adults who are being treated with antidepressant medications. They state that even before these reports became available, the FDA began a complete review of all available data to determine whether there is an increased risk of suicidality in adults being treated with antidepressant medications. The FDA highlights that • adults being treated with antidepressant medications, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment, or when the dose is changed, either increased or decreased. • adults whose symptoms worsen while being treated with antidepressant drugs, including an increase in suicidal thinking or behavior, should be evaluated by their healthcare professional (www.fda.gov/cder/drug/advisory/SSRI200507. htm). Table 1 provides a brief review of currently prescribed antidepressants, dosages, dosage forms, side effects, and other precautions. For more information about depression, visit www. nimh.nih.gov/. (See Table on following page). Chicago, the site of the 2006 annual conference, offers many exciting views. August/September 2006 • ARNNetwork Continued from page 7 Table 1 Drug Daily Dose Dosage Forms (mg) Common Adverse Effects Additional Comments ACH1 Sedation Cardiac GI Weight Gain * **** Also used for neuropathic pain Common Tricyclic Antidepressants Amitriptyline (Elavil® ) 100–300 T, I **** **** *** Desipramine (Norpramin®) 100–300 T * ** ** * Approved for OCD Doxepin (Sineqaun®) 100–300 C, L *** **** ** **** Monitor blood levels Imipramine (Tofranil®) 100–300 T, C *** *** **** **** Monitor blood levels Nortriptyline (Pamelor®) 50–150 C, L ** ** ** * Monitor blood levels Citalopram (Celexa®) 20–60 T *** * Reduce dose in hepatic impairment Escitalopram (Lexapro®) 10–20 T *** * S-enantiomer of citalopram Fluoxetine (Prozac®, Prozac® weekly, Sarafem® 20–80 C, L, T *** * FDA-approved for OCD; panic disorder; PDD; Bulimia Fluvoxamine (Luvox®) 100–300 T *** * Use with pimozide, thioridazine, mesori-dazine is contra-indicated; monitor drug interactions Paroxetine (Paxil®; Paxil CR®) 20–50 T, L *** ** monitor drug interactions Sertraline (Zoloft®) 50–200 T *** * monitor drug interactions * Selective Serotonin Reuptake Inhibitors (SSRIs) * * Dopamine Reuptake Blocking Agents Bupropion (Wellbutrin®, 300–450 Wellbutrin SR®, Wellbutrin XL®, Zyban®) T * * Contra-indicated in seizures, bulimia, anorexia Serotonin/Norepinephrine Reuptake Inhibitors Duloxetine (Cymbalta®) 40–60 C * * * *** FDA-approved for diabetic peripheral neuropathy pain Venlafaxine (Effexor®, effexor XR®) 75–375 T * * * *** Increase in BP may occur at higher doses 15–45 T * *** * Isocarboxazid (Marplan®) 10–30 T ** ** ** Phenelzine (Nardil®) 15–90 T ** ** Tranyl-cypromine (Parnate®) 10–60 T ** Nafazodone (Serzone®) 300–600 T * Trazodone (Desyrel®) 150–600 T Noradrenergic Antagonist Mirtazapine (Remeron®, Remeron Sol tab®) *** Doses >15 mg less sedating * ** Diet must be low in tyramine; contra-indicated with some other meds ** * *** Diet must be low in tyramine; contra-indicated with some other meds * ** * ** Diet must be low in tyramine; contra-indicated with some other meds * ** * **** *** * Monoamine Oxidase Inhibitors Serotonin-2 Receptor Antagonist Low incidence of sexual dysfunction ** Note: ACH = anticholinergic effects; * – **** = relatively low incidence to very common; BP = blood pressure; T = tablet; C = capsule; I = injectable; OCD = obsessive compulsive disorder ARNNetwork • August/September 2006 certification Update Prepare for the CRRN Examination Mary Ann Reilly, MS BSN RN CRRN, Rehabilitation Nursing Certification Board member Preparing for the Certified Rehabilitation Registered Nurse (CRRN®) examination may seem like a daunting task. The scenario usually begins with a friend or manager encouraging you to take the examination. They promise to give you all the help you need. Next, you order study materials and when they arrive you take a deep breath and ask yourself, “What have I committed to?” I am here to congratulate you for taking the first step and to tell you that the next few steps will take dedication and commitment, and that you can be successful. There are several ways to prepare for the examination. No one way is better than another. An important point to remember is that the examination was developed to certify nurses who practice in every field of rehabilitation nursing. You don’t need to be an expert in every field. You need to know the concepts and principals of rehabilitation and be able to apply them. The examination was developed to evaluate your application of rehabilitation knowledge. As you prepare for the examination, you will want to consider your learning style (e.g., auditory, visual) and develop a study plan. Studying for the certification examination may include any or all of the following steps: 1. Identify weak areas of knowledge. You must keep in mind that the examination content covers the scope of rehabilitation nursing (e.g., age, diagnosis). If your practice is limited, you will want to focus on those areas that are less familiar. There is a list of suggested resources available in the candidate applica- tion handbook and on ARN’s Web site at www.rehabnurse.org. 2. Obtain a general rehabilitation nursing text such as The Specialty Practice of Rehabili- tation Nursing: A Core Curriculum, 4th edition or Rehabilitation Nursing: Process, Application, and Outcomes, 3rd edition. Both provide a foundation for preparing for the examination. 3. Attend a review course such as the Professional Rehabilitation Nursing Course offered by ARN. This course describes the major pathophysio- logical and sociological states occurring with prolonged illness and disability. It provides you with a discussion on how rehabilitation services 4. affect today’s healthcare environment. It iden- tifies nursing interventions for rehabilitation clients and families that will meet individual needs and promote positive client outcomes. It examines settings where the continuum of rehabilitation nursing care occurs. Join a study group. As part of a group, you will have an opportunity to discuss the information obtained from a review class or self-study. Plus, the moral support obtained is invaluable. Finally there are basic cues for taking multiplechoice tests: • Read the entire question before you look at the answer. • Read all the choices before choosing your answer. • Eliminate answers you know aren’t right. • Don’t keep changing your answer; usually your first choice is the right one. You will never obtain your CRRN certification if you don’t take the first step. Call for the application handbook, talk to your peers and get a core support group and begin today. Use the encouraging words you give to your patients to begin your road to becoming a CRRN. Is It Time To Renew Your Certification? If you passed the exam in… Your certification will expire on… The application deadline is… You may use points earned between… December 2001 December 31, 2006 September 30, 2006* September 30, 2001–September 30, 2006 June 2002 June 30, 2007 March 31, 2007* March 31, 2002–March 31, 2007 Renewal applications are mailed approximately 1 year prior to your certification expiration date. Please call 800/229-7530 if you have not received the renewal application within 6 months of the certification expiration date. To be fair to all candidates, all deadlines are strictly enforced. *Applications postmarked after the deadline date but on or before the expiration date are accepted with payment of a late fee. 2006 CRRN Examination Schedule The Certified Rehabilitation Registered Nurse (CRRN®) examination will be offered December 1–31. The application receipt deadline is October 15, 2006. The application is available at www.rehabnurse.org or by calling 800/229-7530. Don’t miss this opportunity to demonstrate your skill and commitment to caring for individuals with physical disability or chronic illness. August/September 2006 • ARNNetwork Celebrate Rehabilitation Awareness Week We recognize the efforts of rehabilitation professionals whose expertise and encouragement have given them the ability and courage to make their own dreams come true. Rehabilitation Nurses Make a Difference! The Department of Veterans Affairs, Puget Sound Health Care System (VA PSHCS) and the Department of Rehabilitation Medicine are seeking a Certified Rehabilitation Registered Nurse (CRRN) for a full-time position with clinical case management responsibilities, and education of rehabilitation principles. The required professional requirements are a minimum of two years of experience. The successful candidate will need advanced experience in clinical case management which involves acting as a point of contact for emerging medical, psychosocial, and/or rehabilitation problems. The position will be integrated into our new Polytrauma program for Operation Iraqi Freedom and Operation Enduring Freedom patients and our Comprehensive Inpatient Rehabilitation Unit. The VA PSHCS is a two division facility (Seattle and Tacoma). VA PSHCS has several Centers of Excellence which include Spinal Cord Injury, Multiple Sclerosis, and Preservation Amputation Care Team and have been selected as a secondary site for a Polytrauma program involving Operation Iraqi Freedom and Operation Enduring Freedom patients. Our staff also participates in Parkinson’s Disease Research Education and Clinical Center (PADREC). Our inpatient rehabilitation unit and the Spinal Cord Injury program are both CARF accredited. For information regarding the position, please refer to the posting on www.usajobs.com or call Carol Wieltschnig, Nurse Recruiter at (206) 764-2487 for an application packet. Please mail your application to: Nurse Recruiter Office, VA Puget Sound Health Care System 1660 S. Columbian Way, Mailstop 663/S-118, Seattle WA, 98108 The VA Puget Sound Health Care System is an Equal Opportunity Employer. 10 ARNNetwork • August/September 2006 Fabulous News for Rehabilitation Nursing Rehabilitation Nursing has been added to the Institute of Scientific Information (ISI) Web of Science with V 31(1) 2006. It will appear in the Science Citation Index Expanded and in the Social Sciences Citation Index, two of the key components of the Web of Science. This action will provide more visibility for the journal and give users worldwide access to Rehabilitation Nursing articles. The purpose of the ISI Web of Science is to provide seamless access to current and retrospective multidisciplinary information from approximately 8,700 of the most prestigious, high-impact research journals in the world. With ISI, users can navigate the literature, searching all disciplines and time spans to uncover all the information relevant to their research and in our case, rehabilitation nursing practice. In this age of evidence-based practice, Rehabilitation Nursing’s inclusion in this selective network permits users to identify relevant data to guide practice, but it also illuminates areas requiring additional exploration. With the inclusion of Rehabilitation Nursing in ISI , our journal and its authors now receive recognition of their significant contributions to the body of science and the resultant nursing practice within the global community. It also affirms the important responsibility of rehabilitation nurses to continue to develop the science underpinning our practice, but it also describes how this scientific evidence is specifically applied and what areas of knowledge must be explored. Log On to See What’s New with the ARN-CAT! The ARN Competencies Assessment Tool (ARNCAT) now provides assessment for Pediatrics and Gerontology! ARN volunteer experts have been hard at work developing two new assessments along with adding all NEW questions for autonomic dysfunction, communication, disability adjustment/ grieving, neuropathophysiology (CVA, SCI, TBI) and functional neurological assessment, patient and family education, and skin and wound care. Nurse managers, administrators, or rehabilitation nursing educators need a simple way to evaluate staff competency in the basic areas of rehabilitation nursing. The next time you need to provide evidence of competency to JCAHO, to test your staff ’s knowledge to meet internal education goals, or evaluate the proficiency of visiting/floating nurses, think of ARN. ARN-CAT can help, at no cost to you or your staff! ARN-CAT is an easy-to-use, online assessment tool that encompasses 14 basic rehabilitation nursing competency areas. Upon completion, your staff will receive instant documentation of the accuracy of their answers. The tool also identifies areas where further education may be needed and suggested references. To see for yourself how easy it is to use and to use the new assessments, log on to the ARN Web site at www.rehabnurse.org. ARN Calendar September 15–16 October 17 The Southeast Texas Chapter is sponsoring a CRRN review class in Houston. For more information, call 713/704-6219 or 281/855-3704. Greater Kansas City Chapter presents “Epilepsy: Diagnosis and Treatment.” For more information, contact Joan McMahon at jmcmahon@ kumc.edu. September 19 Greater Kansas City Chapter presents “Spasticity Management PostStroke” on September 19. For more information, contact Joan McMahon at [email protected]. October 4–7 Join ARN for the rehabilitation nursing educational event of the year! The 32nd Annual Educational Conference will be held at the Palmer House Hilton, Chicago. November 21 Greater Kansas City Chapter presents “The Challenges of Caring for Wounds for the Bariatric Patient.” For more information, contact Joan McMahon at [email protected]. For more information about these programs, visit the ARN Web site, www.rehabnurse.org, and click on the link to the chapters. Promote Rehabilitation Nursing Research by Participating in the RNF Basket Auction Join the fun and excitement of bidding on baskets filled with useful and fun items at the ARN conference in October in Chicago. As a fundraiser for the Rehabilitation Nursing Foundation (RNF), a variety of eye-catching baskets donated by ARN members, chapters, and exhibitors will be on display for the auction. Attendees are invited to bid on the baskets of their choice, and winning bidders will bring home fabulous baskets as reminders of their donation to support the RNF and rehabilitation nursing research. For more details about the auction or to donate a basket, visit the ARN Web site, at www.rehabnurse.org. Keep Us Informed! Be sure to visit the members’ only section of the ARN Web site at www.rehabnurse.org to access the Online Membership Directory. If you have a new address, phone number, or e-mail address, be sure to update your information in the ARN Online Membership Directory. To log on to the members’ only section for the first time, enter your membership number in Web ID field and your last name in the password field. You can also use the directory to search for members by name, city, state, ZIP code, present position held, current clinical practice interest, or chapter. August/September 2006 • ARNNetwork 11 Register Now Plan to attend the rehabilitation nursing event of the year! Learn about the latest treatment advances and cuttingedge issues in rehabilitation, as well as state-of-the-art approaches to improve patient care and outcomes. Gain vital knowledge, resources, and practical solutions you can use in your practice right away. Register now at www.rehabnurse.org or call 800/229-7530. Association of Rehabilitation Nurses 4700 W. Lake Avenue Glenview, IL 60025-1485 Address Service Requested PRSRT STD U.S. Postage PAID Glenview, IL Permit No. 62