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
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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