Wisconsin Nurse - March 2021

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Page 10 The Wisconsin Nurse March 2021 For some, safer at home is not safe at all Domestic violence (DV) often used interchangeably with intimate partner violence (IPV) includes the emotional, physical, or sexual assault by a current or past intimate partner, child, and elder abuse (Center for Disease Control, 2008). At baseline annually, the rate of DV/IPV is one in four women and one in ten men (Smith, Zhang, Basilek, et al, 2018). Since the pandemic’s safer at home order, measures preventing families from leaving their homes has caused the rate of domestic and intimate partner violence to rise more than sixty percent. Data from all of 2019 identified 52 domestic homicides for the year (Luthern, 2020), yet as of the end of October 2020, there were an alarming 78 domestic deaths with two additional months of data collection pending. Examples of this increase is further seen in the number of calls to law enforcement. As of May 2020, there was a 16% increase in calls to the Madison police department (Walters, 2020). Across the country, similar reports to law enforcement were identified as early as one week after the saferat-home orders went into effect. The percentage of call volume increased between 10% in New York to 27% in Jefferson County, Alabama with 22% increase in Portland, Oregon and 18% in San Antonio, Texas (Boserup, McKenney, & Elkbuli, 2020). Additionally, shelters were closed or offered limited bed space due to pandemic restrictions. A rise in DV is not new and these trends have been seen following other natural disasters. Following the aftermath of hurricane Katrina, studies reported a fourfold increase, primarily intimate partner violence toward women (Anastario, Shehab, & Lawry, 2009). Another study recorded a 98% increase in prevalence of physical abuse of women following hurricane Andrew (Laudisio, 1993). The rise in DV is likely multifactorial including unemployment, anxiety, economic strain, mental health, and a lack of social support (Boserup, McKenney, & Elkbuli, 2020). DEPARTMENT OF NURSING OFFERS THE FOLLOWING OPPORTUNITIES STARTING IN FALL 2021 Full-time Clinical/Instructional Faculty and Adjunct Clinical positions • Teach traditional undergraduate baccalaureate students • Enjoy classrooms with latest technology to enhance teaching and learning • Join a talented team of educators • Utilize state of the art simulation center • Help to educate the next generation of nurses • Enjoy support for professional development and scholarship Faculty Application Deadline: April 1st For more information and application, visit https://www.carrollu.edu/employment Recognizing the signs of domestic violence and greatest risk factors increasing the likelihood of homicide will be important for nurse practitioners. Women 20-24 are at the highest risk of non-fatal violence. This same age is also at risk of the highest rate of sexual assault and rape, followed closely by those 16-19 years old. Stalking rates are the highest among 18-19 years old. Native Americans and Alaskan Natives experience the highest rates of IPV (Catalano, 2007 & Centers for Disease Control and Prevention, 2008). Teenagers are equally a highrisk population in the United States, one in three teen girls are a victim of physical, emotional, or verbal abuse from a dating partner (Davis, 2008). Additionally, nurse practitioners must know the highest risk when counseling their female patients to consider leaving their perpetrator. The highest risk of fatality is access to a firearm. Access to a firearm increases the risk of homicide ten times. The highest risk of harm occurs in the first three months following the escape from a perpetrator of DV (Spencer & Stith, 2020). Although challenging, conversations assessing safety risks include prior threats with a weapon or harm of strangulation as these risks increase homicide seven times (Spencer & Stith, 2020). Working with these patients should include creating a safety plan and identifying a haven available to support the patient and any children when ready to leave. Nurse practitioners should incorporate screening tools for IPV/DV into standard patient care. Several screening tools are available, with the most studied screening tools including the Hurt, Insult, Threaten, and Scream (HITS), the Women Abuser Screening Tool/Woman Abuse Screening Tool (WAST/WAST-SF), the Partner Violence Screening (PVS), and the Abuse Assessment Screen (AAS). (Rabin, Jennings, Campbell, & Bair-Merritt, 2009). These tools can be utilized to identify patients at risk of IPV/DV and resources can be provided to maintain safety and promote a strategy to abandon the abuser. During this pandemic, the utilization of these screen tools could potentially save a life. Reference Adverse Health Conditions and Health Risk Behaviors Associated with Intimate Partner Violence, Morbidity and Mortality Weekly Report. February 2008. Centers for Disease Control and Prevention. Available at www.cdc.gov/mmwr/ preview/mmwrhtml/mm5705a1.htm. Anastario, M., Shehab, N., & Lawry, L. (2009). Increased gender-based violence among women internally displaced in Mississippi 2 years post- Hurricane Katrina. Disaster Medicine and Public Health Prepared-ness, 3, 18–26. http://dx.doi. org/10.1097/DMP.0b013e3181979c32 Boserup,B., McKenney, M., & Elkbuli, A.(2020). Alarming trends in US domestic violence during the COVID-19 pandemic. The American Journal of Emergency Medicine. 38. 2753- 2755. Doi:10.1016/j.ajem.2020.04.077. Brown (1996). WAST Screening for Intimate Partner Violence. Family Medicine. 28(6): 422-8 Catalano, Shannan. 2007. Intimate Partner Violence in the United States. U.S. Department of Justice, Bureau of Justice Statistics. Available at http://www.ojp.usdoj.gov/bjs/intimate/ ipv.htm. Retrieved from: http://www. futureswithoutviolence.org/userfiles/file/ Children_and_Families/DomesticViolence.pdf Davis, Antoinette, MPH. 2008. Interpersonal and Physical Dating Violence among Teens. The National Council on Crime and Delinquency Focus. Available at http://www.nccdcrc.org/nccd/pubs/ Dating%20Violence%20Among%20Teens.pdf. Hope domestic violence homicide help (2020). Retrieved from: https://domesticviolencehomicidehelp. com/2020-deaths/ Kofman,Y. B. & Garfin, D. R. (2020). Home is not always a haven: the domestic violence crisis amid the COVID-19 pandemic. American Psychological Association. 12(S1). S199-S201.http://dx.doi. org/10.1037/tra0000866 Laudisio, G. (1993). Disaster aftermath: Redefining response—Hurricane Andrew’s impact on I&R. Emmitsburg, MD: National Emergency Training Center Luthern, J. (2020). 'A sobering reminder': Wisconsin had 52 victims of domestic violence homicide last year, and experts fear those numbers are growing. Retrieved from: https://www.jsonline. com/story/news/crime/2020/09/16/wisconsin- domestic-violence-statistics-52-killed-2019- homicides/5819004002/ Rabin, R. F., Jennings, J. M., Campbell, J. C., & Bair- Merritt, M. H. (2009). Intimate partner violence screening tool. American Journal of Preventive Medicine. 36(5). 439–445.e4. doi: 10.1016/j. amepre.2009.01.024 Spencer, C. M. & Smithm S.M. (2018). Risk factors for m ale perpetrator and female victimization of intimate partner homicide: A meta-analysis. Retrieved from: https://journals.sagepub. com/doi/full/10.1177/1524838018781101?ca sa_token=7xFMAjOwSH0AAAAA%3Aqhi_a9tL Z8hn9f32pLqmVcSE3JUkKV1N2juR3J77HIJEGbVTxHaN9RCcdu4brTqq_orwId1v2g-mg. https:// doi.org/10.1177/1524838018781101 Smith, S.G., Zhang, X., Basileck, C. et al, (2018). The national intimate partner and sexual violence survey: 2015 data brief update. CDC. Retrieved from: https://stacks.cdc.gov/view/cdc/60893 Walter, A. (2020). Madison’s only emergency domestic violence handles pandemic-related surge in demand. Retrieved from: https://badgerherald. com/news/2020/05/09/madisons-onlyemergency-domestic-violence-shelter-handlespandemic-related-surge-in-demand/ We’re looking for Superheroes! RNs, LPNs, CNAs | All Shifts Available Christian Community Homes www.cchhudson.org or call 715-386-4534 Two Locations: Hudson & Osceola Bryant & Stratton College Nursing Department Openings Program Administrator – Nursing | https://bit.ly/3pgY72k The focus of this position is supporting the Nursing Program and Dean of Nursing with ongoing faculty development, program accreditation activities, managing data, supporting students, and ongoing curriculum review and revision. • Five (5) years teaching experience in higher education setting; instruction in educational theory and techniques preferred Registered Nurse Instructor | https://bit.ly/36ecUDv • Teach 15 to 21 contact hours clinical and/or theory classes • Collaborate with nursing faculty in developing and evaluating course curriculum, learning support, and assessments • Implement and evaluate strategies for improved student retention and success Contact Linda Krueger for more info lmkrueger@bryantstratton.edu
March 2021 The Wisconsin Nurse Page 11 CMS Evaluation and Management Coding Changes Dr. Tina Bettin DNP, MSN, RN FNP-BC, APNP, FAANP As of January 1, 2021, the requirements for documentation of office visits in the clinic/outpatient setting changed significantly. This change is the most substantial in 30 years to CPT evaluation and management (E/M) codes. For those of you who do not know about E/M codes, these are the requirements for charting documentation to bill or charge different levels for the visit. Back when I first started working at a nurse practitioner, there was only one level for billing CMS and insurance companies. This eventually changed to five levels of billing based history and physical exam along with being either a new or established patient. In the former E/M levels, one billed based the elements addressed and medical decision making. These elements included a system (i.e., respiratory) and then the number of bullets addressed under this system (lung sounds, chest excursion, etc.). There was also an option for time spent with the patient but this was only face to face time for counseling. Approximately three years ago, CMS under took an initiative called “Patients over Paperwork.” This initiative was to get the provider back to caring for patients and not spending excessive time charting/documenting, which is one of the most common complaints of providers. This article will provide a high level overview of the changes. CPT code 99201or level 1, which is the lowest level, was deleted. This leaves levels of 99202 to 99215 for new and established patients. In the new way of coding, your level is based on medical decision making or total time of visit including non-face to face time such as chart review on the day of the encounter. The visits are now based on the number of new or old problems addressed. With old problems/illness, it is stable or has there been an exacerbation or progression of the disease state from previous. Within the medical management section, the provider can receive credit for social determinants of health, emergency surgery, elective surgery with no risk or risk factors identified, drug therapy requiring monitoring for toxicity, decision for hospitalization or decision for do not resuscitate. The criteria for new and established patients are the same whereas previously the provider had to address more elements and bullet points for a new patient. For most providers, this is a huge change. The change was also very quickly implemented with most providers hearing about it in early December 2020 with the effective date of January 1, 2021. Hopefully, this change does what it was intended to do–patients over paperwork. This is yet to be determined, since the new guidelines were only implemented two weeks ago. Please stay posted for additional information and/or changes. Wisconsin Emergency Assistance Volunteer Registry (WEAVR) Help Support Wisconsin During the COVID-19 Pandemic. Join WEAVR Today! https://weavrwi.org/ WEAVR is open to active and retired health care professionals and also welcomes behavioral health and animal health professionals. What is WEAVR? The Wisconsin Emergency Assistance Volunteer Registry (WEAVR), is a secure, password-protected, web-based volunteer registration system for health care and behavioral health professionals. Volunteers interested in filling critical response and recovery roles following a major public health emergency self-register and are the only ones that can update their information. Based on the information collected from each volunteer, public health officials identify those professionals willing to fill the specific volunteer roles needed in an emergency. Public health officials use the WEAVR registry to generate a list of volunteers to be contacted. Those contacted will be given information on where to report and the role that is needed, as well as the option to accept or decline the opportunity. Training will be provided at the reporting site. WNA offers a member-only professional development and networking platform all in one place WNA created Wisconsin Nurses Connect for you the WNA member. If one of your New Years Resolutions is to increase your professional knowledge that is time sensitive, nursingfocused Wisconsin NursesConnect will help you with your goal. Wisconsin NursesConnect will also allow you to post and have real time on-line discussions. Give Wisconsin NursesConnect a try in 2021! https://www.mightynetworks.com/ Is being a My Choice Wisconsin Nurse right for me? My Choice Wisconsin nursing is ideal for: • Recent graduates ready to start their nursing careers • RNs that are re-entering the workforce; looking for work and life balance • Experienced Nurses that are ready for a change • RNs that enjoy autonomous, but supported work Ask about our sign-on bonus! www.mychoicewi.org/careers/NN
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