collaboration-teamAs a nurse practitioner collaborating with a physician to manage a group of patients within long term care facilities or skilled nursing facilities I find it imperative to implement and consistently utilize a multidisciplinary team approach. A team approach that actively incorporates members from the other health care areas such as MDS, Social Services, Physical/Occupational/Speech Therapy, Pharmacy, Dietitian and if applicable the Surgeon, Infectious Disease and a Specialty Physician – all to ensure for the best patient outcome. 

Lastly, it is also important to familiarize yourself with current policies and procedures such as understanding Medicare and your State’s Board of Registered Nursing laws. 

For example:

  • Medicare requires that the initial visit (history and physical), for the purpose of certifying that the patient requires skilled care, must be performed by a physician. An NP may, however, make a “medically necessary” visit without an initial physician visit; this could occur when a newly admitted Medicare patient in a skilled nursing facility develops a problem that requires medical evaluation and intervention, before being seen by the physician.
  • The NP is responsible for the accuracy and adherence to regulations for all billing claims submitted under the NP’s Medicare provider number, even though the actual completion of forms may be done by a billing service.
  • Medicare requires NPs to be certified by a recognized national certifying body such as American Nurses Credentialing Center (ANCC) in order to become a Medicare provider.
  • Medicare defines collaboration as “a process whereby a NP works with a physician to deliver health care services within the scope of the NP’s professional expertise with medical direction and appropriate supervision as provided for in jointly developed guidelines or other mechanisms as defined by Federal regulation and the law of the state in which the services are performed.


Zika virus disease cases in United States, 2015–2016 (as of June 08, 2016)

Zika Virus:  Map of laboratory-confirmed cases reported to ArboNET by state or territory — United States, 2015–2016 (as of June 08, 2016)

According to the CDC… “Zika virus disease (Zika) is a disease caused by the Zika virus, which is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected. However, Zika virus infection during pregnancy can cause a serious birth defect called microcephaly, as well as other severe fetal brain defects.” 

What we know

  • No vaccine exists to prevent Zika virus disease (Zika).
  • Prevent Zika by avoiding mosquito bites (see below).
  • Mosquitoes that spread Zika virus bite mostly during the daytime.
  • Mosquitoes that spread Zika virus also spread dengue and chikungunya viruses.
  • Zika virus can be spread during sex by a man infected with Zika to his sex partners.

For more information… 

  1. Protect Yourself Against Zika Virus
  2. Zika – The Basics of the Virus and How to Protect Against It
  3. Mosquito Bite Prevention
  4. Testing Algorithm for a Pregnant Woman with Possible Exposure to Zika Virus


APRN BUTTON IN COLOR PICMoore On Health believes that the CURES Database is a best practice for Nurse Practitioners. CURES is the acronym for Controlled Substance Utilization Review and Evaluation System  California’s prescription drug monitoring system. 

According to the State of California Department of Justice Office of the Attorney General – CURES 2.0 (Controlled Substance Utilization Review and Evaluation System) is a database of Schedule II, III and IV controlled substance prescriptions dispensed in California serving the public health, regulatory oversight agencies, and law enforcement. CURES 2.0 is committed to the reduction of prescription drug abuse and diversion without affecting legitimate medical practice or patient care. Do not put off registering with CURES another day. Identifying a medical provider prescriber may save a life. The combination of California’s Nurse Practitioners armed with the latest best practices and routinely using the CURES database will lead to better patient outcomes.

To begin your CURES registration click on the link below.

Also, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and confidentiality and disclosure provisions of California law cover the information contained in CURES 2.0.

Access to CURES 2.0 is limited to licensed prescribers and licensed pharmacists strictly for patients in their direct care; and regulatory board staff and law enforcement personnel for official oversight or investigatory purposes.