Thank you to all who contributed their time and efforts in support of HB21-1184, Physician Assistant Collaboration and Reimbursement. The bill did not pass out of the Colorado House Health & Insurance Committee (5 in favor, 8 oppose) and will not move any further in the legislative process (Click here to listen to the hearing). While this is not the outcome we desired, CAPA recognizes the progress made in engagement and awareness around the need to modernize PA practice in Colorado.  We are in it for the long game.

CAPA remains committed to our mission to advocate for state regulation change that supports PA practice and access to high quality health care in Colorado. PAs are well-trained, quality medical providers who take care of patients as part of the medical team, and we will continue educate, advocate and increase understanding of the important role that PAs play. As an organization, we wholeheartedly believe that removing arbitrary administrative barriers will allow PAs to better serve the patients of Colorado.

What can you do to help these efforts? A great place to start is continuing your CAPA membership and encouraging your colleagues to join. CAPA now has an auto-renewal feature that takes one thing off your to-do list and ensures your support of Colorado PA advocacy remains consistent. Next, look for opportunities to get involved! Stay tuned for opportunities for further input and engagement around legislative priorities!

For more information about this bill and CAPA legislative priorities, please visit ColoradoPAs.org/legislative-priorities.

Alyn Whelchel, PA-C

President, CAPA 2020-2021

Table of Contents:

• President's Perspective
• CAPA|NIH Collaboration: All of Us Research Program
• Announcements: Call for Board-of-Directors and House of Delegates Nominations
• COPIC Corner
  
• House of Delegates Update
• Student Affairs Committee Update: Virtual Silent Auction
• 
  

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Colorado Academy of PAs

PO Box 100356

Denver, CO 80250

720-515-4480

info@coloradopas.org

www.coloradopas.org

Looking to get involved?

Click here to learn about joining a committee

COPIC Corner

by Michael Victoroff, MD, COPIC Patient Safety and Risk Management

DEALING WITH POTENTIALLY DANGEROUS PATIENTS

Health care providers regularly deal with patients under stress and are exposed to the risk or threat of violence in the workplace at higher rates than most other professions. Unfortunately, at times, the nature of the profession makes it necessary for providers to care for, manage, or defend themselves from a person who is acting out violently.

RISK FACTORS FOR VIOLENCE IN PATIENTS

The strongest risk factor for violence is a history of violence. Other risk factors include:

·         Intoxication

·         Delirium and delusional states

·         Suicidal intent

·         Fear, anger, and revenge

·         Explosive or antisocial personality traits

·         Communication barriers, like language, sensory or intellectual impediments

AWARENESS OF SIGNS IN PATIENT BEHAVIOR

Violence can be impulsive and unpredictable.  But, there are signals that give a sense of when an assault may be impending. Many of these are intuitively apparent, including head shaking, jaw tightening, eyes diverted, and impingement on interpersonal space. Verbal signals like shouting and threatening are familiar. The important goal is neither to disregard these behaviors, nor to escalate them by overreacting. It is hard to be non-judgmental in the face of an assault, but training and experience can help people remain composed and professional in situations that can be deflected or de-escalated.

OSHA requires employers to provide their workers with “a workplace free from recognized hazards.” Facilities should implement comprehensive plans addressing violence prevention, warning signal recognition, threat assessment, verbal and physical de-escalation, and other topics. These and other valuable tips are outlined in “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers,” which can be downloaded at https://www.osha.gov/Publications/osha3148.pdf

CONSIDERATIONS FOR ADDRESSING TENSE SITUATIONS

A delicate judgment needs to be made sometimes between confronting a belligerent person with threats (e.g., “You’re making me very uncomfortable. If you continue to act like this, I’m going to call security.”) versus attempting to bond with them by being accommodating (e.g., “I definitely get why that’s bothering you. Let me see if I can do something to help.”). Unfortunately, there is no fixed rule for when to apply one tactic or the other.

The practitioners who are most talented in this art tend to be those with experience. One important point about verbal confrontation is that high stress levels can generate a state of “auditory exclusion,” in which any party might actually not be able to hear questions, instructions, or commands. Besides offering training, facilities and practices need to assure adequate staffing for safety. They can support their staff with policies that encourage personnel to take unobtrusive, protective steps at an early stage of discomfort. Some of these include involving chaperones or asking a colleague to join a tense discussion, maintaining interpersonal space, not leaning/reaching across the patient’s body, or not allowing a patient to block the way out of a room. In some cases, it might be better to avoid giving a patient the sense of being physically or emotionally “cornered.”

Physical and technological measures are available that can be useful. Some of these are flags in the patient chart about a past history of violence or delirium, a coded flag on the patient’s door or stretcher, color-coded patient gowns or wristbands, “panic buttons” in patient care areas or even wireless alarms carried as ID badges. Appropriate physical barriers (such as reception desks) and clear pathways within the facility are common sense measures. Visible video cameras may have a deterrent effect (and recordings can help defend providers, when their actions are proper.)

Finally, it should be remembered that people who have been subjected to violence may carry a bit of latent PTSD. The very training and policy discussions intended to improve safety can be experienced as stressful by some trainees. Some people don’t have the temperament to intervene in a violent encounter, and it is not reasonable to build this duty into everyone’s job requirement.

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Tyler Anderson, PA-S, and Danielle Pelletier, PA-S

Jessica Dowgiert, PA-S, and Alexandra Pollack, PA-S

Happy Spring from Rocky Vista University’s PA program!

The class of ‘21 is finishing up the last couple months of their clinical rotations. They are participating in clinical rotations throughout Colorado and surrounding states. Even when they are busy with rotations, the class of ’21 has been so generous and helpful to the class of ’22 by hosting “Fireside Chat” zoom sessions where they give advice and answer questions about clinical rotations. The class of 2022 is so appreciative for their generosity and mentorship! When they aren’t busy in clinical rotations or giving advice to the class of ’22, the class of ’21 can also be found working hard on their capstone projects.

The class of ‘22 has been busy studying as they are over halfway through the last semester of didactic year! Although they are entirely virtual for lectures, the students have been ecstatic to be able to get onto camps for a couple days this semester to practice ultrasound and physical exam skills. They are also looking forward to May when they will start the Introduction to Supervised Clinical Practice Experiences course before they begin clinical rotations in June. With a virtual learning environment, the class of ’22 has worked hard to be creative in their efforts to stay connected and continue to build a sense of community among their cohort. They have enjoyed scheduling times to play virtual Codenames when they aren’t busy studying. They are also looking forward to welcoming the upcoming class of ’23 by being assigned a “PA-pal” to share advice and tips with on how to survive the didactic year.

Follow us on Instagram and on Facebook to see what RVU and our PA program is up to!

Catherine Atkinson, PA-S and Andrew Pratt, PA-S

Volunteering

Our students have been working at the Community Table Health Clinic every other Wednesday, learning about patient care, screening patients, and providing patient education.  They have loved it so far and are grateful for the experience.  In addition to that, the class of 2022 has been volunteering at Covid clinics throughout Denver, helping to vaccinate over 5,000 people per day.

Clinical Rotations

The class of 2021 has been working tirelessly each month on their clinical rotations.  Our students have completed rotations all across the state of Colorado and even Wyoming.  They have had incredible experiences thus far, ranging from doing wellness checks on infants to rotations in palliative care.  They will be graduating before we know it.  We are so proud of them!

New Appearances on Campus

Our students welcomed our beloved professor Dr. Witwer back to campus two weeks ago.  Due to Covid, the class of 2022 had only interacted with him on Zoom for lectures.  We are thrilled and grateful to have Dr. Witwer back on campus in the classroom with us.  We even greeted him with his favorite drink, Pepsi Max.