Prior approval is used to review applications and award CE credit in advance. Prior approval by the AANA signifies that a CE activity has met specific standards and has been awarded CE credit before its actual presentation. In addition, it obliges the provider to assume certain responsibilities for recordkeeping and recording attendance. The program content must be consistent with the overall purpose and goals of AANA’s CE Program.

Application Submission
Providers are encouraged to submit applications, including all supporting material, 90 days before the first date of presentation. Although the 90-day submission period is not mandatory, it allows time for processing, corrections, and advance publicity.

Four options are available for submission of an application for prior approval:

1. Use an original AANA application form.
2. Use a photocopy of the AANA application form. Applications may be photocopied, but two copies of the front page must be submitted if the provider wants confirmation that the application has been processed. The photocopy must be on 8-1/2" x 11" white paper, clear, legible, and show all the information that is part of the front of an original application in an unreduced likeness.
   
   Facsimile (fax) copies of applications are accepted only if they are legible and if all the information on the form appears on the faxed copy.
3. Use a computer-generated application form. Two copies of the front page must be submitted, and they are accepted only if they are identical to the official AANA application form. The Committee suggests that a copy of the proposed computer form be sent to the CE Department for evaluation before submitting it for approval.
4. Use a pdf file. Contact the CE Department to receive this file or check the AANA web site for availability.

If the application is submitted by fax or email, all of the information required on the application must be received before the application can be processed.

The duplicate of the AANA-provided form or the second copy of the front page is used to inform the provider of the approval status. A notice will not be sent if the duplicate or second copy is not received.

Educational activities for which AANA prior approval is sought must be reviewed thoroughly before approval. Allow at least 30 working days before contacting the CE Department about the status of the application. The CE Department does not acknowledge, by phone, facsimile, or e-mail, the receipt of applications for prior approval.

Fees
A nonrefundable, nontransferable fee must accompany all applications submitted for prior approval. The current application form indicates the fee.

Prior Approval Notification
All providers who submit an application for prior approval will be notified as to the status of the application within 30 working days.

The notification that a CE activity has been awarded prior approval contains the AANA code number, the number of CE credits awarded, the date of AANA approval, the program approval expiration date, a list of the provider’s recordkeeping responsibilities, attendance recording, and all pertinent information about the approval.

If additional information is requested before an application can be approved, it must be received before the presentation of the CE activity. Prior approval will not be awarded until the application is complete. In addition, the approval will be awarded as of the date the processing of the application is completed, not the date the application was first received by the AANA office.

Types of Continuing Education Activities
CE activities that are eligible for prior approval must be relevant to the practice of anesthesia in the clinical, educational, research, or administrative area. Such activities also must relate to professional growth and promote quality anesthesia care. Activities that are acceptable for approval include:

A. Educational Programs. Sponsored by associations or organizations at the local, state, regional, or national level, an educational activity is a planned, organized series of sessions (offerings) that have a common theme and an overall purpose. The programs may vary in length, but they are usually a one-time presentation.

Tours. CE credit will be awarded only for the lecture/discussion portion of a tour and not for observations or a physical walk-through of a hospital or any other health facility on the tour. Providers should make the learner objectives available to the participants before the tour.

B. Inservice Programs. An inservice activity is a planned, ongoing educational program of an employer and other than a departmental orientation or policy meeting, intended to assist the nurse anesthetist in acquiring, maintaining, and increasing competence in fulfilling assigned responsibilities specific to the expectations of that employer. The program can be sponsored by a hospital anesthesia department. Such meetings usually are held on a regular basis.

C. Provider-Directed Independent Study. Independent study is a self-paced learning activity developed for individual use in which the participant receives program materials through the mail or computer and completes the required activity outside a formal, organized learning environment. Provider-directed independent study is also known as home study. Each activity submitted for CE approval is evaluated individually to determine the number of credits it will receive. This is inclusive of distance learning options (e.g., on-line, teleconference education and self-directed study options).

The CE Program definition assumes that the individual receives the information by mail or computer. There may be certain circumstances under which a provider will be given approval by the CE Committee to distribute an independent study on site, but the CRNA must mail the answer sheet back to the provider rather than return it to the provider on site. Each lesson must require at least 50 minutes (excluding testing) to complete.

The medium by which a CE program is presented does not alter the specific requirements established by the AANA CE Committee. The fact that an independent study is offered via the Web or Internet does not diminish the necessity for submission of complete and substantive materials as part of an application for approval.

A completed application that meets the following criteria is required for consideration for prior approval of an independent study.

1. The overall design that is submitted for approval must include:

1. One (1) complete packet of the instructional materials sent to a subscriber. The materials must be in a packet that is commercially prepared and professionally printed.
2. Content for the proposed independent study.

• Outlines and power point presentations are not acceptable as sole content for an independent study. Outlines and short abstracts are not sufficient, except as supplemental materials.
• The content must be in the form of articles that could be submitted for publication using the style that is acceptable for publication in the AANA Journal.
• The content must contain sufficient substantive information to provide the learner with all the essential information without reference to original articles. Each article must contain a bibliography.

3. A statement that describes the program, the materials required to complete the study, directions on how to complete the program, the distribution schedule and how the program reaches the subscriber.
4. A statement that describes the testing mechanism and feedback for the learner. The description must demonstrate that the learner automatically receives feedback concerning correct answers; the material should not have to be requested by the participant. The answers to the test questions should not appear in the materials that the subscriber will see before completing the posttest. The feedback and answers can be provided to the CRNA when they receive their certificate of attendance. This must be part of the learning package. A notice that the passing score is 80% must be a part of the description.
5. A statement that describes the recordkeeping mechanism.
6. A copy of the evaluation instrument the subscriber will complete at the end of the study program.
7. A copy of the certificate of attendance the subscriber will receive upon completion of the study program.

2. The instructional materials that the subscriber receives for each lesson must include:

1. Learning materials such as cassettes, videos, CD-ROMs, DVDs, articles, study guides, written lessons, and any other information related to the experience.
2. A statement that explains all the materials required to complete the independent study activity and a detailed description of how to interact with the resources provided.
3. Specific learner objectives.
4. Test questions.

3. A minimum of five (5) objectives and ten (10) test questions is required for each CE credit requested. These must appear as part of the printed learning materials. Each article should start out with the objectives and conclude with the test questions. They cannot be included as an addendum on a separate sheet in the subscriber packet.

If the program is administered via computer, the objectives must appear as part of the program. They cannot be sent to the subscriber as an addendum or appear on a screen where the participant can fail to see them.

4. If the learning activity is transmitted by computer or administered via the internet, a hard copy of what the subscriber will see in its entirety must be submitted with the application for approval.

5. Programs that use learning materials such as video and audio cassettes, CD-ROMs, DVDs, must provide the participant with a hard copy of the learner objectives, test questions, and content outline, as well as identify the instructional staff. Teleconferences must also provide the participant with a hard copy of the learner objectives, content outline, and data on the instructional staff.

6. Independent studies may use abridgments or condensations of previously published material that are relevant to achieving the learner objectives.

1. Such abridgments must contain sufficient information to provide the learner with all the essential information, without reference to the original article. Short abstracts of randomly published material are not acceptable, except as supplemental materials.

7. The provider should refer to the content section of this booklet to make sure that the proposed content is within the approval criteria. If there is any question about topics to be presented, the provider should contact AANA’s CE Department for confirmation of acceptable content; otherwise, there is a chance that an article in print or other learning material content may not be accepted for CE credit.

8. Although CE credit is awarded on the basis of the number of objectives and test questions, each lesson must require at least 50 minutes (excluding testing) to complete.

9. A code number and volume number will be assigned to each program. Both numbers must be printed on the certificate of attendance.

The beginning and ending dates for which the code number and volume are assigned cannot be changed without first notifying the CE Department.

10. At the discretion of the CE Committee, the independent study may receive approval for a maximum of 36 months. A three-year approval is not automatic.

At the end of the 36-month approval period or expiration date if less than 36 months, the independent study will not be reapproved in the form in which it was originally submitted for prior approval. All the subscriber materials must show evidence of updated content.

11. To receive CE credit, a participant must complete the independent study by the expiration date specified by the provider.

12. A certificate of attendance must be forwarded to the participant upon successful completion of the program. It must contain the following printed (not handwritten) information: (a) the name of the participant; (b) the AANA membership or recertification number; (c) the name of the CE activity; (d) the name and address of the provider; (e) the date of the CE activity; (f) the number of CE credits awarded; (g) the AANA code number, volume number, and expiration date; and (h) the signature of the provider who verifies participation in the program.

13. The certificate of attendance must indicate the number of CE credits earned monthly during an August 1 to July 31 time frame. The actual date(s) of completion of the CE activity must be shown on the certificate in an August to July time frame. For example, issuing a certificate with the dates of lessons completed monthly from January 1 to September 30 is unacceptable. The correct way to assign credits is from January 1 to July 31 and from August 1 to September 30. Failure to issue certificates with dates of completion in the August to July time frame may result in withdrawal of approval.

14. The provider must be prepared to issue an interim certificate of completion for all CRNAs who require the credits for recertification.

15. The date on the certificate must match the date on the attendance record. For example, if a certificate of attendance is issued in June, then the corresponding credit must appear on the June attendance record.

16. Attendance records must be submitted monthly. A contact person must be available to verify attendance and to answer questions from the AANA and subscribers about CE credits and subscription.

D. Research in Anesthesia-Related Fields. Scientific investigation that has an impact on anesthesia practice (clinical, education, research, and administration) is eligible for a maximum of forty (40) credits. Twenty (20) CE credits (contact hours) may be awarded for the proposal and twenty (20) CE credits for the completion of the project.

To be eligible for credit, the CRNA must be the principal investigator or a co-investigator of the research project.

The following information must accompany the application for CE credit for prior approval of research in anesthesia-related fields:

1. A copy of the research proposal and a statement supporting its relevance to anesthesia practice. The role of the CRNA who is a co-investigator in the research project, including tasks and responsibilities, must be defined.

2. Where applicable, a copy of the approved research proposal from the institute(s) where the research is to be conducted.

3. Where applicable, a copy of the approval document or letter of authorization issued by an institutional review committee or its equivalent.

4. Where applicable, a copy of the informed consent form that research subjects must sign for the protection of human rights.

5. Where applicable, a copy of the protocol stating that humane standards regarding the use of animals will be used that equal those of the American Physiologic Society.

Upon completion of the project, a copy of the research protocol and results of the study must be submitted in which the CRNA is identified as the author or co-author of the research design.

Scope of Prior Approval
Prior approval is granted only for the date(s) of the presentation the provider indicates on the application. The CE activity may not be presented at any other time unless the CE Department is notified or approval is granted before the presentation. At the discretion of the committee, certain CE activities may be approved for a period not to exceed 3 years.

CE activities that receive prior approval are assigned a code number for use by the provider only for the date(s) and number of CE credits specified on the application. If the provider has a CE program approved for a year and it is offered in multiple locations, the attendees can receive the maximum number of credits only one time. The code number must appear on all promotional materials, certificates of attendance, attendance records, and correspondence sent to AANA’s CE Department.

Changes in Programs
The number of CE credits originally prior approved cannot be changed unless the provider receives approval from the CE Department. A portion of a program, rather than the entire program, may not be presented unless prior approval is awarded. For example, if a program was prior approved for 3 days and awarded 18 CE credits, the provider cannot shorten it to 1 day for 6 credits. Prior approval must be obtained because this is a major change and considered a new program.

If the provider wishes to extend, add, or revise dates for a part of the program yet to be presented, the CE Department must approve a written request before the first day of presentation.

Minor changes in content may be undertaken without additional committee review, provided they involve an improvement and comply with the standards for approval. An example of a minor change would be substitution of a presenter who was scheduled to speak on a topic that had been already approved. Substituting a lecture on computer skill/technology for one on pharmacology is not a minor change. Any questions regarding content should be addressed to the CE Department. A notice of minor changes can be submitted with the attendance record.

For inservice programs, the CE Department notifies the provider approximately 3 months before the actual inservice expiration date using a stamped notice on the carbon or duplicate copy of the attendance record, which is returned to the provider after the processing has been completed. The provider of an inservice program who does not receive this notice is still responsible to reapply for approval before the program expires to ensure the continuous awarding of CE credit.

ACLS Courses
To receive credit for ACLS or other life support courses, that are based on the American Heart Association protocols, the applicant must pass the relevant test to receive CE credit.

The CRNA who does not pass the ACLS test can receive credit for the didactic part only if the provider has requested a separate code number for the testing portion of the ACLS course. In such a case, the provider must submit two attendance records-one for the didactic portion and one for the testing part. If all the CRNAs pass the ACLS test, then only one attendance record is submitted.

Provider Recordkeeping Responsibilities.
When a program receives AANA prior approval, the provider assumes certain responsibilities for recordkeeping. CRNAs attend programs with the expectation that the provider will send attendance records to the AANA in a timely manner so that during the recertification period, the CRNA’s recertification is not delayed. Failure to meet any of the responsibilities may result in loss of approval.

The following steps are required of all providers for recording attendance and issuing certificates of attendance.

Attendance Recording.

1. Submit an AANA attendance record within 30 days after the activity for all CRNAs – both AANA members and nonmembers – containing their name, AANA membership/recertification number, AANA code number, date of program, name of program, name and address of provider and CE credit awarded.

2. The attendance record may be prepared several ways instead of using the original form:

1. Computer generated and sent by regular mail, email, or fax to the CE Department.
2. Created in a WORD document and sent via email or fax to the CE Department.
3. Created in a pdf file and sent via email or fax to the CE Department.

3. Email and fax documents must be legible. If important information is left off the fax copy, the provider may be requested to resubmit.

4. The attendance record may be photocopied but two copies of the record must be submitted so the provider can be notified that the processing has been completed.

5. The number of CE credits awarded to each CRNA cannot exceed the maximum number of CE credits initially awarded for the program. For example, if the program lasted longer than planned, only the number of credits originally assigned for prior approval will be recorded.

6. The provider is responsible for completing and submitting one official attendance record, typewritten or clearly printed in ink, with the total number of credits for each CRNA. Attendance records and sign-in sheets on which the attendees have signed or printed their names are not acceptable.

7. Only CE credits submitted on an AANA attendance record, or a copy of the record, will be entered into a CRNA’s CE record. If the provider forgets to include a name on the official attendance record, an additional attendance record must be submitted. Credits will not be entered into a CRNA’s record from a copy of a certificate of attendance submitted by either the CRNA or the provider.

8. Contact the AANA CE Department in writing if the beginning or ending date of the program changes as soon as possible prior to the new beginning date.

Certificates of Attendance.

1. Issue a certificate of attendance to all participants including CRNAs – both AANA members and nonmembers – who attended the program. Certificates must contain the following information:

1. Name of participant;
2. AANA membership or recertification number;
3. Name of CE activity;
4. Date of CE activity;
5. Number of CE credits awarded;
6. AANA code number and expiration date;
7. Provider name and address;
8. Provider signature that verifies attendance.

2. The actual date(s) of attendance at the program must be shown on the certificate in an August 1 to July 31 time frame. Issuing a certificate with the dates of attendance from May 1 to October 31 is unacceptable. The correct way to assign credits is to issue one certificate showing credits earned from May 1 to July 31 and another showing credits earned from August 1 to October 31.

3. Submit 3 copies of certificates of attendance that were actually issued to 3 CRNAs attending the program with the attendance record.

4. At the request of the CRNA or AANA, verify attendance by confirming that the:

1. CRNA was registered, attended the program; their name and correct AANA number were submitted on the attendance record; and
2. attendance record was submitted to the AANA, and the provider received confirmation it was processed.

Failure to Comply with Provider Responsibilities
If a CE provider fails to comply with the AANA’s Continuing Education Program standards, or fails to meet any of the recordkeeping responsibilities, the CE Committee may withdraw its approval of the CE activity. The provider will receive 30 days written notice of the specific charges and the reasons for withdrawal and will have a reasonable opportunity to respond and be heard by the committee.

If the CE Committee withdraws its approval, the provider may formally appeal the action to the AANA’s Continuing Education Appeals Panel within a 30-day period.

Prior Approval Announcement
The announcement of AANA prior approval is to appear on the certificate of attendance and all other materials in the following format:

Approved by the American Association of Nurse Anesthetists for XXX CE credits; Code Number XXXXX; Expiration date XX/XX/XX.

The AANA’s CE Program does not award CE units (CEUs), continuing medical education credits (CMEs), or CE points (CEPs). The designations CEU, CME, and CEP cannot be used on certificates of attendance. The definition of these terms is based on a 60 minute clock hour, and not a 50 minute contact hour as used by AANA. In addition, the term accredit should not be used on the certificate of attendance. The AANA approves CE programs; it does not accredit CE programs.

The use of any statement such as "AANA approval pending" or "approval applied for," is not permitted on any materials or promotional literature; it is misleading and can be considered false advertising.

Providers are required to clearly state the overall program objectives in behavioral terms and include a clear, concise description of the content for brochures and other promotional materials. This allows the participants to know in advance exactly what they can expect to derive from participation in or attendance at the CE activity.

Incomplete Applications
If an application is incomplete, a letter will be sent to the provider requesting additional information. If the material to complete the processing is not received before the start of the program, the application is considered inactive and will not be processed. The approval fee will not be refunded.

Advertisement of Prior Approval in AANA NewsBulletin
Providers who receive prior approval can advertise their CE program in the AANA NewsBulletin monthly Calendar of Events for a fee which also includes a duplicate listing on the AANA Web site. Notices of inservice programs are not published in the calendar.