Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.
It is with great sadness that we announce the passing of Ira P. Gunn, CRNA, MLN, FAAN, on Tuesday, Oct. 25, 2011 in El Paso, Texas.
We have lost a very dear friend, and our profession grieves the loss of a great leader: Ira P. Gunn. Her sphere of influence included universities, state and federal agencies in the areas of healthcare, nursing regulation, education, accreditation, credentialing, funding, and research. Her courage to speak out and document her arguments in seminal publications is legendary. Through these, her words and wisdom will inform decisions surrounding our profession for generations.
Ira applied them all in large measures in her life’s interactions.
Her passion for the profession drove her work, and her philosophy was straightforward: As nurse anesthetists, we collectively could and must determine the course of our profession’s destiny. It is our professional birthright. That right to self determination must be protected so that our profession can be applied for the betterment of society. Ira used nursing’s social contract with the public as a moral compass, often advocating that decisions made on behalf of the profession should also keep the public’s interest at the forefront.
Mentoring colleagues and students is a measure of leadership. Ira was a great leader who fostered the development of members of our profession as leaders for 50 years. In this she was generous with her time and brought out the best in those who benefited from her counsel.
Ira believed that debate of ideas is healthy for organizations, and she was a proponent of public discourse. However, she also believed that people should be able to disagree without becoming disagreeable. To this end she would often cite an old Moravian principle that calls for unity, not uniformity.
In her later years she used the Internet as her tool for communication. She would end her comments with her signature block and the expression “A man's reach should exceed his grasp." Her reach will be felt for generations to come.
But, I would like to finish that expression written by Robert Browning. The complete quote is: “A man's reach should exceed his grasp or what's a heaven for?” Indeed, it is for you my dear friend; your work is done. Rest in peace.
According to the U.S. Food and Drug Administration (FDA), as of Oct. 21, 2011, the propofol injection drug shortage has been resolved. Propofol manufacturers Hospira, Inc. and APP Pharmaceuticals do not anticipate any further drug supply issues. View the listing on
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On Oct. 13, 2011, the U.S. Food and Drug Administration (FDA) launched its Surgical Fire Prevention Initiative with support from partners in the healthcare community, including the AANA. Access
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The Education Committee is seeking candidates who are interested in serving on the committee as a delegate. The deadline for receiving completed candidate packets is Jan. 31, 2011. Click
for the candidate information packet. If you have questions, contact the Education Department at (847) 655-1161.
December 1
The Program Committee is pleased to announce an exciting new event to showcase members who would like the chance to speak at a national venue. Six individuals will be given the opportunity to present their topics in front of a panel of expert speakers and a live audience during the 2012 AANA Annual Meeting. After all six sessions are presented, the speakers will individually meet with the panel of expert speakers to receive constructive feedback.
Email the topic you would like to present along with a content statement and learner objectives to Jamie Hogan, AANA Meetings Coordinator at jhogan@aana.com by Dec. 1, 2011. Presentations will then be reviewed and speakers contacted by Dec. 15, 2011. Each speaker will be given 30 minutes to present their topic.
If you think you have what it takes to be a national speaker, but never had the chance to do so, this is your opportunity.
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Request for Applications (RFA) for the Patient Safety Investigator Career Development Award Program
Deadline: December 31, 2011
The Anesthesia Patient Safety Foundation (APSF) is soliciting applications for training grants to develop the next generation of patient safety scientists. In this initial, proof-of-concept RFA, the APSF intends to fund one ($150,000 over two years) Patient Safety Career Development Award (PSCDA) to the sponsoring institution of a highly promising new patient safety scientist. See the APSF website to download the application.
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New Course on Sale for Limited Time
AANALearn® online education is offering “What Can the CRNA do to Improve Medication Safety & Decrease Cost in the OR?” at 50 percent off to AANA members—$35 for 2 CE credits—until Nov. 14. This course features expert CRNA clinicians and a pharmacist reviewing procedures for successful safety management in the OR, safety regulations, and methods to reduce pharmacy costs. The One Needle, One Syringe, Only One Time initiative and the One and Only Campaign of the Centers for Disease Control are featured. Check out the AANALearn® catalogs now. Available courses provide a total of 45 CE credits.
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CRNAs Needed for Medical Mission in Sierra Leone
International Surgical Heath Initiatives (ISHI) has announced that it is in urgent need of CRNAs for a medical mission scheduled for Nov. 30 through Dec. 13. Active since 2009, ISHI is engaged in global humanitarian outreach activities and is devoted to delivering free surgical care to those in need around the world. Visit the ISHI website for details about this and other missions.
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Protect Nursing Priorities to Ensure Safety, Cost Savings, AANA and Nursing Community Urge Congressional Super Committee
Because the work of CRNAs, advanced practice registered nurses (APRNs), and registered nurses (RNs) helps ensure patient access to quality care and save healthcare dollars, the AANA and 43 other organizations of the Nursing Community urged the congressional debt and deficits super committee to protect priority nursing programs from draconian cuts.
In a letter dated Oct. 13, the organizations stated, “The work of the Super Committee to address our national debt in a bipartisan manner is to be commended, and we sincerely appreciate the dedication that you and the other committee members have made in forming sound recommendations for our nation in advance of the November 23 report deadline…. The members of our organizations and the millions of nurses throughout the country provide life-saving care to patients and families each and every day. To meet the demand for nursing care and improve quality of care, we believe funding for HHS programs is critical and appreciate the Super Committee’s consideration of the role they play in our nation’s health as well as the economy. Crippling cuts to HHS programs would negatively impact the sustainability and improvement of our healthcare system.”
The 12-member bipartisan bicameral super committee, formally called the Joint Select Committee on Deficit Reduction, has until Nov. 23 to submit to Congress a legislative package of $1.2 trillion or more in 10-year deficit reduction. Congress then has about a month to pass the package and for the President to sign it into law. But if the supercommittee process fails, automatic spending cuts take hold beginning in 2013, half from national and homeland security, exempting Medicaid and Veterans programs from the cuts.
Read the Nursing Community letter (requires AANA login and password and visit the super committee website.
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Medicare Issues Regulatory Relief Proposals for Hospitals and Other Facilities, and a Final Rule on ASC Patients Rights; Under AANA Review Now
The Medicare agency on Oct. 18 issued a preview of its regulatory relief proposals for hospitals, critical access hospitals, and ambulatory surgical centers where CRNAs provide care, and a preview of its final rule regarding ambulatory surgical centers patients’ rights. The AANA Federal Government Affairs team is reviewing the agency releases and will provide members further information shortly.
The proposed rules follow the U.S. Department of Health and Human Services (HHS) regulatory reform strategy published for comment early this summer, commented upon by the AANA, and released late this summer. According to an HHS news release, the proposals will help save nearly $1.1 billion across the healthcare system in the first year for a total of over $5 billion over five years.
The proposed rules are subject to a 60-day public comment period, closing mid-December 2011.
Learn more…Read the Medicare proposed rule on hospital conditions of participation; the Medicare proposed rule on other regulations intended to promote program efficiency; and the Medicare final rule on ambulatory surgery centers patient rights conditions for coverage. Read the Medicare agency press release describing the agency’s actions. Read HHS’ August regulatory review document; and AANA’s June 30, 2011, comment to HHS.
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MedPAC Formally Presents Congress Its Recommendation for 3-Year, 17 Percent Specialty Payment Cuts that AANA Opposes
The Medicare Payment Advisory Committee (MedPAC) formally presented Congress Oct. 14 its recommendations for fixing the Medicare Part B “SGR” payment problem—a fix that includes 5.9 percent cuts each year for anesthesia and other specialty services for a total of three years and a 17 percent reduction.
The AANA had urged the MedPAC to reject such cuts, saying the undervaluation of anesthesia payment had prompted Medicare to increase anesthesia payment by 25 percent within just the past few years. AANA had also advised MedPAC that anesthesia does not drive service volume through referrals or other practices, and that CRNA care is the most cost-effective alternative available.
Having landed in Congress’ lap again, the sustainable growth rate (SGR) cuts issue now awaits action on Capitol Hill before 30 percent cuts to Part B take effect Jan. 1, 2012. Congress can enact: long-term relief, which increases Medicare costs by more than $300 billion over 10 years compared with current law; short-term relief, whose costs and benefits are much shorter in duration; nothing, which would implement the 30 percent cuts; or take up some other alternative.
CRNAs can contact Congress today to urge lawmakers to reverse harmful Medicare cuts (requires AANA login and password).
Read the MedPAC letter to Congress and the AANA’s letter to MedPAC (requires AANA login and password).
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How Does a CRNA Clear a RAC Audit? Medicare’s 2010 Report Shows the Way
The Medicare agency’s Recovery Audit Contractor (RAC) program 2010 report to Congress shows CRNAs and other providers how to reduce risk associated with a potentially costly RAC audit, by outlining what the agency’s anti-fraud RAC program focused upon in the past year. “For CRNAs, the two most important lessons are to thoroughly and accurately document the care you provide, and to know your claims systems are compliant with the law,” said Larry Hornsby, CRNA, BSN, a past AANA president and longtime anesthesia businessman and current member of the AANA’s Anesthesia Payment Policy Advisory Panel. “The increased costs associated with complying the first time are far less than the costs of errors, accounting and professional fees, and RAC audit clawbacks, and penalties associated with failure to comply.”
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AANA’s National CRNA Advocacy Day Generates Over 2,000 Messages to Capitol Hill Oct. 4; You Can Continue Today!
Over 2,000 messages were sent to Capitol Hill by CRNAs taking action Oct. 4 on AANA’s National CRNA Advocacy Day … and you can keep the beat coming! Take action on the Care To Be Counted website (requires AANA member login and password), and contact Congress to reverse the 30 percent Medicare payment cuts and restore Medicare pain care access.
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Congressional Super Committee Gets Wide-Ranging Advice from Lawmakers on Health Issues
With a little over a month remaining to complete its work, the bipartisan congressional super committee charged with reporting $1.2 trillion in ten-year deficit reduction has received wide-ranging advice from House and Senate health committees and leadership on issues affecting healthcare initiatives important to the patients, practice and profession of nurse anesthesia.
The Republican chairman of the House Energy and Commerce Committee serves on the super committee, and so the panel’s minority Democrats led by ranking Rep. Henry Waxman (D-CA) urge protection of the health reform law, the Affordable Care Act, from cuts, and the reversal of a 30 percent Part B “sustainable growth rate” cut. Waxman urges that these cuts be replaced with “a sustainable, fair policy that encourages coordinated care.” But the SGR fix was not specifically mentioned in the House Ways and Means Committee Democrats’ letter, which urged, “Our first priority in the health arena must be to protect Americans’ health coverage and access to care, including existing coverage under Medicare, Medicaid, and the expansions in the Affordable Care Act.” That panel’s Republican chair also serves on the super committee.
With the Senate Finance Committee chair serving on the super committee, Senate health panel comments came from the minority Republicans, who said, “(W)e are all committed to repealing the partisan health law” and that “(o)ur deficits and debt are primarily a spending issue,” focusing on imbalances in the Medicare and Medicaid programs in particular.
See the congressional committee recommendation letters to the super committee.
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Essential Health Benefits Should Be Affordable, IOM Tells HHS Secretary in Report
In a major report issued Oct. 7, the Institute of Medicine (IOM) recommended that the “essential health benefits” (EHB) offered by health plans, including those participating in state-based exchanges, should be developed with consideration of benefit costs in mind. The AANA had urged the IOM to ensure anesthesia services are covered, including high-quality cost-effective CRNA services. The report also suggested that the starting point in establishing the initial EHB package should include the scope of benefits provided under a typical small employer plan.
For CRNAs, the high-level report makes few specific mentions of anesthesia services, which are usually a covered benefit in employer and public health plans. However, one of the report’s recommendations directs the HHS Secretary to establish a framework for obtaining and analyzing data necessary for monitoring implementation of the essential health benefits – including changes related to providers’ payment rates, contracting mechanisms, financial incentives, scope and organization of practice.
The IOM report to Health and Human Services (HHS) Secretary Kathleen Sebelius represents a significant development in the implementation of the Affordable Care Act health reform law. With the IOM report in hand, HHS will work to develop proposed rules governing health coverage and its marketing in states, due out later this year.
Read the IOM report and the comments AANA submitted to the IOM (requires AANA member login and password).
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AANA Submits Comments to CMS Requesting CRNAs Be Recognized to Participate as Eligible Providers in the Basic Health Program
Health plans participating in the Basic Health Program should adopt policies that permit CRNAs to be recognized to participate as eligible providers within health plans participating in the Basic Health Program, said the AANA in a comment letter to the U.S. Department of Health and Human Services (HHS) Oct. 21.
The AANA’s comment was in response to HHS’ request for information “Regarding State Flexibility to Establish a Basic Health Program under the Affordable Care Act (ACA).” AANA and CRNAs’ interests in the exchanges lie primarily in ensuring that CRNA services are fairly reimbursed in plans marketed through this program and that CRNAs be included in the oversight process of these plans.
The AANA’s comment was in response to HHS’ request for information “Regarding State Flexibility to Establish a Basic Health Program under the Affordable Care Act (ACA).” AANA and CRNAs’ interests in the exchanges lie primarily in ensuring that CRNA services are fairly reimbursed in plans marketed through this program and that CRNAs be included in the oversight process of these plans. This particular federal program allows states to enter into contracts to offer one or more ‘‘standard health plans’’ providing at least the essential health benefits described in the ACA to eligible individuals in lieu of offering such individuals coverage through the state-based Affordable Insurance Exchanges.
In a letter signed by President Debbie Malina, CRNA, DNSc, MBA, APN, the AANA also urged HHS to require these health plans to comply with and ensure full application of existing state and federal provider nondiscrimination laws. The AANA interprets these nondiscrimination laws to protect patient choice and access to a range of beneficial providers and prevents discrimination against an entire class of health providers, such as CRNAs, by health insurance plans.
The AANA also recommended that the Basic Health Program recognize that CRNAs acting as the sole anesthesia provider are a highly cost-effective model for anesthesia delivery and nonmedically directed CRNA services should be covered in this program. Furthermore, we urged that health plans participating in a basic health program include a quality assurance and quality improvement mechanism.
The AANA’s comments and the Federal Register RFI are available (require AANA login and password).
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State Nurse Anesthetist Association Leaders: Enroll in AANA’s Fall Leadership Academy Today
Leaders in state nurse anesthetist associations are invited to enroll in the AANA’s 2011 Fall Leadership Academy today, now less than a month away, to help improve the influence, effectiveness and operations of CRNA organizations in every state. Formerly known as the Fall Assembly of States, the AANA Fall Leadership Academy takes place Nov. 11-13, at the Newport Beach Marriott Hotel and Spa in Newport Beach, Calif.
Formerly known as the Fall Assembly of States, the AANA Fall Leadership Academy takes place Nov. 11-13, at the Newport Beach Marriott Hotel and Spa in Newport Beach, Calif. Far more than the name has changed; at the request of AANA members, the Fall Leadership Academy provides state nurse anesthetist association leaders the most current education on the best practices of effective state associations, plus four concurrent educational tracks on state association communications, finance, state government affairs, and federal government affairs.
The AANA Fall Leadership Academy is recommended to state nurse anesthetist association leaders, which includes not only officers on state nurse anesthetist association boards but any CRNA who aspires to greater influence and leadership in the fields of nurse anesthesia and healthcare. A CRNA attending the conference can obtain 14 CE credits, and gain all the benefits of a robust and targeted educational program focused on developing healthy state nurse anesthetist associations, and on building strong networks of state association leaders from around the country.
See the program and register today!
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Get Your Tickets for CRNA-PAC’s “Jammin’ Good Time” at AANA Fall Leadership Academy
Surf’s up with CRNA-PAC at the AANA Fall Leadership Academy. On Sat., Nov. 12, from 6:30 – 9:00 p.m., join CRNA-PAC and your colleagues in the Marriott Newport Beach for a slice of paradise at a beach-style reception while listening to the summer sounds of Jimmy Buffett, the Beach Boys, and other warm weather favorites.
At the CRNA-PAC’s “Jammin Good Time,” wear your summer attire, and be sure to show your toes in CRNA-PAC’s first-ever flip-flop competition. Categories for the competition will be announced soon. In addition, be prepared to bid on some nautical-themed silent auction items.
The ticket cost is $225 for each participant (regardless of past PAC contributions), payable through your AANA Fall Leadership Academy meetings registration form. With a $225 donation to CRNA-PAC, an AANA member automatically becomes part of the CRNA-PAC Congressional Club, and makes progress toward the $1,000 annual donation required to become part of the elite CRNA-PAC Presidential Club. Please see the CRNA-PAC website for further details.
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As part of AANA’s participation in the Alliance for Injection Safety, we sent our thanks to Rep. Frank Pallone (D-NJ) for requesting a Government Accountability Office (GAO) report on the costs of outbreaks and mechanisms for improving safe injection practices.
Standards Revision Underway
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) has announced that a major revision of the Standards for Accreditation of Nurse Anesthesia Educational Programs is underway. The COA Standards Revision Task Force is preparing a first draft of the proposed Standards, which will be presented during a hearing at the 2012 Assembly of School Faculty meeting in San Diego, Calif. Following the hearing, the COA will be soliciting written comments on the revised Standards through an online survey. Contact the COA to be included in the solicitation for written comments.
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Visit the CRNA Career Center
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Regional Anesthesia Benefits Kidney Recipients
Researchers say kidney transplant patients who undergo regional anesthesia experience less nausea and need significantly less opioid medication in the first two days after their procedure compared to those who receive conventional analgesia. Specifically, the retrospective study compared clinical outcomes from 30 kidney recipients who were given intravenous, patient-controlled pain relief against the results of 30 recipients who were delivered anesthesia through a transversus abdominis plane (TAP) block. "Theoretically if your opioid requirement decreases, all the complications related to postoperative opioids usage also decrease, such as nausea, ileus, respiratory depression and the increased potential for infection," said lead researcher Maged Giurgis, MD, of the Cleveland Clinic's anesthesiology department. "Overall the patient satisfaction also was high among those with TAP catheters." The TAP method—proven successful following hernia repair, hysterectomy, cesarean childbirth, and other procedures—differs from other regional nerve block techniques because it offers the benefit of continuous analgesia via catheter. The Cleveland Clinic team, which presented its findings at the American Society of Anesthesiologists' 2011 annual meeting, agreed with outside researchers that additional studies are needed to determine if TAP blocks are the best analgesia strategy for kidney transplant patients.
From "Regional Anesthesia Benefits Kidney Recipients"
Renal and Urology News (10/24/11) Frei, Rosemary
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Less Invasive Anesthetic Methods Better for Endovascular Aneurysm Repair
Researchers at North Carolina's Wake Forest Baptist Medical Center say their work shows that spinal anesthesia, epidural anesthesia, and local/monitored anesthesia care (MAC) are less-invasive and more effective strategies than general anesthesia for aneurysm repair. The multi-center study, conducted from 2005 to 2008, collected data from more than 6,000 patients undergoing elective endovascular repair of infrarenal abdominal aortic aneurysms (EVAR)—4,868 of whom received general anesthesia and 1,141 of whom received one of the other three types of anesthesia studied. While none of the four methods were associated with a higher rate of mortality, investigators did document longer hospital stays following surgery and increased pulmonary morbidity among the patients receiving general anesthesia. "Our study data suggest that increasing the use of less invasive anesthetic techniques may limit postoperative complications and decrease overall costs of care in EVAR patients," said lead researcher Dr. Matthew Edwards, an associate professor of vascular and endovascular surgery. The study is published in the November issue of the Journal of Vascular Surgery.
From "Less Invasive Anesthetic Methods Better for Endovascular Aneurysm Repair"
Newswise (10/24/11)
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Postop Respiratory Complications in Obese Asthmatic Children
Research presented at the 2011 annual meeting of the American Society of Anesthesiologists indicates that children who suffer from asthma and obesity are at a greater risk of respiratory complications—and, thus, morbidity and mortality—than are normal-weight, nonasthmatic kids. Both conditions have been flagged as independent risk indicators, although they have not often been studied as joint factors; but with both obesity and asthma becoming more commonplace in young people, lead investigator Dr. Olubukola Nafiu said healthcare providers must be aware. Nafiu and colleagues from the University of Michigan conducted a prospective study of more 1,102 children, including 107 who were obese and had asthma, 118 who were normal weight but had asthma, 309 who did not have asthma but were obese, and 568 who were neither obese nor asthmatic. The findings showed respiratory troubles in 14 percent of the obese/nonasthmatic patients, with the rate jumping to 22 percent for kids who were both obese and asthmatic; but the levels were only 8 percent and 7 percent, respectively, in the normal weight/asthmatic and normal weight/nonasthmatic groups. The two sets of obese patients also experienced airway obstruction more frequently than the two non-obese groups of kids. This complication affected 15.9 percent and 9.4 percent, respectively, of obese patients with and without asthma but only 3.5 percent and 1.8 percent, respectively, of non-obese patients who were and were not asthmatic. Nafiu said the finds suggest "that obese children undergoing anesthesia should receive additional evaluation and care to prevent the increased potential for complication."
From "Postop Respiratory Complications in Obese Asthmatic Children"
Medscape (10/19/11) Helwick, Caroline
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Three Factors Appear to Correlate With Mortality for a Patient After Surgery
Researchers have identified three medical factors—median arterial pressure (MAP), median anesthetic concentration (MAC), and bispectral index (BIS)—that they say correlate with mortality for patients who have been anesthetized for a surgical procedure. Led by Dr. Tong Gan, MD, the team from Duke University Medical Center reviewed data from almost 20,000 patients who underwent operations not tied to heart disease. Even after taking into consideration patient age and risk profile, the results revealed a 2.5 times greater risk of death in the first year following surgery for patients with combined low MAP, MAC, and BIS values when compared to patients with normal values for all three gauges. The "triple-low" theory also proved true in "double-low" scenarios where patients had low MAC and BIS values, with those subjects also facing a significantly higher risk of dying during the first 12 months after their procedures. "The take-home message is that physicians who learn about this triple-low set of factors should be alert to the needs of such a patient after surgery and watch for potential problems or avoid the triple-low combination in the first place," said Tong, who presented the research findings at the American Society of Anesthesiologists Oct. 19 meeting in Chicago.
From "Three Factors Appear to Correlate With Mortality for a Patient After Surgery"
News-Medical (10/20/11)
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Laryngeal-Mask Airway Risk Factors Outlined
Risk factors for "failed" intraoperative laryngeal-mask airways (LMAs) have been identified, for the purpose of helping to design airway management plans in ways that might mitigate the risk for adverse respiratory events associated with such events. The use of LMAs under general anesthesia has steadily increased, and intraoperative success has been strongly documented. However, as with endotracheal intubation with general anesthesia, the technique does present some patient risks, observed Dr. Michael Mathis from the University of Michigan in Ann Arbor, who presented the risk factors on Oct. 19 at the American Society of Anesthesiologists 2011 annual meeting. Minor risks include gastric aspiration and postoperative sore throat or cough; but greater concerns include the risks for airway obstruction and laryngospasm, which Mathis said can culminate in life-threatening hypoxemia. The intent of the study was to examine the profiles of LMA failures that necessitate acute airway intervention. "Our hypothesis was that patient history and intraoperative characteristics exist that predispose to LMA failure," Mathis said. After studying outcomes from 15,795 cases from 2006 to 2009, the Michigan researchers identified four independent risk factors for failed LMA: poor dentition, a high body mass index, male gender, and intraoperative surgical table rotation. According to Mathis, "the risk factors we identified provide valuable information to anesthesia caregivers when assessing the feasibility of an LMA for a particular surgical case."
From "Laryngeal-Mask Airway Risk Factors Outlined"
Medscape (10/19/11) Helwick, Caroline
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A Quest to Prevent Post-Surgery Blindness
Bonnie Molloy, a clinical faculty member at Fairfield University's School of Nursing and chief certified registered nurse anesthetist in the Bridgeport Anesthesia Associates practice at Bridgeport Hospital, has been researching the phenomenon of waking blind after surgery for the past five years. She has found that intraocular pressure of the fluids in the eye can climb to potentially dangerous levels when patients are placed into the steep, head-down Trendelenburg position for surgery. Through Molloy's research, an observation scale measuring the swelling of the eyelids and inner eyelid lining as well as bruising around the eye—all indicators of higher pressure—has been developed. Use of the Molloy/Bridgeport Anesthesia Associates Observation Scale, or MBOS, has been adopted at Bridgeport Hospital and the Hospital of St. Raphael in New Haven, Conn. The American Association of Nurse Anesthetists Foundation, meanwhile, has granted Molloy $50,000 to further develop her research. "It's extremely innovative," according to AANA staff director Lorraine Jordan. "It will make a huge impact on anesthesiology."
From "A Quest to Prevent Post-Surgery Blindness"
Hartford Courant (CT) (10/19/11) Weir, William
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New Assessment Tool Helps Detect Parental Behaviors That Lead to Poor Outcomes in Children Undergoing Surgery
A clinical study presented at Anesthesiology 2011 showcased a behavioral assessment tool that may help anesthesia providers identify pre-surgical behaviors in parents and children that correlate with maladaptive post-surgical behaviors in children. The Perioperative Adult Child Behavioral Interaction Scale (PACBIS) uses a series of real-time assessments to gauge the coping, stress, and anxiety behaviors of children and parents before surgery, during administration of anesthesia, and following the procedure. Dr. Nancy Hagerman of the Cincinnati Children's Hospital Medical Center and colleagues conducted a study on 405 children between the ages of three and 12 years who had their tonsils or adenoid glands removed. The results showed that better child coping before surgery and anesthesia resulted in less emergence delirium post-surgery; and negative PACBIS parental behaviors during anesthesia administration increased instances of separation anxiety and sleep disturbances in children, while positive behaviors curtailed negative outcomes such as withdrawal and eating disturbances. The researchers also documented a correlation between PACBIS behaviors and pain levels. "Parents who cope well and provide distracting, nonprocedural talk during the stressful perioperative period help their child by reducing distress during induction, thereby decreasing the probability of emergence delirium, surgical pain and maladaptive behaviors," Hagerman summarized.
From "New Assessment Tool Helps Detect Parental Behaviors That Lead to Poor Outcomes in Children Undergoing Surgery"
Newswise (10/18/11)
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Adding Gabapentin Does Not Decrease Post-TKA Pain
Contrary to earlier findings, a new study concludes that gabapentin used in tandem with traditional spinal anesthesia does not reduce patients' pain before and after primary total knee arthroplasty. A meta-analysis published in the Canadian Journal of Anesthesia in 2006 reported lower postoperative pain scores with gabapentin use; but the new study observed no statistically significant differences in morphine consumption, pain scores, patient satisfaction, or length of hospital stay for those who received the drug compared to those who took a placebo. "Our new study shows that there is not a strong indication for using gabapentin in total knee arthroplasty, although it still may be useful in other patient populations," said James Paul, MD, MSc, of the anesthesiology department of McMaster University in Hamilton, Canada. "Perhaps in the context of multimodal analgesia, it has less incremental benefit." However, what his team did document was a substantially lower rate of nausea or vomiting in the gabapentin group than in the placebo group as well as a lower rate of moderate to severe pruritus.
From "Adding Gabapentin Does Not Decrease Post-TKA Pain"
Anesthesiology News (10/01/11) Vol. 37, No. 10, Frei, Rosemary
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Popliteal Blocks Cause Rebound Pain Compared to Anesthesia
A study presented at the Orthopaedic Trauma Association's 27th Annual Meeting by Rachel Goldstein, MD, MPH, confirmed that popliteal blocks control pain more effectively than general anesthesia during open reduction and internal fixation (ORIF) of fractured ankles. However, she reported, popliteal blocks also generate post-operative rebound pain that often requires narcotics to alleviate. Goldstein said that "patients who received popliteal block experienced a dramatic increase in pain in the first eight to 24 hours, while patients who received anesthesia alone experience a steady decrease in their pain." The study looked at 43 ORIF patients with ankle fractures, who were randomly assigned either a popliteal block or intravenous sedation and general anesthesia.
From "Popliteal Blocks Cause Rebound Pain Compared to Anesthesia"
Ortho Supersite (10/17/11)
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Prefilled Syringes Cut Waste—And Bottom Line
Research suggests that using prefilled syringes instead of vials of medicine could greatly curtail drug waste, saving hospitals thousands of dollars per annum. Speaking at the International Anesthesia Research Society's 2011 annual meeting, Christopher Fortier—a clinical assistant professor at the Medical University of South Carolina—said that waste often occurs when anesthesia providers draw up medications into vials in the operating room to have on hand in case they need it. That medication must be discarded if not used, but Fortier noted that prefilled syringes are sealed and can be returned to the supply shelves if not opened. Waste also is reduced because less drug goes unused in the syringes, which are prefilled with specific doses of medication that clinicians can choose from as warranted. The team of investigators from Medical University tracked the volume of discarded drugs from 154 surgeries where vials went unused or had medication remaining after use and compared it to the amount of drug wasted from 171 surgeries where prefilled syringes were used. Drug waste occurred in 38 percent of the procedures using prefilled syringes, significantly lower than the 71 percent result from the other surgeries. Fortier and colleagues found that the waste reduction saved $126 per day when they switched to the prefilled syringes in a 10-room operating room suite. While there are higher upfront costs associated with prefilled syringes, the savings, as well as other benefits—including less room for provider error and lower risk of contamination—are considerable.
From "Prefilled Syringes Cut Waste—And Bottom Line"
Clinical Oncology (10/11) McCook, Alison
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Nurse-Physician Infection Prevention Teams Conduct Rounds and Provide Support to Frontline Clinicians, Leading to Fewer Hospital-Acquired Infections
In an effort to reduce hospital-acquired infection rates, the University of Maryland Medical Center established three physician-nurse infection prevention teams to perform rounds at least once a week in assigned hospital units. Team members include a physician epidemiologist and a registered nurse with infection-prevention expertise. The teams perform surveillance, educate residents and fellows, evaluate patient care needs, and identify opportunities for improvement. Team members report on infection control practices during monthly quality meetings and report performance to units each quarter. As a result of this program, central line-associated bloodstream infections have been reduced by 70 percent. Surgical-site infections associated with instrumented spinal surgery have decreased by 50 percent, and bloodstream infections associated with antibiotic-resistant bacteria have been reduced by 25 percent. The hospital also met nine out of 10 internal infection control objectives in 2010.
From "Nurse-Physician Infection Prevention Teams Conduct Rounds and Provide Support to Frontline Clinicians, Leading to Fewer Hospital-Acquired Infections"
AHRQ Innovations Exchange (10/12/2011) Harris, Anthony; Hebden, Joan
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Sweet-Tasting Solutions for Reduction of Needle-related Procedural Pain in Children Aged One to 16 Years
Studies have shown that oral sucrose or glucose, with or without non-nutritive sucking, can reduce behavioral pain responses during or after painful procedures done on babies up to 12 months of age. In an effort to determine if these pain-reducing effects exist for children over one year, investigators analyzed data from four studies and a total of 330 participants. Two studies focused on toddlers and pre-school children receiving sucrose for immunization pain compared with water or no treatment, while the other two studies included school-aged children receiving sweet or unsweetened chewing gum before, or before and during immunization and blood collection. Results for the toddlers/pre-school children were conflicting, but the data showed that chewing sweet gum did not significantly reduce pain scores in school-aged children. The researchers concluded that there is insufficient evidence of the analgesic effects of sweet-tasting substances during painful procedures in children over one year of age.
From "Sweet-Tasting Solutions for Reduction of Needle-related Procedural Pain in Children Aged One to 16 Years"
Cochrane Database of Systematic Reviews (10/11) Harrison, D.; Yamada, J.; Adams-Webber, T.; et al.
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