Anesthesia E-ssential Aug. 30, 2013

 
Anesthesia E-ssential

Aug. 30, 2013

 

Vital Signs

 
AANA Joins with Merck to Promote Effective Communication and Collaboration in the Surgical Setting
Communication is a topic surgical and anesthesia professionals have discussed for some time. Though both groups have distinct roles throughout the perioperative process, earlier communication among providers could facilitate greater collaboration in the OR. OR Xchange, a program funded by Merck, encourages surgical teams and their institutions to make communication and collaboration a priority. The AANA is joining efforts with Merck on this important initiative.
 
As part of OR Xchange, Merck sponsored a survey of more than 500 healthcare professionals (including 255 surgeons, 202 anesthesiologists, and 50 CRNAs) that examined communication and collaboration at all stages of surgery. Merck distributed a preview of the survey results at the AANA Annual Meeting.
 
“Robust communication before, during, and after surgery is vital to ensuring patient safety and successful surgical outcomes. The AANA fully supports OR Xchange, and in the interest of our members and their patients is promoting the importance of effective, well-planned communication in the OR,” said AANA President Dennis Bless, CRNA, MS.
 
The Merck study revealed that CRNAs, anesthesiologists, and surgeons agree that increased communication in the surgical setting could facilitate a more collaborative working environment in the OR. The principal findings of the survey concluded that survey participants are generally satisfied with the level of communication and collaboration with members of their surgical team. However, 99 percent of anesthesiologists, 96 percent of surgeons, and 94 percent of CRNAs reported that open communication between surgical team members would be helpful to improve communication and collaboration during a surgical procedure. All three groups believe that use of other strategies and tools could be effective at improving collaboration and communication in the OR. Such strategies and tools include:
  • Surgeons having an understanding of the anesthesia plan (92 percent of CRNAs, 91 percent of anesthesiologists, and 85 percent of surgeons)
  • Anesthesia providers having an understanding of the surgical plan (97 percent of anesthesiologists, 96 percent of CRNAs, and 95 percent of surgeons)
  • Anesthesia professionals discussing the anesthesia plan preoperatively, as well reaching an agreement on the overall anesthesia plan before surgery starts (92 percent of surgeons, 91 percent of anesthesiologists, and 80 percent of CRNAs)
  • Implementing a checklist of guidelines to streamline communication at all stages of a surgical procedure (72 percent of CRNAs, 70 percent of anesthesiologists, and 69 percent of surgeons)
According to 93 percent of anesthesiologists and 86 percent of CRNAs responding to the survey, communication with surgeons affects their ability to manage the anesthesia plan to some degree; while 88 percent of surgeons say that communication with anesthesia professionals affects their ability to manage the surgical procedure to some degree. Other factors evaluated include the duration of surgeries, communication with nurses and technicians, and changes in surgical requirements during procedures.
 
 

 

The Pulse

 
  • Leadership Education, CE Credits, and Florida Sunshine in November: Sign Up Now!
  • World-Class Speakers Highlight Fall Leadership Academy Nov. 8-10 in Miami Beach
  • Master Crucial Communication Techniques at the Spokesperson Training Workshop
  • Business of Anesthesia Conference Coming to Pittsburgh
  • Hot off the Presses: Expanded Second Edition of Evidence Trumps Belief Now Available
  • Urgent Need for Volunteers in Belize
  • Jack Neary Pain Management Workshop Series Coming this October
  • Congratulations to Advertising Effectiveness Award Winners
  • AANALearn® Special Labor Day Weekend Sale!
  • Update on Drafts of Practice Doctorate Standards and Post-Graduate Fellowship Standards
  • Introducing New COA Directors and Officers
Professional Practice
  • Center for Improvement in Health Care Quality
  • Joint Commission Resources and Updates
  • AANA Asks Congress to Oppose Anesthesiologist-Sponsored Bill Repealing Provider Nondiscrimination
  • Key House Committee Approves AANA-backed Bill Permanently Repealing SGR Cuts, Reforming Medicare Payment
  • APRNs Tell Congress Medicare Reforms Should Reflect Full Scope of Practice
  • AANA Member Faut-Callahan, CRNA, PhD, FAAN, Named to Federal Agency Pain Policy Workgroup
  • AANA Works to Make CRNAs Heard Before Governors
  • How Was the Rat Pack at the CRNA-PAC's Event in Las Vegas?
  • FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
 

Healthcare Headlines

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.
 
 

 
Inside the Association
 
Leadership Education, CE Credits, and Florida Sunshine in November: Sign Up Now!
Hone your professional and leadership skills at the one high-level weekend meeting tailored to fit your needs: The AANA Fall Leadership Academy Nov. 8-10, 2013, in sun-drenched Miami Beach, Fla. This three-day event features your choice of educational tracks designed to inspire you with creative ideas and empower you with essential nuts and bolts information. Five specialized tracks for state association leaders focus on presidents-elect, state government affairs, federal political directors, state reimbursement specialists, and AANA Foundation advocates; in addition, a brand-new general leadership track has been created for other interested CRNAs and students. Round out the weekend networking with old friends and establishing new relationships at the fabulous Eden Roc Hotel. All are welcomed and encouraged to attend. Register online today!
 
 
World-Class Speakers Highlight Fall Leadership Academy Nov. 8-10 in Miami Beach
Advance your career and your profession at the AANA Fall Leadership Academy Nov. 8-10 in Miami Beach, Fla. Highlighting a long list of motivating and informative speakers will be keynote presenter Sarah Sladek, a noted author and generational expert and Dr. Donna Shalala, former U.S. Secretary of Health and Human Services and currently University of Miami president. Don’t miss this outstanding three-day event at the fabulous Eden Roc Hotel. Register online today!
 
 
Master Crucial Communication Techniques at the Spokesperson Training Workshop
Are you interested in improving your communication skills and becoming an effective representative for your profession? Then you won’t want to miss the Spokesperson Training for State Association Leaders Workshop, to be held Sunday afternoon and Monday morning, Nov. 10-11, directly after the Fall Leadership Academy. Using an interactive/discussion format, this unique full-day workshop teaches persuasive communication skills that are invaluable for handling media interviews situations as well as counseling patients and their families, providing testimony, lobbying, negotiating contracts, and resolving workplace conflicts. Register online today! 
 
 
Business of Anesthesia Conference Coming to Pittsburgh
Today’s healthcare environment, including reform, impacts the business of anesthesia. Learn how to navigate these changes by attending the AANA Business of Anesthesia Conference, Nov. 2, at the Renaissance Hotel in Pittsburgh, Pa. This meeting is designed to help you achieve the content expertise needed to meet the economic and quality requirements of your practice. We will provide you with best practices for the nurse anesthesia profession, and you will leave this one-day meeting with the knowledge necessary to be more resilient and successful. This program is designed specifically for you by your peers, and past participants agree:
  • “This was one of the best educational meetings of my career… from ANY source!”
  • “It’s the best AANA meeting that I have attended in my 38-plus years as a CRNA.”
  • “I got information there that you just don't find anywhere else.”
Register before Friday, Oct. 4, and save $75 on the registration fee.
 
 
Hot Off the Presses: Expanded Second Edition of "Evidence Trumps Belief" Available Now
An expanded second edition of "Evidence Trumps Belief: Nurse Anesthetists and Evidence-Based Decision Making," by Chuck Biddle, CRNA, PhD, AANA Journal editor-in-chief, is available now through the AANA Bookstore. The book contains additional chapters that make the text more versatile and provide readers a better foundation for achieving statistical power, identifying biomedical betrayal, and spotting statistical errors in published reports.
 
“Evidence-based decision making is a complex interplay among often competing domains of knowledge, experience, and patient concerns. It was clear in the wake of the first edition that vital information was missing,” said Biddle.
 
In revising and expanding the book, Biddle takes aim at some of the more prominent criticisms of evidence-based decision making, such as that it’s over-reliant on randomized trials, there is insufficient time to accomplish what is required, and the available evidence is flawed and contradictory.
 
“There will always be pockets of resistance to any evolving paradigm,” Biddle continued. “The major critics of evidence-based decision making are generally blinded to their own biases and seem prone to select out observations, views, and studies that support their preconceived notions of how things should be done.”
 
The new chapters will focus on publication bias, advanced statistical considerations, mega-databases, methodological power, number-needed-to-treat, and new research methods such as the adaptive clinical trial. Biddle said the added material will provide the reader with a better foundation for systematized thinking.
 
Biddle is a tenured full professor and staff anesthetist at Virginia Commonwealth University, Richmond, Va. He earned his doctorate in the outcomes sciences of epidemiology. A nurse anesthetist for nearly 30 years, his research has always been grounded in the broad domain of patient safety and marshaling evidence-based decisions to the patient. He believes this approach maximizes the opportunity to engage in truly patient-centric care because it merges science, personal skill set, and a humanist approach to decision making.
 
“Evidence Trumps Belief” is published by the AANA and available here.
 
 
Urgent Need for Volunteers in Belize
There is an urgent need for nurse anesthetist volunteers to travel to Belize City, Belize, in September, October, and November 2013. Health Volunteers Overseas is working with the University of Belize and the Belize Ministry of Health to provide faculty for a post-baccalaureate certificate program in nurse anesthesia. The project is in need of both didactic and clinical faculty to work with the 16 students currently enrolled in the program. HVO is also recruiting volunteers to serve as clinical and didactic faculty in the spring and summer of 2014.
 
The assignment for the HVO Belize project is four weeks preferred, two weeks minimum. Housing, a small food allowance, and in-country phone are provided.
 
Please contact Tony Li at t.li@hvousa.org if you would like more information about the upcoming volunteer opportunities with HVO's nurse anesthesia project in Belize.
 
 
Jack Neary Pain Management Workshop Series Coming this October
Oct. 11-16, 2013
Hyatt Rosemont Hotel and Orthopaedic Learning Center, Rosemont, Ill.
Interventional pain management requires the proper diagnosis and a precise treatment plan to help your patients better manage their pain. The AANA Jack Neary Advanced Pain Management Workshop series will expand your knowledge in interventional pain management. Attendees will have an opportunity to practice pain management techniques on human cadavers and state-of-the-art pain procedure simulators.
 
CRNAs can register for each workshop separately, but by combining the two workshops you not only will understand the complexities of pain treatment but will receive the hands-on opportunities to master your techniques. Register today.
Advanced Physical Assessment for Pain Practice—Oct. 11, 3013
  • AANA Jack Neary Advanced Pain Management  I Workshop—Oct. 12-13, 2013
  • AANA Jack Neary Advanced Pain Management  II Workshop—Oct. 14-15, 2013
  • Neuroanatomy Prosection Lab—Oct. 16, 2013
 
 
Congratulations to Advertising Effectiveness Award Winners
Two AANA Journal advertisers, Arizant Healthcare Inc., a 3M Company, and Covidien, received the AANA Advertising Effectiveness Award at the Annual Meeting in Las Vegas. Each year, SLACK Incorporated performs an Advertising Effectiveness Survey on behalf of the AANA based on the advertisements placed in the April issue of AANA Journal. This survey was emailed to a random selection of 2,000 AANA members, and based on the feedback, AANA awarded three top prizes to the companies that scored the highest in overall communication/effectiveness with their advertisement. 
Arizant Healthcare, Inc. received the First Place award for their 3M Bair Hugger Therapy advertisement and Second Place for their 3M SpotON Temperature Monitoring System advertisement. Covidien received the Third Place award for their McGRATH MAC advertisement.





Larry Sawyer, BA, managing editor, AANA Journal (far left) presents the First Place AANA Advertising Effectiveness Award to Arizant Healthcare Inc. Accepting the award for Arizant are (left to right):  Susan Symons, RN, BSN, clinical specialist, South West Region;  Chip Wilson, territory manager, Western Region;  and Kathy Hiemenz, trade show and meeting coordinator. 
 
 
 
 
 
 
 
 

 
 
 
 
 
Larry Sawyer, BA, managing editor, AANA Journal (right) presents the Third Place AANA Advertising Effectiveness Award to Covidien. Accepting the award for Covidien is Jerry Minardi, convention planner, Communications, Respiratory and Monitoring Solutions.
 
 
 
 
 
 
 
 
 
 
Thank you to those that participated. These studies enable advertisers to evaluate the impact of their advertising message with our readers/members. The feedback received is invaluable to the companies that support the AANA.  
 
 
AANALearn® Special Labor Day Weekend Sale!
“What Can the CRNA do to Improve Medication Safety & Decrease Cost in the OR?” This popular course providing 2 CE credits is being offered at half price for a limited time in AANALearn®. Once you are enrolled, the course is accessible for 90 days, and the credits transfer directly to the member’s CE transcript within the same day*. There are more than 60 other courses to select from with a wide variety of topics. 
 
AANA members have an existing account with AANALearn® which is easily accessed from the AANA website using the AANA login username and password. Using your member login provides an automatic 30 percent discount on all courses. Browse the AANALearn® catalogs NOW at www.aanalearn.com.
 
* CE credit transfer is only for AANA members or nonmembers with record keeping contracts.
 

 


 
 
Update on Drafts of Practice Doctorate Standards and Post-Graduate Fellowship Standards
The second drafts of the Practice Doctorate Standards for Nurse Anesthesia Programs and the Standards for Post-Graduate Fellowships were approved at the May 2013 COA meeting. A hearing and a focus session were held by the AANA Education Committee at the 2013 AANA Annual Meeting in Las Vegas, Nev., to obtain comments from the community of interest. In addition, a general call for comments was distributed to the community of interest and a survey was sent to a representative sample of the community of interest to assess the validity and relevancy of the Standards. The Standards Revision Task Force will be reviewing the comments and statistical analysis in September. Third drafts of the Standards will be distributed for general comment and a Hearing and a Focus Session will be held at the Fall Leadership Academy. The draft Standards are scheduled for review and adoption at the January 2014 COA meeting. Please direct any questions regarding the major revisions of the Standards to the COA at accreditation@coa.us.com or (847) 655-1160.
 
 
Introducing New COA Directors and Officers
At the May 2013 COA meeting there were several changes in COA membership. Leaving the COA due to the expiration of terms are Mary Shirk Marienau, CRNA, PhD, educator representative; Maria Garcia-Otero, CRNA, PhD, practitioner representative; and Christopher Reed, MSN, MPH, RN, CCRN, CTRN, CFRN, student representative. New COA directors filling the vacant educator, practitioner, and student positions are James Walker, CRNA, DNP, educator representative; Maria Hirsch, CRNA, DNAP, practitioner representative; and Jenny Bucaro, RN, BSN, student representative. The new COA directors will start their terms at the October 2013 COA meeting.
 
The Executive Committee members are elected annually at the spring COA meeting. The newly elected Executive Committee assumed office immediately following the May 2013 meeting. The committee includes Kathleen Cook, CRNA, MS, chair; Kay Sanders, CRNA, DNP, vice chair; and Keith Torgersen, CRNA, MSN, secretary/treasurer.
 
 

 

Professional Practice

 
Center for Improvement in Health Care Quality
A new hospital accrediting organization, Center for Improvement in Health Care Quality (CIHQ), has received CMS approval for deeming authority for acute care hospitals. Read more, including accreditation standards, at http://cihq.org/home.asp.
 
 
Joint Commission Resources and Updates
The Joint Commission regularly disseminates updates and valuable resources for accredited organizations. The Professional Practice Division compiles pertinent announcements for AANA members on our newly redesigned Joint Commission website (login required). Recent highlights from The Joint Commission include:
  • The National Fire Protection Association (NFPA), the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), and The Joint Commission have worked with the Centers for Medicare & Medicaid Services (CMS) to devise a cost-effective relative humidity range for anesthetizing locations that meets patient safety requirements. Read more here.
  • The Joint Commission is seeking input from the field on the proposed new and revised diagnostic imaging services requirements in the Ambulatory Care, Critical Access Hospital, and Hospital programs. Comments are due Sep. 25, 2013. Read more here.
  • The Joint Commission has received a sole source contract from the federal Office of the National Coordinator for Health Information Technology to establish a credible and meaningful process that can be used to identify, understand, disseminate, and eventually help prevent health IT-related sentinel events that may cause serious or fatal harm to patients. Read more here
Visit our newly redesigned Joint Commission webpage to view more information. If you have accreditation-related questions, please contact the Professional Practice Division at practice@aana.com or (847) 655-8874.
 
 

 
 
AANA Asks Congress to Oppose Anesthesiologist-Sponsored Bill Repealing Provider Nondiscrimination
AANA has asked Congress to oppose legislation seeking to repeal the federal provider nondiscrimination law, because by overturning provider nondiscrimination, the bill would reauthorize policy favoring discrimination against qualified licensed healthcare providers, such as CRNAs, solely on the basis of their licensure.
 
Rep. Andy Harris (R-MD), the only anesthesiologist in Congress, introduced the bill, HR 2817, on July 24 with the backing of the American Society of Anesthesiologists (ASA). The federal provider nondiscrimination law was enacted in 2010 with the support of the AANA to promote patient safety, access, choice, and competition in healthcare. In the letter signed by Past President Janice Izlar, CRNA, DNAP, the AANA states that HR 2817 would “reverse market-oriented, pro-competitive, pro-consumer choice policy that respects state scope of practice laws and would promote anticompetitive practices that deny patient access to such providers, and increase healthcare costs by impairing competition and rewarding provider guild collusion with plans.” In addition, the AANA, as part of the Patients’ Access to Responsible Care Alliance (PARCA), sent a letter to Congress with a similar message opposing this legislation. PARCA is a national coalition representing the interests of millions of patients and non-MD/DO healthcare professionals.
 
Provider nondiscrimination, an Affordable Care Act provision backed by AANA, was the target of a joint letter signed by the ASA and several physician groups supporting HR 2817. It said, “We are deeply concerned that for certain covered services in a number of states, this new part of the Public Health Service Act will be interpreted to provide that all health professional groups be considered as if their education, skills, and training were equal even if their state-based medical and healthcare professional licenses or certifications are very different … This ACA [Affordable Care Act] provision disrupts over a century and a half of dynamic state-based licensure and certification, interjecting the federal government into interpreting the limits of scope of practice and procedure.” The letter was co-signed by medical societies representing dermatologists, family practice physicians, otolaryngologists, ophthalmologists, OB/GYNs, and plastic surgeons.
 
Rep. Harris’ legislation was referred to the House Energy and Commerce Committee, where he does not serve, and has no cosponsors and no Senate companion bill at this date.
 
As part of the ACA, the AANA-backed provider nondiscrimination provision takes effect Jan. 1, 2014, and prohibits health plans from discriminating against qualified licensed providers like CRNAs solely on the basis of their licensure. AANA members should stay alert for opportunities to advocate for proper implementation of this provision and to urge members of Congress to not cosponsor Rep. Harris’ legislation.
 
Read AANA’s letter and the PARCA Letter (AANA member login and password required), the bill, and the medical groups’ letter.
 
 
Key House Committee Approves AANA-backed Bill Permanently Repealing SGR Cuts, Reforming Medicare Payment
By a 51-0 vote on July 31, the House Energy and Commerce Committee approved legislation repealing Medicare sustainable growth rate (SGR) funding formula cuts and reforming Medicare payment (HR 2810). Sponsored by Reps. Michael Burgess, MD (R-TX) and Frank Pallone (D-NJ), the legislation is important to CRNA and physician Medicare reimbursement—and particularly for averting 24 percent Medicare Part B payment cuts coming Jan.1.
 
Before moving the bill, lawmakers adopted by voice vote an amendment making several technical changes, including two notably requested by AANA and the community of APRN organizations in a July 30 letter to the committee. One change clarified the bill’s definition of “eligible professional organizations” to effectively include those representing CRNAs and APRNs, so they can have a stronger voice in the development, implementation, and evaluation of quality measures and incentive payment systems. The other change authorized Medicare coverage of nurse practitioner complex chronic care management services in patient-centered medical homes; the original bill restricted such Medicare coverage to allopathic and osteopathic physicians. AANA was present in the committee room during its legislative action July 31, and the advocacy of AANA, CRNAs from congressional districts served by Energy and Commerce Committee members, and other APRN groups proved crucial to the bill’s improvement and adoption in committee.
 
In addition to stabilizing Medicare Part B payment for five years with 0.5 percent annual increases, for each year starting in 2019 providers would be expected to report quality measures, including clinical practice improvement activities, and would have their reporting ranked by peer cohort or group as defined. Higher scorers would get a 1 percent payment increase, with those in the middle and new providers getting no boost, and lower scorers being cut 1 percent in the following year. The quality measures and incentive payment systems would be approved by the HHS Secretary following processes intended to coordinate with existing systems like Medicare’s Physician Quality Reporting System (PQRS). Providers who do not report quality measures or participate in alternative payment models (APMs) would receive 95 percent of the base fee schedule starting in 2019.
 
The bill would also authorize providers to bill for services using APMs submitted, approved, and evaluated according to processes described in the bill. Providers billing by APM would be deemed to be meeting the quality measures. APMs, which would be approved by a contractor under the HHS Secretary’s direction, are to focus on improving care coordination, quality care improvements, and cost savings.
 
The legislation is not final. It awaits action in the House Ways and Means Committee in the fall following Congress’ August recess. That committee has the job of identifying and approving the revenue source to pay the costs of HR 2810, and possibly adding entitlement reforms. The full House appears unlikely to take up the bill until November at the earliest; prior to that, lawmakers anticipate addressing other significant budget issues before the new fiscal year begins Oct. 1.
 
Medicare payment legislation is also under development in the U.S. Senate, where the Finance Committee is likely to take up the issue later in the fall.
 
APRNs Tell Congress Medicare Reforms Should Reflect Full Scope of Practice
Medicare reforms should encourage the use of CRNAs and other APRNs to their full scope of practice, treat APRNs the same as physicians in the development and use of quality measures for payment incentives, and eliminate unnecessary supervision requirements, according to an APRN workgroup letter signed by the AANA and sent Aug. 16 to the Medicare-writing House Ways and Means Committee.
 
“Though scope of practice is a state issue, many federal and Medicare policy artifacts impair the use of APRNs and should be eliminated,” the letter stated. “These policies include instances where Medicare pays APRNs differently or less than physicians for providing the same service; authorizes coverage of APRN services only ‘incident to’ a physician thus increasing cost, reducing patient choice and inviting fraud; requires unnecessary supervision by physicians increasing costs and impairing access. In reforming payment systems, Congress should direct Medicare to reimburse providers the same fee for the same service, authorize direct reimbursement of medically necessary services performed within the scope of the APRN’s practice, and advance health care policy based on evidence, eliminating unproven physician supervision requirements.”
 
The workgroup’s letter responded to the committee’s call for comments to its proposed Medicare entitlement reforms, which included increasing Part B deductibles for new enrollees, raising cost-sharing for higher-income individuals, and requiring copays for home health.  The AANA and CRNAs have been active in Washington and on Capitol Hill promoting the value of CRNAs toward patient access to safe, cost-effective healthcare.
 
 
 
AANA Member Faut-Callahan, CRNA, PhD, FAAN, Named to Federal Agency Pain Policy Workgroup
Margaret Faut-Callahan, CRNA, PhD, FAAN, has been named to the Professional Education and Training Workgroup of the federal Inter-Agency Pain Research Coordinating Committee of the National Institute of Health (IPRCC). Dr. Faut-Callahan is a longtime leading member of the AANA, which nominated her for the position, and also serves as Dean of the Marquette University School of Nursing.
 
The IPRCC is charged by the HHS Office of the Assistant Secretary for Health to create a comprehensive population health level strategy for pain prevention, treatment, management, and research, an assignment that echoes the Institute of Medicine’s 2012 report, “Relieving Pain in America” Recommendation 2-2. Since the IPRCC is first and foremost a collection of researchers, the IPRCC has sought the expertise of others to inform and advise on this major initiative. The structure for the IPRCC work includes establishment of five working groups and an oversight panel.
 
Learn more about the IPRCCand see the notice about Dr. Faut-Callahan’s appointment.
 
 
AANA Works to Make CRNAs Heard Before Governors
The AANA continues to make CRNAs heard among the nation’s governors, most recently through participation in the National Governors Association (NGA) meeting Aug. 1 to 4 in Milwaukee.
 
With about half of all U.S. governors in attendance, AANA staff had ample opportunity to meet and greet each one and have more in-depth conversations about CRNAs with several. To date, our activities with the governors’ associations in aggregate have netted contact with nearly three-fifths of all U.S. governors since late this spring.
 
Of particular note at NGA, Dr. Jeffrey Brenner, founder and executive director of the Camden Coalition of Healthcare Providers, spoke about the waste in healthcare, citing as examples unnecessary knee scope procedures, unnecessary cardiac stents, and physicians changing indications for cardiac procedures to maximize revenues. Many governors used the question-and-answer period to observe that financial incentives in the current system contribute to waste and abuse, and that high healthcare cost growth makes them and their taxpayers feel “ripped-off.” Governors also heard from Alison Hickey of the Veterans Administration, who outlined the agency’s efforts to transition military personnel into civilian life and to address wounded warriors’ healthcare and educational needs. 
 
 
How Was the Rat Pack at the CRNA-PAC's Event in Las Vegas?
Over $50,000 was raised for CRNA-PAC during the AANA Annual Meeting in Las Vegas where “Ol’ Blue Eyes” and his Rat Pack pals entertained in the Frank Gehry-designed Cleveland Clinic Lou Ruvo Center for Brain Health just off of the Strip.
 
More than 200 AANA members contributed to the event in support of the CRNA-PAC, the only PAC working full-time in Washington solely for CRNAs and their federal issues in Congress, and were greeted by AANA President Dennis Bless, CRNA, MS, a longtime CRNA-PAC supporter and Presidential Club member.
 
The CRNA-PAC Committee, chaired for 2013-14 by Paul Beninga, CRNA, MS, says “thank you” to everyone who participated. To learn more about the CRNA-PAC and to contribute, see www.caretobecounted.org and enter you AANA member login and password.
 
 
About This Document
The AANA Federal Government Affairs Hotline is published for the nurse anesthetist members of AANA Mondays when Congress is in session by the AANA Office of Federal Government Affairs, Washington DC, (202) 484-8400, info@aanadc.com, Frank Purcell, Senior Director. © 2013 American Association of Nurse Anesthetists. The following is an FEC required legal notification for CRNA-PAC: Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.
 
 

 
 

 
 
 
Two Alternative Treatments May Help Relieve Postoperative Nausea
New studies indicate that aromatherapy and intravenous dextrose solution are simple but effective alternatives for treating nausea and vomiting after surgery. At Carolinas Medical Center in Charlotte, N.C., researchers studied 301 patients experiencing these symptoms. They were randomly assigned to receive gauze pads infused with essential oil of ginger or a mix of aromatherapy oils—true aromatherapy treatments—or gauze pads soaked in either rubbing alcohol or a placebo saline solution. Comparisons of the four sets of patients showed that those receiving aromatherapy reported lower nausea scores and were less likely to require antiemetic medications to relieve the nausea. The aromatherapy blend alleviated nausea in about 80 percent of the patients who received it, compared to a 70 percent success rate with ginger alone. "Aromatherapy is promising as an inexpensive, noninvasive treatment for postoperative nausea that can be administered and controlled by patients as needed," the team wrote in its research report. The second study, out of Yale School of Medicine, identified a 5 percent intravenous solution of dextrose—or simple sugar—as another way to alleviate postoperative nausea and vomiting (PONV). Among 62 patients randomly assigned to receive either the dextrose solution or a standard IV fluid following surgery, there was no notable difference in nausea scores. However, the dextrose group needed fewer antiemetic drugs and spent less time in recovery. "This form of PONV therapy has a low side effect profile, is easily accessible, and is inexpensive," the researchers write. Both studies appear in the September issue of Anesthesia & Analgesia.
 
From "Two Alternative Treatments May Help Relieve Postoperative Nausea"
Medicalxpress (08/22/2013)
 
 

Study Finds Norgine's Dantrium Reduces Fatal Anesthetic Reactions
Dantrolene sodium effectively curtailed fatal anesthetic reaction in patients with malignant hyperthermia (MH), according to Canadian researchers. Their study reviewed 129 patients believed to be at risk for MH, which was confirmed via caffeine-halothane contracture testing. Dantrolene—commercialized by the U.K. manufacturer Norgine under the brand name Dantrium—proved to lower the rate of renal and cardiac dysfunction, disseminated intravascular coagulation, and other complications in these patients. When the drug—which lowers the intracellular calcium concentration in the skeletal muscle—is administered within 10 to 19 minutes after the start of MH, the complication rate falls below 20 percent, according to the findings. The longer the time lapse before administration, however, the greater the chance of complications, with the rate reaching 100 percent if dantrolene administration does not occur within 50 minutes. "These new data are very important as they emphasize that survival from a malignant hyperthermia crisis, a rare condition, is highly dependent on early recognition and prompt action, and that the rapid use of dantrolene can ensure patient survival," said Gunilla Islander, from the anesthesia department at Sweden's Lund Hospital.
 
From "Study Finds Norgine's Dantrium Reduces Fatal Anesthetic Reactions"
Pharma Letter (08/19/2013)
 
 

Anesthesia: Is it Safe for Young Brains?
Although scientific studies have suggested that anesthesia can harm the developing brains of young animals, the findings have been less conclusive for children. Since 1 million U.S. children under age four need surgery each year, the question is important for health organizations like the Food and Drug Administration (FDA) to answer. The FDA and the International Anesthesia Research Society launched an initiative called SmartTots (Strategies for Mitigating Anesthesia-Related neuroToxicity in Tots) to help close the research gap. SmartTots seeks to ensure that children under four years will be as safe as possible when receiving anesthesia, as this is a period of significant brain development. The SmartTots partnership seeks to encourage the scientific community to explore this issue and stimulate dialogue among leaders in the anesthesia community. In December, SmartTots issued a consensus statement, endorsed by organizations including the FDA and the American Academy of Pediatrics, which acknowledged that, without conclusive evidence, it is unethical to withhold necessary sedation and anesthesia from children. SmartTots is funding research at Columbia University and the University of Iowa on the effects of anesthesia on infant brain development. Until more data is available, parents and caretakers should talk to their pediatrician or other healthcare provider about the risks and benefits of procedures requiring anesthetics.
 
From "Anesthesia: Is it Safe for Young Brains?"
FDA Consumer Updates (08/07/2013)
 
 
 
 
Side Effects of Opioids Worse for Girls Than for Boys
A new study of children undergoing tonsillectomies suggest that girls are more likely than boys to experience adverse effects from morphine, report researchers at Cincinnati Children's Hospital. The study included 275 children, aged six to 16, all of whom received a standard dose of intraoperative morphine and underwent assessment of their postoperative pain and opioid-related outcomes. This included postoperative nausea and vomiting (PONV), respiratory depression, and prolonged stays in the post-anesthesia care unit (PACU) due to adverse effects of opioids. As the total dose of morphine increased up to 0.4 mg/kg, girls had a twofold to threefold higher rate of major adverse effects, such as respiratory depression, PONV, and longer stays in the PACU. Women are already known to have more opioid-related side effects than men; and while the difference was assumed to be hormonally mediated, the new research suggests that prepubertal girls were more likely to experience side effects than older girls. The researchers are now studying other potential mechanisms behind these findings. The researchers presented their results at the 2013 annual meeting of the Society for Pediatric Anesthesia.
 
From "Side Effects of Opioids Worse for Girls Than for Boys"
Pain Medicine News (08/01/2013) Vol. 11 Savoie, Keely
 
 

Preemptive Pain Management May Reduce Postsurgical Discomfort
According to the results of a prospective, observational study published in the May/June 2013 issue of Pain Physician, administering preemptive analgesia to manage pain prior to spinal surgery may alleviate patient pain following the procedure. There were 393 patients included in the multi-site study, each of whom underwent spinal surgery for degenerative spine disease and filled out questionnaires on their pain management protocols afterwards. Twenty percent of the patients were given preemptive analgesics, including COX-2 inhibitors, before the surgery at the time of antibiotic prophylaxis. Post-operative pain management regimens ranged from multimodal therapy to combinations of patient-controlled anesthesia, NSAIDs, COX-2 inhibitors, and narcotics. While there was no variance between the pain levels of those receiving different post-operative pain management regimes, those who had received preemptive pain management had significantly different pain levels and were less likely to report postoperative self-administration of anesthesia than their counterparts. In addition, the preemptive analgesia group reported less anxiety or depression two weeks after the surgery and were better able to care for themselves and resume their normal routines.
 
From "Preemptive Pain Management May Reduce Postsurgical Discomfort"
Pharmacy Times (08/07/13)
 
 

Exparel Falls Short in Nerve Block Trial
Pacira Pharmaceuticals has experienced a minor complication in its effort to get Exparel (bupivacaine liposome injectable suspension) approved as a nerve block by the U.S. Food and Drug Administration (FDA). The surgical-pain drug, which contains no opioids, failed a Phase III clinical trial held to determine its efficacy at blocking intercostal nerves. Involving 180 patients in five countries, the study provided mixed results, with patients in some nations responding favorably to the drug and others exhibiting a high placebo response. Pacira said it is conducting further analysis of the data to understand the disparity in the study results. There are two more Phase III trials in the works for Exparel, and the FDA has said that a single positive trial will be enough to support the drug's approval as a nerve block. Pacira signaled that it still expects to be able to file for marketing approval for this indication early next year.
 
From "Exparel Falls Short in Nerve Block Trial"
Outpatient Surgery (08/05/13) Burger, Jim
 
 
 
Efficacy of Pain Control With Topical Lidocaine-Epinephrine-Tetracaine During Laceration Repair With Tissue Adhesive in Children
Children with minor lacerations who are treated with topical lidocaine-epinephrine-tetracaine before wound closure have lower pain ratings and more painless repairs compared to placebo, research shows. Investigators conducted a study to test whether a topical solution of lidocaine-epinephrine-tetracaine could decrease pain during tissue adhesive repair. The study included 221 children between the ages of three months and 17 years who presented to a pediatric emergency department with lacerations that required closure with tissue adhesive rather than sutures. The children received either lidocaine-epinephrine-tetracaine or a placebo before their wounds were closed. The children who received the analgesic before wound closure reported less pain compared to those who received a placebo, and they were significantly more likely to report having a pain-free procedure.
 
From "Efficacy of Pain Control With Topical Lidocaine-Epinephrine-Tetracaine During Laceration Repair With Tissue Adhesive in Children"
Canadian Medical Association Journal (07/29/2013) Harman, Stuart; Zemek, Roger; Duncan, Mary Jean; et al.
 
 

Procedural Sedation With Propofol for Emergency DC Cardioversion
Though propofol has been used in procedural sedation for direct current countershock cardioversion (DCCV) on emergency patients with cardiac arrhythmias since 1995, existing evidence supporting dose requirements and propofol safety in emergency DCCV use was limited. Researchers reported a prospective case series of patients undergoing sedation-facilitated DCCV using propofol where the results indicated that the anesthetic was a safe drug for achieving procedural sedation in patients with an atrial tachyarrhythmia without evidence of hemodynamic compromise. A dose of 1 mg/kg appeared to be safe in most of those patients, as no moderate or sentinel adverse events were reported in these patients. In patients with atrial tachyarrhythmia and evidence of hemodynamic compromise, propofol was found to be safe for procedural sedation in emergency or urgent DCCV at a dose of 0.5 mg/kg, with no sentinel adverse events reported. The report notes that there is limited evidence to support using propofol for DCCV for patients with ventricular tachycardia.
 
From "Procedural Sedation With Propofol for Emergency DC Cardioversion"
Emergency Medicine Journal (07/29/13) Kaye, Philip; Govier, Matthew
 
 
 
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