February 17, 2014
MANA Issues Statement Regarding FTC Letter
The Massachusetts Association of Nurse Anesthetists has issued a statement regarding the recent Federal Trade Commission letter addressing Massachusetts House Bill 2009, which would permit CRNAs and nurse practitioners to order tests and therapeutics and issue written prescriptions without a supervisory agreement with a physician. Click here
to read the statement.
- APSF Releases Patient Safety Videos
- Updated Version of AAAASF Surgical Standards Manual Now Available
- The Joint Commission Issues Clarification of Storage Requirements for Freestanding Medical Gas Cylinders
- Make Professional Development a Priority: AANA 2014 Meetings and Workshops Calendar Now Available
- The AANA Essentials of Obstetric Analgesia/Anesthesia Workshop
- Apply Now - Applications Now Available Online
- Calling all Performers: Talent Application Deadline – April 1, 2014
- Nurse Anesthetists Week Viewed Thousands of Times
- Legislation Introduced to Repeal “Sustainable Growth Rate” Cuts, Reform Medicare Payment, but Hard Work Remains
- Thousands of CRNAs Contact Congress to Oppose “Grimm-Kirkpatrick” Letter Attacking CRNA Care for Our Veterans
- AANA Participates in National Health Policy Conference
- Register Now for 2014 AANA Mid-Year Assembly
- Pardon the Interruption
- FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
Healthcare HeadlinesHealthcare 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
APSF Releases Patient Safety Videos
The Anesthesia Patient Safety Foundation announced the availability of three patient safety videos based on the proceedings and concluding recommendations from APSF-sponsored consensus conferences.
To view the video from Opioid-Induced Ventilatory Impairment (OIVI): Time for a Change in the Monitoring Strategy for Postoperative PCA Patients, held June 8, 2011, visit http://apsf.org/resources_video4.php
To view the video from Simulated Informed Consent Scenarios for Patients at Risk for Perioperative Visual Loss Due to Ischemic Optic Neuropathy, visit http://apsf.org/resources_video5.php
Visitors may also request a complimentary one-hour DVD of the OIVI and/or POVL proceedings that includes the executive summaries (click on “Request a complimentary DVD copy of the video”). A complimentary DVD copy of the Simulated Informed Consent Scenarios video may also be requested.
Updated Version of AAAASF Surgical Standards Manual Now Available
Version 14 of the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) Surgical Standards Manual is now available for download
and review. The updates in the 14th edition of the manual will take effect May 1. Prior to that time, all surveys that take place will be based on the Version 13 AAAASF Surgical Standards Manual.
The Joint Commission Issues Clarification of Storage Requirements for Freestanding Medical Gas Cylinders
Improper storage of medical gas cylinders poses a number of hazards to patients and staff. The Joint Commission has published new clarifications to its requirements regarding the storage of medical gas cylinders. Read the clarifications on The Joint Commission’s website
Make Professional Development a Priority: AANA 2014 Meetings and Workshops Calendar Now Available
AANA Meetings and Workshops
are offered throughout the year and provide CRNAs a great opportunity for professional development, to earn continuing education credits, and for peer-to-peer interaction with colleagues about critical topics in the field of nurse anesthesia. Click here
to access the calendar.
The AANA Essentials of Obstetric Analgesia/Anesthesia Workshop
Building and maintaining knowledge of the parturient is critical
to the success of CRNAs who work, or who are preparing to begin working, in the labor and delivery suite
. AANA’s Essentials of Obstetric Analgesia/Anesthesia Workshop will be held on April 30, 2014, at the AANA’s offices in Park Ridge, Ill
. Register here
Apply Now – Applications Now Available Online
The AANA Foundation is proud to continue its history of funding research and education to advance the science of anesthesia. Scholarships, fellowships, grants, and awards with March, April, and May deadlines are listed below. Applications are currently available on the AANA Foundation website at www.aanafoundation.com
March 1 Deadlines
- Nurse Anesthesia Student Scholarships
Scholarships are available to all nurse anesthesia students currently enrolled in an accredited nurse anesthesia program. Students must be in good standing within the attended program and meet the specific scholarship requirements outlined in the application. Scholarships start at $1,000.
- Dean Hayden Student Research Scholarship – Awarded up to $5,000.
April 1 Deadlines
- “State of the Science” – Oral Poster Presentation
An opportunity for CRNAs and nurse anesthesia students to present their research findings and innovative educational approaches through an oral presentation at the AANA Annual Congress. Research, literature reviews, and innovative, creative techniques in anesthesia are appropriate topics. Up to $1,000 accompanies oral presentation.
Doctoral and Post Doctoral Fellowship Opportunities
- Post Doctoral Fellowship
Funding will be awarded to CRNAs who, having been awarded the doctorate, are actively involved in the development of a research program. The goal of this program is to support nurse anesthetists who evidence a strong commitment to nurse anesthesia and are seeking to develop a research program. Awarded up to $60,000.
- Doctoral Fellowship
Supports CRNAs actively engaged in doctoral studies that evidence a strong commitment to research. Recipients possess the vision to impact the healthcare system as a doctorally-prepared CRNA. Awarded up to $10,000.
- Florida Association of Nurse Anesthetists Practice and Research Doctoral Fellowship – Maximum of $3,000 award.
- Kay Wagner Pennsylvania Association of Nurse Anesthetists Practice and Research Doctoral Fellowship – Clinical Doctorate and Research Doctorate – Maximum of $5,000 award each.
- Lorraine D. Dankowski Doctoral Fellowship - Maximum of $10,000 award.
- Palmer Carrier, CRNA Scholarship
Applicants must be currently enrolled in a doctorate degree program at a nationally accredited university to enhance their professional development as a leader in research. Awarded up to $5,000.
May 1 Deadlines
- “State of the Science” – General Poster Presentation
An opportunity for CRNAs and nurse anesthesia students to present their research findings and innovative educational approaches through a poster presentation at the AANA Annual Congress. Research, literature reviews, and innovative, creative techniques in anesthesia are appropriate topics.
- Grant Proposals
General research grants are awarded to AANA member CRNAs in good standing. Research funding priorities change annually. Please refer to the research priorities on the proposal application for more information. Funding varies.
If you have any questions, please contact the AANA Foundation at (847) 655-1170 or email@example.com
Calling all Performers: Talent Application Deadline – April 1, 2014
Mark your calendar and plan to attend a fabulous and fun event, Orlando – The Stars Come Out Again, on Monday, Sept. 15, 2014, at the AANA 2014 Nurse Anesthesia Annual Congress.
YOU can help make the night a huge success. If you have a talent you’d like to share, submit a Talent Application today. Click here
to visit our event webpage, learn more about the event, and access the application.
Share the stage with other CRNAs and students who will be showcasing their talent and creativity, competing for fabulous prizes, and supporting the AANA Foundation’s mission of advancing the science of anesthesia through education and research.
If you have any questions, please contact Luanne Irvin at the AANA Foundation at (847) 655-1173 or firstname.lastname@example.org
Nurse Anesthetists Week Viewed Thousands of Times
The AANA’s Facebook post celebrating the first day of National Nurse Anesthetists Week, Jan. 19, 2014, was shared 411 times, reaching 41,284 people. The post was:
Today begins National Nurse Anesthetists Week! The AANA salutes the 47,000 Certified Registered Nurse Anesthetists across the United States for all you do for patients in every practice setting! Thank you for keeping patients safe!
Legislation Introduced to Repeal “Sustainable Growth Rate” Cuts, Reform Medicare Payment, but Hard Work Remains
Bipartisan House and Senate health committee leaders introduced legislation Feb. 7 repealing the Medicare “sustainable growth rate” (SGR) funding formula that threatens CRNA and physician payment with 24 percent cuts, and reforming Medicare payment. But the bill, HR 4015, has one big gap—no mechanism for paying its approximately $140 billion cost. Lawmakers must fill that gap if they are to complete a permanent repeal of the cycle of SGR cuts by the March 31, 2014, deadline when the current relief expires and the next round of cuts hits.
Together with a coalition of organizations representing advanced practice registered nurses (APRNs), the AANA has been working to repeal the flawed SGR formula, and to ensure that Medicare payment reforms treat CRNAs and other APRNs the same as physicians. In most aspects, the legislation achieves that objective. However, one provision authorizes “providers” and “medical specialty societies”—and not organizations representing CRNAs, APRNs, or other providers who are not physicians—to submit clinical quality improvement recommendations that may affect Medicare payment. The AANA and CRNAs continue working to ensure patient access to safe, cost-efficient CRNA care under the Medicare program.
Thousands of CRNAs Contact Congress to Oppose “Grimm-Kirkpatrick” Letter Attacking CRNA Care for Our Veterans
In response to an AANA call to action, thousands of AANA members contacted their U.S. Representatives during the past several weeks to urge support for the Veterans Health Administration (VHA) recognizing CRNAs and other APRNs to their full practice authority, and to oppose a letter circulated by Reps. Michael Grimm (R-NY) and Ann Kirkpatrick (D-AZ) that mischaracterizes and attacks the care CRNAs provide our veterans.
The “Grimm-Kirkpatrick” letter, which is now finalized, erroneously states that VHA recognition of APRNs to their full scope of practice “would override the current and longstanding Anesthesia Service Handbook,” and that the proposal “must be closely examined to ensure that there are no unintended consequences which could have a detrimental effect on our veterans’ health care services.” Support for the Grimm-Kirkpatrick letter was driven by the American Society of Anesthesiologists and its members.
With thanks to our Federal Political Directors and Key Contacts in each state, and to our coalition partners, CRNAs made and continue to make their voices heard on Capitol Hill—underscoring the safety of CRNA care, and how CRNAs and APRNs ensure veterans access to the care they need and deserve.
To assist in our continued advocacy efforts, we would like to hear any feedback you receive on the issue from your Representative or a member of their staff as well as any personal stories related to CRNA care in the VHA that you feel could be helpful to our cause. To record feedback, please use the following link: http://ssl.capwiz.com/caretobecounted/lrm/feedback.tt?event=43780
Please also be on the lookout for additional information as we expand our advocacy efforts on this issue.
AANA Participates in National Health Policy Conference
Representatives from the White House outlined health reform implementation, the chief medical officer of Medicare reviewed the present and future of quality measures reporting, and industry experts prognosticated on the future of “big data” in healthcare delivery systems, as part of the AcademyHealth national health policy conference Feb. 3-4 in Washington, D.C. The AANA was in attendance.
Register Now for 2014 AANA Mid-Year Assembly
To make your voice and the voice of CRNAs strong in Washington, the time is now to register for AANA Mid-Year Assembly, April 5-9, 2014, in Arlington, Va.
Pardon the Interruption
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 U.S. Citizen.
Certified Registered Nurse Anesthetist (Per Diem) – Somnia Anesthesia
Somnia, a national anesthesia practice management company, is seeking several Per Diem CRNAs to join its team at Memorial Healthcare.
Read more about this position
Full or Part-Time CRNA – Eon Clinics
Multiple locations, IL
Eon Clinics, a Premier All-In-One Dental Implant Center in the Chicagoland area, where our focus is only on dental implants, is expanding.
Read more about this position
More Than 14 Percent of Pregnant Women Prescribed Opioids
While experts agree it is normal for women to experience pain at some point during pregnancy, they say the unusually high number of expectant mothers in this country who are given opioids is cause for concern. Researchers analyzed data for more than 530,000 women giving birth between 2005 and 2011, finding that 14.4 percent were prescribed opioids while pregnant—most often for back pain but also for abdominal or joint pain, migraine, and fibromyalgia, among other conditions. Hydrocodone was prescribed most often, followed by codeine, oxycodone, and propoxyphene. According to the study, which was posted online in Anesthesiology, opioid use by pregnant mothers in America is markedly higher than in Europe. In a commentary accompanying the research, Stanford University anesthesiology professor Pamela Flood, M.D., wrote that "the risk to the fetus of short-term exposure to prescription opioids under medical supervision is difficult to assess and needs to be carefully examined in future studies."
From "More Than 14 Percent of Pregnant Women Prescribed Opioids"
Epidural Prolongs Second Stage of Labor by More Than 2 Hours
According to research published in the March issue of Obstetrics & Gynecology
, epidural anesthesia administered during childbirth significantly extends the length of time spent in second-stage labor. The retrospective study compared the duration of this phase of labor with and without epidural in a historical sample of more than 42,000 women who delivered vaginally and had normal neonatal outcomes. The second stage of labor lasted more than two hours longer for those who received an epidural—or roughly double the amount of time considered normal based on clinical guidelines. The finding has implications for what is considered an "abnormal" labor that requires intervention. Typically, that threshold is one hour after epidural; but the investigators say that duration of labor has lengthened in recent years, possibly due to evolving obstetric characteristics and/or the increased prevalence of obesity and gestational weight gain. With that in mind, the researchers suggest that current definitions of prolonged second stage of labor are "insufficient" and that "proper second stage of labor norms" need to be established.
From "Epidural Prolongs Second Stage of Labor by More Than 2 Hours"
Medscape (02/05/14) Barclay, Laurie
Stellate Ganglion Blockade May Be Alternative to HT for Vasomotor Symptoms
A new study led by David Walega, MD, of the Northwestern University Feinberg School of Medicine suggests that the use of stellate ganglion blockade could be a viable alternative treatment for hot flashes in women who are unable to or chose not to take hormone therapy. For the research, 40 postmenopausal women were randomly assigned to receive treatment for moderate to severe vasomotor symptoms in the form of either a saline solution or a stellate ganglion blockade. Although the sham control group demonstrated significant placebo effects from the time the injections started until three months out, the stellate ganglion blockade group experienced equally significant reductions in their symptoms—relief that lasted into the fourth and six months, while the sham group's reductions had decreased. Overall, there were no significant group differences in vasomotor symptom frequency according to the researchers—although the active group had a lower frequency of moderate to severe vasomotor symptoms as well as fewer objective vasomotor symptoms. No adverse events were reported, but the researchers noted that all patients in the stellate ganglion blockade group developed Horner syndrome immediately following the injection.
From "Stellate Ganglion Blockade May Be Alternative to HT for Vasomotor Symptoms"
Researcher Finds Hispanic Women Opt for Labor Pain Relief Less Often Than Others
According to research conducted by University of Virginia School of Nursing doctoral candidate Juliane Milburn, Hispanic women are 53 percent less likely to have an epidural than women of other racial backgrounds and 41 percent less likely to receive both an epidural and IV medications during labor. Milburn detected the unusual racial patterns in pain relief for childbirth while looking through more than 7,000 medical records from the U.Va. Medical Center archives. In her dissertation, she qualified and quantified the reasons why so many Hispanic women prefer not to receive pain relief during childbirth. Overall, slightly more than 16 percent of women giving birth at the center in the last six years chose not to have any pharmacologic pain control during labor. In contrast, 22.4 percent of Hispanic women chose not to have pain relief—with nearly 45 percent refusing to have an epidural, compared to 26 percent of women from other races who turned down regional anesthesia. Based on interviews with groups of Hispanic mothers across the country, Milburn found that Hispanic women often go medication-free during childbirth because of a number of culturally based belief systems—including their mothers' and grandmothers' stories, misconceptions about possible side effects, religion, and their cultural concept of ideal birth standards. She argued that the low rate of epidural use among Hispanic women was not the disparity described by literature; rather, the real disparity is the lack of U.S. healthcare providers' cultural competency and belief that their values should apply to the client, in spite of that client's wishes.
From "Researcher Finds Hispanic Women Opt for Labor Pain Relief Less Often Than Others"
Medical Xpress (02/05/14) Kueter, Christine Phelan
Patient Controlled Analgesia Not Equivalent to Epidural Analgesia for Pain Relief During Labor
Research presented at the Society for Maternal-Fetal Medicine's annual meeting in New Orleans suggests that remifentanil patient-controlled analgesia (RPCA) does not provide the same level pain relief or satisfaction with pain relief in women during labor as does epidural analgesia (EA). Though recent studies had speculated that RPCA equals EA in terms of patient satisfaction with pain relief, the researchers decided to launch a randomized controlled equivalence trial that would compare the effectiveness of these two forms of analgesia. They randomly chose healthy pregnant women who intended to deliver vaginally at 15 different hospitals in the Netherlands—709 of whom were to receive RPCA, and 705 whom would be given EA. Thirteen percent of the women in the study switched to EA after RPCA. Liv Freeman, MD, one of the study's authors, commented, "The results of the study show that RPCA is not equivalent to EA with respect to pain appreciation, i.e. satisfaction with pain relief. Pain appreciation scores in women, who requested pain relief during labor, randomized to EA, are significantly better."
From "Patient Controlled Analgesia Not Equivalent to Epidural Analgesia for Pain Relief During Labor"
Drug Shortages Continue to Vex Doctors
The Government Accountability Office (GAO) reports that the number of annual drug shortages—both new and continuing ones—increased nearly threefold between 2007 and 2012. The most common drug shortages are for generic versions of sterile injectable drugs, as factories that manufacture them are aging and prone to quality problems that lead to temporary closings of production lines or entire factories. The GAO report concluded that the U.S. Food and Drug Administration (FDA) was preventing more shortages now than in the past, but the total number of shortages has continued to grow. There were 456 drugs in short supply in 2012, up from 154 in 2007. University of Utah drug expert Erin Fox said, "We are at a public health crisis when we don't have the medicines to treat acutely ill patients and we don’t have the basics like intravenous fluids." FDA senior official Dr. Douglas C. Throckmorton told lawmakers on Feb. 10 that the number of new shortages was on the decline for the first time in 2012 and that 2013 data indicates a similar downward trend. Two-thirds of the production disruptions that led to shortages were caused by quality problems and efforts to fix them, he said. Manufacturers are now required to report potential shortages to the FDA before they happen, and in some cases, where particles were found in drugs in short supply, the FDA allowed the company to filter out the particles, rather than shut down production completely.
From "Drug Shortages Continue to Vex Doctors"
The New York Times (02/11/14) P. A15 Tavernise, Sabrina
New Pain Treatment Aims to Reduce Prescription Opioids
Research conducted at the University of Utah and published in the Journal of Consulting and Clinical Psychology
identifies an alternative pain relief method that possibly could be used in place of prescription painkillers. The study looked into a treatment called "Mindfulness-Oriented Recovery Enhancement," which is designed to train people to respond to pain, stress, and other opioid-related cues in a different way in order to reduce their dependence on narcotics. Researcher Eric Garland randomly assigned 115 chronic pain patients—75 percent of whom has misused opioid painkillers in the past—to receive either conventional support group therapy or the new treatment. The new protocol involves three therapeutic components—mindfulness training, reappraisal, and savoring—which curtailed opioid misuse by 63 percent and improved patient behavior. By contrast, opioid abuse declined only 32 percent in the conventional support group. In addition, patients subjected to the new approach reported a 22 percent reduction in pain-related impairment following treatment. The results are positive enough that the treatment could soon be prescribed by doctors, provided that further studies continue to show that it is a successful alternative.
From "New Pain Treatment Aims to Reduce Prescription Opioids"
Science World (02/04/14) Carannante, Thomas
Sedation and Delirium in the Intensive Care Unit
Because patients in intensive care units (ICUs) often are experiencing pain, the use of sedatives and analgesics in these wards is widespread. With recovery from sedation, however, comes a risk of delirium that can affect patient outcomes for the worse. Not only can the condition deteriorate long-term cognitive function, there also is a correlation to increased mortality—particularly if pain, oversedation, and agitation go unnoticed and untreated. The "ICU triad" approach recognizes that pain, agitation, and delirium all tie together and so, therefore, must their management. Research shows, for instance, that while routine monitoring of sedation depth can improve patient outcomes, there is a surprising lack of attention to this detail in ICUs. Current data indicate that the best outcomes occur when clinicians adopt a protocol under which depth of sedation, pain, and delirium are monitored; pain is treated immediately and effectively; and ICU patients are administered safe levels of sedatives, just enough to make them comfortable, and mobilized as quickly as possible.
From "Sedation and Delirium in the Intensive Care Unit"
New England Journal of Medicine (01/30/14) Vol. 370, No. 5, P. 444 Reade, Michael C.; Finfer, Simon
TAVR With Local Anesthesia Only Found Feasible
A study involving several hundred patients has demonstrated the safety and efficacy of conducting transcatheter aortic valve replacement (TAVR) using local anesthesia only. The study parameters stipulated a small dose of lidocaine for the procedure, which proved successful in 459 out of 461 patients—for a performance rate exceeding 95 percent. Four patients had to be converted to general anesthesia because they needed cardiopulmonary resuscitation, and seven required conscious sedation with intravenous midazolam due to agitation or inotropic medication to treat prolonged hypotension. "Our results show that [TAVR] performed under local anesthesia with only mild analgesic medication and under fluoroscopic guidance is feasible, with good outcome comparable to published data," the researchers wrote.
From "TAVR With Local Anesthesia Only Found Feasible"
Healio (01/28/2014) Greig, M.
From Research to Nationwide Implementation: The Impact of AHRQ's HAI Prevention Program
The Agency for Healthcare Research and Quality's (AHRQ's) Patient Safety Portfolio examines such things as healthcare–associated infections (HAIs), which impact one out of every 20 hospital patients at any given time. The Patient Safety Portfolio takes into account whether or not planned AHRQ projects addressed one of six HAIs prioritized in the National Action Plan: central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections, ventilator-associated pneumonia, methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile. Priority was also given to the National Action Plan's health care settings, including acute care hospitals, ambulatory surgery centers, end-stage renal disease facilities, and long-term care. AHRQ's HAI prevention research efforts include funding projects to implement the Comprehensive Unit-based Safety Program to address CLABSI, CAUTI, and MRSA nationwide.
From "From Research to Nationwide Implementation: The Impact of AHRQ's HAI Prevention Program"
Medical Care (02/01/14) Vol. 52, P. S91 Battles, James B.; Farr, Stacy L.; Weinberg, Daniel A.
Guidelines for Safety in the Gastrointestinal Endoscopy Unit
The American Society for Gastrointestinal Endoscopy (ASGE) has issued new guidelines for safety in the gastrointestinal endoscopy unit, including recommendations for implementing and prioritizing safety efforts and a specific framework with which to evaluate endoscopy units. The Centers for Medicare and Medicaid Services' Ambulatory Surgical Center Conditions for Coverage in 2009 stopped distinguishing between a sterile surgical room and a non-sterile procedure room—meaning that non-sterile procedure environments, including endoscopy units, are required to meet the same standards as sterile operating rooms. "Over the past two years, surveyors have called into question accepted practices at many accredited endoscopy units seeking reaccreditation," the ASGE noted. "Many of these issues relate to the Ambulatory Surgical Center Conditions for Coverage set forth by CMS and the lack of distinction between the sterile operating room and the endoscopy setting." The new guidelines include a summary of issues faced by endoscopy units around the United States as well as the ASGE position on each and the accompanying rationale.
From "Guidelines for Safety in the Gastrointestinal Endoscopy Unit"
Gastrointestinal Endoscopy (01/14) Calderwood, Audrey H. ; Chapman, Frank J.; Cohen, Jonathan; et al.