Anesthesia E-ssential, January 13, 2012

Anesthesia E-ssential
 

Anesthesia E-ssential

January 13, 2012
 
 

Vital Signs

The Pulse

Inside the Association
Hot Topics
  • Don't Forget to Order Your National Nurse Anesthetists Week Materials
  • Public Comment Requested by (MHAUS)
  • Federal Political Director of the Year Award Nomination Deadline: January 15
  • Would You Like to Serve on the CRNA-PAC Committee?
  • Wanted: Members and Students to Serve on AANA Committees
  • AANA Recognition Awards Nominations Sought
  • Student Writing Contest
  • Students Needed for Anesthesia College Bowl
  • CRNAs Needed for College Bowl Challenge Team
  • New This Year: The Business of Anesthesia Workshop
  • From Health Volunteers Overseas: Volunteers Needed in Bhutan
  • New AANALearn® Pharmacology Course Coming Soon
  • Health and Wellness News
  • Federal Government Affairs and PAC
  • With Congress on Recess through Mid-Jan., 26.2% Medicare Cuts Coming March 1 Dominate Early Agenda
  • Care to be Counted 2012 Campaign for the CRNA-PAC Begins
  • HHS Office of Inspector General Lists its 2012 Anti-Fraud Work Plan
  • AANA Urges Senate to Confirm Marilyn Tavenner, RN, to Head Medicare Agency
  • Congress OKs Omnibus Appropriation that Maintains Funding for CRNA, Nurse Workforce Development
  • Supreme Court Schedules Health Reform Oral Arguments for March 2012
  • New HHS Guidance Puts Onus on States to Identify “Essential Health Benefits”
  • AANA, Nursing Groups Urge Medicare to Raise Opportunities for Use of CRNAs, APRNs
  • Would You Like to Serve on the CRNA-PAC Committee?
  • FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
  • PR, Publications and eCommunications
  • Featured Member Benefit
  • AANA Foundation and Research
  • Greetings from the Chair of the AANA Foundation
  • AANA Foundation – Fellowship and Scholarship Applications
  • Jobs
  • Visit the CRNA Career Center
  • News from COA
  • Hearings on First Draft of Standards
  • COA Welcomes Your Feedback
  • 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.

    AHA Submits Brief in Support of the Colorado Opt-Out

    As you may already be aware, the Colorado Society of Anesthesiologists (CSA) and the Colorado Medical Society (CMS) have filed an appeal in the Colorado Court of Appeals, seeking reversal of the lower court decision upholding Colorado’s opt-out from the federal supervision requirement.

    The AANA has learned that the American Hospital Association (AHA) has filed a legal brief in opposition to the CSA and CMS, supporting the governor’s choice to opt-out. The AHA’s brief states that “[t]he opt out will improve access to health care for rural Coloradans,” and argues that “[h]ealth care providers are well-positioned to determine what anesthesia delivery arrangements will best serve the local population.”

    In addition, the AHA notes that “[w]here a governor, in consultation with the Boards of Medicine and Nursing, determines that allowing CRNAs to administer anesthesia without requiring physician supervision is in the best interests of the State and consistent with State law, that exercise of the governor’s discretion should be upheld.”
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    Inside the Association

    Hot Topics
     
    Don't Forget to Order Your National Nurse Anesthetists Week Materials
    National Nurse Anesthetists Week (Jan. 22-28) is almost upon us—make sure you order your promotional materials before supplies run out. Visit www.aana.com/nnawpublic.aspx for the order form and list of materials. 
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    Public Comment Requested by (MHAUS)
    The Malignant Hyperthermia Association of the United States (MHAUS) has recently begun a new process to develop evidence-based recommendations for use in the healthcare community. Recommendations are being developed on topics for which MHAUS is frequently asked for guidance.
     
    The process being followed by the MHAUS for development of each recommendation document includes:
     
    • Research and review of a topic by an MH expert;
    • Preparation of a summary document, which includes the proposed recommendation and includes rationale and supporting evidence.
    • Review by MHAUS Professional Advisory Council and the MH Hotline Consultants;
    • Review of the document in a "public comment" period of 30 days. All feedback on the recommendation documents posted on the MHAUS website will be welcomed and considered for the final recommendation statement. The specified timeframe for public comment is noted at the top of each document. Public comments can be made by clicking the following link: http://www.mhaus.org/category/public-comment/.
    Topics currently posted on the MHAUS website for public comment include:
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    Federal Political Director of the Year Award Nomination Deadline: January 15
     
    Click here for further information and visit www.aana.com/awards.aspx to download an application form.
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    Would You Like to Serve on the CRNA-PAC Committee?
    Deadline: Jan. 31, 2012
    See http://www.caretobecounted.org/who/how-do-i-join for further information (AANA member login required).
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    Wanted: Members and Students to Serve on AANA Committees
    Deadline: May 1, 2012
    Members interested in serving on a fiscal year 2013 AANA Committee can visit www.aana.com/membersoncommittees.aspx for further information and an application. There will be a student position on the AANA Health and Wellness Committee, Practice Committee, and Public Relations Committee for Fiscal Year 2013. See www.aana.com/studentsoncommittees.aspx for further information and an application.
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    AANA Recognition Awards Nominations Sought
    Deadline: March 15, 2012
    Nominations are being sought for the following awards, which are presented during the Annual Meeting: the Agatha Hodgins Award for Outstanding Accomplishment, the Helen Lamb Outstanding Educator Award, the Alice Magaw Outstanding Clinical Practitioner Award, the Ira P. Gunn Award, the Clinical Instructor of the Year Award, the Didactic Instructor of the Year Award, and the Program Director of the Year Award. Visit the AANA website at www.aana.com/awards.aspx for more information.
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    Student Writing Contest
    Deadline: April 1, 2012
    Students are encouraged to submit their entries to the Student Writing Contest by April 1. The winning paper may be published in the AANA Journal. The winner will be announced at the 2012 AANA Annual Meeting in San Francisco, Calif. Click here for further information and contest guidelines.
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    Students Needed for Anesthesia College Bowl
    Deadline: April 15, 2012
    Each school is encouraged to submit one student to be selected at random for participation in the 23rd Annual Anesthesia College Bowl, which will be held during the 2012 AANA Annual Meeting. Applications may be obtained from your program director, or by clicking here.
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    CRNAs Needed for College Bowl Challenge Team
    Deadline: April 15, 2012
    The Annual Anesthesia College Bowl at the AANA Annual Meeting will once again be the site of a stirring contest between the 2012 Student Champion Team and a CRNA Challenge Team. Don’t be afraid to show off your brainpower and volunteer to be on the CRNA Challenge Team! Send an email to the Education Department for an application.
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    New This Year: The Business of Anesthesia Workshop
    Members requested it, and here it is! This new workshop will be held on Saturday, April 14, 2012, at the Renaissance Washington, D.C. Downtown hotel prior to the Mid-Year Assembly. The registration price is $275 for members and $375 for nonmembers until 3/23/12 when the registration prices will increase.
     
    The workshop features expert speakers on a variety of business related topics: the nuts and bolts of billing, coding, reimbursement options, anesthesia economics, compliance and RAC audits, contracts, quality measurements, legal issues, and advocacy. Download the Registration Form from the website: www.aana.com
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    From Health Volunteers Overseas: Volunteers Needed in Bhutan
    CRNA or MD is needed for one-month assignment in March and August 2012. Volunteers provide continuing education and training to the local anesthesia providers. Please contact the HVO program department for more information.
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    New AANALearn® Pharmacology Course Coming Soon
    In response to members’ requests for more pharmacology topics with CE credit, a new pharmacology course titled “Inotropes and Vasopressors - New Uses in Clinical Anesthesia?” will soon be added to the AANALearn® catalog. Watch for further announcements on Facebook and the AANA website.
     
    As always, the online continuing education courses in AANALearn® are available for members 24/7 and the CE credits are automatically and quickly transferred into your CE transcript. AANA members always receive a 30 percent discount off the regular price of courses. If you are seeking a few or many CE credits for 2012 recertification, AANALearn® can provide what you need. Check us out now at www.aanalearn.com to browse the catalogs.
     
    Health and Wellness News
    Recent doctoral work by Heather Hamza, CRNA, MS, who served for seven years as an AANA Peer Assistance Advisor, has resulted in several published items. Hamza authored a chapter in the book Perioperative Addiction titled “Non-narcotic Anesthetic Options for the Patient in Recovery from Substance Abuse,” and co-authored an article in Journal of Clinical Anesthesia evidencing her research on anesthesia exposure during surgery potentially triggering a relapse and defining factors that may help reduce that risk.
     


    Federal Government Affairs and PAC

    With Congress on Recess through Mid-Jan., 26.2% Medicare Cuts Coming March 1 Dominate Early Agenda

    Legislation adopted just before the holidays averted the 26.2 percent Medicare Part B cuts that would have hit CRNA and physician payment Jan. 1 – but just until March 1, 2012, when the cuts hit again.
    Though lawmakers uniformly support the relief, the difficulty enacting it is threefold.

    • First, its cost must be offset by other revenues, from spending cuts, or from fee or tax revenues. The cost of the two-month Medicare payment relief, packaged with extension of the payroll tax holiday and certain unemployment insurance benefits, was offset by a 10-year, 0.1 percentage point boost in Fannie Mae and Freddie Mac federal guaranteed housing loan origination fees.
    • Second, the Medicare relief is likely to be packaged with other legislation extending other expiring tax or public benefit provisions.
    • Third, in a presidential election year, moving any legislation in a hyper-partisan environment is difficult.

    Thousands of AANA members in late 2011 “Cared to be Counted” by contacting their members of Congress to urge relief from these cuts, which affect both CRNAs and physicians and all types of services reimbursed by Medicare Part B. Stay tuned for your opportunity to contact Congress again soon.
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    Care to be Counted 2012 Campaign for the CRNA-PAC Begins

    To continue strengthening the voice of CRNAs in Washington during this major election year, the CRNA-PAC is kicking off its Care to be Counted (member login and password required) 2012 campaign this month with the release of a new video that underscores the importance of every AANA members’ contribution.

    Already, the CRNA-PAC is halfway towards its two-year, $1.75 million fundraising goal, intended to help make the profession’s voice heard in a politically polarized U.S. Capitol that has many new faces – two-fifths of the House is new since 2007. And even though the CRNA-PAC in 2011 raised more money in a year than ever before – more than $750,000 – the American Society of Anesthesiologists ASAPAC raised an astounding $1.633 million in 2011 alone, more than twice what CRNA-PAC did.

    “Our practice and our profession is under attack from huge Medicare cuts, and from organized efforts to characterize our services as solely the practice of medicine in a way that would eliminate CRNA care through payment cuts – a kind of economic credentialing,” said CRNA-PAC chair Steven Mund, CRNA, DNP. “With 2012 being an election year, we are asking all AANA members – CRNAs and students – to care to be counted by contributing to CRNA-PAC today.”

    If 26.2 percent Medicare payment cuts take effect March 1 as threatened, the average CRNA providing 900 13-unit nonmedically directed cases, 30 percent to Medicare patients, could see a $19,000 cut in reimbursement over a year – just about $365 per week.

    “A dollar a day for the CRNA-PAC is a small investment to keep Washington from cutting Medicare CRNA reimbursements $365 every single week,” said Mund.
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    HHS Office of Inspector General Lists its 2012 Anti-Fraud Work Plan

    The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) late December issued its 2012 anti-fraud work plan, and it includes several areas of interest to CRNAs that should spur all healthcare professionals to focus on proper compliance with Medicare rules and requirements.

    Though neither CRNAs nor anesthesia services are called out specifically for the OIG’s focus, the plan indicates the agency will put significant work into several areas in which CRNAs are involved in some way. The report states that OIG will pay particularly close attention to:

    • In hospitals, reporting for adverse events, reliability of hospital-reported quality measure data, claims with high or excessive payments, duplicate Graduate Medical Education (GME) payments, the appropriateness of payments for nonphysician outpatient services, and the appropriate designation of Critical Access Hospitals (CAH).
    • For physicians and other suppliers (including CRNAs and APRNs), compliance with assignment rules, high cumulative Part B payments, “incident-to” services, ambulatory surgery center payment systems, trends in coding evaluation and management services claims, evaluation and management services provided during global surgery periods, the use of modifiers during the global surgery period, potentially inappropriate evaluation and management services payments, and claims submitted by error-prone providers.
    AANA Urges Senate to Confirm Marilyn Tavenner, RN, to Head Medicare Agency
    In a Jan. 3 letter (member login and password required) to Senate Leadership, AANA President Debra Malina, CRNA, MBA, DNSc, urged the U.S. Senate to schedule hearings and votes promptly to confirm Marilyn Tavenner, RN, nominated by the president as administrator of the Centers for Medicare & Medicaid Services (CMS).

    “A registered nurse, Ms. Tavenner has held senior posts with the major hospital system HCA, chaired the Virginia Hospital Association and served on the Board of Trustees of the American Hospital Association, and served as Secretary of Health and Human Resources for the state of Virginia, and as principal deputy administrator of CMS,” the letter states. “Her demonstrated clinical, administrative and leadership skills and experience have prepared her well to head an agency that touches the life of every American through the Medicare, Medicaid and CHIP programs, promotes quality standards, and access to high quality healthcare.”

    Since the departure of recess-appointed Dr. Don Berwick from the Medicare agency late 2011, Tavenner has served as acting administrator and Chief Operating Officer of CMS. The agency has lacked a Senate-confirmed administrator since 2006.
     
    Congress OKs Omnibus Appropriation that Maintains Funding for CRNA, Nurse Workforce Development
    On Dec. 17 Congress enacted and the president signed into law the fiscal year (FY) 2012 Labor-HHS-Education appropriations bill as part of a $1 trillion omnibus spending package (H.R. 3672) that provided near-level funding for Title VIII nursing workforce development programs important to CRNAs, even while other programs saw significant cuts.
     
    The legislation provided near-level funding for Title VIII nurse workforce development programs ($228 million, down about $13 million from FY 2011), level funding for Advanced Education Nursing which includes nurse anesthetist traineeships ($64 million, about $1 million below FY 2011), and report language that states, “Within the funds for Advanced Education Nursing, the conferees direct [Health Resources and Services Administration] HRSA to allocate funding for nurse anesthetist education at no less than fiscal year 2011 levels.” With nurse anesthetist education reaping about $3-4MM from the Advanced Education Nursing and traineeships programs, this report language, sought by the AANA annually, is particularly helpful this FY 2012.
     
    Supreme Court Schedules Health Reform Oral Arguments for March 2012
    The U.S. Supreme Court is scheduled to hear oral arguments on the constitutionality of the Affordable Care Act health reform law on March 26-28, 2012, days after the law’s two-year birthday, and well into the national presidential and congressional elections. The court is slated to focus on whether the law’s requirement that persons purchase health coverage or pay a penalty (the “individual mandate”) is constitutional, as well as whether Congress was acting within its authority when it expanded eligibility for the Medicaid program funded by the federal government and operated by the states. Read more from Kaiser Health News.
    New HHS Guidance Puts Onus on States to Identify “Essential Health Benefits”
    A guidance document issued by the U.S. Department of Health & Human Services directs states to determine what “essential health benefits” health plans are required to cover as implementation of the Affordable Care Act health reform law continues. Critical for CRNAs are whether plans must cover anesthesia services and pain management services and under what circumstances, an issue on which the AANA submitted public comments to the agency tasked by the law to examine essential health benefits, the Institute of Medicine.
     
    The agency guidance amounts to a “pre-rule,” indicating how the agency might issue a proposed regulation on the issue later in 2011 or into 2012. Under the Department’s intended approach announced Dec. 16, states would have the flexibility to select an existing health plan to set the “benchmark” for the items and services included in the essential health benefits package. States would choose one of the following health insurance plans as a benchmark: one of the three largest small group plans in the state; one of the three largest state employee health plans; one of the three largest federal employee health plan options; or the largest HMO plan offered in the state’s commercial market. The benefits and services included in the health insurance plan selected by the state would be the essential health benefits package. Plans could modify coverage within a benefit category so long as they do not reduce the value of coverage. Consistent with the law, states must ensure the essential health benefits package covers items and services in at least ten categories of care, including preventive care, emergency services, maternity care, hospital and physician services, and prescription drugs.

    For CRNAs, this development places new value on state nurse anesthetist association leaders building relationships with the administrator of the state board running the health insurance exchange, with provider relations personnel with major health plans, and to come up to speed on an issue that may be new to many AANA members.
    Read the essential health benefits bulletin at http://cciio.cms.gov/resources/regulations/index. html#hie. Comments are due to be emailed by Jan. 31, 2012, to EssentialHealthBenefits@cms.hhs.gov. A further fact sheet on the essential health benefits bulletin is at http://www.health care.gov/news/factsheets/2011/12/essential-health-benefits12162011a.html.
    AANA, Nursing Groups Urge Medicare to Raise Opportunities for Use of CRNAs, APRNs
    Comment letters (AANA member login and password required) to the Medicare agency from the AANA, groups including AANA representing advanced practice registered nurses (APRNs), and the nursing community the week of Dec. 18 urged the adoption of regulatory relief proposals that promote the use of CRNAs and APRNs and thereby help enhance access to safe healthcare services and reduce healthcare costs. Read More.
     
    In response to two proposed rules issued by Centers for Medicare & Medicaid Services (CMS) earlier in the fall, the AANA comments urge the Medicare agency to clarify that CRNAs are among the practitioners who can order drugs and biologicals and document and sign for them, to clarify that CRNAs are among the practitioners authorized to authenticate orders, and urged the agency to continue work with AANA and nursing organizations to pursue additional beneficial regulatory reforms such as the repeal of the Medicare requirement for physician supervision of nurse anesthetists.

    All of the comment letters are posted on the AANA member website at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Pages/Comments.aspx (requires AANA member login and password).
     
    Would You Like to Serve on the CRNA-PAC Committee?
    Deadline: Jan. 31, 2012 Each year at its Mid-Year Assembly meeting, the CRNA-PAC Committee elects two CRNAs for three-year terms and one student nurse anesthetist for a one-year term from a slate of member nominees provided by the AANA Board of Directors in February. See http://www.caretobecounted.org/who/how-do-i-join for further information (AANA member login required).
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    Is Your State’s FPD Exceptional?
    Then nominate him or her for the AANA Federal Political Director of the Year Award, issued at AANA Mid-Year Assembly in Washington, April 2012.
     
    FEC REQUIRED LEGAL DISCLAIMER 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 our 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. I am a US Citizen.
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    PR, Publications and eCommunications

     
    Featured Member Benefit
    As an AANA member, you enjoy a wide range of benefits and services that support you, your practice and your profession. Each month the E-ssential will highlight a member benefit. This month, we feature the AANA Web Site and Online Services, which include educational opportunities through AANALearn®, www.CRNAcareers.com, speaker databank, AANA Journal Course online (6 CE credits), certification and recertification verification, membership renewal, and online voting for the AANA election. For additional information on benefits and services provided to AANA members, go to www.aana.com/memberbenefits.aspx.
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    AANA Foundation and Research

    Greetings from the Chair of the AANA Foundation

    On behalf of everyone at the AANA Foundation, I would like to extend our warmest wishes for a safe, happy, and prosperous New Year. The year 2011 was an eventful one for the Foundation. With your help and support, we were able to:

    • Fund $73,045 in Research Initiatives
    • Award $129,000 in Student Scholarships
    • Award $150,000 in Post-Doctoral and Doctoral Fellowships
    • Recognize Maureen P. Reilly, CRNA, MSN, MHS, PhD as the John F. Garde Researcher of the Year; David Schwytzer, CRNA, BS, ARNP, State of Kentucky Advocate as the Advocate of the Year; Alverna Skoog, CRNA, BS, as the Rita LeBlanc Philanthropist of the Year; and honor Lorraine M. Jordan, CRNA, PhD, FAAN, with our 30th Anniversary Special Recognition Award.
    • Arrange for 95 Research Poster Presentations
    • Conduct our inaugural Research Funding Workshop

    I am deeply grateful for the continued dedication and commitment of the entire Foundation team, as well as friends, families, colleagues and donors who continue to support the Foundation’s efforts. We are now poised for another eventful year in 2012.

    Wishing you all the very best in the New Year.

    Sincerely,

    Bette Wildgust, CRNA, MS, MSN

    Chair

    AANA Foundation
    AANA Foundation – Fellowship and Scholarship Applications
    The AANA Foundation will once again be offering Doctoral and Post Doctoral Fellowships and Student Scholarships in 2012. Applications will be available online at www.aanafoundation.com by Jan. 15, 2012, and the application deadline is April 1, 2012. Fellowship awards range from $5,000 to $50,000 and Student Scholarship awards range from $1,000 to $3,000 each. For further information contact the AANA Foundation at (847) 655-1170, or foundation@aana.com.

     

    News from COA

    Hearings on First Draft of Standards
    A first draft of the proposed Standards for Accreditation of Nurse Anesthesia Educational Programs will be presented during a hearing at the 2012 Assembly of School Faculty meeting in San Diego, Calif., on Feb. 23, 2012, from 2:30 pm-3:30 pm. Following the hearing, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) will be soliciting written comments on the revised Standards through an online survey. A second hearing will be provided at the Mid-Year Assembly in Washington D.C. on April 16, 2012. If you would like to be included in the solicitation for written comments, please contact the COA at accreditation@coa.us.com
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    COA Welcomes Your Feedback
    On Dec. 13, 2011, the COA launched its newly redesigned website. By updating the COA’s home page, http://home.coa.us.com, with a new look and feel, the COA has improved navigation and provided a central location for information regarding Council meeting dates, accreditation decisions, upcoming workshops, training sessions, publications, and contact information.
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    Healthcare Headlines

     
    Bar-Code Scanning Can Fix 'Black Hole' of OR Drug Safety
    Dr. Ludwik Fedorko, anesthesia provider at the University Health Network’s (UHN) Toronto General Hospital in Canada, has referred to the operating room (OR) as a "black hole of medication safety." Fedorko discussed the problem during a session on OR drug safety at the 2011 American Society of Health-System Pharmacists December meeting. The OR and the post-anesthesia care unit disproportionately accounted for 81 percent of all medication error reports compared to the rest of the hospital. More than 60 percent of drug-related errors from anesthesiology providers involve the removal of incorrect vials from anesthesia drug trays, incorrect syringe labeling after admixing, and syringe swaps during surgery. UHN established a pharmacy-anesthesia collaboration to explore a point-of-care, computer-aided syringe labeling and verification process. In January 2010, all 20 ORs at Toronto General implemented the system. The process requires the scanning of every drug ampoule and syringe label for accuracy verification during dispensing, premixing, administration, and documentation. After 23 months of use in more than 20,000 surgical cases, no medication error incidents related to mistaken drug identity were reported when bar-code scanning was used. One critical drug error occurred when the bar-code scanning process was bypassed, however.

    From "Bar-Code Scanning Can Fix 'Black Hole' of OR Drug Safety"
    Anesthesiology News (01/01/12) Vol. 38, No. 1, Frandzel, Steve
     
    Conscious Sedation Feasible for Ambulatory Spine Procedures
    The low frequency of adverse events during ambulatory spine procedures when conscious sedation is applied, rather than local anesthesia alone, makes it a viable option for these surgeries, according to the results of a retrospective review. Led by Dr. Michael Schaufele of Atlanta's Emory Orthopedics & Spine Center, researchers analyzed nearly 2,500 charts to reach their findings. Of the 1,266 cases where patients received only local anesthesia, the rate of immediate adverse events was calculated at 4.82 percent; while immediate adverse events were documented in 5.12 percent of the 1,228 procedures where conscious sedation was used in addition to local anesthesia. At a three-day follow-up, moreover, patients in the two groups presented statistically comparable results for adverse events, the exception being a higher rate of postoperative hypertension in the local anesthesia patients. The study indicates "that mild to moderate conscious sedation in interventional spine procedures is associated with low rates of adverse events when established protocols are followed," the authors wrote in the December issue of The Spine Journal.

    From "Conscious Sedation Feasible for Ambulatory Spine Procedures"
    DoctorsLounge (01/10/12)
     
    In San Diego, PTSD Relief May Be in an Injection
    A study underway at Naval Medical Center San Diego hopes to deliver an effective solution for service members and others suffering from the nightmares, suicidal thoughts, and other symptoms associated with post traumatic stress disorder (PTSD). The research is being spearheaded by Dr. Anita Hickey, whose preliminary findings show that the treatment—an anesthetic injection in the neck—almost immediately quiets the brain's "fight or flight" syndrome, which triggers PTSD symptoms. The anesthesia numbs the stellate ganglion, a bundle of nerves in the neck, providing some patients with several weeks of relief. One study subject who had been chronologically suicidal for two years straight and unable to leave his home reportedly was cleared of his symptoms just two days after receiving an injection. Hickey's study of 42 people, most of them active-duty enlisted men, is about halfway through; preliminary results are slated for release in May, and Hickey anticipates that the shot could be widely available as early as 2013 if the research is successful. She launched her investigation based on findings by Dr. Eugene Lipov, who noticed that a local anesthesia he was using on combat veterans seemed to soothe not only their pain but their emotional state as well. Hickey's study is the first placebo-controlled experiment of the treatment.

    From "In San Diego, PTSD Relief May Be in an Injection"
    Southern California Public Radio (01/05/12)
     
    Surgery Affects Concentration and Memory
    Researchers from the Sweden's Karolinska Institutet and Karolinska University Hospital have recently published a study in the Annals of Neurology that provides greater insight into postoperative cognitive decline. The condition is common in the first week following surgery but can last as long as three months in 10 percent of patients. Led by anesthesiology and intensive care professor Lars Eriksson, the investigators mapped signal pathways from the peripheral surgical lesion to the areas in the brain associated with learning and memory and studied neuroinflammatory changes resulting from surgery to find causes for postoperative cognitive decline. No reason was determined, although the researchers did discover that surgery can damage the blood-brain barrier, allowing activated immunocompetent blood cells called macrophages into the cognitive areas of the brain. Eriksson noted that by administering "an acetylcholine-like substance with an affinity for an alpha-7 protein, part of the natural anti-inflammatory reflex pathway, prior to surgery, you significantly decrease the levels of inflammatory proteins and the consequent damage to the blood-brain barrier, and thus prevent the infiltration of macrophages into the brain." The study concluded that an endogenous inflammatory pathway treated in this manner almost fully normalized cognitive capacity in the postoperative period, indicating that such an approach can prevent postoperative neuroinflammation and cognitive decline.
     
    From "Surgery Affects Concentration and Memory"
    AsianCorrespondent.com (12/31/11)
     
    Anesthesia Boosts Colonoscopy Price Tag
    The January issue of Clinical Gastroenterology and Hepatology includes the publication of research relating to the use of anesthesia for colonoscopies on asymptomatic patients. A retrospective analysis was conducted on data from more than 16,000 adults who underwent a colonoscopy from July 2001 through 2006. The researchers found that 17.2 percent of the procedures involved an anesthesia provider, with the frequency increasing over the years from 11 percent to 23.4 percent by 2006. The findings revealed that surgeons were more likely than primary care physicians to involve the services of an anesthesia provider and that this clinician's involvement inflated the procedure cost by about 20 percent.
     
    From "Anesthesia Boosts Colonoscopy Price Tag"
    DoctorsLounge (12/29/11)
     
    Study Uncovers Clues to What Makes Anesthetics Work
    Investigators at the Seattle Children's Research Institute published a study in the Dec. 20, 2011, issue of Current Biology that illustrates how anesthetics work in the roundworm C. elegans, which is often used for research purposes. The team inserted a protein found in the human retina, called a retinal-dependent rhodopsin channel, into the roundworm's cells. Shining a blue light on the roundworm activated channels that caused a instant reversal of anesthetics. The scientists noted that while the results will not allow for an immediate discovery that would work for humans, they intend to replicate the experiment in other animal models, beginning with mice. Lead study author Phil Morgan, MD, noted, "We believe that there is a class of potassium channels in humans that are crucial in this process of how anesthetics work and that they are perhaps the ones that are sensitive to potential anesthesia reversal. There are drugs for blocking these channels and with these same drugs, maybe we can eventually reverse anesthesia."
     
    From "Study Uncovers Clues to What Makes Anesthetics Work"
    HealthCanal.com (12/22/2011)
     
    Report Finds Most Errors at Hospitals Go Unreported
    Federal investigators recently found that hospital employees recognize and report only one out of seven errors involving hospitalized Medicare patients. Even when preventable injuries and infections were investigated and reported, hospitals rarely alter their practices to prevent such adverse events in the future. Daniel R. Levinson, inspector general of the U.S. Department of Health and Human Services, notes that hospitals must "track medical errors and adverse patient events, analyze their causes," and improve care as a condition of being reimbursed by Medicare. Adverse events may include medication errors, severe bedsores, hospital-acquired infections, delirium caused by overuse of painkillers, and excessive bleeding from improper use of blood thinners. The federal investigators conducted an in-depth review of 293 cases involving patient harm. Of these, 40 cases were reported to hospital managers and 28 were investigated by the hospitals, while only five led to policy changes. Estimates show that over 130,000 Medicare beneficiaries experienced adverse events in hospitals in a month. Hospital employees often fail to recognize patient harm or are not aware that certain events should be reported. Medicare officials intend to develop a list of "reportable events" for hospitals to use.
     
    From "Report Finds Most Errors at Hospitals Go Unreported"
    New York Times (01/06/12) P. A12 Pear, Robert
     
    Perioperative High Inspired Oxygen Therapy Does Not Prevent SSIs
    A study published in Anesthesia & Analgesia shows that perioperative high inspired oxygen therapy did not positively affect the rate of surgical site infections (SSIs). The research team was prompted to look into the clinical impact of hyperoxia in preventing SSIs because of inconsistencies in prior reports. After performing an electronic search using the National Library of Medicine's MEDLINE and other databases, the investigators concluded that, overall, hyperoxia was not found to be beneficial. Two subgroup analyses of general anesthesia and colorectal surgery trials, however, did suggest a benefit in the use of hyperoxia for preventing SSIs.
     
    From "Perioperative High Inspired Oxygen Therapy Does Not Prevent SSIs"
    Becker's ASC Review (12/11) Fields, Rachel
     
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