Anesthesia E-ssential Oct. 15, 2013

Anesthesia E-ssential

Oct. 15, 2013


Vital Signs

National Nurse Anesthetists Week Turns 15—Get Ready to Celebrate!
CRNAs and SRNAs across the country are gearing up to celebrate the 15th annual National Nurse Anesthetists Week, Jan. 19-25, 2014. The theme for 2014 is “Our Priority, Our Passion, Our Patients.” National Nurse Anesthetists Week allows the nurse anesthesia community to educate the public about anesthesia safety and the benefits of receiving anesthesia care from nurse anesthetists.
Promotional Items Available Nov. 1
Promotional items, including posters, buttons, pens, table tents, and more will be available beginning Nov. 1 through the AANA website at The AANA website will also feature downloadable items such as sample press releases and ideas for promoting National Nurse Anesthetists Week. As always, the ever-popular Nurse Anesthetists Week logo merchandise, including T-shirts and mugs, will be available for purchase. Because ordering is now online-only, phone, fax, or mail orders will not be accepted.
Educate and Inform Your Colleagues and Patients
You will notice QR codes on select items. Scanning these codes will bring patients, healthcare colleagues, and others to the refreshed patients’ area of the AANA website ( This user-friendly webpage includes a broad range of downloadable patient education resources, including brochures, fact sheets, and a children’s coloring and activity book.


The Pulse

  • The Future of Nursing: Leading Change, Advancing Health
  • Blue Cross/Blue Shield to Reimburse Alabama CRNAs Directly
  • CRNAs Responded to AANA Scope of Nurse Anesthesia Practice Survey
  • AANA Fall Leadership Academy - Nov. 8-10, 2013
  • Business of Anesthesia - Nov. 2, 2013
  • Bing Takes Home Excellence in Nursing Award
  • Two CRNAs Inducted in American Academy of Nursing 2013 Class of Fellows


  • Donate to the AANA Foundation's FY14 Annual Giving Campaign
  • AANA Foundation Fall Fellowship Opportunities
Professional Practice
  • Preventing Surgical Fires Initiative Celebrates Two-Year Anniversary
  • The Joint Commission Releases Sentinel Event Data
  • State Healthcare Exchange Websites Report Problems on First Day
  • Register Now for the Next State Government Affairs Webiner


Federal Government Affairs
  • Uncle Same Shutdown Continues with some Modifications
  • 40 Nursing Groups Support Veterans Health Administration Recognition of APRNs to their Full Scope
  • AANA Supports HHS Strategy for Preventing Adverse Drug Events, Noting CRNA Expertise
  • Health Coverage Enrollment Opens as Feds Address Technical Issues
  • Following NECC Drug Contamination Disaster, House Approves Compounding Reform Legislation
  • Working for Your Reimbursement: How You Can Avoid a 1.5 Percent Medicare Cut in 2015
  • Register Now for “Havana Nights” CRNA-PAC Fundraiser at Fall Leadership Academy
  • Amendments

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
The Future of Nursing: Leading Change, Advancing Health
Three years ago, the Institute of Medicine, with the support of the Robert Wood Johnson Foundation, released its landmark report, "The Future of Nursing: Leading Change, Advancing Health." In light of the tremendous need for nurses in healthcare today and in the future, the report provided a blueprint for transforming the nursing profession. The report committee recommended removing barriers to practice and care, expanding opportunities for nurses to serve as leaders, and increasing the proportion of nurses with a baccalaureate degree to 80 percent by 2020. Read the commentary by Dr. Harvey V. Fineberg, president of the Institute of Medicine, and Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, here
Blue Cross/Blue Shield to Reimburse Alabama CRNAs Directly
The Alabama Association of Nurse Anesthetists (ALANA) announced that as of Oct. 1, 2013, Blue Cross Blue Shield of Alabama (BCBSAL) now offers a network contract for CRNAs across all their health plans with an effective date of Jan. 1, 2014. Calling the newly created network “an historic milestone for Alabama’s CRNAs and a huge leap in the right direction,” ALANA President Jennifer Overton, CRNA, MSN, noted that “improvement in the proposed CRNA network will be necessary to ensure full access to CRNA services, efficient delivery and local decision making of these services, and equitable reimbursement for CRNA services based on quality and performance, rather than licensure.” Visit the ALANA website, for further information.
CRNAs Responded to AANA Scope of Nurse Anesthesia Practice Survey
In May, the AANA conducted the 2013 Scope of Nurse Anesthesia Practice Survey. Nearly half of all CRNA respondents indicated that they are not permitted to practice to the full scope of their education and training due to unnecessary barriers. The top three perceived barriers identified from the survey were: individual anesthesiologists, administration, and facility policy. Access the complete survey report
AANA Fall Leadership Academy – Nov. 8-10, 2013
The Fall Leadership Academy offers you 16 CEs in three days with your choice of educational tracks designed to empower and inspire you with creative ideas and to provide you with the essential tools needed to advance the practice of nurse anesthesia. The meeting will be held in sunny Miami Beach, Fla., at the Eden Roc hotel. If you are involved in your state association, you need to attend the Fall Leadership Academy.
This is what your fellow CRNAs have said about FLA:
“Of all the national meetings, the Fall Leadership Academy is focused on the development of leadership at the state level.” – Christine Salvador, CRNA, MSN, APN, President, Illinois Association of Nurse Anesthetists
“The information we learned during the meeting allowed us to begin our terms with a strong sense of what best practice leadership/board governance is all about.” – Marjorie Geisz-Everson, CRNA, PhD, President, Louisiana Association of Nurse Anesthetists
“As a state nurse anesthesia association leader, I cannot emphasis enough how important leadership training is for CRNAs.” – Don Beissel, CRNA, MSNA, RN, President, Missouri Association of Nurse Anesthetists
Engaging and thought-provoking speakers, including Dr. Donna Shalala, former U.S. Secretary of Health and Human Services and currently University of Miami president, and six specialized tracks to meet your needs await at FLA. Register before Oct. 18 and receive a $50 discount on your registration fee. Register online today!
Business of Anesthesia – Nov. 2, 2013
Today’s healthcare environment, including reform, impacts the business of anesthesia. Knowledge is the key to navigating your professional future in the nurse anesthesia profession. The Business of Anesthesia workshop, in Pittsburgh, Pa., will give you access to leaders and expert faculty in the field and the opportunity to meet with like-minded peers in this engaging one-day meeting, all while earning 6 CEs. You will leave with the essential information needed to guard your best interests in negotiating a contract, managing strategic operations, and understanding the relevant economic and legal issues affecting the nurse anesthesia profession.
Your colleagues have said:
“This is one of the best educational meetings of my career...from ANY source!”
“It is the best AANA meeting I have ever attended in my 38-plus years as a CRNA.”
“I got information that you just don’t find anywhere else.”
Register before Oct. 31 and save $75 on the registration fee.
Bing Takes Home Excellence in Nursing Award
Every year, the Washingtonian magazine receives hundreds of nominations for its Excellence in Nursing Awards. These 10 nominees are nurses who go beyond the call of duty to protect their patients, enhance their communities, and train the next generation of healthcare professionals. This year, the magazine bestowed one of the honors to John Bing, CRNA, president of the Diversity in Nurse Anesthesia Mentorship Program and founder of J. Bing & Associates Anesthesia Services, Clarksville, Md.
One of the criteria the Washingtonian lists to be considered an excellent nurse is exemplifying the best in his or her profession. Bing has an impressive list of accomplishments to represent his leadership in the field, including being the first CRNA to chair the University of Maryland’s School of Nursing Board of Visitors. After gaining a wealth of experience working with facial reconstructions, he decided to start his own anesthesia company because many cosmetic surgeons pay for anesthesia on a fee-for-service basis. Twenty five years later, J. Bing & Associates Anesthesia Services works with prominent clients such as the Johns Hopkins Hospital Division of Plastic Surgery.
Bing also gives back to his profession on the state and national levels. He’s served two terms as president of the Maryland Association of Nurse Anesthetists, as a member of the AANA Resolutions Committee, and as a chair of the AANA Political Action Committee.
Bing takes his anesthesia talents beyond the hospital, and often beyond the country. Two times a year for the last 15 years, he has served as the senior anesthesia provider on an eight- to 10-person mission team as part of the Fundacion Futuro de Nicaragua (Future of Nicaragua Foundation).
Students in the Diversity in Nurse Anesthesia Mentorship Program (, of which Bing is president, have accompanied him to Central America to use the skills they’ve learned in school in an environment outside their comfort zones.
As president of the all-volunteer program, he is responsible for planning the multitude of activities to expose minority students to a career in nurse anesthesia. The program provides information sessions, luncheons, anesthesia airway workshops, and sponsorships to minority students to the AANA Annual Meeting. It also participates in career days at local schools. These outreach efforts offer young people in diverse populations traditionally underrepresented in nurse anesthesia the chance to learn firsthand about the profession and to establish valuable connections with leaders in the field.
Bing and the nine other Excellence in Nursing Award recipients will be honored at an Oct. 23 reception at the Madison Hotel in Washington, D.C., sponsored by the Washingtonian.
For more information, or to view the full list of award winners, visit For more information on Bing, see the November 2013 NewsBulletin.
Two CRNAs to be Inducted into American Academy of Nursing 2013 Class of Fellows
The American Academy of Nursing selected two CRNAs—Jacqueline Rowles, CRNA, MBA, MA, ANP-BC, FAAPM, DPNAP, and Michael Rieker, CRNA, DNP—as part of 172 nurse leaders for induction as Fellows. The two will be inducted during the Academy’s 40th annual meeting on Oct. 19, 2013, in Washington, D.C.
Selection criteria include evidence of significant contributions to nursing and healthcare and sponsorship by two current Academy Fellows. Applicants are reviewed by a panel comprised of elected and appointed Fellows, and selection is based, in part, on the extent the nominee’s nursing career influenced health policies and the health and well-being of all.
Rowles was president of the AANA in 2008 and is the 2012 recipient of the Agatha Hodgins Award for Outstanding Accomplishment as well as the 2005 Alice Magaw Outstanding Clinical Practitioner Award. The first nurse anesthetist in Indiana to work exclusively in the field of comprehensive pain management, Rowles led the way in the protection and expansion of CRNA pain services both at the state and national levels. She developed and taught the first interventional pain management cadaver course for CRNAs and has continued to work vigorously for the advancement of nurse aneshesia pain practice. She also stepped in as interim AANA Executive Director when John Garde, CRNA, FAAN, passed away in 2009.
While continuing to work with the AANA, IFNA, and AAPM, Rowles has taken on other leadership roles as well. In September 2013, she was named to a HHS/NIH working panel created by the Inter Agency Pain Research Coordinating Committee charged with creating a national comprehensive population health-level strategy for pain prevention, treatment, management, and research. She also serves as the treasurer of the American Academy of Pain Management (AAPM) and as the U.S. Country National Representative and First Vice President of the International Federation of Nurse Anesthetists (IFNA). As IFNA First Vice President, Rowles works to further the organization’s mission of advancing the educational standards and practices of nurse anesthesiology, thereby enhancing quality anesthesia care worldwide. The IFNA currently has 41 country members.
Rieker, a native of Cleona, Pa., began his nursing career in 1990 as a critical care registered nurse in pediatric and adult trauma ICU at Parkland Hospital in Dallas, Texas. He then attended Rush University, Chicago, where he graduated with a master's degree as a nurse anesthetist. In 2003, he completed a doctor of nursing practice degree from Rush University, with a focus on business and leadership in healthcare.
As the director of the nurse anesthesia program at Wake Forest Baptist Medical Center, Winston-Salem, N.C., Rieker introduced a global studies initiative which broadened the reach of the program.  Currently ranked seventh in the country, Wake Forest recently became the first program in the United States and the second in the world to receive full accreditation by the IFNA. “The accreditation attests to the commitment of the program to meet the highest international standards for educating nurse anesthetist,” said Rieker. An active volunteer and board member of Kybele, a humanitarian organization dedicated to improving childbirth safety worldwide through educational partnerships, Rieker was instrumental in establishing a nurse anesthesia educational program in Ghana. 
A consummate educator, Rieker has been a featured speaker in more than 75 state, national, and international venues, spanning seven countries. He has been published in numerous academic journals including the AANA Journal and has authored eight textbook chapters.
The AAN’s purpose is to track national and international trends in healthcare and create and execute policy-related initiatives to help reform America’s healthcare system. There are currently 2,068 Fellows. For more information, see the November 2013 NewsBulletin

Donate to the AANA Foundation’s FY14 Annual Giving Campaign
Join thousands of other CRNAs who support the AANA Foundation by making a tax-deductible donation to the FY14 Annual Giving Campaign. Your support is critical to advancing the nurse anesthesia profession through research and education that validates quality and cost-effective anesthesia care. 
Donations to the AANA Foundation can be made in the following ways:
  1. FY2014 AANA dues statement—Include your gift on the form mailed to you from AANA.
  2. AANA Membership renewal online—Include your gift when renewing your membership online by visiting and accessing your renewal form through the Member Login section.
  3. AANA Foundation website—Make a gift by visiting
  4. AANA Foundation via mail—Send your gift to AANA Foundation, 222 S. Prospect Avenue, Park Ridge, IL 60068.
  5. AANA Foundation via phone—Call (847) 655-1170 and Foundation staff members will be happy to assist you.
All donations of $100 or more will be recognized in the AANA Foundation Annual Report, at the AANA Annual Meeting in Orlando, at AANA assemblies, and on the AANA Foundation website. AANA members who make donations of $250 or more to both the AANA Foundation and CRNA-PAC will be recognized as Triple Crown members.
Thank you in advance for your support. 
AANA Foundation Fall Fellowship Opportunities
The AANA Foundation is offering two special fall fellowship opportunities.
Thanks to a sponsorship from Merck, the AANA Foundation will award up to six Doctoral Fellowships at $10,000 each, and up to two Post Doctoral Fellowships at a maximum of $40,000. The deadline for applications is Thursday, Oct. 31, 2013.
Thanks to a sponsorship from NBCRNA, the AANA Foundation will award one $10,000 Doctoral Fellowship. The project must address the value of certification or recertification in the advancement of patient safety through enhancing provider quality. The deadline for applications is Saturday, Nov. 30, 2013.
The overall goal of the Fellowship Program is to:
  • Cultivate the development of leaders in research within nurse anesthesia
  • Encourage CRNAs to pursue a program of research
  • Equip CRNAs with the skills to be leaders in research
  • Recognize exceptional academic ability and leadership
  • Establish a network of talented researchers
  • Support a strong research commitment
  • Funding is to be used to support an academic course of study and/or a target research project
Click here to access the applications. If you have any questions, contact the AANA Foundation at (847) 655-1170.


Professional Practice

Preventing Surgical Fires Initiative Celebrates Two-Year Anniversary
The AANA, FDA, and numerous other healthcare organizations celebrated the two-year anniversary of the Preventing Surgical Fires Initiative during National Fire Protection Week, Oct. 6-12, 2013. The Initiative’s goal is to increase awareness of factors that contribute to surgical fires, disseminate surgical fire prevention tools, and promote the adoption of risk reduction practices throughout the healthcare community. Learn more about the Preventing Surgical Fires Initiative and the steps you can take in your own facility to prevent these devastating events at
The Joint Commission Releases Sentinel Event Data
The Joint Commission has posted sentinel event data summarizing information through June 2013.  Access the individual reports by type: Sentinel Event Data - Including Anesthesia Event Data, Sentinel Event Data - General Information, Sentinel Event Data - Root Causes by Event Type, and Sentinel Event Data - Event Type by Year.

State Healthcare Exchange Websites Report Problems on First Day
On Oct. 1, state healthcare exchanges opened for enrollment. Seventeen states are running their own exchanges, six are in a state/federal partnership, and 27 states have allowed the federal government to run their exchange for them. Millions visited state exchange websites the first day, reporting crashes and other glitches as the websites were overwhelmed with users. California’s exchange website received 5 million visitors the first day, while New York’s site had 2 million visitors in the first 90 minutes. Many Republicans viewed the website problems as a failure of the system. Democrats, on the other hand, viewed the overwhelmed websites as a sign of success because it showed the huge demand for quality healthcare coverage the exchanges are designed to address. Despite the crashes, many states reported thousands of people successfully applying for healthcare via the sites on the first day, although it is uncertain how many of these were previously uninsured and how many were simply changing from existing coverage.
Register Now for the Next State Government Affairs Webinar
Making State GR Part of Your State Association’s Daily Life
Wednesday, Oct. 30, 2013 (7:00 p.m. CST)
All AANA members are invited and encouraged to attend webinars on state government affairs issues presented by members of the AANA’s Government Relations Committee and AANA State Government Affairs Division staff. Don’t miss the opportunity to learn about valuable information and resources important to CRNAs and state nurse anesthetist associations.
Click here for more information and to register for the webinar. Future webinars will be recorded and posted on the AANA website for viewing at your convenience. More information to follow in an upcoming E-ssential.


Federal Government Affairs

Uncle Sam Shutdown Continues with some Modifications
Washington’s budget standoff, which has shut down much of the federal government, is extending into a second week. Modifications enacted by Congress and signed by the president have restored pay to military personnel, returned most defense civilian employees to work, and promised to pay furloughed federal employees retroactively to Oct. 1 once the shutdown concludes. Closer to home, direct effects on most CRNAs appear to remain slight in the short term. But with more fiscal challenges ahead, specifically whether Congress will raise Uncle Sam’s $16.7 trillion debt limit by an Oct. 17 deadline or risk default and significant economic unknowns, no formula has emerged for ending the standoff or the shutdown.
Of specific interest to CRNAs, Medicare continues processing claims for CRNA and physician services for the time being. Because most federal CRNAs in the military, Veterans Affairs, and Public Health Service systems are involved in direct care to patients, most remain on duty, though not all are guaranteed to be paid on time for that duty. As a result, federal CRNAs must remain in close contact with their managers and human resources departments. Funding for Title 8 nurse workforce development programs is usually not paid until late in a federal fiscal year, and is likely to be relatively unaffected by a temporary shutdown. Enrollment in health plans through Affordable Care Act healthcare marketplaces began as scheduled Oct. 1, subject to delays attributable to technical hurdles.
Some services CRNAs rely on appear to be impaired by the shutdown. Certain federal agencies with indirect or longer-term impacts on CRNA practice all have staff subject to furloughs, which impairs customer service and backlogs work while the shutdown is in place. These agencies include the Centers for Disease Control and Prevention, Food and Drug Administration, Drug Enforcement Administration, and Medicare offices that process provider enrollments or conduct fraud investigations.
The longer the shutdown continues, the more services will see disruptions. Once any short-term federal funding agreement expires–the most recent bills have proposed expirations of Nov. 15 or Dec. 15–the fiscal fights likely will resume.
See how the shutdown impacts individual federal agencies at See how your House members voted on a bill extending government funding under the condition that the Affordable Care Act individual mandate be delayed a year,, and how your Senators voted to table and effectively defeat that legislation at See the Treasury’s debt ceiling warning letter at
40 Nursing Groups Support Veterans Health Administration Recognition of APRNs to their Full Scope
Forty nursing organizations, including the AANA, wrote Veterans Affairs Secretary Eric Shinseki Oct. 2 to support the Veterans Health Administration (VHA) recognizing CRNAs and other APRNs to their full scope of practice. The action was taken in support of the VHA updating its Nursing Handbook and to refute claims made by the American Society of Anesthesiologists (ASA) against APRN practice.
“The VHA’s recommendation to acknowledge APRNs as LIPs (Licensed Independent Practitioners) supports the profession to practice to the full extent of APRN education and training,” the letter stated. “This in turn will help ensure an adequate supply of LIPs is available to care for the military and veteran populations. We applaud the VA for working to recognize APRNs as LIPs, as it directly responds to the decades of empirical evidence that shows the care provided by APRNs is of high quality, reduces healthcare costs, and increases access.”
The ASA claimed that APRNs did not want to practice to their full scope, and that the nursing handbook somehow prohibits APRNs from working with physicians.
Read the letter at (requires AANA member login and password).
AANA Supports HHS Strategy for Preventing Adverse Drug Events, Noting CRNA Expertise
AANA supports evidence-based prevention tools to promote safe opioid prescribing and to reduce adverse drug events and recommends including CRNAs in further development of these strategies, said the AANA in a comment letter submitted to the Department of Health and Human Services (HHS) Oct. 4. The AANA offered its comments in response to the HHS draft National Action Plan to Prevent Adverse Drug Events (ADEs).
Developed in partnership with the U.S. Departments of Veterans Affairs and Defense, the Centers for Disease Control and Prevention, and the Bureau of Prisons, the National Action Plan for Adverse Drug Event Prevention has two key objectives: to identify common, clinically significant, preventable and measurable adverse drug events; and to align the efforts of federal agencies to reduce harm to patients from these specific adverse drug events. Of specific interest to CRNAs, the draft National Action Plan includes opioids as one of three high-priority targets for the plan’s surveillance, prevention, incentive, and research initiatives.
The letter signed by AANA President Dennis Bless, CRNA, MS, also states that CRNAs use a multi-modal pain management approach which may reduce patient need for opioids. CRNAs also play an important role in prevention of ADEs through the preanesthesia assessment and evaluation that includes taking a patient’s medication history, the letter said. The AANA also reminded the agency that CRNAs provide access to vital pain management services in rural and underserved areas and should attend any public meetings focused on sharing current and future best practices and research around ADE prevention. 
See AANA’s comments at (AANA Member ID and password required). Read the draft National Action Plan at
Health Coverage Enrollment Opens as Feds Address Technical Issues
Patient enrollment in Affordable Care Act (ACA) healthcare marketplace plans opened Oct. 1 for health plans taking effect Jan. 1, 2014. News reports indicated over 8 million people attempted to access and several hundred thousand called 800-318-2596 to learn more, and that technical issues with the website and the phone number kept some people from enrolling.
Information available at provides patients a breadcrumb trail for new health insurance options that may be available to them, help with healthcare and health coverage costs, and apples-to-apples comparisons of health plans so patients can make wise decisions. CRNAs that would like to help promote patient enrollment in the health insurance marketplace should see for a wide variety of publications, articles, research and online tools in English, Spanish and other languages.
Following NECC Drug Contamination Disaster, House Approves Compounding Reform Legislation
One year after pain injection patients became victims of unsanitary production practices at the NECC pharmaceutical compounder, the House has moved bipartisan legislation reforming the Food and Drug Administration regulation of large compounders, establishing a path toward tracking and tracing pharmaceuticals by unit within a decade, and otherwise leaving alone smaller compounding practices in hospitals, healthcare facilities and community pharmacies. The legislation was of interest to CRNAs who share the public’s concern about ensuring a safe supply of pharmaceutical products and avoiding unintended legislative consequences.
The “Drug Quality and Security Act” HR 3204 was supported by organizations representing hospitals and community and health system pharmacists, and by both House and Senate committee negotiators. The House approved the bill by voice vote on Sept. 28, and it awaits action in the Senate.
See a joint House-Senate statement and a summary of the bill at Read HR 3204 at See the CDC investigation of the multistate fungal meningitis outbreak at
Working for Your Reimbursement: How You Can Avoid a 1.5 Percent Medicare Cut in 2015
How can a CRNA avoid having all Medicare services cut by up to 1.5 percent in 2015? By reporting one Medicare Physician Quality Reporting System (PQRS) code on one Medicare claim this year (2013), according to representatives of the Medicare agency.
A reduction of 1.5 percent of Medicare payment in 2015 might not seem like much now, but, come 2015, no CRNA would be happy with a pay cut of up to 1.5 percent because he or she provided care to Medicare patients and did not ensure that Medicare’s PQRS participation requirement was met in 2013. CRNAs should report all of the quality measures they can in their Medicare claims, because reporting or failing to report will affect Medicare CRNA reimbursement in 2014 and in following years. Successfully completing these reports in 50 percent or more of your Medicare cases in 2013 may make a positive 0.5 percent difference in your Medicare revenues paid in 2014. However, failing to complete these reports in 2013 may reduce your 2015 payments by up to 1.5 percent, says Medicare.
Medicare has also said that CRNAs and other healthcare providers have until Oct.18 to enroll in a Medicare computer database (IACS) that tracks participation in the PQRS online and provides estimates of providers’ eligibility for incentive payments. To learn more, see
A tip sheet is available from CMS to help CRNAs and other healthcare professionals avoid PQRS-related payment cuts in 2015. See it at   
Many CRNAs are already participating in the PQRS. According to Medicare Chief Medical Officer Dr. Patrick Conway, 17,166 CRNAs were eligible participants in the PQRS in 2011, and 38.9 percent of eligible CRNAs participated in the program that year. According to a separate CMS report, the most common measures reported by CRNAs are these five, in order of their use:
  • 30. Perioperative Care: Timely Administration of Prophylactic Parenteral Antibiotics
  • 193. Perioperative Temperature Management
  • 76. Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol
  • 20: Perioperative Care: Timing of Antibiotic Prophylaxis-Ordering Physician
  • 145: Radiology: Exposure Time Reported for Procedures Using Fluoroscopy
Every CRNA should become familiar with PQRS reporting instructions and guidelines. This incentive represents future earnings for an individual CRNA or for his or her employers. Please refer to the CMS website for details.
Register Now for “Havana Nights” CRNA-PAC Fundraiser at Fall Leadership Academy
Attendees of the AANA Fall Leadership Academy in Miami Beach are invited to join the CRNA-PAC for “Havana Nights,” a reception on Saturday, Nov. 9, from 6-8 p.m., to benefit the one PAC that works 24/7 in Washington, D.C., for the interests of CRNAs–your CRNA-PAC.
Latin music like this, a cigar roller, and your AANA member colleague friends will all be on hand to make this a special night for the special cause of keeping your CRNA voice strong in Washington. And for this night only, Havana Nights attendees will enjoy salsa dancing lessons led by AANA Region 7 Director Juan Quintana, CRNA, DNP, MHS!
  • The CRNA-PAC unveiled a new video in which AANA members share how their own experiences in advocacy and support of the CRNA-PAC have made a positive difference to their practice and the nurse anesthesia profession. See (AANA member login and password required) and click “WATCH our new CRNA-PAC video.”
  • AANA’s Fall Leadership Academy Nov. 8-10 will offer an educational track for Federal Political Directors and the first dedicated track for State Reimbursement Specialist (SRS) development. Every participant will leave the FLA educated and energized and well-prepared to coordinate grassroots and reimbursement advocacy in their states. To learn more or register online, click
  • New Jersey CRNAs: the Garden State holds a special general election on Wed., Oct. 16, to elect a U.S. Senator to complete the term of the late Sen. Frank Lautenberg (D-NJ), pitting Newark mayor Cory Booker (D) against Bogota mayor Steve Lonegan (R). The winner faces the voters again in 2014 to win a full six-year term. The seat is now occupied by interim Sen. Jeffery Chiesa (R-NJ). Polling information about the special election is here,
  • The U.S. Supreme Court heard a major campaign finance case on Oct. 8 that challenges federal limitations on individual campaign contributions to candidate and political party committees. Currently, individuals may give no more than $123,200 to a federal candidate and party committees over a two-year election cycle, and no more than $2,600 to an individual candidate campaign—but may give unlimited sums to independent issue advocacy organizations and super-PACs. The case is McCutcheon v. Federal Election Commission (12-536),
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,, 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.


Surgeons Report 2 New Approaches to Lessen Postoperative Pain
While morphine and other opioids are typically administered to alleviate postoperative pain, they can cause a host of unpleasant side effects and are potentially habit-forming. New evidence suggests that reducing the amount of narcotic given and pairing it with a second pain treatment might be a more effective strategy for patients coming out of surgery. Applying ice packs to surgical wounds has proven to be a simple and safe alternative to opioids for orthopedic and certain other kinds of operations; but research out of Emory University has now demonstrated the efficacy of cryotherapy for major, larger-incision surgeries as well. The small study involved 55 patients undergoing abdominal procedures, about half of whom applied ice packs to the incision area afterwards and about half of whom did not. Those who iced reported about 50 percent less pain and used 22.5 percent less narcotics than the control group on the first postoperative day, with some patients skipping the opioids altogether. Meanwhile, an animal study conducted by researchers at Houston Methodist Research Institute used nanoparticles to create a controlled-release delivery system for lidocaine to prolong its numbing effects for days. The results showed that the innovative method, combined with daily nonsteroidal anti-inflammatory drugs, produced the best outcomes. Both studies were presented at the 2013 Clinical Congress of the American College of Surgeons.
From "Surgeons Report 2 New Approaches to Lessen Postoperative Pain"
RedOrbit (10/08/13)

Operating Room Noise May Pose Risks to Clinicians, Patients
Researchers at the University of Kentucky (UK) report that noise in the operating room (OR) often is louder than recommended by workplace and patient safety groups. A survey of OR personnel at the Center for Advanced Surgery at UK Healthcare showed that 88 percent of anesthesia providers and 92 percent of nurses said they had trouble hearing in the OR—which UK's Dr. Rosalind Ritchie said can compromise patient safety. "When you add multiple contributing factors such as beepers, cell phones, overhead pages, monitors and music, conversations and instruments, the ability to communicate effectively becomes impaired—critical communications about the patient's care may be heard incorrectly or not heard at all," she explained. Survey respondents reported miscommunications about everything from local anesthetic dosage to bed positioning. Ritchie presented her study results at the 2013 annual meeting of the Society for Ambulatory Anesthesia.
From "Operating Room Noise May Pose Risks to Clinicians, Patients"
Anesthesiology News (10/01/13) Vol. 39, No. 10 Savoie, Keely
Critically Important Anesthetic Faces Drug Shortage If Used in a Missouri Execution
U.S. health professionals are growing increasingly concerned that the European Union may add propofol to a list of products that cannot be exported if Missouri proceeds with a plan to execute a prisoner using the anesthetic. Under an amendment to the European Union Torture Regulation, overseas drug makers are prohibited from exporting certain products that could be used for the execution of humans via lethal injection. Thus, it is almost certain that Missouri's use of the drug to carry out a capital punishment sentence scheduled for Oct. 23 will result in the sedation agent being included on the no-export list. Since propofol is used in about 85 percent of anesthetic procedures in the United States, the nation could face a drug shortage and subsequent healthcare crisis. The sole U.S. manufacturer of propofol, Hospira, is unlikely to have the output capacity to fill the void; and Teva, the only other company that has produced the drug in the United States, has been off-line with its product for some time with no clear indication of when it may return to market. A previous shortage of propofol, in 2010, created problems when clinicians used too little of the drug in efforts to conserve supply or used less safe anesthetics that produced adverse outcomes and side effects.
From "Critically Important Anesthetic Faces Drug Shortage If Used in a Missouri Execution"
Philadelphia Inquirer (PA) (10/01/13) Cohen, Michael R.
Epidural During Labor May Cause Abnormal Head Position
Researchers at Brigham and Women's Hospital in Boston have found a correlation between receiving epidural analgesia during labor and an increased risk of delivering a baby face-up. The study involving 1,562 pregnant women evaluated changes in fetal position during labor through the use of ultrasounds performed at first admission to the labor delivery unit, during epidural administration or four hours after the initial ultrasonography if no epidural was given, and in the late stages of labor. Investigators discovered that there were not more fetuses in the face-up position in those women receiving an epidural when they were admitted to the labor delivery unit. By the time they delivered, however, the patients in the epidural group did have more face-up fetuses than other groups. The researchers note that the findings appear to explain why there is a higher rate of C-sections association with epidurals.
From "Epidural During Labor May Cause Abnormal Head Position"
TeleManagement (09/01/13)
Rising Rates of Severe and Fatal Sepsis During Labor and Delivery
A study in the October issue of Anesthesia & Analgesia reported that, over the last decade, the rates of severe and fatal sepsis have increased among American women hospitalized for labor and delivery. Overall, the University of Michigan Health System researchers found that sepsis occurred in one out of every 3,333 women hospitalized for delivery—a rate that did not fluctuate greatly over the 11-year study period. During that same time frame, however, the rate of severe sepsis roughly doubled for women in labor, from about one in 15,400 to one in 7,250. Overall the rate for severe sepsis increased by about 10 percent annually during the study period, as did the rate of fatal sepsis. Several medical conditions associated with increased risk of severe sepsis were identified, including "cervical stitch", chronic liver and kidney disease, congestive heart failure, and lupus along with factors that were similar to other labor and delivery complications, including African-American race/ethnicity, Medicaid insurance, and older maternal age. However, none of these factors accounted for more than 6 percent of cases; and many women who developed severe or fatal sepsis had no known risk factors. In developed countries, sepsis is increasingly becoming the cause of complications and death among women in labor, as recent U.K. research has shown that sepsis-related deaths doubled in the last decade. The study co-authors wrote that the U.S. increase "may have been due to similar factors as those identified in the United Kingdom... such as increasing microbial resistance, obesity, smoking, substance abuse, and poor general health."
From "Rising Rates of Severe and Fatal Sepsis During Labor and Delivery"
RedOrbit (09/24/13)
Preoperative Blood Typing May Not Be Needed for Some Pediatric Surgeries
For some pediatric surgeries, the risk of serious blood loss is so low that clinicians can safely skip blood typing and blood stocking beforehand, according to researchers at the Johns Hopkins Children's Center. The findings, published in the journal Pediatric Anesthesia, included a list of 10 operations with a transfusion risk of near zero. Researchers reviewed the records of 8,620 pediatric non-cardiac surgeries performed at The Johns Hopkins Hospital over 13 months. Preemptive blood-type testing and blood stocking can increase healthcare costs, and even waste vital supplies if unused blood expires and cannot be restocked. Among the surgeries studied, blood transfusions were unnecessary more than 97 percent of the time. Of the 8,380 patients for whom a transfusion was unnecessary, 707 underwent preliminary blood typing and 420 of them underwent additional cross-matching, with a total price tag of nearly $60,000. The procedures found least likely to require transfusions include common surgeries of the colon and spinal cord, lumbar punctures, central-line placements, arthrogram, repairs of a dislocated or fractured elbow, and tonsil and adenoid removal. A surgery to reposition a catheter that drains excess cerebrospinal fluid from the brain and an operation performed in some scoliosis patients both carried an extremely small risk of blood transfusion. The researchers determined that nearly one-third of children underwent excessive blood testing before surgery.
From "Preoperative Blood Typing May Not Be Needed for Some Pediatric Surgeries"
Medical Xpress (09/23/13)
A New State of Consciousness May Exist for Surgery Patients
New research supports the potential existence of a third state of mind under anesthesia, where patients are able to respond to a command without being disturbed by the surgery or feeling pain. This possibility of "dysanaesthesia" was discussed at The Annual Congress of the Association of Aneaesthetists of Great Britain and Ireland on Sept. 19 by Dr. Jaideep Pandit, an anesthetist at St. John's College in England, who wrote an editorial accompanying the study. About a third of the 34 surgery patients who participated in the research moved their finger when asked to, despite being under what appeared to be adequate anesthesia. Pandit noted that the most remarkable part about the reaction "is that [the patients] only move their fingers if they are asked [to do so]. None of the patients spontaneously responded to the surgery," suggesting that they were not in pain. Though doctors working on the study interpreted this movement as a sign of consciousness, Pandit argues that the patients were not "conscious" because there was no spontaneous movement. He believes that patients in this third state of mind may be aware of their surroundings to some extent, but not enough that it bothers them or that they can feel pain. This hypothesis, Pandit adds, may serve as the basis for developing anesthesia monitors in the future. He believes that while the state of dysanaesthesia may seem harmless, it could be a precursor to more uncomfortable states of awareness during surgery that should be avoided. The research was published Sept. 12 in the journal Anaesthesia.
From "A New State of Consciousness May Exist for Surgery Patients"
eMaxHealth (09/21/13) Tanoos, Teresa
Identification and Treatment of Unrecognized Obstructive Sleep Apnea Before Surgery Improves Outcomes
University of Toronto researchers set out to determine how best to treat the 80 percent of patients with obstructive sleep apnea (OSA), which can cause a host of health problems ranging from hypertension and arrhythmia to diabetes and heart failure. Under anesthesia and surgery, moreover, these patients are more susceptible to complications; and they also are at high risk of respiratory depression when taking opioids for postoperative pain. The researchers conducted a randomized trial of 177 patients in order to determine the effectiveness of a special type of continuous positive airway pressure (CPAP)—the standard care for OSA—in treating the condition. The results were published in the October 2013 issue of Anesthesiology. Auto-titrated CPAP, known as APAP, works by slightly adjusting delivered pressure to keep airways open during the course of the night, based on breath-by-breath measurement. The 87 study participants who received APAP for two to three nights prior to surgery and on the five nights following surgery were found to do better postoperatively than those participants who received routine care. The median apnea-hypopnea indices for those participants who received APAP was three events per hour on the third postoperative night, while control patients had a median of 32 events per hour. Those patients who received CPAP also displayed better oxygenation during the postoperative nights. The researchers hope their findings will encourage patients with OSA to use APAP, since daily compliance can be low.
From "Identification and Treatment of Unrecognized Obstructive Sleep Apnea Before Surgery Improves Outcomes"
Newswise (09/18/13)
Gene Mutation That 'Blocks' Pain Identified
In a finding that could aid new painkiller development, German scientists have identified a gene mutation that prevents people from sensing physical pain. The condition is known as congenital analgesia, and the mutation was discovered in a gene called SCN11A when the gene sequence of a girl with congenital analgesia was compared against the gene sequences of her parents. SCN11A controls the development of channels on pain-sensing neurons, where sodium ions create electrical nerve impulses that are sent to the brain, which registers pain. When SCN11A is mutated, however, hyperactivity prevents the build-up of the charge that the neurons need to transmit an electrical impulse, leaving the body numb to pain. Researcher Ingo Kurth from Jena University Hospital noted that the outcome of the mutation "is blocked transmission of pain signals." Trials in mice showed that those with a mutated version of SCN11A developed injuries similar to those seen in people with congenital analgesia, such as bone fractures, while the control group with the normal gene did not. The team is looking into identifying drugs that would "selectively block [the SCN11A channel] but not other sodium channels," Kurth said, "which is far from simple."
From "Gene Mutation That 'Blocks' Pain Identified"
Business Standard (09/16/13)
Why Hospitals Want Patients to Ask Doctors, 'Have You Washed Your Hands?'
Despite years of effort by the Centers for Disease Control and Prevention (CDC) to educate both caregivers and patients, studies reveal that hospital staff on average comply with hand-washing protocols, including washing with soap and water or alcohol-based gels, only about 50 percent of the time. To combat infections, hospitals have implemented strict "wash in, wash out" protocols, used designated unidentified staffers to secretly monitor co-workers, tied merit increases to compliance, and have suspended doctors' privileges if they ignore the rules. Others are adopting electronic sensors, thermal imaging, and video cameras to monitor hand hygiene. To increase patient involvement in the fight against infection, the CDC has provided 16,000 copies of the "Hand Hygiene Saves Lives" video to hospitals to show to patients during admission, and a 2010 study of 17 hospitals run by Cincinnati-based Catholic Health Partners indicated that the video increased the number of patients asking staff to wash their hands and the number of physicians and nurses reporting that they were asked to wash their hands.
From "Why Hospitals Want Patients to Ask Doctors, 'Have You Washed Your Hands?'"
Wall Street Journal (09/30/13) Landro, Laura
A National Initiative to Reduce Central Line-Associated Bloodstream Infections: A Model for Reducing Preventable Harm
On the CUSP: Stop BSI—a national initiative involving 1,100 hospitals in 44 states, the District of Columbia, and Puerto Rico—succeeded in reducing central line-associated bloodstream infections (CLABSIs) in intensive care units to one infection per 1,000 line-days at most hospitals. The campaign involved implementation of the Comprehensive Unit-based Safety Program to improve safety culture and teamwork; checklists of evidence-based practices for catheter insertion, maintenance, and removal to prevent CLABSIs; tools to determine local barriers to such practices; and guidance to ensure these practices were consistently received by patients. The initiative showed that national programs should meet several criteria demonstrating that they reduce harm before being rolled out countrywide; have a clear chain of accountability and a sufficient infrastructure at each level; align the work of all stakeholders around a common standard measure; summarize the evidence and encourage local clinicians to adapt the interventions to fit their culture and needs; and more.
From "A National Initiative to Reduce Central Line-Associated Bloodstream Infections: A Model for Reducing Preventable Harm"
Health Affairs (Summer 2013) Pronovost, Peter J.; Marsteller, Jill A.; Weeks, Kristina; et al.
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