AANA Anesthesia E-ssential

Vital Signs

Be Sure to Vote in the AANA 2016 Election! Voting ends May 17 at noon CT

The AANA 2016 election started on April 19, and will continue until May 17 – 12 noon CDT. By now, active AANA members should have received their ballot materials, including their election passcode and voting instructions, electronically or in the mail from Survey & Ballot Systems (SBS), the AANA's election coordinator. The email with the voting credentials originates from noreply@directvote.net. Please make sure this email did not end up in your spam or junk mail folder.

To vote online and view candidates’ biographical information and position statements visit the election site and enter your member number and the election passcode provided to you by SBS.

If you do not have your election login information, click on the “Email me my login information?” link on the login page and enter the email address on file with AANA, and your election login information will be emailed to you. SBS can be reached by phone at (952) 974-2339 (Monday through Friday, 8 a.m. to 5 p.m. CDT) or by email at support@directvote.net.

If it’s more convenient, please feel free to contact lrivera@aana.com or vgiannopoulos@aana.com, and they will ask SBS to re-send you your voting credentials.
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CPC Facts

CPC Program: Class B Credits – What they are and are not

Class B Credits are the most flexible component of the CPC Program! They were designed to encourage CRNAs to engage in professional activities that are beyond traditional continuing education for nurse anesthetists. They also provide recognition of the practitioner’s involvement in activities that support anesthesia practice and include engagement in the broader healthcare environment. Reference the Class B information table that details what information needs to be collected and retained for Class B credits.

For more information about the NBCRNA's Continued Professional Certification (CPC) Program, which will launch on Aug. 1, 2016, go to the cpc-facts.aana.com and NBCRNA websites.

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Hot Topics

AANA Seeking Committee Members for Fiscal Year 2017

Positions are available on AANA Committees for CRNAs and student registered nurse anesthetists. Check out the committee page on the AANA website to read about the various opportunities. Deadline for submission of a committee request is May 15, 2016. Please note: If you currently serve on a FY16 committee, you must reapply for FY17.
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“2016 PQRS Essentials for CRNAs” Recording Now Available

If you missed the live program that took place on Thursday, April 14, 2016, presented by SCG Health expert Jennifer Searfoss, you can now view and listen to the video recording by logging into the Quality Resources page on the AANA website. (AANA member login and password required.)
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CMS Presentation: “2016 PQRS Reporting: Avoiding 2018 Negative Payment Adjustments”

On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) hosted a live educational call, which provided an overview of the 2016 PQRS and related resources and covered guidance and instructions on how individual eligible professionals and PQRS group practices can get started, satisfactorily report/participate, and avoid the 2018 PQRS negative payment adjustment. The presentation slides are currently available through the CMS website page and a transcript of the session including the question and answer session will be made available soon.
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2016 PQRS Group Practice Reporting Option (GPRO) Registration Is Now Open

Group practices defined as two or more eligible professionals (EPs) who have reassigned their billing rights to a single Taxpayer Identification Number (TIN) can register to participate in the 2016 PQRS GPRO via the CMS Physician Value-PQRS Registration System by June 30, 2016. Group practices must meet the 2016 satisfactory reporting criteria through the PQRS GPRO in order to avoid the 2018 PQRS payment adjustment. For more information on GPROs, please visit our new “2016 PQRS Reporting Mechanisms for Group Practices” FAQ page under our Quality-Reimbursement section of the AANA website.
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ANCC Awards AANA Accreditation with Distinction

In late March, after extensive evaluation the American Nurses Credentialing Center (ANCC) awarded AANA Accreditation with Distinction, the highest recognition awarded by the ANCC. In announcing the decision, AANA Senior Director, Education and Professional Development Bruce Schoneboom, PhD, CRNA, FAAN, COL (Ret), USA, stated: “This designation speaks to the strength and quality of the educational content we are producing at AANA and reaffirms the dedicated work and commitment of our entire staff and volunteers to the core values and mission of our organization.” The accreditation has been granted for four years, from March 28, 2016 to March 31, 2020.

The mission of the ANCC, a subsidiary of the American Nurses Association (ANA), is to promote excellence in nursing and health care globally through credentialing programs. In addition, ANCC accredits healthcare organizations that provide and approve continuing nursing education. It also offers educational materials to support nurses and organizations as they work toward their credentials. ANCC was incorporated in June 1990.

The ANCC Accreditation program recognizes the importance of high-quality continuing nursing education (CNE) and skills-based competency programs. Around the world, ANCC-accredited organizations provide nurses with the knowledge and skills to help improve care and patient outcomes.
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AANA Seeks to Record CRNA Vietnam Stories

A new section of the AANA website features profiles of CRNAs who served in the Vietnam War: Vietnam Voices. AANA seeks to recognize and record the military accomplishments of CRNAs in Vietnam. "I became a CRNA in 1959, five years before going to Vietnam...Most of the time before Vietnam I worked in large hospitals, so I was used to giving anesthesia for trauma surgery," begins Theodore Kehn, BA, CRNA, in his account of his time there. Read more, and also learn how to contribute your profile: Vietnam Voices.
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Student Excellence Award Deadline is May 15

The Education Committee will present a Student Excellence Award at the 2016 AANA Nurse Anesthesia Annual Congress to a student who demonstrates outstanding leadership and professionalism during his or her nurse anesthesia program, participates in activities that foster a positive public image of nursing, participates in activities that foster high-quality healthcare to consumers, or engages in volunteer activities of community service or support of healthcare.
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Students and CRNAs Needed for Anesthesia College Bowl

The annual Anesthesia College Bowl at the AANA Nurse Anesthesia Annual Congress will once again be a rousing battle of the brains between the 2016 Student Champion Team and a CRNA Challenge Team. Deadline: June 1, 2016.
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Professional Practice

Joint Commission Addresses Misconceptions about Pain Management Standards

In response to critics of its pain management standards, The Joint Commission issued a statement seeking to dispel misconceptions that the standards require drugs or opioids to ease a patient’s pain. The standards do require that patients experiencing pain have their pain assessed and managed. The Joint Commission stated, “We believe that our standards, when read thoroughly and correctly interpreted, continue to encourage organizations to establish education programs, training, policies, and procedures that improve the assessment and treatment of pain without promoting the unnecessary or inappropriate use of opioids.”
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Joint Commission Issues Alert Addressing Implicit Bias in Healthcare

Extensive evidence shows implicit bias can lead to different treatment of patients by race, gender, weight, age, language, income and insurance status. The Joint Commission’s Quick Safety Alert notes that “implicit (or subconscious) bias” consists of: "attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner. These biases encompass both favorable and unfavorable assessments, and are activated involuntarily and without an individual’s awareness or intentional control. Once learned, stereotypes and prejudices resist change, even when evidence fails to support them or points to the contrary. People will embrace anecdotes that reinforce their biases, but disregard experience that contradicts them." Actions healthcare professionals can take to address implicit bias include:
  • Having a basic understanding of your patients’ cultural backgrounds
  • Recognizing situations that magnify stereotyping and bias
  • Knowing the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care
  • Performing “teach back” methods (e.g., the National Patient Safety Foundation’s “Ask Me 3®” educational program)
  • Practicing evidenced-based healthcare
  • Using techniques to de-bias patient care
Read the Quick Safety Alert for detailed recommendations for both healthcare organizations and healthcare providers to combat implicit bias. for detailed recommendations for both healthcare organizations and healthcare providers to combat implicit bias.
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Joint Commission Redesigns Standards FAQs

Many CRNAs have questions concerning interpretation of Joint Commission standards. In response to customer feedback, The Joint Commission has updated its FAQ format. The highest-rated FAQs are now listed by chapter, and there will only be one question/answer per FAQ. Users will also be able to:
  • Filter search results by manual, chapter, or keyword.
  • See new and featured FAQs for two weeks.
  • Print individual FAQs, or by chapter or manual.
  • Vote thumbs up or down on FAQ with comment option.
If the FAQ doesn’t answer your question, you may complete the standards online question form, which is sent to the Standards Interpretation Group. Please also feel free to contact the AANA Professional Practice Division at (847) 655-8870 or by email at practice@aana.com with your accreditation questions and view the AANA facility accreditation webpage for additional resources.
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Upcoming Webinar: Labor Support and Culture Change to Promote Vaginal Births

Register for “Fostering Labor Support and Culture Change to Promote Vaginal Births,” the next complimentary Safety Action Series webinar from the ACOG Council on Patient Safety in Women’s Health Care being held on May 12 at 2:00 pm ET.
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Meetings and Workshops

Registration is now open for the AANA Annual Congress!

Join us September 9-13 at the Washington Marriott Wardman Park for nurse anesthesia's premier educational, professional, and social event! Just take a look at the lineup of top notch sessions and unparalleled networking events on the schedule at a glance.        
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Fall Leadership Academy: Save the Date!

The Fall Leadership Academy will be held November 11-13, 2016 in Rosemont, Ill. Watch the AANA website and future issues of the NewsBulletin and E-ssential for more information!
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Register Now for Business of Anesthesia Conference

On June 24-25, join the AANA for a two-day conference on Chicago’s Magnificent Mile that will arm you with critical tools for navigating the business aspects of anesthesia practice. Get real-world advice from expert speakers with experience in building and maintaining a successful practice.
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Save the Dates for These Popular Hands-On Workshops

Visit Meetings for further information and to register!

Jack Neary Pain Management Workshop II
  • Rosemont, IL
  • October 29-30, 2016
Upper and Lower Extremity Nerve Block Workshop
  • AANA Foundation Learning Center
  • September 24-25, 2016
Essentials of Obstetric Analgesia/Anesthesia Workshop
  • AANA Foundation Learning Center
  • November 2, 2016
Spinal and Epidural Workshop
  • AANA Foundation Learning Center
  • November 3-5, 2016
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Federal Government Affairs

Congress’ Appropriations Committees Address VHA Full Practice Authority Issue as they Approve FY 17 Military Construction, Veterans Affairs, and Related Agencies Appropriations Bills

On April 14 and 15, the House and Senate Appropriations Committees passed their respective Military Construction, Veterans Affairs and Related Agencies Appropriations bills for the 2017 fiscal year (FY). Report language affecting the issue of full practice authority for CRNAs and other APRNs serving in the Veterans Health Administration (VHA) arose during committee consideration of both the House and Senate bills, and the AANA and its allies in Congress were engaged in advancing veterans access to care and protecting CRNA practice by securing needed improvements.

The House bill provides $81.6 billion in discretionary funding, including a 3 percent increase in funding for the VA from FY 16. In a manner similar to what Congress adopted with AANA support last year, the report accompanying this year’s House committee-passed bill includes language acknowledging that the VHA is working to publish a proposed rule recognizing CRNAs and other APRNs to their full practice authority. The Senate bill provides $83 billion in discretionary funding, including a 4.8 percent increase in funding for the VA. Different from what the House committee did, however, subcommittee chairman Sen. Mark Kirk (R-IL) included language in his bill’s report wrongly suggesting that the full practice authority rule awaiting publication would “dismantle team-based anesthesia care.” The AANA was successful working with several Senators, including Sen. Jeff Merkley (D-OR), adding a sentence urging the VHA to note the benefits of full practice authority, effectively balancing out Sen. Kirk’s language with positive support.

The next step for these bills is consideration on the House and Senate floors respectively, which has not been scheduled. The AANA and CRNAs continue to work on both sides of the Capitol and with both political parties to advocate effectively for expanding access to care for America’s veterans.

See more information on the House bill (H.R. 4974, H. Rept. 114-497).

See more information on the Senate bill (S. 2806, S. Rept. 114-237).
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Update: Expand Veterans Access to Care through Full Practice Authority for VHA CRNAs, APRNs

The AANA continues to work with a broad coalition of groups in support of improving veterans access to care through full practice authority for CRNAs and other APRNs at the VHA. Here is a brief rundown of activities to keep members apprised of current actions.
  • Legislation: The AANA continues to encourage members of the U.S. House of Representatives to cosponsor the “Improving Veterans Access to Quality Care Act” (H.R. 1247) and members of the Senate to cosponsor the “Veterans Health Care Staffing Improvement Act” (S. 2279). The bills currently have 52 and 9 bipartisan cosponsors respectively. Be sure to thank your U.S. Senators and Representatives who have supported expanding veterans access to care through full practice authority for CRNAs and other APRNs.
  • Regulation: The White House Office of Management and Budget (OMB) continues to evaluate a proposed rule on APRN full practice authority submitted by Veterans Affairs Secretary Robert McDonald in early January. The OMB may at any time publish the rule in the Federal Register and trigger a 60-day public comment period, or return it to the VHA for more work. AANA continues urging all members to use Veterans Access to Care to submit regulatory comments ahead of time in support of improving Veterans access to quality healthcare through CRNA and APRN full practice authority. AANA members can also share the site with colleagues, friends, and family—especially veterans—to take action.
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AANA Leads APRN Letter to House Energy and Commerce Subcommittee on Health Regarding MACRA Implementation

In advance of an April 19 House Energy and Commerce Health Subcommittee Hearing titled “Medicare Access and CHIP Reauthorization Act (MACRA) of 2015: Examining Physician Efforts to Prepare for Medicare Payment Reforms,” the AANA and 10 other APRN groups sent a letter to subcommittee members outlining steps APRNs have taken to implement the MACRA Medicare payment reform law, concerns with its implementation process thus far, and the need for the subcommittee to include APRNs, not just physician groups, as witnesses in future hearings.

The APRN groups who signed the letter include: American Association of Colleges of Nursing, AANA, American Association of Nurse Practitioners, American College of Nurse-Midwives, American Nurses Association, Gerontological Advance Practice Nurses Association, National Association of Clinical Nurse Specialists, National Association of Nurse Practitioners in Women’s Health, National Association of Pediatric Nurse Practitioners, National League for Nursing, and National Organization of Nurse Practitioner Faculties.

Read the letter. Watch the hearing or read witness testimony.
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Medicare Issues Hospital Inpatient Prospective Payment System (IPPS) Proposed Rule; Comments Due this Summer

On April 18, the Centers for Medicare & Medicaid Services (CMS) issued a preview its 2017 hospital inpatient prospective payment system (IPPS) proposed rule and announced its plans to publish it in the Federal Register on April 27. The proposed rule governs hospital regulatory and payment policy in the next year and includes provisions to Medicare hospital payment incentives programs.

The following proposals are included in this proposed rule:
  • Regarding provisions in the Hospital Value-Based Purchasing (VBP), the rule proposes changes for determining the policy that governs whether a hospital will be excluded from the program if it is cited for deficiencies that pose immediate jeopardy to the health and safety of patients.
  • CMS is proposing to change the name of the Patient- and Caregiver-Centered Experience of Care/Care Coordination domain for the VBP program.
  • CMS is not proposing any changes to the Hospital Readmissions Reduction Program (HRRP) measures in this proposed rule.
  • As part of the Hospital Acquired Condition (HAC) Reduction Program, CMS is proposing to adopt a refined PSI 90: Patient Safety and Adverse Events Composite Measure (NQF # 0531), which it includes as part of its composite Iatrogenic Pneumothorax Rate.
Read the proposed rule in preview until April 27 when it will be published in the Federal Register.

Read more about the proposed rule.
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AANA Warns Against Anesthesiologist Medical Direction Claims Fraud in Medicare and Medicaid Programs

The AANA warned the Centers for Medicare & Medicaid Services (CMS) that instances of fraud in Medicare claims for anesthesiologist medical direction where the anesthesiologist did not perform all seven medical direction tasks might also occur in state Medicaid programs. The warning was in response to a proposed rule that works to reduce fraud, waste and abuse in the Medicare, Medicaid and Children’s Health Insurance Program (CHIP) programs by implementing sections of the Affordable Care Act that require providers and suppliers within these programs to disclose certain current and previous affiliations with other providers and suppliers.

In a letter from AANA President Juan Quintana, DNP, MHS, CRNA, the AANA stressed that fraud is a serious matter that can have negative implications for federal programs and highlighted a fraud risk that contributes to high costs without improving quality under the current fee-for-service Medicare model that may also apply to state Medicaid programs. With this information in mind, the letter recommended that the agency emphasize the use of cost-effective anesthesia care provided by CRNAs as the agency and states continue to combat waste, fraud and abuse in the Medicare, Medicaid and CHIP programs.

See AANA’s comments and view the proposed rule.
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AANA Joins Campaign for Sustainable Rx Pricing

To address the problem of rapidly raising medication costs affecting patient care, AANA has joined the Campaign for Sustainable Rx Pricing to help work for market-based solutions to rising prescription drug prices. AANA joins a diverse and growing list of organizations participating in the campaign, including those representing hospitals, physicians, pharmacists, consumers, patients, employers and health plans.

“Patients do not have a choice in the anesthesia medications they are given for surgery, labor and delivery, and other procedures, yet CRNAs are acutely aware of how pharmaceutical pricing affects patient care,” said AANA President Juan Quintana, DNP, MHS, CRNA, in an April 14 press release. “When the prices of medications used in anesthesia suddenly skyrocket, one of two things happens: Everyone is stuck paying the higher costs, or the hospital pharmacy and anesthesia professionals may be forced to use different, less-expensive medications that may not work ass effectively or as well for a given patient. That is a patient care issue, and the AANA is pleased to join this campaign to be part of the solution.”

The campaign on April 25 released its proposals for market-based policy solutions to curb rising drug prices on April 25.

Read more about the Campaign for Sustainable Drug Pricing.
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House Committee Investigates Government Accountability Office (GAO) Report that Finds Primary Care Access Problems within the VA

A new U.S. Government Accountability Office (GAO) report titled “Actions Needed to Improve Access to Primary Care for Newly Enrolled Veterans” was the subject of an April 19 hearing in the House Committee on Veterans’ Affairs. Though the report did not address CRNAs or other APRNs directly, its conclusion that veterans lack access to timely primary care services speaks to the larger need for full practice authority for APRNs within the VA.

In its report, the GAO analyzed 180 veterans who were newly enrolled in the VHA. Of these veterans, more than 33 percent had not been seen by a provider at the time of the review, and the remaining 66 percent waited between 22 and 71 days from the time they requested that the VA contact them to schedule an appointment to the time they saw a provider.

House Veterans Affairs Committee Chairman Jeff Miller (R-FL) expressed a number of concerns, including that VA Secretary Robert McDonald had earlier this month announced that veterans wait an average of five days, not the more than three weeks found in the GAO report. In his testimony, VA Under Secretary for Health David Shulkin, MD, stated that the VHA needs to “change the way that we measure wait times and put in place a new system for how we see veterans that focuses on the clinical urgency.”
Access the GAO report.

Read testimony or access the video of the House Committee on Veterans Affairs.
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Upcoming Presidential and Congressional Elections

The AANA encourages CRNAs to vote and be active in primary elections this spring in support of candidates of their choice. If you are involved in one of the following primary or caucus campaigns below, AANA DC would be delighted to hear from you. Tell your story or send your pictures to info@aanadc.com with “CRNAs in Campaigns” in the subject line.
  • May 3, presidential and congressional primaries in Indiana
  • May 7, presidential caucus in Guam
  • May 10, presidential and congressional primaries in Nebraska and West Virginia
  • May 17, presidential and congressional primaries in Kentucky and Oregon; congressional primaries in Idaho
  • May 24, presidential primary in Washington; congressional primary in Georgia
See an up-to-date list of 2016 election dates by state and by date.
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  • On April 21, Health Affairs issued a Health Policy Brief focusing on MACRA and its Implementation.
  • The Campaign for Sustainable Rx Pricing (CSRxP) released its proposals for market-based policy solutions to curb rising drug prices on April 25. The AANA joined the CSRxP earlier this month. To learn more about these proposals, which focus on transparency, competition and value.
  • With Medicare expected any day to publish a proposed rule implementing major Medicare payment reform changes for CRNAs and physicians, AANA was present at the Washington summit meeting of the Health Care Payment Learning and Action Network (LAN) on April 25-26 in the interest of protecting and advancing CRNA markets and reimbursement. Learn more about the LAN Summit and about the work of the LAN. See tweets about the LAN Summit at #LANSummit and follow the LAN on Twitter at @Payment_Network.
  • The American Society of Anesthesiologists’ Washington advocacy conference takes place May 16-18 in Washington, DC. Have you completed your AANA Mid-Year Assembly follow-ups? This includes your thank-you notes to legislators and staff you met, follow-up calls with further information or to ask their status on actions they are considering, and completing your lobby report form here.
  • Engage with your profession’s social media feed on Facebook and Twitter.
  • Keep up with the AANA’s new efforts for educating hospital administrators, healthcare policymakers and other health industry leaders about the role and value of CRNA care at the Future of Anesthesia Care Today.
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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.
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Visit www.crnacareers.com to view or place job postings
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Featured Career Opportunities

Nurse Anesthetist – CRNA – Loyola University Medical Center
Maywood, IL

As a CRNA you’ll provide anesthesia care in the operating room and off site settings. Full time employment opportunity that does not require call coverage.

Assistant Program Administrator Position – MTSA
Nashville, TN

Located in Metropolitan Nashville, Tennessee, MTSA is a private, regionally and professionally accredited, highly selective graduate/professional school. This position requires a CRNA with a Doctoral Degree and the ability to obtain Tennessee licensure.


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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.

Off-Label Ketamine Prescribing: US Psychiatrists Troubled

As ketamine is used more frequently in non-anesthetic settings, experts in psychiatry—where the drug has found new life as an antidepressant—are growing increasingly concerned. University of Miami professor Charles Nemeroff, MD, PhD, acknowledges that off-label applications are nothing new but finds the trend troubling nonetheless. Prescribing "an anesthetic and a well-known drug of abuse, especially when there are no data on its long-term effectiveness or its safety, is very worrisome," he warns. Nemeroff chairs an American Psychiatric Association task force that is developing an advisory statement on the appropriate use of ketamine. While a meta-analysis by the panel affirmed the drug's efficacy in depression, it also found those benefits to be short-lived. In addition, there are dissociative and psychotomimetic side effects tied to ketamine use in depressed patients; and there also is a risk for bladder toxicity. Many healthcare providers and their patients have focused on the positive reports, however, and ketamine clinics have popped up nationwide to offer the treatment as an alternative to or in conjunction with electroconvulsive therapy. The authors of the meta-analysis insist the available data do not support this approach. "The fleeting nature of ketamine's therapeutic benefit, coupled with its potential for abuse and neurotoxicity, suggest that its use in the clinical settings warrant caution," they wrote.

From "Off-Label Ketamine Prescribing: US Psychiatrists Troubled"
Medscape (04/25/16) Harrison, Pam

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Intraperitoneal Local Anesthetic in Pediatric Surgery: A Systematic Review

While the efficacy of intraperitoneal local anesthetic (IPLA) has been demonstrated in adult patients, researchers in New Zealand questioned whether the same was true for children. They conducted a systematic review of three published trials and one unpublished study, each of which compared pain or opioid use outcomes with and without IPLA in kids undergoing abdominal operations. Although the highly absorptive properties of the peritoneum and high peritoneal surface area-to-volume ratio in younger patients limit the amount of anesthetic that can be administered, the investigators noted several potential benefits from IPLA use in children. According to the data, the approach could lower pain scores, opioid consumption, time to first opioid, and the need for rescue analgesia. The findings—slated for publication in the European Journal of Pediatric Surgery—encourage further study.

From "Intraperitoneal Local Anesthetic in Pediatric Surgery: A Systematic Review"
Uro Today (04/22/16) Hamill, James K.; Rahiri, Jamie-Lee; Liley, Andrew; et al.

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Olanzapine Shows Analgesic Properties, May Help Reduce Chronic Pain

Although classified as an atypical antipsychotic, olanzapine carries some analgesic traits that might make it a viable candidate for treating chronic pain. A systematic review, led by the Cleveland Clinic's Xavier Jimenez, MD, looked at 18 studies that explored the use of antipsychotics for pain relief. Jimenez found that, of five different antipsychotic agents investigated, olanzapine yielded the most convincing results. The drug consistently managed pain stemming from fibromyalgia, headache, and migraine—and did so using lower doses than required for psychiatric treatment. "You're using atypical antipsychotics as adjuncts for pain control. So you get the best of both worlds," explained Jimenez, a staff psychiatrist and pain physician at the clinic. "You don't have the overwhelming side effects that you get with higher doses, but you have some analgesic effects." He speculated that olanzapine is characterized by a number of biochemical actions that may indirectly affect pain but conceded that further research is needed.

From "Olanzapine Shows Analgesic Properties, May Help Reduce Chronic Pain"
Pain Medicine News (04/22/2016) Wysong, Pippa

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Assessment May Predict Postoperative Mobility for Older Patients

Researchers have qualified an assessment tool for its ability to enhance planning for postoperative care and even avoid some surgeries in the first place. The study at Wake Forest Baptist Medical Center involved 197 patients aged 69 or older, each of whom underwent four different preoperative evaluations. In addition to a traditional risk assessment, five-point frailty test, and measurement of high-sensitivity C-reactive protein, they were administered the Mobility Assessment Tool: Short Form (MAT-sf). Compared to the other approaches, MAT-sf more accurately predicted postoperative complications, extended hospital stays, and discharge to nursing homes by gauging patient mobility following the procedure. According to the investigators, the other methods perhaps were too specific or focused on the wrong metrics. "Mobility is a powerful indicator of health in the elderly," remarked researcher Leanne Groban, MD, a professor of anesthesiology, "and our results indicate that self-reported mobility, as measured by MAT-sf, can complement existing assessment tools in determining which patients are at risk of adverse postoperative outcomes." The findings from the study appear in the journal Anesthesiology.

From "Assessment May Predict Postoperative Mobility for Older Patients"
United Press International (04/22/16) Feller, Stephen

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Light May Be Effective Treatment for Chronic Pain, Study Says

With no end in sight to the opioid addiction and abuse epidemic, the hunt is on for alternative pain-control strategies. Researchers at Canada's McGill University believe they have uncovered one such option, by using light to control neurons in a process known as optogenetics. In laboratory studies, shining light on peripheral neurons in mice with a light-sensitive trait reduced their sensitivity to touch and heat. While the investigators concede that the technology is not ready for human study, the finding offers promise for a future system of pain management that poses no risk of drug dependency. "Chronic pain is an increasingly big problem clinically and for many years we've relied only on opiates," said Philippe Seguela, a researcher at the Montreal Neurological Institute and Hospital, in a press release. "It's hard to treat because of tolerance, making it necessary to increase dosages, which leads to serious side effects. Optogenetic therapy could be a highly effective way to relieve chronic pain while avoiding the side effects of traditional pain medication."

From "Light May Be Effective Treatment for Chronic Pain, Study Says"
United Press International (04/21/16) Feller, Stephen

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In Pain? Snail Venom May Soothe It

Australian researchers are making progress in the effort to turn snail venom into an analgesic. The team from the University of Queensland managed to shrink—or simplify—a toxin from cone snails so that only the core components remained, a press release reports. They then tested the "conotoxin" in the laboratory, by generating pain in a rat to mimic the symptoms of irritable bowel syndrome in humans. The modified toxin, once introduced into the rat's system, delivered significant pain relief. "Simplifying the conotoxin will make a drug much faster and cheaper to develop," according to researcher Richard Clark, MD, who said the team is already working to improve the conotoxin's efficacy on other types of pain.

From "In Pain? Snail Venom May Soothe It"
DailyRx (04/21/16) Fitzgerald, Erica

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Stem Cells for Personalized Pain Therapy Testing

Stem cells could be the key to testing pain and anticipating a patient's response to an inhibitor medication, researchers report in Science Translational Medicine. They tested the premise on four patients, all suffering from a pain disorder called inherited erythromelalgia (IEM) and all enrolled in a Pfizer clinical trial for a new pain drug. Erythoid progenitor cells were extracted from the participants' blood samples and reprogrammed into induced pluripotent stem cells (iPSCs). From those cells, investigators created laboratory neuron models reflecting each patient's sensitivity to the Pfizer drug. It is suspected that SCN9A mutations in IEM patients, the mechanism that makes them particularly vulnerable to heat pain, contribute to a high rate of spontaneous firing compared to neurons derived from iPSCs contributed by four healthy patients with no SCN9A mutations. "While the physiological responses of the neurons from the four patients may not actually literally be 'pain,' they nonetheless may represent a useful surrogate assay for studying drugs that could alleviate pain in patients," noted University of California, Davis, stem cell researcher Paul Knoepfler, who was not involved in the study.

From "Stem Cells for Personalized Pain Therapy Testing"
The Scientist (04/21/16) Azvolinsky, Anna

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Study: Outpatient Staff Neglect Hand Hygiene 37% of the Time

Despite evidence demonstrating the importance of hand washing in clinical settings, a recent study documented significant levels of noncompliance at outpatient facilities. Researchers recruited medical students to evaluate policies and practices at 15 locations using direct observation and a checklist prepared by the Centers for Disease Control and Prevention. Based on what they saw, hand hygiene was ignored completely 37 percent of the time—even though hygiene supplies were available 100 percent of the time. Staff followed recommended protocol 63 percent of the time overall and 66 percent of the time when administering injections. Safe injection guidelines included not only hand hygiene but also disinfecting the rubber septum, using a fresh needle and syringe, properly disposing of single-dose vials, and dating multi-dose vials once unsealed. "Despite high levels of report of hand hygiene education and observed supply availability, observations of hand hygiene and aseptic injection technique showed lack of similarly high behavior compliance," the researchers from the University of New Mexico and the New Mexico Department of Health reported in the American Journal of Infection Control. "These findings highlight the need for ongoing quality improvement initiatives regarding infection prevention policies and practices in outpatient settings."

From "Study: Outpatient Staff Neglect Hand Hygiene 37% of the Time"
Anesthesiology News (04/18/16)

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Preoperative Videos Help to Cut Patient Anxiety

Being overly anxious before a joint replacement procedure can mean greater and more persistent pain during the recovery period, but research suggests that viewing educational videos beforehand can calm high-strung patients. In an experiment at the Mayo Clinic in Florida, 28 patients received standard preoperative counseling through reading materials and in-person consultations. Their anxiety levels were compared against those of 25 patients who underwent the same protocol but also watched a series of YouTube videos discussing the surgical and hospital experience. While the small scale of the study kept the results from being statistically significant, patients in the video cohort were slightly less anxious that patients who received routine counseling only. The research, reported in the Interactive Journal of Medical Research, dovetails with similar findings presented recently in Munich, Germany, at the European Association of Urology Congress.

From "Preoperative Videos Help to Cut Patient Anxiety"
FierceHealthIT (04/18/16) Bowman, Dan

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Proliposomal Ropivacaine May Offer Valuable New Option for Pain Relief

Based on animal and human testing, Israeli researchers have identified a new pain-relief option that avoids limitations seen with other liposomal local anesthetics. The team from Hadassah Hebrew University Medical Center reports that a single injection of proliposomal ropivacaine alleviates pain for a longer period of time than similar slow-release anesthetics. For example, heat-related pain in human volunteers was managed for 36 hours with the new formulation but for only a third of that time with plain ropivacaine. Meanwhile, relief from pinprick pain lasted about 29 hours with the proliposomal ropivacaine—13 hours longer than with standard preparation of the drug. The new form of anesthetic also is easier to prepare and may be stored at room temperature for as long as two years, compared to a shelf life of less than one or two months for regular, refrigerated ropivacaine. "This is an important advance over existing liposomal preparations," according to Dr. Steven L. Shafer, editor-in-chief of Anesthesia & Analgesia, which reported the findings. "Proliposomal products could significantly extend the duration of pain control after infiltration of local anesthetic—a worthy but so far elusive goal."

From "Proliposomal Ropivacaine May Offer Valuable New Option for Pain Relief"
News-Medical.net (04/15/2016)

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Anxiety and Depression Can Exacerbate Post-Operative Pain

New research suggests that a patient's psychological mindset prior to surgery may dictate how much pain he or she experiences afterwards. The study, published in the British Journal of Pain, involved 304 patients whose anxiety and depression levels—along with their "expected" pain scores—were evaluated ahead of an operation. Postoperative pain scores were then documented at 4 hours and 24 hours. Pre-surgery anxiety was reported in 43 percent of the study population, and depression was reported in 27 percent. Overall, 70 percent of the patients with anxiety suffered severe postoperative pain, compared to 60 percent of patients who were not anxious. "With a high prevalence of anxiety and depression in this study as well as their significant influences on postoperative pain, it may be worthwhile evaluating patients for these mood disorders during their preoperative assessment," the researchers concurred. "Interventions may then be used, where possible, to address these disorders, with the aim of decreasing postoperative pain."

From "Anxiety and Depression Can Exacerbate Post-Operative Pain"
MD Magazine (04/13/2016)

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Guidelines Updated for Optimal Perioperative Geriatric Care

The American College of Surgeons (ACS), in conjunction with the American Geriatrics Society (AGS), has crafted new best practices governing the perioperative care of seniors. The guidelines seek to address changes in the cardiovascular, pulmonary, nervous, endocrine, and hepatic systems of mature adults that can affect their response to anesthesia. Among other topics, ACS and AGS discuss hypothermia prevention and fluid management in geriatric patients after surgery as well as the best way to handle perioperative nausea and vomiting. Pain is also a key point—in particular, the positive outcomes associated with using regional anesthesia for certain procedures and the benefits of multimodal analgesia, with an emphasis on offering alternatives to opioid drugs. The recommendations stop short of endorsing any single approach to anesthesia management for older patients, however, and instead advise anesthesia providers to rely on their best clinical judgment. The guidelines are currently available online at the ACS website and will appear in the publications of both ACS and AGS later this year.

From "Guidelines Updated for Optimal Perioperative Geriatric Care"
Anesthesiology News (04/11/16) Van Voorhis, Scott

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Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed bimonthly to AANA members.

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