April 30, 2015
At the Mid-Year Assembly AANA Members Take Capitol Hill
For our Seniors, For our Veterans, For our Future
- Recertification Reminder.....
- PQRS Reporting Mechanisms FAQ Webpage Available Now
- AANA Seeking Committee Members for Fiscal Year 2016
- Student Excellence Award Deadline is May 15
- Students and CRNAs Needed for Anesthesia College Bowl
- Need CE Credits?
- Urgent Need for CRNA Volunteer
- Top Five Most Challenging Joint Commission Requirements for 2014
- OSHA Updates Healthcare Violence Prevention Guidelines
- Accelerating the Adoption of a Safety Culture
- Register Now for Business of Anesthesia Conference
- Register Now for the Nurse Anesthesia Annual Congress
- Fall Leadership Academy: Save the Date!
- AANA Names Rep. Jan Schakowsky its 2015 National Health Leadership Award Winner
- Update on the Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care
- Thanks to CRNAs for Supporting the CRNA-PAC’s “Great Moments in Time” Event at the Newseum
- Medicare Agency Issues Revised Information on Payment for Anesthesia Furnished during Screening Colonoscopy
- Medicare Issues Inpatient Hospital Payment Proposed Rule; AANA is Reviewing It for CRNA Impacts
- FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
Healthcare HeadlinesHealthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.
Inside the Association
Are you due to recertify in 2015? About a third of those CRNAs due to recertify this year have successfully completed the process. If you are going through recertification this year, we encourage you to complete your requirements and application for recertification in enough time for the credits to be received by the AANA and NBCRNA, and the application approved before the July 31 deadline. For more information, go to the NBCRNA website at www.nbcrna.com.
PQRS Reporting Mechanisms FAQ Webpage Available Now
AANA Seeking Committee Members for Fiscal Year 2016
Student Excellence Award Deadline is May 15
Students and CRNAs Needed for Anesthesia College Bowl
Need CE Credits?
Urgent Need for CRNA Volunteer
Top Five Most Challenging Joint Commission Requirements for 2014
OSHA Updates Healthcare Violence Prevention Guidelines
Accelerating the Adoption of a Safety Culture
Register Now for Business of Anesthesia Conference
Register Now for the Nurse Anesthesia Annual Congress
Salt Lake City
Fall Leadership Academy: Save the Date!
AANA Names Rep. Jan Schakowsky its 2015 National Health Leadership Award Winner
Update on the Current Status of AANA’s Efforts to Ensure Veterans Access to Quality CareThe AANA and its members continue to advocate for legislation and a Veterans Health Administration (VHA) proposal that would authorize all advanced practice registered nurses (APRNs), including CRNAs, to practice as full practice providers in the VHA and help improve veterans’ access to quality healthcare.
- The AANA is supporting new legislation in the House, H.R. 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). The bill has garnered 19 bipartisan cosponsors – and AANA is requesting that AANA members continue to contact their U.S. Representatives to cosponsor this bill. Please do so here.
- The AANA has expressed strong concerns about legislation in the Senate, S. 297, the “Frontlines to Lifelines Act,” sponsored by Sen. Mark Kirk (R-IL). Unlike the House bill, H.R. 1247, S. 297 recognizes only three of the four APRN specialties for full practice authority in the VHA, omitting CRNAs. The AANA encourages CRNAs to contact their U.S. Senators with similar concerns about S. 297, and to request that the bill be amended to include CRNAs. Please do so here.
- The AANA continues to strongly support the VHA’s efforts to update its Nursing Handbook to recognize CRNAs and other APRNs to their full practice authority, consistent with the recommendations of the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. According to the VHA, the agency intends to publish regulatory rulemaking later this year recognizing CRNAs and other APRNs to their full practice authority in the VHA. Thousands of AANA members have already contacted the VHA in support of this work; AANA members are currently being requested to focus on contacting Congress.
Thanks to CRNAs for Supporting the CRNA-PAC’s “Great Moments in Time” Event at the Newseum
Medicare Agency Issues Revised Information on Payment for Anesthesia Furnished during Screening Colonoscopy
Medicare Issues Inpatient Hospital Payment Proposed Rule; AANA is Reviewing It for CRNA Impacts
- Both the House and Senate are in Washington the week of April 27. you see your legislators or their staff at home, let us know how your visits went by logging your visit on the CRNA-PAC website at https://www.crna-pac.com/legisreport.aspx (AANA login required) and sending us pictures to email@example.com. To see when Congress is in Washington or at home, go toHouse schedule,Senate schedule.
- Stay up to date on CRNA reimbursement issues by obtaining Version 3.1 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150413%20AANA%20Issue%20Briefs%20Regarding%20Reimbursement%203d%20ED%20FINAL.pdf (requires AANA member login and password).
- Engage with your profession’s social media feed on Facebook at https://www.facebook.com/AmericanAssociationofNurseAnesthetists and Twitter at https://twitter.com/aanawebupdates.
- 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 http://www.future-of-anesthesia-care-today.com.
Visit the CRNA Career Center
A study funded by Cornell University determined that surgery patients who sent a text message to a stranger prior to a minor procedure needed less intraoperative pain relief than other patients. The research covered 98 subjects who were randomly assigned to text a companion, text a stranger, play a game on their mobile phone as a distraction strategy, or simply undergo surgery with no intervention. Both texting options curbed the need for supplemental anesthesia compared to standard protocol, which researcher Jamie Guillory, PhD, said is important since a "social support companion" is not always able to be present. Texting a stranger, meanwhile, had a greater impact on pain management during surgery than even the distraction method. The investigators theorized that communications with unknown people were more emotionally positive and reinforced the patient's core values, while texts with companions expressed negative emotions and shared anxiety. "Although at first it seems counterintuitive that text messaging with a stranger was more effective than with a companion, it's the content of the conversation that makes the difference in reducing patients' need for pain relief during surgery," Guillory explained.
Adding Dexamethasone to Brachial Plexus Block Extends Duration and Eases Postoperative Pain
The duration of brachial plexus block can be substantially prolonged when supplemented with perineural dexamethasone, according to research out of Northwestern University. Not only that, lead investigator Meghan Rodes, MD, says her team's meta-analysis indicates that this approach can also generate better postoperative outcomes. The review involved nine studies involving a total of 760 patients under regional anesthesia, with enrollees randomized to receive perineural dexamethasone. The findings showed that analgesia and motor block lasted longer when dexamethasone was added, and those subjects also needed fewer opioid medications following surgery compared to control patients. Rodes said additional research is warranted. "The question is whether we have captured enough patients to determine dexamethasone's true effect," she remarked. "For even though no significant neurologic symptoms were attributed to the use of perineural dexamethasone, you have to use caution anytime you use a medication that's off-label and has potential toxicity."
Anesthesiology News (04/01/15) Vol. 41, No. 4 Vlessides, Michael
Post-Hernia Pain Persists, Even After Intraoperative Efforts
Administering bupivacaine during hernia repair surgery basically has no impact on chronic postoperative pain three months later, researchers report. They studied 357 patients undergoing inguinal hernia repair, finding no statistically significant difference between those who received bupivacaine during the procedure and those who received a saline solution. At 12 months, the researchers also noted no big disparities between the two groups in terms of surgical site infection, bodily pain, physical function, and other markers. The results are published in the journal Surgery.
Outpatient Surgery (04/27/15) Burger, Jim
Scientists Target New Painkillers From Spider Venom
A discovery made by scientists in Australia could lead to the development of new analgesics that work by utilizing spider venom. Researchers isolated seven peptides in spider venom that showed the ability to block pain signals to the brain. The discovery has huge ramifications for the 15 percent of adults in the world who suffer from chronic pain. The biggest advantage is that some experts believe a spider venom-based analgesic would have is that it could prove to be non-addictive. This is because the venom-based analgesic blocks a specific channel that transmits pain signals to the brain, while opiate-based analgesics block opioid receptors in the brain and spinal cord, among other organs. Out of 205 spider species tested, 40% showed signs of at least one peptide that blocked pain channels, the researchers report in the British Journal of Pharmacology.
Wall Street Journal (04/20/15) Pannett, Rachel
Findings reported by researchers at the University of Minnesota suggest that propofol is a safer option than sevoflurane for sedating pediatric patients. The team reviewed the charts of 761 children who were sedated at a single, anesthesiologist-led sedation unit between May and December of 2011. There was no statistically significant difference in procedure or recovery times for kids who received propofol and those who were administered sevoflurane; but the researchers did discover a greater likelihood of complications, especially nausea and agitation, in the sevoflurane patients. Although there are fewer adverse outcomes associated with propofol for pediatric sedation and that is already the more common approach, lead researcher Kumar Belani, MBBS, said sevoflurane is a suitable alternative in some cases—particularly when administered exclusively by anesthesia providers.
Anesthesiology News (04/01/15) Vol. 41, No. 4 Vlessides, Michael
The constitutionality of a lethal injection drug used in Oklahoma is being heard before the nation's highest court, with arguments opening on April 29. The plaintiffs, all currently sitting on death row, complain that midazolam—which also is used in Arizona, Florida, Ohio, and Oklahoma executions—is not approved for painful surgeries and should not be used to carry out capital punishment sentences. The state contends that the sedative is effective, but the inmates say its failure to maintain a coma-like state in the recipient creates an opening for intense pain caused by the other drugs in the fatal cocktail. That, they argue, is tantamount to cruel and unusual punishment. Meanwhile, other states continue to scramble for alternatives as the supply of lethal injection drugs evaporates, largely because foreign manufacturers have prohibited the use of the products in executions and as U.S. pharmacists have united against participation as well. Some say the difficulty in procuring drugs for executions will continue no matter the Supreme Court outcome.
Reuters (04/27/15) Herskovitz, Jon
Rates of Opioid Dispensing and Overdose After Introduction of Abuse-Deterrent Extended-Release Oxycodone and Withdrawal of Propoxyphene
Opioid dispensing and prescription opioid overdoses declined significantly after the introduction of abuse-deterrent extended-release oxycodone hydrochloride and the withdrawal of propoxyphene in 2010. Researchers from Harvard Medical School and Boston Medical Center examined insurance records of 31 million people from 2003-2012 to look for patterns of opioid abuse before and after the market changes took effect. Two years after the changes were made, total opioid dispensing was 19 percent lower than the expected rate, and the estimated overdose rate for prescription opioids had dropped by 20 percent. However, heroin overdoses increased by 23 percent in that time. The researchers call for more research into the issue as well as "complementary strategies that improve recognition and treatment of opioid abuse and addiction, including overdose prevention."
JAMA Internal Medicine (04/20/15) Larochelle, Marc R.; Fang, Zhang; Ross-Degnan, Dennis; et al.
Sleep Apnea Linked to Post-Surgery Atrial Fibrillation
Research has identified obstructive sleep apnea as an independent predictor of postoperative atrial fibrillation (AF) in cardiac surgery patients. Looking at the records of 545 such people—none of whom had an existing history of AF—investigators discovered that 67 percent of the 72 patients with apnea developed AF after their procedures, compared to just 38 percent of the 473 patients without apnea. Because AF was more prevalent among the apnea patients who did not use positive airway pressure therapy systems at home, the researchers suspect the machines could lower risk; but they acknowledged that additional study is needed to confirm this theory. The findings are published in the Journal of Cardiothoracic and Vascular Anesthesia.
HCPLive (04/16/15) Smith, Andrew
Patients with chronic back or neck pain often undergo surgery when opioids fail to deliver complete relief; however, there is mounting concern that people already taking high doses of painkillers may suffer poorer outcomes. Researchers in the anesthesia department at Massachusetts General Hospital conducted a retrospective review of 626 spinal surgery patients, 84 of whom were considered to be opioid tolerant. The analysis showed that 71 percent of opioid-tolerant patients were still taking the narcotics six to 12 months following back surgery, whereas just 28 percent of patients in the control group were. Contrary to fears, however, opioid-tolerant patients did not require greatly increased doses of the drugs to alleviate post-operative pain. Only 22 of the 84 patients needed more painkiller; while 38 were treatable with lower doses, and another 22 did not need the narcotics at all upon discharge.
HCPLive (04/15/15) Scott, Gale
ERAS Approach in Older Patients Lowers Morbidity and Length of Hospital Stay
Researchers have found that older patients undergoing major surgery can benefit from enhanced recovery after surgery (ERAS), a multimodal rehabilitation protocol. The benefits include lower morbidity, reduced hospital length of stay (LOS), and quicker functional recovery. Anesthesia providers and surgeon members from Hospital Universitario Infanta Leonor in Madrid found that ERAS can be successfully applied in patients aged 75 years or older undergoing colorectal tumor surgery. The research team retrospectively analyzed 56 patients, average age 80.12 years, who underwent colorectal tumor surgery in 2013 and received fast-track ERAS. Half of the patients had no postoperative complications, and all those to which the ERAS protocol was applied were able to get out of bed within eight hours after surgery. The authors reported that mean hospital LOS was 9.15 days in ERAS patients, and readmission was only 3.6 percent. Researcher Javier Ripollés Melchor, MD, presented the findings at the 68th New York State Society of Anesthesiologists' PostGraduate Assembly.
Anesthesiology News (04/01/15) Vol. 41, No. 4 Dunleavy, Brian
Community Outbreak of HIV Infection Linked to Injection Drug Use of Oxymorphone — Indiana, 2015
An outbreak of HIV linked with I.V. use of the prescription opioid oxymorphone has affected 135 people in rural Indiana, as of April 21. That number includes 129 confirmed cases and 6 with preliminarily positive results from rapid HIV testing. The patients, aged 18–57 years, are primarily male, and 80 percent of the individuals with confirmed HIV infection reported I.V. drug use. All 108 of those patients reported dissolving and injecting oxymorphone. Interviews with the patients indicated an average of nine syringe-sharing partners and other social contacts who might be at risk for HIV, and as of April 21, about two-thirds of those individuals had been located. Indiana health officials are working to stem the spread of HIV and reduce I.V. drug use, while also building social resilience in the area. The outbreak highlights a number of issues, including the importance of timely HIV and hepatitis C surveillance efforts and the risk that some rural and resource-poor areas are at for drug use, misuse, and addiction.
Morbidity and Mortality Weekly Report (04/24/15) Conrad, Caitlin; Bradley, Heather M.; Broz, Dita; et al.
Hospira Recalls One Lot of Bupivacaine HCl Injection
Hospira has issued a voluntary recall for one lot of preservative-free bupivacaine HCl injection, USP, 0.5% (5 mg/mL), 30 mL single-dose. The recall is being undertaken following a customer complaint of orange and black particles embedded and free floating in a single-dose glass teartop vial. The particles were identified as iron oxide. The affected lot, NDC: 0409-1162-02, Lot 38-515-DK, Expiry 1FEB2016, was distributed from July 2014 to September 2014.
FDA MedWatch (04/24/15)