AANA Anesthesia E-ssential
Anesthesia E-ssential

April 30, 2015


Vital Signs

At the Mid-Year Assembly AANA Members Take Capitol Hill
For our Seniors, For our Veterans, For our Future
Over a thousand CRNAs and student registered nurse anesthetists took Capitol Hill the week of April 21 as part of an AANA Mid-Year Assembly program focused on promoting access to care “for our seniors, for our veterans and for our future.”
Including a first-ever AANA member rally on the west front of the U.S. Capitol building, AANA members heard from healthcare industry thought leaders like Katherine Baicker, PhD, from Harvard University and MedPAC, Sean Cavanaugh from the Centers for Medicare & Medicaid Services, Phil Cox and Colm O’Comartun formerly with the Republican and Democratic Governors Associations, grassroots advocacy specialist and author Amy Showalter, and members of the AANA elected leadership and staff team.
On Capitol Hill, AANA members thanked members of the House and Senate for enacting Medicare payment reforms and permanently repealing the “sustainable growth rate” (SGR) cuts that threatened to reduce the average CRNA’s income by some $15,000 over a year. Lawmakers also were urged to support the Veterans Health Administration (VHA) modernization of its nursing handbook to expand Veterans access to quality care by recognizing APRNs including CRNAs to their Full Practice Authority, strengthen rural healthcare, and fund APRN and nurse anesthetist workforce development.
At the first-ever Rally for CRNAs on Capitol Hill, President Pearce and President-elect Quintana addressed hundreds of AANA members on the west front of the U.S. Capitol building. Cherie Burke photo.



The Pulse

  • 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
  • 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


Recertification Reminder…

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
The AANA is pleased to announce the release of its new PQRS Reporting Mechanisms FAQ page, which will guide CRNAs with selecting an appropriate reporting method so that they have a better chance of avoiding the negative payment adjustment for 2017. For additional information on PQRS, please visit our AANA website resource titled Quality-Reimbursement
The Physician Quality Reporting System (PQRS), a Centers for Medicare & Medicaid Services (CMS) quality initiative program that uses negative payment adjustments to promote reporting on quality measures, offers several reporting mechanisms for solo practitioners and group practices. Depending on their specialty, setting, and practice, CRNAs may choose from the following methods: Medicare Part B Claims; Electronic Health Record (EHR); Qualified Registry; Qualified Clinical Data Registry (QCDR); and Group Practice Reporting Option (GPRO). In order to satisfactorily report, it is important for you to review each method’s specific criteria and requirements to determine which reporting mechanism is best for you or your practice.

AANA Seeking Committee Members for Fiscal Year 2016
Deadline is May 15
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, 2015. Please note: If you currently serve on a FY15 committee, you must reapply for FY16.

Student Excellence Award Deadline is May 15
The Education Committee will present a Student Excellence Award at the 2015 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. Click here for rules and guidelines.

Students and CRNAs Needed for Anesthesia College Bowl
Deadline: June 1, 2015
The annual Anesthesia College Bowl at the AANA Nurse Anesthesia Annual Congress will once again be a rousing battle of the brains between the 2015 Student Champion Team and a CRNA Challenge Team. For further information, click here.

Need CE Credits?
The recertification period is now open, and the July 31 deadline is coming up fast. AANALearn can help with a plethora of courses. AANA members save 30 percent every day. Find out more.

Urgent Need for CRNA Volunteer
International Relief Teams, a San Diego based relief organization, has an urgent need for a CRNA to join their ENT surgical mission to Honduras on June 14-23, 2015. The team of six volunteers will be working in a 26 bed hospital that serves an impoverished population in the small town of Sula, located three hours from San Pedro Sula. To join or for more information, please contact Rose Uranga at ruranga@irteams.org or (619) 284-7979.

Top Five Most Challenging Joint Commission Requirements for 2014
The Joint Commission collects data on organizations’ compliance with standards, National Patient Safety Goals, the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery™, and Accreditation and Certification Participation Requirements to identify trends and focus education on challenging requirements. View the five Joint Commission requirements identified most frequently as “not compliant” during surveys and reviews from January 1-December 31, 2014 at http://www.jointcommission.org/assets/1/23/jconline_April_8_15.pdf.
OSHA Updates Healthcare Violence Prevention Guidelines
The Occupational Safety and Health Administration (OSHA) recently released an update to its Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. The publication includes industry best practices and provides insight on how to reduce the risk of violence in various healthcare and social service settings.
Accelerating the Adoption of a Safety Culture
The March/April 2015 issue of Healthcare Executive magazine features an interview with Ana Pujols McKee, MD, executive vice president and chief medical officer at The Joint Commission, discussing how to build a culture of safety. Read the article "Accelerating the Adoption of a Safety Culture" to find out why McKee says it is "probably the most challenging work that a healthcare organization has to do."

Register Now for Business of Anesthesia Conference
Join us in San Diego on June 26-27 for a two-day conference 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. Whether you are still in training or have owned your practice for years, you’ll benefit from best practices and strategies for success in an ever-changing healthcare climate. Register before May 26 and Save $50!
Register Now for the Nurse Anesthesia Annual Congress
August 29-Sept. 1
Salt Lake City
The Nurse Anesthesia Annual Congress is the world's largest educational, professional, and social event for Certified Registered Nurse Anesthetists. Choose from seven education tracks, including practical hands-on learning and networking, in addition to the largest exhibit of its kind. Register Now!
Fall Leadership Academy: Save the Date!
November 6-8, 2015
Westin O'Hare, Rosemont, Ill.
Watch the AANA website and future issues of the NewsBulletin and E-ssential for more information!

AANA Names Rep. Jan Schakowsky its 2015 National Health Leadership Award Winner
During Mid-Year Assembly, AANA President Sharon Pearce CRNA MSN and a delegation of Illinois CRNAs and nurse anesthesia students presented U.S. Rep. Jan Schakowsky (D-IL) with the AANA 2015 National Health Leadership Award.
“Congresswoman Schakowsky, for your leadership advancing the patients, practice and profession of nurse anesthesia, the AANA Board of Directors has named you the winner of the AANA 2015 National Health Leadership Award,” said President Pearce. “As a member of the influential Energy and Commerce Committee, you have played a significant role in almost all major CRNA issues, from the Patient Bill of Rights, to provider nondiscrimination in the Affordable Care Act, and most recently for our veterans. Recently you and Congressman Graves introduced H.R. 1247, the Improving Veterans Access to Quality Care Act. This legislation recognizes all APRNs in the VA, including CRNAs, to their Full Practice Authority. For that and so much more, we say thank you.” The 10th District of Illinois represented by Rep. Schakowsky includes the AANA national headquarters in Park Ridge.
Pictured with Rep. Schakowsky (seated) are AANA President Pearce (center), President-elect Quintana (center left), EDCEO Wilson (center right), and CRNAs and student nurse anesthetists from the state of Illinois.
Update on the Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care
The 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.
Clear understanding of the complex procedural aspects of this VHA issue is critical to knowing what to say to your lawmakers in support of veterans access to care delivered by CRNAs. In short:
  • 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.
Since mid-February, AANA members have sent over 12,000 messages to their federal legislators expressing support for H.R. 1247 and concern for S. 297 as written.
If you have not already done so, please contact your Representative and request that they cosponsor H.R. 1247: https://www.crna-pac.com/actionalerts.aspx. If you have not yet contacted your Senators, take action today and request that they refrain from cosponsoring or supporting S. 297 until it is amended to include CRNAs: https://www.crna-pac.com/actionalerts.aspx (requires AANA member login and password). 
Thanks to CRNAs for Supporting the CRNA-PAC’s “Great Moments in Time” Event at the Newseum
Some 350 AANA members raised over $75,000 in support of the CRNA-PAC during its Mid-Year Assembly event titled “Great Moments in Time” located in the Washington, D.C., Newseum.
Organized by the CRNA-PAC Committee chaired by Rick Jueneman CRNA, the event featured a silent auction and dozens of AANA members who took the opportunity to dress as famous historical figures, including flappers from the 1920s, the sailor and the nurse from V-J Day on Times Square in 1945, flower children from the 1960s, and founding father Ben Franklin.
On behalf of the PAC Committee, thank you to all of the AANA members and staff who made the event a huge success!
Medicare Agency Issues Revised Information on Payment for Anesthesia Furnished during Screening Colonoscopy
The Centers for Medicare & Medicare Services (CMS) on April 3 issued a revised transmittal on preventive and screening services, which includes important information on anesthesia associated with screening colonoscopies.  Following an AANA inquiry regarding denials by Medicare carriers of the use of the PT modifier for anesthesia cases for screening colonoscopies that start as screenings but finish as diagnostic cases, the new transmittal states: “When a screening colonoscopy becomes a diagnostic colonoscopy, anesthesia code 00810 should be submitted with only the PT modifier and only the deductible will be waived.”
This transmittal implements a provision issued in the final rule of the CY 2015 Physician Fee Schedule covering the separate anesthesia service without patients having to pay out of pocket when the service is provided in relation to colorectal cancer screening.  It also modifies Medicare’s December 2014 transmittal on the policy.  Read the revised transmittal at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3232CP.pdf.
Medicare Issues Inpatient Hospital Payment Proposed Rule; AANA is Reviewing It for CRNA Impacts
The Medicare agency on April 17 issued in preview its 2016 hospital inpatient prospective payment system (IPPS) proposed rule, and planned to publish it in the Federal Register on April 30.  Governing hospital regulatory and payment policy in the next year, the rule is annually important to CRNA practice, and indirectly affects CRNA reimbursement.
Among other issues that the AANA is reviewing is that the proposal seeks comment on the potential future expansion of the Medicare Bundled Payments for Care Improvement (BPCI) initiative. Comments are due June 16.
Read the proposed rule in preview at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-09245.pdf until April 30 when it is published in the Federal Register. Read more about the proposed rule at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-04-17.html.
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.


Study: Text-Messaging Strangers Reduces Need for Pain Relief During Minor Surgeries
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.
From "Study: Text-Messaging Strangers Reduces Need for Pain Relief During Minor Surgeries"
News-Medical (04/28/15)
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."
From "Adding Dexamethasone to Brachial Plexus Block Extends Duration and Eases Postoperative Pain"
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.
From "Post-Hernia Pain Persists, Even After Intraoperative Efforts"
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.
From "Scientists Target New Painkillers From Spider Venom"
Wall Street Journal (04/20/15) Pannett, Rachel
Propofol Safer Than Sevoflurane in Ped Sedation, Study Finds
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.
From "Propofol Safer Than Sevoflurane in Ped Sedation, Study Finds"
Anesthesiology News (04/01/15) Vol. 41, No. 4 Vlessides, Michael
Oklahoma Lethal Injection Drug Faces U.S. Supreme Court
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.
From "Oklahoma Lethal Injection Drug Faces U.S. Supreme Court"
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."
From "Rates of Opioid Dispensing and Overdose After Introduction of Abuse-Deterrent Extended-Release Oxycodone and
Withdrawal of Propoxyphene"
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.
From "Sleep Apnea Linked to Post-Surgery Atrial Fibrillation"
HCPLive (04/16/15) Smith, Andrew
Back Surgery OK for Opioid-Tolerant Patients
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.
From "Back Surgery OK for Opioid-Tolerant Patients"
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.
From "ERAS Approach in Older Patients Lowers Morbidity and Length of Hospital Stay"
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.
From "Community Outbreak of HIV Infection Linked to Injection Drug Use of Oxymorphone — Indiana, 2015"
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.
From "Hospira Recalls One Lot of Bupivacaine HCl Injection"
FDA MedWatch (04/24/15)
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