Anesthesia E-ssential

AANA Anesthesia E-ssential, August 1, 2019
 
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Review and Comment on the Full Scope of Practice Competency Task Force Draft Recommendations

The Full Scope of Practice Competency Task Force (FSOPCTF), through research and deliberation, has drafted multiple recommendations to support the task force's charges. The draft recommendations are now available to the AANA membership for review and comment. The draft recommendations are for open comment only and should not be cited, referenced, reproduced, or distributed for any other purpose. The open comment period closes on Aug. 14, 2019. Visit www.aana.com/OpenComment (login required) to review each recommendation and provide comments.
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AANA Letter to Editor of AARP Magazine Calls Attention to VA CRNAs

In a letter to AARP Magazine, AANA President Garry Brydges, PhD, DNP, MBA, ACNP-BC, CRNA, FAAN, applauded Secretary Robert Wilkie for his focus on reducing wait times for veterans’ healthcare. He also pointed out one possible solution to the problem which is immediately available to the Secretary: granting full practice authority to VA CRNAs. Read the full letter (member login required).
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Anesthesia E-ssential on Hiatus - Here Comes the Annual Congress!

This will be the last issue of the Anesthesia E-ssential until after the AANA 2019 Annual Congress (Aug. 9-13, 2019, Chicago). Publication will resume on Thursday, August 22. News from the Annual Congress will be relayed through the AANA Congress Daily publication, which will be published next with a preissue on August 5, and then three more issues while Annual Congress is in session. The three issues will be published the evenings of Saturday, Aug. 10; Sunday, Aug. 11; and Monday, Aug. 12. Stories from these issues will be posted on AANA social media platforms throughout those days. See you in Chicago!
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Hot Topics


Agenda, Background Materials, Live Stream Info Available for Annual Business Meeting

The 2019 Annual Business Meeting of the AANA will take place on Saturday, Aug. 10, 2019, at 1:15 p.m., in the Hyatt Regency Chicago hotel. This meeting will be live streamed for viewing by members who cannot attend.

See agenda, background materials and live stream information. (Requires member login)
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Webinar: Enhanced Recovery Update and CRNA Leadership Opportunities

Monday, Aug. 13, 6:30-7:30 p.m. CST, Hyatt (Atlanta Room)/webinar

Join the Enhanced Recovery Shared Interest Group panel live from the AANA Annual Congress for a presentation, discussion, and Q&A regarding the latest enhanced recovery guidelines, intraoperative patient management, and CRNA leadership experiences in implementing enhanced recovery initiatives.

Not able to attend in person? Register for the webinar and be a part of the discussion!
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Data Validation and Audit for MIPS Performance Years 2017 and 2018

The Centers for Medicare and Medicaid Services (CMS) announced the data validation and audit (DVA) of merit-based incentive payment system (MIPS) data from Performance Years 2017 and 2018 will be conducted in 2019. The DVA will cover the Quality, Improvement Activities and Promoting Interoperability (formerly Advancing Care Information) performance categories. MIPS-eligible clinicians will be randomly-selected from different clinician types (e.g. groups or solo practices) and submission methods (e.g. QCDR, CAHPS). CRNAs who are selected for the DVA are currently being notified. If you need information about the DVA process or how to submit information, refer to the MIPS Data Validation and Audit Overview Fact Sheet available on the Quality Payment Program Resource Library website.
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Enrich Your Clinical Skills and Obtain Additional Class A CE Credits with A Selection of Pre-Congress Workshops

The Pre-Congress Workshops take place Friday, Aug. 9, at the AANA Congress in Chicago. The workshops are:
  • 2019 Peer Assistance and Wellness Workshop Program - Full Day; 7.25 Class A CE Credits
  • Ultrasound-Based Acute and Chronic Pain Procedural Workshop - there is a morning and an afternoon session to choose from; 4.00 Class A CE Credits
  • Ultrasound-Guided Peripheral Nerve Blocks: A Focused Review and Clinical Applications - Full Day; 7.25 Class A CE Credits
  • Obstetrical Regional Anesthesia - A Focused Review and Clinical Applications - Full Day; 7.25 Class A CE Credits
  • Fundamentals in Perioperative Transesophageal Echocardiogram (TEE) Workshop - there is a morning and an afternoon session to choose from; 4.00 Class A CE Credits
Learn more and register now.
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NewsMaker: Former AANA President Larry Hornsby Receives Distinguished Service Award

AANA Former President, and University of Alabama at Birmingham (UAB) School of Nursing two-time alumnus, Larry Hornsby, BSN, CRNA, has received the Distinguished Service Award from the Alabama Association of Nurse Anesthetists (ALANA). The award is given to ALANA members who have done outstanding work toward advancing the association and the nurse anesthesia profession.

Hornsby served two terms as president of the ALANA. He also became the only nurse anesthetist from Alabama to serve as president of the American Association of Nurse Anesthetists (2000-01).

The award was presented to Hornsby at the ALANA Spring Meeting on April 27, 2019.

Hornsby and his wife, Carol, a fellow UAB School of Nursing graduate, established the Larry G. and Carol C. Hornsby Family Endowed Scholarship in Nurse Anesthesia — the first scholarship at the UAB School of Nursing designated solely for students of the nurse anesthesia program. Learn more.
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Meetings and Workshops


Annual Congress Product Theater Preview
Promoting Medication Safety

Medication safety was recently discussed at the Anesthesia Patient Safety Foundation Conference. This presentation will further explore continued opportunities for anesthesia providers to promote patient safety through the use of safe medication practice.

Speakers:
  • Mark Warner, MD, President, APSF
  • Bernadette Henrichs, PhD, CRNA, CCRN
  • Lynn Reede, DNP, MBA, CRNA, FNAP
Monday, Aug. 12: 12-1 p.m.
Location: Crystal Ball C, West Tower, Lobby Level, Hyatt Regency Chicago
(Lunch is provided.)

Space is limited and pre-registration is required. Registrants will receive an email and will need to bring the email to the Fresenius Kabi booth (#840) to obtain a ticket for the product theater program. The ticket will provide entrance to the program and lunch. RSVP

Presented by:


Fresenius Kabi logo


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Sunrise Breakfast Symposia Discusses, Demonstrates Ultrasound-guided Regional Anesthesia

The Sunrise Breakfast Symposia on Ultrasound-guided Regional Anesthesia features speakers Andrew R. Biegner, CRNA, MSNA, FAAPM, and Bill Prosser, DNAP, MSN, CRNA. They will discuss published data supporting the use of liposomal bupivacaine in various surgical settings. They also will demonstrate, via live ultrasound and 3D anatomy tools, the optimal approaches for administering liposomal bupivacaine in abdominal field blocks, pectoralis blocks, and interscalene brachial plexus block.

When: Monday, Aug. 12, 6-7:30 a.m.
Location: Crystal Ball C, West Tower, Lobby Level, Hyatt Regency Chicago
(Breakfast is provided.)

Register!

Presented by:
Pacira logo
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Jobs


CRNA Jobs: Locum Tenens and Permanent Placement Opportunities Across the Country

United Anesthesia – Various Locations. United Anesthesia has been a leading CRNA and Anesthesiologist Locum Tenens and Permanent Placement firm in the country for 40 years. By specializing in only anesthesia placement, we can partner with you to find the ideal situation to suit your strengths, your priorities, your dreams. Your dedicated personal coordinator is looking forward to your call! Learn more.
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Chief Certified Registered Nurse Anesthetist: Anesthesia Associates of Lancaster, Lancaster, Pennsylvania

Anesthesia Associates of Lancaster, an independent medical practice, has openings for a Chief CRNA to join our clinical team at a surgery center in Lancaster, PA, and an orthopedic specialty hospital and ambulatory surgery center in York, PA. The schedule is Monday - Friday.

The Chief CRNA is responsible for assisting in the management of AAL nurse anesthetist resources in collaboration with the site Medical Directors and AAL Management. They will retain full-time clinical responsibilities under the medical direction of an anesthesiologist, to administer anesthesia and provide anesthesia-related care to patients of all ages. The Chief CRNA will work to further the mission of AAL in providing high quality anesthesia services at all CRNA-covered facilities. Learn more.
 
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CRNA: The Delta Companies, Fort Collins, Colorado

CRNA - Fort Collins, Colorado
  • 45-minute drive time to Denver
  • Opportunity to live and work in the Front Range
  • Endless recreational opportunities, including proximity to the best skiing in the U.S.
  • Unique cultural offerings, employment opportunities for your spouse
  • Great school systems for your children
  • Some of the best craft brewers and restaurants in the country
  • 300 days of sunshine every year
Quality of life Opportunity — Do not be overworked
  • Private-practice group of 100 Anesthesiologists and CRNAs — Excellent relationship with docs
  • Services to state-of-the-art hospitals and ambulatory surgery centers
  • Place spinals, epidurals, arterial lines, central venous lines, and occasional other regional blocks
  • Weekly shifts are based on scheduling needs (6, 8, 10, 12-hour shifts) and are assigned 2 months in advance
Run your own room — No micromanagement by docs
  • Competitive Salary — Base plus production
  • Relocation provided
  • CME provided
  • Employer contribution towards 401K
  Learn more.
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CRNA Faculty: Marian University, Indianapolis, Indiana

Marian University seeks a highly motivated, energetic, doctoral-program-enrolled or doctoral-prepared Certified Registered Nurse Anesthetist (CRNA) Graduate Faculty to assist in developing and teaching assigned courses in the Nurse Anesthesia Doctor of Nursing Practice (DNP) graduate program. Additionally, this position will advise/mentor program students, serve as a primary advisor on DNP scholarly projects, and work collaboratively with the graduate nursing faculty/Marian University faculty and staff. Candidates who do not currently possess a doctoral degree but are experientially qualified and enrolled in a doctoral program with an expected degree completion within 12-18 months of application may be considered for this position.

Essential Duties and Responsibilities:
  • Designs and delivers course material based on the graduate philosophy, course description, course outcomes, and program outcomes.
  • Translates learning material to online, hybrid, and synchronized classes.
  • Evaluates student work and clinical performance based on outcome rubrics/clinical evaluations.
  • Monitors and evaluates student e-portfolios.
  • Advises/Mentors assigned program students.
  • Serves as an advisor for students DNP Scholarly Projects.
  • Engages in clinical practice to maintain professional skills and serve as a model/resource for faculty and students.
  • Participates in student recruitment, student selection, and public relations.
  • Other duties as assigned.
Learn more

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CRNA: Ohio Health, Columbus, Ohio

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities.

Job Description Summary:
The certified registered nurse anesthetist (CRNA) works under the supervision of a physician anesthesiologist who is a member of the Medical Staff with privileges to provide anesthesia services. Except for emergencies, all anesthetic delivered is done so under the supervision of the attending anesthesiologist.

Minimum Qualifications:
  • Associate's Degree (Required)
  • Advanced Cardiac Life Support - American Heart Association, American Association of Nurse Anesthetists, National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)
  • Certified Registered Nurse Anesthetist – NBCRNA
  • Registered Nurse - Ohio Board of Nursing
Licensed by the State of Ohio as a registered nurse. Registered as a CRNA with the state Board of Nursing. Training program is at least 18 months post-RN. Demonstrates competency in airway management and intubation. Must be familiar with anesthesia-related equipment, including but not limited to anesthesia machines, EKG monitors, scenography monitors, oximetry monitors. Maintain recertification as per NBCRNA requirements. ACLS Certification Insurance requirements are identical to those of the attending anesthesiologist. Learn more
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Director of Anesthesia: Steele Healthcare Solutions, Iowa

Leadership Opportunity for Experienced CRNA in Iowa

Our client seeks an experienced CRNA leader to serve as Director of Anesthesia at an independent, progressive regional hospital serving seven counties in west-central Iowa. This is an excellent opportunity for an innovative leader with a vision to help the hospital grow a very busy department.

The director supervises a staff of five full-time CRNAs as well as serving as a clinical provider of anesthesia care. The CRNA team also offers consultative services to other areas of the hospital requesting assistance in areas pertaining to anesthesia.

Highlights include:
  • In Iowa, CRNAs are licensed independent practitioners that do not require physician supervision
  • Responsibilities: approximately 30% administrative and 70% clinical hours
  • 1 in 6 call
  • Progressive facility with da Vinci XI robotic surgery, and new surgery department EMR
  • Service and team-oriented staff that enjoys strong physician support
  • Highly competitive salary plus full benefits
Learn more


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Nurse Anesthetist CRNA: UNC Health Care, North Carolina

Interested in advancing your career with UNC Health Care?

Within the UNC Health Care System, we're hiring experienced Certified Registered Nurse Anesthetists (CRNAs) for our hospital’s Anesthesiology departments who are passionate about their work and delivering quality healthcare across our organization.

Our anesthesiology departments are dedicated to:
  • Offering a full spectrum of anesthesia care to patients of all ages.
  • Providing excellent and compassionate service to our patients with the latest advances available within the field.
  • Training future CRNAs and engaging in cutting edge basic and clinical research.
UNC Health Care provides a full range of anesthesia services working closely with the clinical departments, and is recognized nationwide as a leader and innovator in healthcare.

UNC Health Care also provides a variety of career opportunities for professional development and growth for our employees. We foster both a friendly, professional teaching environment in a collegial anesthesia care team model. We offer flexible work schedules, competitive salaries, and excellent benefits.

Anesthetizes patients undergoing surgical, medical, obstetrical, diagnostic, psychiatric, or resuscitative procedures either by general, regional, or monitored anesthesia. Functions under the administrative guidelines of the Department of Surgical Services, and under the medical direction of the attending anesthesiologists of the Department of Anesthesiology. Learn more.

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CRNACareers

How Does Your Career Grow?

Are you looking to further your career? CRNA Careers is a valuable resource to help you both in your job search and with your career advancement. It's more than a job board. CRNA Careers is where those searching for fulfillment, opportunity, and challenges go to find helpful career tips, search for jobs, and upload anonymous resumes to be found by recruiters and employers.

Here's how to grow your career on CRNA Careers:

  • Seek and find the best jobs in your industry.
  • Set up job alerts to be notified when the jobs you're looking for are posted on the site.
  • Upload your anonymous resume and allow employers to contact you.
  • Access career resources and job searching tips and tools.

Growing your career requires regular care and cultivation. CRNA Careers has the tools to move your career toward your goals. Learn more today!



 

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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.

Hospital 'Black Boxes' Begin Providing Data That Will Help Reduce Distractions, Errors in Operating Room

Taking a cue from the world of air travel, researchers are showcasing the value of collecting data from "black boxes" placed in operating rooms. About a dozen Canadian, U.S., and European hospitals are trying out the technology, which developers believe could enhance surgical safety on a global scale. Recordings from the embedded cameras and microphones are forwarded to analysts at the Toronto-based International Centre for Surgical Safety. The team there has found that numerous distractions—such as unnecessary chatter and noise from alarms, bells, and telephones—contribute to an unsafe environment, as does malfunctioning equipment. In addition, OR doors open often and for extended periods of time, the scientists report, which potentially compromises what is supposed to be a sterile area. While they are still developing a response for the door issue, one way the team is addressing distractions is through the use of a "time out" protocol, where any member of the OR team can ask for silence.

From "Hospital 'Black Boxes' Begin Providing Data That Will Help Reduce Distractions, Errors in Operating Room"
CTV Calgary (07/23/19) Favaro, Avis; St. Philip, Elizabeth

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Correlation Between Gestational Age and Level of Sensory Block in Spinal Anesthesia

Via retrospective review, researchers examined the implications of gestational age on level of sensory block in spinal anesthesia during cervical cerclage. The team, hailing from Korea's Kyungpook National University, focused on 261 cases performed using hyperbaric bupivacaine between March 2016 and May 2018. They found that for each additional day that the pregnancy progressed, sensory block level rose by 0.04 dermatomes. A positive correlation also was drawn between gestational age and several secondary outcomes, including lower systolic blood pressure both during surgery and in the post-anesthesia care unit (PACU). Length of time in PACU, however, increased after spinal anesthesia. More prospective and controlled study is needed to validate the findings, the investigators conclude.

From "Correlation Between Gestational Age and Level of Sensory Block in Spinal Anesthesia"
Regional Anesthesia and Pain Medicine (08/19) Vol. 44, No. 8 Kim, Hyunjee

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Serotonin Transporter Polymorphism Is Associated with Postoperative Nausea and Vomiting

German and Swiss researchers collaborated on a prospective study exploring possible genetic factors contributing to postoperative nausea and vomiting (PONV). The investigation included two independent cohorts of patients undergoing different surgical procedures between 2008 and 2016 at two separate facilities. Participants —all of whom were of European descent—were classified as having no PONV, intermediate PONV, or severe PONV based on their symptoms. Investigators gathered clinical data up to 24 hours postoperatively and took blood samples for genotyping. In a cohort of 918 patients, the primary predictors for PONV were female gender, nonsmoking status, the SS genotype of the promoter polymorphism in the serotonin transporter 1.5, and patient age. The findings were validated in the other cohort, which included 1,663 patients. While the clinical predictors were already known, the work identified a polymorphism of 5-HTTLPR in the serotonin transporter as a biomarker of PONV that could potentially assist in risk stratification.

From "Serotonin Transporter Polymorphism Is Associated with Postoperative Nausea and Vomiting"
European Journal of Anaesthesiology (08/01/2019) Vol. 36, No. 8, P. 566 Stamer, Ulrike M.; Schmutz, Maxime; Wen, Tingting; et al.

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Single or in Combo: Dexamethasone Reduces Risk of Postoperative Sore Throat During Intubation

Sore throat after tracheal intubation is one of the most common complaints from surgical patients, but a recent study found that dexamethasone can be used alone or with lidocaine to alleviate this discomfort. Both agents have been tapped for this purpose in the past, but the prospective research out of Nepal was the first to evaluate their effect together. The participants all required general anesthesia with prolonged endotracheal intubation lasting longer than 90 minutes. A total of 45 patients were randomly allocated to receive dexamethasone, 44 to lidocaine, 44 to dexamethasone and lidocaine combined, and 43 to normal saline. Dexamethasone reduced the incidence of postoperative sore throat (POST), which occurred at a rate of 36 percent alone and 25 percent when used in conjunction with lidocaine. By comparison, the rate was 43 percent with lidocaine by itself and 56 percent with normal saline placebo. The severity of POST was not influenced by the type of intravenous agent used ahead of anesthesia induction, according to the study authors, who reported their findings in Anesthesia & Analgesia.

From "Single or in Combo: Dexamethasone Reduces Risk of Postoperative Sore Throat During Intubation"
Specialty Medical Dialogues (07/26/19) Baranwal, Medha

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Addition of Morphine to Femoral Nerve Block Improves Post-TKA Analgesia

New study results demonstrate the benefits of adding low-dose epidural morphine to femoral nerve block following knee replacement. The trial participants, 110 in all, received either morphine or a saline placebo based on a randomized process. A patient-controlled intravenous pain pump enabled all enrollees to self-administer morphine as needed. The intervention group and the controls were not materially different with regard to adverse events; however, those who received epidural morphine were less likely to report moderate to severe pain within 48 hours of surgery, used less morphine overall, and generated a higher mental component summary score of 30-day quality of life. The findings appear in PLoS One.

From "Addition of Morphine to Femoral Nerve Block Improves Post-TKA Analgesia"
Clinical Pain Advisor (07/25/19) Rice, Tyler

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Propofol Sedation Alters Perceptual and Cognitive Functions in Healthy Volunteers as Revealed by Functional Magnetic Resonance Imaging

Much is still unknown about the mechanisms behind anesthesia and consciousness, but researchers suspected that deepening sedation hinders semantic function more so than perceptual ability. To investigate further, they worked with 13 healthy volunteers—both while awake and while under light and heavy sedation with propofol—to gauge their ability to discern pure tones and familiar names. The team employed task-based functional magnetic resonance imaging (MRI) to study the effects of sedation on specific cognitive systems. The results indicated that activation on functional MRI imaging in higher cognitive areas—including semantic and phonologic processing—is restricted with deep sedation but only partially suppressed under light sedation. In lower sensory processing, meanwhile, activation appears to be undisturbed by light or deep sedation.

From "Propofol Sedation Alters Perceptual and Cognitive Functions in Healthy Volunteers as Revealed by Functional Magnetic Resonance Imaging"
Anesthesiology (Summer 2019) Vol. 131, No. 8, P. 2540 Gross, William L.; Lauer, Kathryn K.; Liu, Xiaolin; et al.

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News summaries © copyright 2019 SmithBucklin



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

Anesthesia E-ssential is for informational purposes, and its contents should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

If you are interested in advertising in Anesthesia E-ssential contact HealthCom Media at 215-489-7000.

For more information on AANA and Anesthesia E-ssential, contact:

AANA
222 S. Prospect Avenue
Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
Fax: (847) 692-6968

Attn: Cathy Hodson
E–ssential Editor
chodson@aana.com
August 1, 2019