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Dole Backs VA Proposed Rule for Full Practice Authority

Support continues rolling in for expanding veterans' access to care through full practice authority for CRNAs and APRNs. Bob Dole, Veteran, former Senate Majority Leader, and 1996 Republican candidate for president, writes in Forbes: "Our veterans deserve the very best, most timely healthcare services the VA can provide, and enabling APRNs to practice to the full scope of their education and abilities is a logical, cost-effective and proven safe way for that to happen. We owe it to our nation's heroes."
http://www.forbes.com/sites/realspin/2016/08/11/a-veterans-s
tance-on-proposed-va-rule-to-reduce-wait-times/#15f6c9cc6405
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CPC Facts


CPC Program At-A-Glance

Not entirely clear on the Class A, Class B, and Core Module components of the Continued Professional Certification (CPC) Program? Quickly access a visual overview of the CPC Program, along with a glossary of the program elements, by downloading the CPC Program card. This handy card succinctly explains the eight-year program, comprised of two four-year cycles, Class A and Class B credits, Core Modules, and more.

The NBCRNA CPC Program Toolkit page provides more convenient tools to further your understanding of the program and components. More information on the program is available on the cpc-facts.aana.com and NBCRNA websites.
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Hot Topics


Are You Registered for #NAAC2016? Online Registration Deadline Almost Here!

August 19 is the last day to register online for the AANA Annual Congress. Join us Sept. 9-13 at the historic 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. www.aana2016.com
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2016 Proposed Bylaw Amendments and Resolutions Available Online

The 2016 AANA Bylaws and Standing Rules proposed amendments and Resolutions to be discussed and voted upon at the September 11, 2016, AANA Business Meeting are posted online. See
http://www.aana.com/myaana/AANABusiness/governance/Pages/AAN
A-Annual-Business-Meeting-Agenda-and-Information.aspx
. In the event a member does not have online access, you may request that a hard copy be mailed to you via a message to mscheuermann@aana.com or phone (847) 655-1101.

Please note: The September 11, 2016, AANA Business Meeting will be live streamed at approximately 8:15 am EDT accessible via a link on the business meeting page. Member sign in to the AANA website is required for access; however there is no need for advance registration. This stream will be presented in listen and view only mode. There is no provision for online participation or voting due to current requirements in the AANA Bylaws. Please note that individual internet speeds and locations may affect video quality during the live stream.        
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CMS to Release PQRS Feedback Reports and QRURs in Early Fall

CRNAs will have the opportunity to review their individual or group’s quality reporting performance for the 2015 program year in early fall, according to the Centers for Medicare & Medicaid Services (CMS). The PQRS Feedback Reports will include 2015 PQRS reporting results for eligible professionals, including payment adjustment assessment for 2017. The 2015 Annual Quality and Resource Use Reports (QRURs) will show how groups performed on the quality and cost measures used to calculate the 2017 Value Modifier. To access these reports, you will need to register for an Enterprise Identity Management (EIDM) account on the CMS Enterprise Portal (click “New User Registration” under “Login to CMS Secure Portal”). For assistance regarding EIDM, please contact the QualityNet Help Desk at 1-866-288-8912 or via email at qnetsupport@hcqis.org
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Share Your Research on the AANA Research Abstract Repository

See what your fellow researchers are posting and get involved today: There are over 100 abstracts and research ideas for you to search and view! The AANA Research Abstract Repository is accessible online to AANA members for posting and viewing of research abstracts. This site is provided with the goal of improving the dissemination of knowledge that is critically important to advancing the science, education, and research of anesthesia and the CRNA profession. At no cost to members, all students and CRNAs are encouraged to enter published or unpublished abstracts to the Research Abstract Repository. To post an abstract, you must be one of the individuals involved in the research. Go to the AANA Research Abstract Repository (member login required) and learn more.
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Professional Practice


ECRI Institute Lists top 10 Safety Concerns for 2016

To help guide organizations in deciding where to focus their patient safety efforts, ECRI Institute has developed the 2016 Top 10 Patient Safety Concerns for Healthcare Organizations. Concerns include IT implementation, patient identification errors, and inadequate monitoring for respiratory depression in patients prescribed opioids, among others. Download a complimentary copy of the report here.        
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Upcoming Webinar: Effective Use of Labor Induction
 
Join the Council on Patient Safety in Women’s Health Care for their next Safety Action Series webinar, “Effective Use of Labor Induction to Support Intended Vaginal Birth,” being held on Wednesday, August 24 at 12:30 PM ET. More information and registration at http://safehealthcareforeverywoman.org/safety-action-series/
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Meetings and Workshops


Registration Open Now for Fall Leadership Academy

Learn to lead at any level, in all practice settings, at the Fall Leadership Academy: November 11-13, 2016, in Rosemont, Ill. Featuring more than 20 expert speakers and five educational tracks, Fall Leadership Academy is designed to expand your leadership skills as well as your network of colleagues. Reserve your spot today!
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Save the Dates for These Popular Hands-On Workshops

Visit www.aana.com/meetings for further information and to register!

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

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Foundation and Research

                  
Foundation Fundraiser Features Capitol Steps

Capitol Steps will be performing at the AANA Foundation fundraiser Stepping Out in DC on Sunday, September 11, 2016, from 7 – 11:45 pm at Washington Marriott Wardman Park. Ticket includes dinner, drinks, entertainment, and the Dance Party. We’re in DC during an election year with the Capitol Steps, so for this patriotic event, wearing red, white or blue seems appropriate, or you can even dress as your favorite politician! Click here to register for Annual Congress and purchase your tickets today. If you’ve already registered for Annual Congress, contact Margaret Brennan at (847) 655-1180 to purchase a ticket.
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Support the AANA Foundation’s Annual Fund: Make Your Fiscal Year-End Donation Today!

Please take a moment to make your tax-deductible, fiscal year-end gift to AANA Foundation’s Proof is Power Annual Fund. Click here to access the Foundation’s secure donation page. The fiscal year ends August 31, 2016. Please make your donation today!

Thank you in advance for your support!
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Attend the “State of the Science” at the 2016 Annual Congress

Competitively-selected investigators will present their research in 15-minute sessions at the AANA Foundation’s “State of the Science” Oral Poster Sessions on Monday, September 12. If you are going to Annual Congress, please plan to attend:
  • Monday, September 12, 2016. 10 am – 12 pm (2 CE credits)
  • 1:30 pm – 3:30 pm (2 CE credits)
Washington Marriott Wardman Park Room - Maryland ABC Washington, DC Visit www.aanafoundation.com to view the list of oral and general presenters.
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Federal Government Affairs

                
  
What Did They Say about CRNAs in their Comments to the VHA Proposed Rule on Veterans' Access to Care?

An unprecedented 223,296 comments were submitted to the Veterans Health Administration proposed rule expanding veterans’ access to care through full practice authority for CRNAs and other APRNs by its July 25 deadline. By way of comparison, that’s more than 36 times the total number of comments that the agency received total on more than a hundred regulatory proposals since 2006. There was tremendous support demonstrated for the proposal. A search of the regulations.gov database of letters revealed that 86,381 letters used the phrase “veteran support,” nearly three times more than the 31,802 letters that used the phrase “veteran oppose.”

But volume is one thing. The key influence is, in addition to the AANA’s comments and those of members and other citizens, what did the most important comment letters say?
  • From the Federal Trade Commission professional staff letter: Granting full practice authority to VA-employed APRNs would benefit both the VA and the patients it serves, consistent with the goals expressed in the Proposed Rule…. Furthermore, the VA’s actions and leadership on this issue may send an important signal (and generate useful data) regarding the likely benefits of full practice authority for APRNs.
  • From the letter by AARP, with 3.5 million Veteran members: AARP wants to be clear that it strongly supports full practice authority for all four categories of APRNs. Just as there is a crucial need for improved access to primary care for all consumers, there is a great need for improved access to pain care and pain management among veterans. For example, the Independent Assessment of the VHA mandated by Congress identified delays in cardiovascular surgery tied to lack of anesthesia support and slow production of colonoscopy services compared with care in the private sector.
  • From the letter by the American Hospital Association: As the VA strives to provide timely, accessible and quality care for the millions of veterans, APRNs offer an important part of the solution if they are allowed to practice to the full scope of their education, training and experience.
  • From the letter by the Air Force Sergeants Association and the Iraq and Afghanistan Veterans of America: Our organizations commend your commitment to improving access to exceptional services within the VHA, and believe adopting this important proposal is a positive step toward achieving this goal. We urge the VHA to finalize and begin implementation of this policy for all four APRN provider types, including CRNAs, to improve veterans’ access to the highest quality health care they have earned and deserve.
  • The letter by 13 APRN organizations: With over nine million patients using VHA services across 1,700 VA care sites each year, ensuring an adequate number of qualified health professionals will increase access to safe and high quality care and also help alleviate the significant demand. Consistent with policy in our military health systems and with the recommendations of the National Academy of Medicine and the VA Independent Assessment, strengthening our veterans’ access to care through APRNs practicing to the full extent of their education, skill and professional scope is a common-sense solution whose time has come.
Contrast these with the comments from the American Society of Anesthesiologists that say, “the proposed rule would fundamentally alter anesthesia care delivery in VA and effectively abandon the most prevalent model and the accepted standard of anesthesia care in VA, the physician-led, team-based model of care. Such a change would impact the quality and safety of care available to veterans when nothing in the record shows a need for such a change or addresses the accompanying risk to the safety and quality of care.”

Read the AANA’s news release. See the comments of the AANA, our APRN Workgroup, the AARP, the American Hospital Association, the professional staff of the Federal Trade Commission, the Military Officers Association of America and the Iraq and Afghanistan Veterans of America. See the ASA comment.
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Our States were Strong in the AANA’s VHA Comment Challenge

The AANA set a goal of 33 percent of membership to comment to the Veterans Health Administration (VHA) proposed rule expanding veterans’ access to care through Full Practice Authority for CRNAs and other APRNs. While AANA members certainly delivered – 36.2 percent of membership submitted comments through the association’s Veterans Access to Care Campaign – our work is not yet done until the rule is finalized and implemented.

Each of our state associations participated in a state challenge to have at least 33 percent of their members submit comments, and to have their state association submit a comment. Not only did every state association of nurse anesthetists submit its own comment, but half of our states met our ambitious challenge goal. Congratulations to the following 25 state associations of nurse anesthetists that met their comment challenge goal: Montana (50 percent, leading wire to wire!), Arizona, Oregon, Alaska, Maine, Colorado, Oklahoma, Iowa, South Dakota, Wyoming, Michigan, Kansas, Nevada, Wisconsin, Washington, Texas, Idaho, Hawaii, Nebraska, Vermont, Kentucky, Connecticut, California, Missouri and New Mexico. One more state, New York, made over 90 percent of its goal.

What remains is for the VHA to finalize the rule, for it to be published in the Federal Register, and for it to take effect and be implemented. Stay tuned for additional advocacy opportunities to ensure our voice continues to be heard for our veterans and for our safe CRNA practice.
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Medicare Confirms No Supervising Physician Signature is Required on Medical Records for CRNA QZ Claims, Regardless of Opt-out Status, Reversing Actions of Part B Contractor WPS in Missouri

Medicare has confirmed that CRNA claims for Part B non-medically directed services (modifier QZ) may not be denied payment solely for lack of a supervising operating practitioner or signature, regardless of whether the state in which the service was provided has opted-out from the Part A Medicare physician supervision requirement.

CRNAs billed and received Medicare payment for QZ services without a supervising operating practitioner signature for more than a decade before Medicare instituted the opt-out process in 2001. But the policy and the practice became an issue earlier this year when the Medicare administrative contractor (MAC) Wisconsin Physician Services (WPS) began denying coverage and instituting audits against CRNAs in rural Missouri for lack of a supervising operating practitioner signature on their claims. Those drew the involvement and intervention of the AANA, including multiple letters to and meetings with the MAC and the Medicare agency. The actions by WPS put rural healthcare delivery and access at significant risk.

In a letter dated July 22 to the Missouri CRNAs’ U.S. Representative, acting Medicare administrator Andy Slavitt wrote, “the lack of a supervising physician’s signature in the associated medical records is not a reason to deny a claim…. We have also instructed WPS to modify its medical review practices to ensure that it does not deny claims solely for lack of a supervising physician’s signature in the future.”

While the news from Medicare headquarters is favorable, the issue is not yet fully resolved. One Missouri CRNA in early August – after the Slavitt letter was sent — received an adverse appeal ruling from WPS, with the lack of a supervising physician signature as the primary reason to deny Medicare payment. And so the AANA and Missouri CRNAs are continuing to work on the case. Additionally, the AANA continues to underscore that such practices by WPS – attacking CRNA practice for nonexistent “supervision” documentation demands — further justify repeal of the Medicare supervision requirement on CRNAs.
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CRNA-PAC Update: Strengthen Your Voice in Washington through a Dues Checkoff Contribution and Respond to ASAPAC “DoC” Campaign

During the AANA membership dues cycle now under way, AANA members can renew or begin their support for the profession’s strong voice in Washington this election year in two convenient ways. You can support CRNA-PAC through an AANA dues checkoff contribution, or by clicking www.CRNA-PAC.com and clicking the “Contribute” button.

Need one more reason to support CRNA-PAC? The ASAPAC on August 11 conducted a major online development campaign challenging anesthesiologists to support their PAC. “The Day of Contributing ‘DoC’ challenge will give us the opportunity to help our friends who are already in the House and Senate and further our cause in electing more physicians to Congress,” wrote the chair and secretary of the ASAPAC executive board. “As a reminder, our goal is to raise $300,000 during the ‘DoC’ challenge.”

With Election Day so close, and with such significant issues at hand in Washington shaping CRNA practice and reimbursement, will you join in supporting our CRNA-PAC today? Only your continued voluntary gifts ensure that the CRNA-PAC can be strong for you and your practice on Capitol Hill. Click www.CRNA-PAC.com to learn more and to make a one-time or sustaining contribution.
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Amendments

  • The House and Senate are on recess until after Labor Day. See your lawmakers at home! If you plan to see your legislators in Washington or at home, let us know by emailing info@aanadc.com. You can access the House calendar here and the Senate calendar here to see where your members of Congress will be this summer and fall.
  • At the Republican and Democratic National Conventions, the AANA cosponsored “Decoding 2016: The Future of Healthcare” policy forum luncheons hosted by our media partner Real Clear Politics and attended by numerous health industry and policy leaders – including AANA. Now you can see both conventions’ forums as they happened, with former HHS Secretary Tommy Thompson at the Republican convention in Cleveland, and Clinton and Obama healthcare advisor Chris Jennings at the Democratic convention in Philadelphia. Click here to watch: http://livestream.com/accounts/10079335/events/5816420.
  • Have you seen your legislators at home? Let us know and send them to info@aanadc.com ! Below, AANA members Johnny Garza, CRNA, and Rachel Reidinger, RN, met with Rep. Pete Aguilar (D-CA-31) in his Fontana district office.

 

 
 

 

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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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Jobs


Visit www.crnacareers.com to view or place job postings
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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.

Risk for Chronic Opioid Use Low in Older Surgical Patients

Unlike younger counterparts, patients aged 66 years and up rarely get hooked on opioids following an operation, assert researchers at Toronto General Hospital. The team previously found that of about 39,100 older opioid-naive patients who underwent major elective surgery between 2003 and 2010, only 3 percent were still taking the drugs 90 days later. For the new findings, published in JAMA Surgery, they looked at opioid use in the same study population for 12 months post-procedure. The analysis revealed that slightly more than half of the patients were prescribed opioids three months after surgery, but just 0.4 percent still had an active prescription at the one-year mark. Hance Clarke, MD, an anesthesia provider and director of the hospital's Pain Research arm, explains that most older surgery patients who continue to take opioids are not addicted but are simply trying to manage pain during a long recovery process—for joint replacement surgery, for example. There are exceptions, he acknowledges—specifically, patients with a history of depression or drug abuse—but vigilant doctors will be able to single them out.

From "Risk for Chronic Opioid Use Low in Older Surgical Patients"
United Press International (08/10/16) Feller, Stephen

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Brain-Stimulation Method Provides Significant Reductions in Phantom Limb Pain

By stimulating the brain, transcranial magnetic stimulation (rTMS) is able to significantly reduce phantom limb pain, researchers report. The study authors, from Massachusetts General Hospital and Spaulding Rehabilitation Hospital, compared pain in amputees undergoing two weeks of rTMS with pain in amputees receiving a placebo treatment. The results indicated a clinically meaningful reduction in phantom limb pain in 70 percent of the rTMS patients, who felt relief for as long as 15 days with no serious adverse effects. The research, published in the Journal of Pain, appears to uphold earlier work demonstrating the analgesic benefits of rTMS for people with phantom limb pain.

From "Brain-Stimulation Method Provides Significant Reductions in Phantom Limb Pain"
News-Medical.net (08/10/2016)

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Minorities Suffer From Unequal Pain Treatment

African Americans have been largely insulated from the opioid crisis—possibly due to insurance gaps and a general aversion to the drugs, but also likely due to stereotyping and discrimination. One analysis, which reviewed 20 years of published research, found that African Americans were 34 percent less likely to get prescription opioids for migraines and back or abdominal pain. They were 14 percent less likely to be prescribed them even following surgery or a serious injury. Other studies have also documented the reluctance to treat African Americans with opioids. Researchers surmise that health professionals work under the false belief that African Americans are more likely to abuse drugs. Additionally, some doctors have less empathy for people racially different from themselves and, thus, tend to underestimate their pain. "We may agree that opioids can be harmful and that fewer of them may be a good thing," said Indiana University pain researcher Adam Hirsh. "But we should not ignore that black and white patients are getting treated differently."

From "Minorities Suffer From Unequal Pain Treatment"
New York Times (08/09/16) Goodnough, Abby

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Transdermal Buprenorphine May Ease Neuropathic Pain, With Caveat

New evidence suggests that transdermal buprenorphine, a synthetic opioid analgesic approved for chronic pain, can also alleviate diabetic peripheral neuropathic pain—as long as patients can withstand the side effects. Australian researchers investigated the drug in 186 diabetics with moderate or greater neuropathic pain who failed to respond to conventional non-opioid analgesic therapy. Half were randomly assigned to buprenorphine patch, with the other 93 receiving placebo. Nearly 40 percent of the buprenorphine patients dropped out of the study, however, mostly due to untreated nausea and vomiting. About one-quarter of the placebo patients left the project as well, primarily because of insufficient pain relief. For the 51 buprenorphine patients who remained for all 12 weeks, the benefits were evident. About 86 percent of that group reported pain relief of at least 30 percent with the patch, compared to only about 55 percent of the 63 placebo patients who completed the study. To increase the odds of tolerating the treatment, researchers say caregivers must anticipate the common side effects of opioids, then manage them with patient education and co-prescription of antiemetics and aperients. The study results are published in Diabetes Care.

From "Transdermal Buprenorphine May Ease Neuropathic Pain, With Caveat"
Medscape (08/05/16) Tucker, Miriam E.

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Obesity Linked With Increased Operative Time During THA

Obesity is the primary factor behind prolonged operative time during total hip arthroplasty, according to new findings. A search of the American College of Surgeons National Surgical Quality Improvement Program database yielded a study population of 30,361 patients who underwent the procedure between 2006 and 2012. Linear models based on patient characteristics, body mass index and other comorbidities, and type of anesthesia were then used to identify independent predictors of longer operative time and overall room time. Morbid obesity was the top contributor, extending operative time by 13 minutes, while general anesthesia added 11 extra minutes. Being male, white, or a smoker also increased operative time; and there was an association with age as well. While all of those factors had a similar effect on overall room time, the biggest predictor for that outcome was congestive heart failure—which tacked on another 20 minutes.

From "Obesity Linked With Increased Operative Time During THA"
Healio (08/05/2016) Tingle, Casey

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Which Anesthesia Regimen Is Best to Reduce Morbidity and Mortality in Lung Surgery?

Swiss researchers conducted the first multi-center, randomized study to compare complications with volatile anesthetics versus intravenous anesthesia during thoracic surgery with one-lung ventilation. Previous findings have suggested that volatile anesthesia lessens the risk for hypoxia-reoxygenation damage to the lung that is deflated and then reventilated during such procedures. With that in mind, the investigators theorized that volatile anesthesia would outperform IV anesthesia in terms of postoperative complications. That assumption proved false, however, with 230 patients who received propofol producing similar outcomes to 230 patients who were administered desflurane. The rate of major complications prior to hospital discharge was 16.5 percent in the propofol group and 13 percent in the desflurane patients. At six months, the rate of major complications was 40.4 percent for propofol and 39.6 percent for desflurane.

From "Which Anesthesia Regimen Is Best to Reduce Morbidity and Mortality in Lung Surgery?"
Anesthesiology (08/16) Vol. 125, No. 2, P. 313 Beck-Shimmer, Beatrice; Bonvini, John M.; Braun, Julia; et al.

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Vexing Question on Patient Surveys: Did We Ease Your Pain?

With hospital surveys typically asking discharged patients to score how well caregivers managed their pain, anecdotal evidence suggests doctors often prescribe opioids as a buffer against low marks. They and others say patients have unrealistic expectations that their pain will be completely and quickly erased, aided by prescription drugs. While a Health and Human Services Department spokesman said there is no solid proof tying patient-satisfaction ratings to inappropriate prescribing behavior, he said the wording on an inpatient poll required under federal law is being amended to avoid "any unintended, negative influence over prescribing practices." The questions in place now inquire about the efficacy of pain treatment, but the new ones will be geared more toward doctor-patient communication about pain. They may even eventually be worked into Medicare reimbursement formulas for hospitals. A similar effort in 2013 failed, forcing the Obama administration to table it for the time being. Some doctors insist that survey questions about pain are an ineffective gauge of medical competence, given the highly individualized and subjective nature of pain. Others believe patient views on pain deserve to be heard but agree that how the question is posed should be tweaked. For example, rather than asking "did staff members do everything they could for your pain?" Indiana health commissioner Jerome M. Adams, MD, suggests asking: "Did staff set reasonable expectations for what your pain should be?"

From "Vexing Question on Patient Surveys: Did We Ease Your Pain?"
New York Times (08/05/16) P. A14 Hoffman, Jan; Tavernise, Sabrina

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Illicit Use of Gabapentin on the Rise

Gabapentin, which by itself is not usually associated with abuse and addiction, is becoming a problem as it increasingly is being taken in conjunction with opioids. This combination—as well as pairing gabapentin with muscle relaxants or antidepressants—can leave patients in a state of euphoria. Researchers from Indiana presented evidence of the trend at the recent AACC Scientific Meeting & Clinical Lab Expo, where they reported results of urine testing on 323 patients over five months. The majority, 74.3 percent, screened positive for prescribed drugs and negative for non-prescribed drugs. However, more than 21 percent screened positive for non-prescribed gabapentin; and 66 of those 70 patients were also prescribed opioids, opioids in conjunction with benzodiazepines or cyclobenzprine, or other substances. "While gabapentin is relatively safe and has a low potential for serious adverse effects, even in large doses, negative effects may occur when concomitant use with other CNS depressants occurs," according to the study authors.

From "Illicit Use of Gabapentin on the Rise"
Neurology Advisor (08/05/16) Ciccone, Alicia

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Neuraxial Anesthesia Use in ERAS Pathway Lowers SSIs in TKA

To delve deeper into the link between anesthetic approach and surgical site infection (SSI) following total knee or hip replacement, a team from Johns Hopkins School of Medicine conducted a meta-analysis of existing research. The review, encompassing more than 362,000 patients across 14 studies, noted a significant decline in SSIs with neuraxial anesthesia versus general anesthesia for all arthroplasties. When considered individually, however, SSIs were significantly—and inexplicably—lower for knee replacements, but not for hip replacements. Despite that puzzling development, Johns Hopkins anesthesiology professor Christopher Wu, MD, believes there is a place for neuraxial analgesia in enhanced recovery after surgery (ERAS) pathways for total joint arthroplasty. Before that can happen, he adds, prospective, randomized trials are needed. He reported the results of the meta-analysis at the 2016 annual meeting of the American Society of Regional Anesthesia and Pain Medicine.

From "Neuraxial Anesthesia Use in ERAS Pathway Lowers SSIs in TKA"
Anesthesiology News (08/01/16) Vlessides, Michael

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Effect of Regional vs. Local Anesthesia on Outcome After Arteriovenous Fistula Creation

Researchers believe choice of anesthetic technique may play a role in the maturation of arteriovenous fistulae, created to gain vascular access, in patients with end-stage renal failure. Fistulae lead to fewer serious adverse events and deaths than tunneled central venous catheters in this patient population, but roughly one-third of arteriovenous fistulae experience early failure. Because anesthetic strategy influences some of the contributing factors—early postoperative blood flow, arterial and venous diameters, and arterial inflow, specifically—U.K. researchers compared outcomes using regional and local anesthesia. Noting that regional anesthesia produces greater vasodilation and increases short-term blood flow, they hypothesized that it would improve medium-term fistula patency. As part of a randomized, controlled trial, 63 patients undergoing fistula creation were administered a subcutaneous injection of bupivacaine and lidocaine while another 63 received a brachial plexus block. After three months, arteriovenous fistula patency was greater in the block patients than in the patients who received local anesthesia. Both approaches, however, avoid the risks of general anesthesia—which has been associated with cardiorespiratory complications in patients with end-stage renal failure.

From "Effect of Regional vs. Local Anesthesia on Outcome After Arteriovenous Fistula Creation"
The Lancet (08/01/2016) Aitken, Emma; Jackson, Andrew; Kearns, Rachel; et al.

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Peripheral Nerve Block Associated With Low Postoperative Complication Rate

Foot and ankle surgeries performed under peripheral nerve block produce few complications, research shows. For the study, investigators compiled data for more than 2,700 operations carried out during a two-year period ended in October 2014. Postoperative complications were categorized as likely, possibly, or definitely not attributable to the block. Of only 290 complications overall, 195 were possibly related to the regional anesthesia. Serious complications were limited to 20, with just 16 left unresolved. "The use of the peripheral nerve blocks … is associated with a low postoperative complications rate of 7.2 percent," confirmed Grace Kunas, BA, who presented the findings during the American Orthopaedic Foot & Ankle Society Annual Meeting in July. "Most of the complications are neurological in nature, and the majority of complications are un-attributable to the blocks."

From "Peripheral Nerve Block Associated With Low Postoperative Complication Rate"
Healio (07/28/2016) Tingle, Casey

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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.

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.

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August 15, 2016
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