AANA Anesthesia E-ssential

Vital Signs

New AANA Video Tells CRNA Story with Power and Passion

Featuring high praise from a hospital CEO and physicians who work closely with CRNAs, the AANA’s new video, CRNAs: The Future of Anesthesia Care Today, effectively promotes the role and value of CRNAs in the U.S. healthcare system.

The AANA will soon be delivering CRNAs: The Future of Anesthesia Care Today and its message about patient access to safe, cost-effective anesthesia care directly to hospital administrators, patient care team members, policymakers, and even the patients cared for by CRNAs.

Individual members can also use the video to get the word out about nurse anesthesia. Here’s how:
  • Share it via Facebook, Twitter, and other social media
  • Link to it in emails to legislators, healthcare colleagues, patients, and others as appropriate
  • Show it during in-person lobbying visits with state legislators
  • Bring it to the attention of your facility administrator
  • Show it to your colleagues as part of an in-service at your facility
  • If you speak to the general public on healthcare topics, work the video into your presentation
  • Ask your facility’s PR Department to include the video on the facility website
  • Use the video as part of your 2016 CRNA Week celebration
Get creative, and tell us what other ways you came up with to share the video! Write to PR@aana.com.
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CPC Facts

Core Modules

The core modules are a way for nurse anesthetists to stay informed about areas of anesthesia practice that are common to all CRNAs, regardless of practice focus. Continuing education (CE) providers who participate in the core module program will use a common set of objectives to develop core modules. NBCRNA will not produce core modules. Core modules are voluntary for the first four-year cycle. For more information about the NBCRNA's Continued Professional Certification (CPC) Program, which will launch on August 1, 2016, go to the cpc-facts.aana.com and NBCRNA websites.
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Hot Topics

Happy Holidays—And See You Next Year!

Due to the holidays, Anesthesia E-ssential will not come out on December 30, 2015, and will resume publication with the January 15, 2016, issue. The E-ssential staff wishes all of our readers a joyous holiday season, and we look forward to serving you in 2016.
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AANA Holiday Hours

The AANA Park Ridge and Washington, D.C. offices will be closed from December 24 through January 3, reopening Monday, January 4, 2016. Please note: AANA Insurance Services will be open on December 28, 29, and 30.
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Research and Quality Website Makeover Coming Soon

With the coming new year, the AANA Research and Quality Division will be revamping our website pages. With the 2015 PQRS reporting period coming to an end, we will be adding all of the new 2016 PQRS reporting information to our Quality-Reimbursement FAQ pages as it becomes available from the Centers for Medicare & Medicaid Services (CMS). We are also updating the look and content of our myAANA pages with a new Research and Quality Resources landing page as well as two new separate pages for my AANA Research and myAANA Quality resources (member login required).
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Important CRNA Week Deadlines: Order Your Promo Items Soon!

Thinking about ordering promotional items for CRNA Week 2016? Then here are some important deadlines you need to know about as 2016 approaches: 1) The AANA offices, including the Bookstore, will be closed for the holidays December 24-January 4. Orders received by close of business on Friday, December 18, will be guaranteed to ship before December 24. 2) National CRNA Week will be celebrated January 24-30, 2016. The last orders for remaining promotional items will be accepted on Wednesday, January 20. Please note: Inventory does start to run out after the first week in January, so if there are pens, buttons, posters, or other items you simply must have to complete your promotional plans, visit here to place your order today!
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Research Shows that Brochures Engage Patients

Did you know that new research shows that when informational brochures about anesthesia are given to patients a few days before surgery, the patients are more likely to ask questions and seek additional input from their provider? Learn more at http://www.medscape.com/viewarticle/853999, and be sure to order free AANA brochures such as “Before Anesthesia,” “After Anesthesia,” and “Anesthesia Options for Labor and Delivery” as part of your 2016 CRNA Week strategy to help educate your patients.
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New! AANA Connect Mobile App is Ready to Download

Are you connected? Join thousands of your peers for relevant discussions in the secure environment that is the AANA Connect private community—now on mobile app! See what all the buzz is about. Download the AANA Connect app from iTunes for Apple or Google Play for Android devices. www.aanaconnect.com
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Nominations Sought for AANA Recognition Awards: Deadline March 15

The AANA is seeking nominations for the following recognition awards, to be presented at the Nurse Anesthesia Annual Congress: Agatha Hodgins Award for Outstanding; Accomplishment; Helen Lamb Outstanding Educator Award; Alice Magaw Outstanding Clinical Practitioner Award; Ira P. Gunn Award for Outstanding Professional Advocacy; Clinical Instructor of the Year Award; Didactic Instructor of the Year Award; and Program Director of the Year Award. Visit www.aana.com/awards for further information and to download a nomination form. The deadline for receipt of nomination is: March 15, 2016.
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AANA Journal Course #35, Part 2 is Now Available

The 10-question exam offers AANA Members 1 complimentary Class A credit upon successful completion. This is the second of 6 online journal course examinations that will be available to you this year as part of your AANA membership. You will receive 1 complimentary Class A CE credit for the successful completion of each of the 10-question journal course exams, for a total of 6 Class A CE credits. Be sure to take advantage of this valuable member benefit. Log into AANALearn.com to access AANA Journal Course No. 35, Part 2: Venous Thromboembolism: New Concepts in Perioperative Management.
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Nomination Deadline for Daniel D. Vigness Federal Political Director Award is January 15

Is your state’s Federal Political Director (FPD) awesome? Then nominate him or her for the Daniel D. Vigness Federal Political Director Award, which is presented during AANA Mid-Year Assembly in April 2016. Named for the late Dan Vigness, CRNA, of South Dakota, the first AANA FPD of the Year, this honor recognizes a CRNA who has been involved in federal political campaigns, developed close working relationships with federal officials, led successful CRNA advocacy efforts, helped contribute and raise funds for the CRNA-PAC, and helped recruit CRNAs to participate in political campaigns. To learn more and to submit a nomination, go here.
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Nomination Deadline for Service on the 2016-17 CRNA-PAC is January 31

If you or a colleague would like to serve on the CRNA-PAC Committee, Jan. 31 is the deadline for submitting an application online. In September 2016, the nine-member committee will have two CRNA vacancies, each for three-year terms. One student registered nurse anesthetist vacancy will also open for a one-year term. Two members of the AANA Board of Directors serve on the CRNAPAC Committee, each for a one-year term that may be renewed for one additional year while the member also serves on the Board.

To learn more about the CRNA-PAC Committee, see this link. To submit a CRNA nomination, please click here (AANA login required).
To submit a student nomination please click here.
(AANA login required) and see the additional requirements here (AANA login required).
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Have a Safe and Well Holiday Season!

AANA Health & Wellness wishes you and your families the best during this time of year. Tips to keep healthy – eat well, get enough sleep, avoid germs, drink wisely in moderation, make time to be physically active, reach out to help the needy in your community, and savor your family, friends, and holiday traditions. See Wellness Milestones articles (www.AANA.com/WellnessMilestones) on Seasons and Holidays and maintaining your well-being. This season can be hard on emotional wellness and may not be joyous for everyone. It’s especially difficult for anyone facing seasonal depression, emotional crisis, or recent loss; challenging to those in recovery to maintain sobriety; perilous for those contemplating suicide and battling active addictions. Remember, there is always help available — reach out to a loved one and your doctor. If you need help with substance use disorder/addiction, contact AANA Peer Assistance (see www.AANA.com/GettingHelp or call 800/654-5167).
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Professional Practice

AAAHC Requires Written Infection Control Risk Assessment for 2016

Beginning in 2016, AAAHC Standard 7.I.B will require a written risk assessment for infection control. While AAAHC does not prescribe the risk assessment method, developing an assessment tool that identifies and ranks risks will make the process easier and help organizations prioritize addressing these risks. Areas to consider ranking in the risk assessment include the community and population served, staff and providers, environment of care, care and medication practices, disinfection and sterilization, surveillance, and an emergency management plan. For more information, please read AAAHC’s November 2015 Connection Risk Assessment newsletter.”
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Joint Commission Controlled Substance Storage Standard

Hospitals who fail to follow their own controlled substance storage policy may be cited for noncompliance with MM.03.01.01 EP 3. This standard states, “The hospital stores all medications and biologicals, including controlled (scheduled) medications, in a secured area to prevent diversion, and locked when necessary, in accordance with law and regulation.” Joint Commission surveyors ask about the hospital’s drug diversion strategy, including the plan to properly store and account for controlled substances. One system recommended by Joint Commission, but not required to meet the standard, is drug detection prevention software, which has proven effective in identifying drug diversion patterns. See Top Joint Commission Compliance Patterns.
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Joint Commission Issues Quick Safety Advisory on Transitions of Care and Patient and Family Engagement

The advisory describes the role of the patient and family to support safe, quality transitions of care from one setting to another. It defines “patient engagement,” “patient activation,” and “patient-centered care.” The seven foundations of safe, quality transitions of care listed in the advisory are leadership support, early risk identification, thorough psychosocial assessment, multidisciplinary team involvement, patient and family engagement, medication management, and information transfer. Read the advisory here.
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Joint Commission Standard on Succinylcholine Storage

Joint Commission-accredited organizations must follow the manufacturer’s beyond use date (BUD) when storing succinylcholine on the anesthesia cart. Citing Medication Management standard .03.01.01, Storage and Security of Medications, surveyors are finding hospitals often do not following manufacturers’ recommendations for storage and use of refrigerated medications, including succinylcholine. While manufacturers recommend refrigerator storage of succinylcholine to prolong its shelf life, this medication is typically kept at room temperature in anesthesia carts in the OR so that it is readily available during procedures. Manufacturers may provide a BUD when succinylcholine is stored at room temperature that reflects testing. According to Joint Commission Resources, however, hospitals may try to extend the BUD using supporting literature. This leads to noncompliance because under the standard the manufacturer’s recommendation supersedes literature-based recommendations. For more information, read Top Joint Commission Compliance Challenges.
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OSHA Launches Webpage to Provide Employers and Workers with Strategies and Tools to Prevent Healthcare Workplace Violence

This webpage complements updated OSHA Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers and is part of OSHA’s Worker Safety in Hospitals website. It provides examples from healthcare organizations that have successfully established workplace violence prevention programs, as well as program models. The new strategies and tools include:
  • management commitment and worker participation
  • worksite analysis and hazard identification
  • hazard prevention and control
  • safety and health training
  • recordkeeping and program evaluation
For more information, read OSHA’s trade release .
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The Joint Commission Alarm System Safety National Patient Safety Goa

Effective January 1, 2016, The Joint Commission will being surveying for compliance with Phase 2 of the NPSG .06.01.01 to improve clinical alarm system safety. This second phase focuses on mitigating the risks of alarm systems and educating staff and providers. Hospitals and critical access hospitals must establish policies and procedures for managing the alarms identified as most important during the first phase. The policies and procedures must, at a minimum, address the following:
  • Clinically appropriate settings for alarm signals
  • When alarm signals can be disabled
  • When alarm parameters can be changed
  • Who in the organization has the authority to set alarm parameters
  • Who in the organization has the authority to change alarm parameters
  • Who in the organization has the authority to set alarm parameters to “off”
  • Monitoring and responding to alarm signals
  • Checking individual alarm signals for accurate settings, proper operation, and detectability
In addition, hospitals must educate staff and licensed independent practitioners about the purpose and proper operation of alarm systems for which they are responsible. Review the specifics of the NPSG and read The Joint Commission’s alarm system safety R3 Report – Requirement, Rationale, Reference here . The AANA has posted resources concerning the alarm system safety NPSG at Clinical Practice Resources.
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State Government Affairs

Nomination Deadline for NEW AANA Award for State Government Affairs Advocacy is February 15

Has your state nurse anesthetist association made significant efforts in state government affairs advocacy this year? Describe your state’s efforts and enter to win the new AANA Award for State Government Affairs Advocacy, to be presented at the AANA Mid-Year Assembly in April 2016. This annual award is not tied to a specific “victory” in the state legislative or regulatory arena, but will be given based on the quality of the undertaken effort. Examples of state association efforts include successful lobby days, legislative/regulatory efforts, or increased member participation in grassroots or other efforts. For more information and to submit your state’s application, see www.aana.com/awards.
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Meetings and Workshops

2016 Mid-Year Assembly Travel

The AANA Mid-Year Assembly has quickly become the most important advocacy meeting of the year for CRNAs. We encourage all AANA members to make reservations early this year. The meeting will be held in the heart of Washington, DC during the National Cherry Blossom Festival. The popular festival draws hundreds of thousands of tourists each year and we expect hotel and travel rates to increase as we near the date of the meeting. Attendees receive special rates at the Renaissance Washington, DC Downtown (offer subject to availability) through March 3rd. Also, travel discounts for major airlines are available with our promo codes available on our web site. www.aana.com/mya
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Registration Now Open! COA/AANA Doctoral Workshop at ASF

Don’t miss out on the COA/AANA 1.5 day-workshop, 2022 is Closer than You Think: Transitioning to the Doctoral Degree, on Sunday-Monday, February 28-29, 2016, in San Antonio, Texas. Key activities to establish doctoral degree offerings consistent with the COA’s Practice Doctorate Standards and COA Policies and Procedures will be covered. The content is valuable for programs establishing both entry-level and CRNA post-master’s doctoral degrees. Topics include key considerations in getting started, review of the Practice Doctorate Standards, developing requirements for the scholarly work/doctoral project, developing and mapping the curriculum to COA and national standards, and tips for success in the submission and review of doctoral applications. Who should attend:
  • Nurse anesthesia program administrators
  • Deans of academic units affiliated with nurse anesthesia programs
  • Nurse anesthesia faculty
The fee is $295 per person by January 26 and $350 per person thereafter. CE credits can be earned. Program details are available on the COA website at http://home.coa.us.com. Registration information is available at
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Registration Open for Assembly of School Faculty

We're excited to announce that advance registration is now open for the 2016 Assembly of School Faculty. Join us in historic San Antonio on February 25-27, 2016, for the premier convergence of nurse anesthesia program faculty. Register Now!
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Save the Dates for These Popular Hands-On Workshops

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

Jack Neary Pain Management Workshop
  • Rosemont, IL
  • April 23-25, 2016
Jack Neary Pain Management Workshop II
  • Rosemont, IL
  • October 29-30, 2016
Upper and Lower Extremity Nerve Block Workshop
  • AANA Foundation Learning Center
  • March 19-20, 2016
  • September 24-25, 2016
Essentials of Obstetric Analgesia/Anesthesia Workshop
  • AANA Foundation Learning Center
  • April 20, 2016
  • November 2, 2016
Spinal and Epidural Workshop
  • AANA Foundation Learning Center
  • April 21-23, 2016
  • November 3-5, 2016
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Foundation and Research

Make Your Year-End Donation to the AANA Foundation Today

Your donation to the AANA Foundation supports important research that advances the nurse anesthesia profession. Evidence provides proof and proof is power! Take a moment today to make your year-end, tax-deductible gift to AANA Foundation’s Proof is Power campaign – click here to access the Foundation’s secure donation page. To maximize your opportunity for 2015 tax benefits, please submit your gift before 11:59 p.m. on Wednesday, December 31, 2015. Thank you for your support!
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AANA Foundation 2016 Award Nominations

Each year the AANA Foundation presents awards at the AANA Annual Congress to individuals who have made a difference in the nurse anesthetist community. The deadline for Award nominations is February 1, 2016. Please take the time today to recognize someone you know. It is truly an honor to be nominated. Click here to access the nomination/application forms for:
  • Advocate of the Year, presented to an advocate committed to supporting the AANA Foundation and encouraging others to do the same.
  • John F. Garde Researcher of the Year, presented to an individual who has made a significant contribution to the practice of anesthesia through clinical research.
  • Rita L. LeBlanc Philanthropist of the Year, presented to an individual who has donated time, talent and direct financial support to the AANA Foundation and other deserving organizations.
  • Janice Drake CRNA Humanitarian Award, presented to a CRNA who wishes to volunteer and provide anesthesia, education and training in underserved areas.
Forward the completed form to the AANA Foundation – email to foundation@aana.com or mail to 222 S. Prospect Avenue, Park Ridge, IL 60068. Thank you in advance for recognizing a member of the nurse anesthesia community. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
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Register Today for ASF February Fiesta on the Riverwalk

If you’re planning to attend the AANA Assembly of School Faculty (ASF) meeting in February, you won’t want to miss the AANA Foundation’s February Fiesta on the Riverwalk. This event will be held at La Paloma Riverwalk, 215 Losoya in San Antonio on Thursday, February 25, 2016 from 7 – 9:30 pm. Click here to visit the AANA ASF registration page to learn more and purchase tickets for this event. We hope to see you there!
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Federal Government Affairs

VHA Full Practice Authority Draws Support from Free Market Perspective; Update on AANA’s Efforts to Ensure Veterans Access to Quality Care

Improving Veterans access to care by the Veterans Health Administration recognizing CRNAs and other APRNs to their Full Practice Authority drew additional support this month in the form of an opinion article in The Hill taking a free market perspective to the issue. Christopher Koopman, of the free-market Mercatus Center affiliated with George Mason University, wrote the article published on Dec. 4.

“Expanding the VHA's ability to better serve those seeking care may not necessarily require some complicated approach, or even an increase in budgets or staff,” Koopmans wrote. “It may be as simple as removing barriers and allowing providers within the VHA system to practice to full extent of their education, training and certification.” Read the article at http://thehill.com/blogs/pundits-blog/healthcare/262074-expanding-the-scope-of-veterans-healthcare .

Update on AANA and CRNA Issues to Ensure Veterans Access to Quality Care
  • To ensure Veterans access to care, the AANA has urged the VHA to publish a proposed rule in the Federal Register authorizing Full Practice Authority for CRNAs and other APRNs. With the ASA asking its members to submit comments by the thousands against CRNAs, watch your email inbox for a request from AANA President Juan Quintana, CRNA, DNP, MHS, and Association of Veterans Affairs President Garrett Peterson, CRNA, DNP, urging you to complete and submit a regulatory comment in support of CRNA and APRN Full Practice Authority in the VHA.
  • Your voice also needs to be heard on Capitol Hill. Take action Web Site here and encourage your friends and family to also take action through the Veterans Access to Quality Healthcare Alliance microsite.
  •  The AANA is supporting legislation in the House, HR 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). The bill now has 43 bipartisan cosponsors. The AANA also backs legislation in the Senate, S 2279, the “Veterans Health Care Staffing Improvement Act,” sponsored by Sens. Jeff Merkley (D-OR) and Mike Rounds (R-SD) with eight bipartisan cosponsors.
  • An independent assessment of the VHA completed by the RAND corporation recommended the Agency move forward with the Full Practice Authority proposal for APRNs in the VHA, saying the policy is also a cost saving measure. To read the full recommendation starting on p. 266 of the document. The AANA and APRN organizations have supported the independent assessment in a letter to the VA Secretary and Chair and Ranking Member of the House Veterans’ Affairs Committee, which can be read here (AANA member login required).
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Congress Extends Deadline for Year-End Budget Work; Focus on CRNA Issues

Hours short of a midnight Dec. 11 deadline, Congress approved a five-day stopgap funding measure to buy a little more time for completing overdue year-end appropriations legislation and to avert a threatened federal government shutdown. Now, Congress has until midnight the evening of Dec. 16 to complete its work. For CRNAs, action on year-end appropriations affects overall funding for Medicare administration, Title 8 nurse workforce development programs, the Agency for Healthcare Research and Quality (AHRQ) and for health research. It also touches upon the VHA APRN Full Practice Authority issue, in that both the House and Senate have already adopted identical advisory report language backed by the AANA, that expresses support for the VHA’s process of developing and completing a proposal that expands Veterans access to care this way.
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Following AANA Advocacy, Insurance Commissioners’ Model Law Recognizes Provider Nondiscrimination Provision

Consistent with a recommendation from AANA, the National Association of Insurance Commissioners (NAIC) has included in its latest model law new language expanding recognition of healthcare providers like CRNAs in plan networks, and expressly recognizing the federal AANA-backed Provider Nondiscrimination law. The NAIC propagates its model law text among insurance commissioners in each state, with the recommendation that they urge their state legislatures to enact it. Under the new NAIC model law provisions on network adequacy, “a health carrier providing a managed care network plan shall maintain a network that is sufficient in numbers and ‘appropriate’ types of providers.” The new term “appropriate” creates new impetus for plans to cover CRNA services. The new model law also recommends that states enacts statutes similar to the federal Provider Nondiscrimination Law, backed by AANA and supporting plans’ coverage of CRNA and other APRN services. As state legislatures prepare to convene in 2016, state associations of nurse anesthetists are recommended to keep in close contact with their lobbyists and the AANA State Government Affairs division for opportunities to expand coverage of CRNA services through adoption of NAIC model law provisions. Read the new NAIC network adequacy model law at
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Lawmakers Extol Nurses and APRNs at House Hearing on Bill to Reauthorize Title 8 Nurse Workforce Development Programs

At a hearing of the House Energy & Commerce Subcommittee on Health Dec. 8, lawmakers expressed support for nursing and nurse workforce development as they examined AANA-backed legislation reauthorizing Title 8 nurse workforce development programs. The bill at issue, HR 2713, is sponsored by Reps. Lois Capps (D-CA) and David Joyce (R-OH) and has 52 bipartisan cosponsors. Backed by the AANA and APRN organizations, the measure extends authority for the programs through federal fiscal year 2020. Funding for Title 8 programs, including Nurse Anesthetist Traineeships and Advanced Nursing Education programs used by nurse anesthesia educational programs for modernization and for supporting placements into rural and medically underserved areas, is provided by a separate appropriations process. Read HR 2713 at
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AANA to Medicare: Don’t Penalize CRNAs for Health IT “Meaningful Use” Others are Responsible For

The AANA requested that the Centers for Medicare and Medicaid Services (CMS) not penalize providers, such as CRNAs, who were not previously incentivized to adopt meaningful use of electronic health record (EHR) technology, while the agency is currently in the works with developing future Medicare and Medicaid EHR programs. The comment letter, sent by AANA President Juan Quintana, CRNA, DNP, MHS, was in response to CMS’ Electronic Health Record Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 Through 2017 final rule with comments. This final rule with comment period finalizes policies for the Stage 3 objectives and measures and the EHR reporting period for Stage 3 in 2017 and subsequent years by specifying the requirements that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and Medicaid EHR incentive payments and avoid downward payment adjustments under the Medicare EHR Incentive Program. Also of equal importance for CRNAs, CMS is also using this as an opportunity to gather additional feedback on future EHR Incentive Programs, in particular with the passage of the Medicare Access and CHIP Reauthorization Act of 2015 which establishes new incentive programs such as the Merit-Based Incentive Payment System (MIPS). CMS states that any public comments it receives on this rule may be considered for the incorporation of meaningful use into MIPS. Our comments also include asking the agency that CRNAs be granted a neutral score for their performance on meaningful use/ EHR as part of the MIPS composite performance. View the final rule at,
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As National Academy of Medicine Releases “Future of Nursing Plus Five Years” Report, AANA Participates in Action Summit and Academy Symposium

A major new report evaluating actions following publication of The Future of Nursing: Advancing Health, Leading Change recommends broadening the base of support for recognizing CRNAs, APRNs and other nurses to their full scope of practice. The new report, by a workgroup of the National Academy of Medicine, was released at a summit meeting Dec. 9 in Washington gathered by the AARP Center to Champion Nursing in America, where AANA senior leadership participated. The following day, the AANA joined the National Academy of Medicine for its annual Rosenthal Symposium, this time on the subject of patient safety. The primary message from the speakers was that more needs to be done to improve the quality and resiliency of systems supporting patient safety and improved healthcare outcomes, and that the proliferation of individual quality measures used for payment may not be improving care as much as their sponsors hoped that they would. See the new National Academy of Medicine report at
. See the Rosenthal Symposium online at http://nam.edu/event/2015-rosenthal-symposium/.
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Deadlines Approaching to Nominate CRNAs, Legislators for AANA Honors

If you would like to nominate a legislator or a CRNA to an AANA honor relating to advocacy and policy, or to nominate an AANA member to the CRNA-PAC Committee, your deadlines to submit applications are approaching.
  • National Health Leadership Award applications are due Jan. 15, 2016. Established in 1992, this award is presented during AANA Mid-Year Assembly to an individual working at the federal government level that has made a significant contribution to the formation of national health policy critical to CRNAs. Learn more here:
  • Daniel D. Vigness Federal Political Director Award applications are also due Jan. 15, 2016. Established in 2001, this honor was renamed in 2013 in tribute to and memory of its first winner. This award is presented annually at the Mid-Year Assembly to an individual who has made a significant contribution to the advancement of the national healthcare agenda of Certified Registered Nurse Anesthetists (CRNAs) by coordinating grassroots CRNA involvement at the state level or through special contributions to the federal political process. Learn more here:
  • CRNA-PAC Committee membership nominations are due Jan. 31, 2016. The committee seeks applications from CRNAs to fill two vacancies for three-year terms beginning Sept. 1, 2016, and applications from student registered nurse anesthetists to fill one vacancy for a one-year term also beginning Sept. 1, 2016. Learn more here:
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The U.S. House and Senate in session this week. If you see your legislators at home, let us know at info@aanadc.com. When Congress returns, lawmakers have until Dec. 11 to complete unfinished appropriations work.
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The following is an FEC required legal notification for CRNA-PAC:

Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.
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Visit www.crnacareers.com to view or place job postings
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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.

A Less Risky Anesthesia for Babies

Concerns about the risk of general anesthesia are leading more hospitals to use spinal anesthesia for infants and toddlers who undergo surgery. This method immobilizes children and keeps them free of pain but still awake. Exposure to anesthetics may cause memory loss, learning difficulties, and other damage in developing brains. Spinal anesthesia is associated with fewer breathing complications and faster recoveries, so children can go home sooner. The technique is primarily reserved for procedures that last no longer than 90 minutes and involve the abdominal area and lower extremities. Although the method is not in wide use, spinal anesthesia was first used by the University of Vermont Children's Hospital 40 years ago. Kennith Sartorelli, a pediatric surgeon at the hospital, says the facility has since performed more than 2,500 surgeries using spinal anesthesia, with no major complications. The U.S. Food and Drug Administration is partially funding a trial—involving 28 hospitals in the United States, Canada, Europe, Australia, and New Zealand—that seeks to measure intelligence at age five years in more than 700 infants who received either general or spinal anesthesia during hernia repair procedures. Interim results of the GAS study found no difference in cognitive function at age two years, though lead investigator Andrew Davidson of Murdoch Children's Research Institute in Melbourne, notes that more will be known upon the study's completion in 2017, as "some aspects of neurodevelopment cannot be assessed at two years of age."

From "A Less Risky Anesthesia for Babies"
Wall Street Journal (12/08/15) P. D1 Landro, Laura

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Ibuprofen Patch Delivers Pain Relief Through Skin for 12 Hours

Researchers report that an ibuprofen patch can deliver targeted pain relief for as long as 12 hours. A team from the University of Warwick in the United Kingdom used a polymer technology to deliver higher doses of the analgesic than are currently available in medical patches and gels. The polymer matrix used holds about 30 percent by weight ibuprofen, compared with 10 percent found in other patches and gels. David Haddleton, a research chemist at the University of Warwick, noted that the technology allows them to "for the first time produce patches that contain effective doses of active ingredients such as ibuprofen for which no patches currently exist." In addition, he said they can "improve the drug loading and stickiness of patches containing other active ingredients to improve patient comfort and outcome." The new pain-relief patch could be on the market within two years.

From "Ibuprofen Patch Delivers Pain Relief Through Skin for 12 Hours"
United Press International (12/08/15) Feller, Stephen

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Fed Panel Opposes CDC Opioid Guidelines

The National Institute of Health's Interagency Pain Research Coordinating Committee will file a formal objection to proposed opioid prescribing guidelines being drafted by the Centers for Disease Control and Prevention (CDC). The guidelines would discourage primary care physicians from prescribing opioid pain medications. The committed reportedly believes there is little or no evidence to support many of the prescribing guidelines. The pain research committee includes representatives from the Food and Drug Administration (FDA), Agency for Healthcare Research and Quality, Department of Veterans Affairs, Department of Defense, and the CDC itself. Sharon Hertz, FDA's director of the Division of Anesthesia, Analgesia and Addiction Products, says evidence cited to support the guidelines "is low to very low and that's a problem." CDC has admitted it rushed through the process, apparently to meet a January deadline.

From "Fed Panel Opposes CDC Opioid Guidelines"
Pain News Network (12/07/15) Anson, Pat

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American Society of Anesthesiologists Establishes New Checklist for Mass Casualty Situations to Enhance Emergency Preparedness

Anesthesia providers and operating room staff have a new resource to help them in case of terrorist attacks, mass shootings, and natural disasters. Tragedies like the recent events in Paris and California are occurring more and more often, prompting the American Society of Anesthesiologists (ASA) to publish its Operating Room Mass Casualty Management checklist. With step-by-step guidance, the tool identifies specific tasks that should be completed, including ensuring that enough supplies are on hand and verifying blood availability. "The checklist utilizes the military planning and response principles—command, control, communications, intelligence and logistics—to prioritize tasks necessary for effective surgical and anesthetic response to mass casualty events," explains Joseph McIsaac, MD, MS. Chief of trauma anesthesia at Hartford Hospital in Connecticut, he is a member of ASA's Committee on Trauma and Emergency Preparedness, which developed the new pamphlet. The panel also revised ASA's Manual for Anesthesia Department Organization and Management, augmenting it with a new section on emergency preparedness in the anesthesia department.

From "American Society of Anesthesiologists Establishes New Checklist for Mass Casualty Situations to Enhance Emergency Preparedness"
Newswise (12/07/15)

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FDA Grants Fast Track Designation to Oliceridine for Moderate to Severe Acute Pain

The FDA has accepted oliceridine, a potential substitute for already sanctioned I.V. opioid analgesics, into its Fast Track program. A recent Phase II trial demonstrated the drug's ability to alleviate postoperative pain as well as morphine but without negative outcomes like respiratory depression and dysfunction of the GI system. The drug is slated to move into Phase III development early next year, according to its maker, Trevena. Fast-track status will facilitate the process through frequent interactions with the FDA.

From "FDA Grants Fast Track Designation to Oliceridine for Moderate to Severe Acute Pain"
Pain Medicine News (12/07/2015)

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National Patient Safety Efforts Save 87,000 Lives and Nearly $20 Billion in Costs

An estimated 87,000 fewer patients died in hospitals and close to $20 billion in health care costs were saved as a result of a decrease in hospital-acquired conditions from 2010 to 2014, federal officials report. Hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central line-associated bloodstream infections, pressure ulcers, and surgical site infections. In a new paper, the Agency for Healthcare Research and Quality provided interim data showing that hospital-acquired conditions declined 17 percent over the four-year study period. "Patients in America's hospitals are safer today as a result of this partnership with hospitals and health care providers," said Health and Human Services Secretary Sylvia M. Burwell. "The Affordable Care Act has given us tools to build a better health care system that protects patients, improves quality, and makes the most of our health care dollars."

From "National Patient Safety Efforts Save 87,000 Lives and Nearly $20 Billion in Costs"
HHS News Release (12/01/15)

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Duloxetine Improves Quality of Postsurgical Recovery in Female Patients

Although duloxetine is used mostly for fibromyalgia as well as chemotherapy-induced or diabetic neuropathy, a growing body of research points to its potential in the treatment of pain. In one study, 63 patients undergoing abdominal hysterectomy in Brazil were randomized to receive either duloxetine—which is thought to inhibit pathways related to chronic pain—or a placebo two hours prior to surgery and 24 hours after. There was no difference between the two groups in terms of nausea, vomiting, and time until discharge from the PACU unit; however, quality of recovery was better overall for women in the duloxetine cohort. In addition to improvement in pain, physical comfort and independence, and emotional status, patients who took duloxetine used only about 1 mg of intravenous morphine compared to a mean 5.5 mg for the placebo group. Previous study concluded that the drug curtailed opioid use and significantly improved postoperative pain in patients who had total knee replacement, and research published since the Brazil trial suggests a similar outcome on pain with perioperative spine patients.

From "Duloxetine Improves Quality of Postsurgical Recovery in Female Patients"
Anesthesiology News (12/01/15) Vol. 41, No. 12 Doyle, Chase

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FDA Panel Urges Stronger Regulation of Codeine

An FDA advisory panel said Thursday that prescription drugs containing codeine should not be used to treat children or the majority of teens suffering from pain or a cough. FDA does not have to follow the recommendations of its advisory committees, but it usually does. "My concern, were I to be prescribing codeine in children, would be that I would, frankly, kill them," said pharmacist Maria Pruchnicki, of the Ohio State University College of Pharmacy. Several committee members noted that there are questions about whether codeine is even effective for alleviating children's coughs, and whether there are potentially safer alternatives for alleviating pain. Codeine combined with other opioid analgesics, such as acetaminophen, is commonly used to alleviate kids' pain in a variety of situations, such as when they are recovering from surgery. But FDA has been increasingly concerned because codeine has been found to trigger life-threatening breathing problems in some children.

From "FDA Panel Urges Stronger Regulation of Codeine"
WUNC.org (NC) (12/10/15) Stein, Rob

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AAP Guidelines Address Perioperative Anesthesia Environment

The American Academy of Pediatrics (AAP) has published new guidelines in Pediatrics that identify ways to improve care in children receiving anesthesia. Among infants aged one month to one year, the risk for anesthesia-related cardiac arrest is about four times greater than for children aged 1–18 years. The risk is even higher for infants younger than one month. The authors recommend that pediatric facilities have written policies for the procedures to be followed in elective or emergency anesthesia. Risk categories should include age, need for intensive care, and comorbid conditions. Anesthesia care for children should be provided or supervised by anesthesia providers with clinical privileges and an annual minimum case volume. Providers who care for high-risk patients should be graduates of an Accreditation Council for Graduate Medical Education pediatric anesthesiology fellowship training program. Facilities also should have policies for effective pain management in pediatric populations. Nursing and technical personnel should be trained in routine and emergency pediatric perioperative care, according to AAP.

From "AAP Guidelines Address Perioperative Anesthesia Environment"
Medscape (12/01/15) Barclay, Laurie

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Development of an Opioid Reduction Protocol in an Emergency Department

Researchers studied an opioid-sparing protocol for acute pain management in the emergency department. The project, called "Opioid-Free Shift," tested a multimodal pharmacologic approach to analgesic therapy as an alternative to routine use of opioids. Seventeen patients were treated during the study period. After 30 minutes, the median pain score on the 11-point rating scale dropped from 8 to 6, and it dropped down to 5 after 60 minutes. More than 80 percent of patients were satisfied with the pain relief provided by the protocol. The patients were managed mainly with I.V. ketorolac and oral ibuprofen, the researchers report, and only one patient had to be administered rescue opioid therapy.

From "Development of an Opioid Reduction Protocol in an Emergency Department"
American Journal of Health-System Pharmacy (12/01/15) Cohen, Victor; Motov, Sergey; Rockoff, Bradley; et al.

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Silent Epidemic: Seniors and Addiction

While heroin use and overdoses are rising among younger Americans, more of the country's seniors are getting hooked on the very drugs meant to help them: prescription opioids. The medicines often are taken by older patients being treated for arthritis, headache, fibromyalgia, or another medical problem. "We see the highest rates of overdose deaths in individuals who appear to be receiving legitimate prescriptions for chronic pain problems," confirms Andrew Kolodny, MD, executive director of Physicians for Responsible Opioid Prescribing. While some emergency room (ER) trips or fatal overdoses among older adults are due to accidents—harmful interactions between several drugs or dosing mistakes on the part of the patient, for example—the number of ER cases as a result of narcotic painkiller misuse rocketed 78 percent between 2006 and 2012, based on recent research. The Centers for Disease Control and Prevention, meanwhile, reports that hospitalizations for opioid abuse have increased most sharply among Americans aged 45 to 85 and older, with a more than fivefold jump between 1993 and 2012. It also notes that adults aged 45 to 54 have the highest death rates from opioid overdoses. Prescribing lower-dose painkillers is one way to mitigate the risk of overdose, according to Kolodny.

From "Silent Epidemic: Seniors and Addiction"
U.S. News and World Report (12/02/15) Esposito, Lisa

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Some Topical Anti-Inflammatory Drugs Can Rival Oral Versions

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) can provide relief similar to oral NSAIDs, which can increase the risk for ulcers, heart attacks, and stroke. Like their oral counterparts, topical medicines are prescription drugs that inhibit pain enzymes. The main difference is that they avoid the bloodstream by going directly through skin and underlying tissue. Data show that topical products "can work as effectively" for pain relief as oral medications, according to David Jevsevar, acting chairman of orthopedics at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. A 2012 review of 34 studies and nearly 7,700 patients found similar results for knee and hand arthritis. Topical NSAIDs carry the same boxed warning as oral NSAIDs. This is because topical medications have not been shown to be safer in large, rigorous "outcome studies." Some doctors believe that topicals are probably safer, as less of the drug reaches the bloodstream; however, others say the lack of data is cause for concern. "We don't know if there is a decrease in gastrointestinal toxicity or cardiovascular toxicity, because it's a topical," says Lee S. Simon, formerly of the FDA and now a principal at the drug-development consulting firm SDG LLC.

From "Some Topical Anti-Inflammatory Drugs Can Rival Oral Versions"
Wall Street Journal (11/30/15) Johannes, Laura

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Pain Patients Use Twitter to Complain About Opioid Side Effects

Social media has become a haven for patients who have questions about adverse events associated with their prescription opioids. In a report published in the Journal of Opioid Management, researchers at the Cedars-Sinai Center for Outcomes Research and Education analyzed more than 2.5 billion tweets and posts on other forms of social media. They found that an alarming number of patients turn to social media because their clinicians are not discussing the potential adverse events associated with opioids. The most-cited issues were nausea, vomiting, and constipation, and study leader Brennan Spiegel said it is an indication that there is a need for more information and education. "How effectively do doctors explain the pros and cons of these medicines? How well do they answer patients' questions from the start? How thoroughly do they educate patients? We need to study all of this," Spiegel said.

From "Pain Patients Use Twitter to Complain About Opioid Side Effects"
Forbes (11/23/15) Arlotta, CJ

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

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