Anesthesia E-ssential

AANA Anesthesia E-ssential
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Reporting for MIPS in 2018: QCDRs and Qualified Registries

The second year of the Quality Payment Program (QPP) has officially begun with the ringing in of the new year, and CRNAs should be taking certain steps to prepare. To begin the process of successful participation in the Merit-Based Incentive Program (MIPS), CRNAs should focus on selecting their reporting strategy. Two viable reporting options include the use of Qualified Registries or Qualified Clinical Data Registries (QCDRs). Reporting with a QCDR holds many benefits for CRNAs, including access to measures outside of the MIPS Anesthesia Specialty Measure Set, which can be found on the AANA 2018 MIPS Quality Performance Category Fact Sheet. “QCDR Measures” have undergone a separate approval process with CMS to include these additional measures in their measure set. 

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Hot Topics

Warning Regarding Unapproved Opioid Cessation Products

The U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) have posted joint warning letters to the marketers and distributors of 12 opioid cessation products for illegally marketing unapproved products with claims about their ability to help in the treatment of opioid addiction and withdrawal.  Learn more in the  FDA's press release.

In addition, the FTC, in coordination with the Substance Abuse and Mental Health Services Administration, issued a fact sheet to help consumers get real help for opioid addiction or withdrawal, while avoiding products that promise but do not deliver help. The fact sheet has tips that consumers and health practitioners can share with those considering help for opioid addiction or withdrawal.  
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The Joint Commission Addresses Supporting Second Victims

The Joint Commission issued a Quick Safety Issue—Supporting second victims—addressing the effects that may be suffered by healthcare workers directly involved in an adverse event.  If not treated, this experience may harm the provider’s health and compromise patient safety. Estimates indicate that nearly half of all providers could experience the impact as a second victim at least once in their career.  Providers often suffer in silence. Based on studies reviewed by The Joint Commission, it urges healthcare organizations to take several actions to support second victims as soon as possible after an adverse event.  These actions include instilling a just culture for learning from system defects and communicating lessons learned, engaging all team members in the debriefing process and sharing lessons learned, and providing guidance on supporting each other during an adverse event.  Review the complete Quick Safety Issue to learn additional strategies for addressing support for second victims, including creating a second victim program. In addition, explore the resources on the AANA’s webpage, Adverse Medical Events/Critical Incidents - How to Cope, for additional information on this important topic. 
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AAAASF Requires End Tidal Carbon Dioxide Monitoring for Office-Based Procedural Settings

The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) has strengthened its standards for offices participating in its procedural accreditation program.  In these office-based settings, under the new standards effective Jan. 31, 2018, end tidal carbon dioxide monitoring is required for moderate and deep sedation, as well as general anesthesia. AAAASF adopted this standard to promote patient safety, improve quality of care, and decrease adverse events for all procedures performed in this setting.  Announcing this new standard, AAAASF noted that the AANA, the American Society of Anesthesiologists, and some states have similar requirements. Read the new AAAASF procedural standards and the AANA’s Standards for Nurse Anesthesia Practice, including the patient monitoring standard.
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MAP Partner Laurel Road Launches Resolution Solution Sweepstakes

AANA Member Advantage Program partner Laurel Road, a division of Darien Rowayton Bank, is giving away $75,000 in student loan payments! Enter for a chance to be one of three lucky winners who will each receive $25,000 to pay down their student loan debt. Visit the Laurel Road webpage to learn more about the $100 cash bonus available to AANA members when refinancing. #MyResolutionSolution
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Consider Nominating a Colleague for an AANA Award!
Deadline is March 15

Do you work with an outstanding program director, didactic instructor, or clinical instructor? Do you know someone who has spent a lifetime advancing the practice of nurse anesthesia as a practitioner, educator, clinician, or advocate? Consider nominating your colleague for one of the national AANA recognition awards. Visit Recognition Awards for details on the 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. 
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Resources on New Tax Law, Retirement Planning Available from ONE Advisory Partners

Do you have questions about how the new tax law may affect you, or how to maximize your retirement savings? Take advantage of the expertise of AANA Member Advantage Partner ONE Advisory Partners

Read "The Cognizant CRNA: Significant Changes Made to U.S. Tax Laws!"
Recently there were substantial alterations made to the U.S. tax code. The Tax Cuts and Jobs Act was ultimately passed and signed in December 2017. Since CRNAs earn much higher average compensation than most careers, it is imperative that AANA members optimize the beneficial changes and minimize the negative changes for your family.

Swipe Right: Choosing Your Financial Match!
Do you have questions about how to allocate and how much to contribute to your 401(k)? Do you wonder if you’re paying too much for your SEP-IRA or Solo-K? Are you certain you know how to maximize your Social Security benefit? Are you paying management fees over 1 percent? At what income can you retire? How will you pay your medical expenses in retirement? Get those questions answered with Swipe Right: Choosing Your Financial Match! This popular personal finance book by Daniel A. Jack, JD, MBA, RICP, is available to AANA members at 10 percent off the $19.99 retail price plus free shipping. Visit the Swipe Right webpage and enter the code AANA2018 at checkout.
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Foundation and Research

AANA Foundation Fundraiser: Cool by the Pool at ASF

If you’re planning to attend the AANA Assembly of School Faculty (ASF) meeting, you won’t want to miss the AANA Foundation’s Cool by the Pool event in Scottsdale, Arizona.
Visit the AANA ASF registration page to learn more. If you’ve already registered for ASF and would like to purchase event tickets, contact Margaret Brennan, AANA Registrar, at (847) 655-1180. Tickets will also be available onsite.
Contact Luanne Irvin, AANA Foundation Development Officer, at (847) 655-1173 with any questions. We hope to see you there!
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AANA Foundation 2018 Award Nominations Deadline Extended to March 1

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 extended deadline for Award nominations is March 1.
Nomination/application forms are available online 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 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
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AANA Foundation Student Scholarships Applications Now Available Online: Deadline March 1

The AANA Foundation is pleased to continue its long history of funding nurse anesthesia education. Applications for nurse anesthesia student scholarships are available online, and the application deadline is March 1, 2018. Scholarship awards range from $1,000 to $3,000 each. To apply for a scholarship, you must be enrolled in a program for at least six months prior to March 1, 2018.
Don’t delay! Access the Student Scholarship Application webpage on the AANA Foundation section.
Contact the AANA Foundation at (847) 655-1170 or with any questions. 
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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.

Prediction of Emergence Agitation in Preschool-Aged Kids Undergoing Inguinal Herniorrhaphy

Preliminary evidence suggests that during induction of pediatric anesthesia, withdrawal reaction following rocuronium injection might be a good indication of pain sensitivity—and, thus, risk of emergence agitation (EA)—in young patients. The South Korean study included 40 preschool-aged children, all of whom were scheduled for inguinal herniorrhaphy. Researchers observed withdrawal movement after patients received a rocuronium injection and slipped out of consciousness. They then used the Watcha scale to grade EA upon admission to the postanesthesia care unit (PACU). The results revealed that children who had a severe withdrawal reaction after rocuronium injection—grade three on a scale of four—were significantly more likely to experience EA requiring medication. Although larger studies are warranted, the investigators believe a strong withdrawal reaction after rocuronium injection could help alert clinicians to pediatric patients likely to present with EA upon admission to the PACU following inguinal herniorrhaphy.

From "Prediction of Emergence Agitation in Preschool-Aged Kids Undergoing Inguinal Herniorrhaphy"
Therapeutics and Clinical Risk Management (01/26/18) Vol. 14, P. 189 Kim, Da Hee; Roh, Go Un; Lee, Young Bok; et al.

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Practical Initiatives Improve Outcomes, Shorten Stays

Evidence is piling up in support of enhanced recovery after surgery (ERAS) as an easy and practical strategy that can improve postoperative outcomes while lowering costs. One anesthesia practice in North Carolina compared results in about 620 colorectal and bariatric surgery patients treated under an ERAS protocol with results from controls treated before the program was introduced. The ERAS patients—who received preoperative education and got pain relief through transversus abdominal plane blocks and other methods, among other steps—fared better than patients subjected to standard care only. They used fewer opioids after their procedure, for example, stayed for a shorter period of time in the postanesthesia care unit, and were discharged from the hospital sooner. ERAS also appeared to cut costs by 20 percent per case. Meanwhile, at the University of Pittsburgh Medical Center, researchers discovered that preoperative consultation with a pain medicine specialist alleviates anxiety over post-surgical pain management for some patients coping with chronic pain and substance abuse. The 12 spinal fusion patients reported a drop in stress and anxiety during the perioperative period and greater satisfaction with pain control following the procedure. Both studies were presented at the American Society of Anesthesiologists' PRACTICE MANAGEMENT 2018 meeting.

From "Practical Initiatives Improve Outcomes, Shorten Stays"
Health Leaders Media (01/26/2018) Commins, John

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Predictive Value of Genicular Nerve Blocks for Outcomes of Cooled Radiofrequency Ablation

Researchers wondered if measuring pain relief after a prognostic genicular nerve block might provide a barometer for likely pain relief after genicular nerve cooled radiofrequency ablation (cRFA) in patients with knee osteoarthritis. For the study, 32 patients suffering chronic knee pain as a result of the condition were randomized to undergo a prognostic genicular nerve block ahead of cRFA while 31 others were not. Among the block recipients, only those whose pain declined by 50 percent or more for six hours afterward were included in the post-cRFA analysis. Nearly 59 percent of those 29 patients reported pain relief of more than 50 percent six months after cRFA, according to Numerical Rating Scale scores, versus 64 percent of the 31 patients who did not receive the block. Pain relief levels also were comparable between the two groups based on the Western Ontario and McMasters Universities Osteoarthritis Index as well as the Patient Global Impression of Change. In light of the findings, the study authors conclude that a minimum of 50% pain relief following a prognostic genicular nerve block may not be an effective predictor of pain relief following cRFA. The results are reported in Pain Medicine.

From "Predictive Value of Genicular Nerve Blocks for Outcomes of Cooled Radiofrequency Ablation"
Clinical Pain Advisor (01/24/18) Martin, Jessica

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Supraglottic Airway Use Highly Successful in Neonates

Supraglottic airway devices may be a viable alternative to endotracheal tubes for airway management in newborns undergoing anesthesia, researchers believe. The team reviewed anesthetic records for 3,500 babies younger than 30 days old, all with normal airways, for attempted supraglottic device placement for primary airway maintenance. The approach had a 97 percent success rate, according to investigators, and was associated with neither device failure nor major complications or adverse events for the majority of the neonates. “Given a failure rate of only 3%, we believe it's important to increase clinician awareness of the supraglottic airway as a rescue device option or potentially as a primary airway device,” says investigator John Hajduk, CCRP, from the Department of Pediatric Anesthesiology at Chicago's Ann & Robert H. Lurie Children's Hospital. He reported the retrospective cohort study, the first of its kind, at the 2017 annual meeting of the Society of Airway Management. "This is very preliminary data," he cautions, stressing the need for large prospective trials to evaluate the safety and efficacy of the supraglottic approach.

From "Supraglottic Airway Use Highly Successful in Neonates"
Anesthesiology News (01/22/18) Doyle, Chase

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An International, Multicenter, Observational Study of Cerebral Oxygenation During Infant and Neonatal Anesthesia

A prospective, multinational study focused on cerebral hypoxia-ischemia as a mechanism for potential neurologic damage in babies who undergo anesthesia. Researchers at eight pediatric hospitals measured low cerebral oxygenation and associated factors in 453 infants younger than six months who were exposed to general anesthesia for at least 30 minutes. The results indicated that mild and moderate low cerebral saturation was common, but low cerebral saturation was not — occurring so infrequently, in fact, that proper analysis could not be completed. Such events are so rare and brief that investigators consider them an unlikely explanation for the later development of cognitive dysfunction in anesthetized infants. Longer-term neurodevelopmental outcome studies must be performed in order to prove any association with learning and behavioral delays, they conclude.

From "An International, Multicenter, Observational Study of Cerebral Oxygenation During Infant and Neonatal Anesthesia"
Anesthesiology (01/18) Vol. 128, No. 1, P. 85 Olbrecht, Vanessa A.; Skowno, Justin; Marchesini, Vanessa; et al.

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Painkiller Ketamine to Be Tested as Preventive for Post-Surgical Chronic Pain

Australian researchers are taking the lead on a multinational trial exploring the use of ketamine as prevention against chronic postoperative pain. Existing evidence suggests that the powerful anesthetic, which is also under investigation as a treatment for deep depression and a replacement for battlefield morphine, may intercept pain circuits that go haywire following surgery. “There is reason to think that ketamine might have some useful role in cutting that connection between acute pain and chronic pain," says lead researcher Philip Peyton of the University of Melbourne. “Treating chronic pain once it's established is really hard. This is about getting in there early and preventing acute pain from becoming chronic.” His team expects to eventually enroll nearly 5,000 participants in the study. All will undergo standard anesthesia, but half will additionally receive ketamine intraoperatively and for the first three postoperative days. Peyton and colleagues will track their progress for one year post-procedure.

From "Painkiller Ketamine to Be Tested as Preventive for Post-Surgical Chronic Pain"
Herald Sun (Australia) (01/13/18) O'Connell, Brigid

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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.

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Attn: Linda Lacey
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February 1, 2018
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