AANA Anesthesia E-ssential

Anesthesia E-ssential February 13, 2015

AANA Anestehsia E-ssential 
Anesthesia E-ssential

February 13, 2015


Vital Signs

AANA Research Division Tackles Quality and Reimbursement
Quality and reimbursement issues are becoming more important to CRNAs in this rapidly changing healthcare environment. The research division is responsible for consulting on research matters, assessing current research, and targeting topics identified by the AANA and AANA Foundation's strategic plans. In our efforts to bring more awareness to matters related to quality and reimbursement, we created a new resource within the AANA website titled Quality-Reimbursement. It will highlight important issues related to nurse anesthesia such as pertinent quality initiatives and measures, reporting programs, and payment adjustments. Our foray into CMS’ quality programs begins with a list of frequently asked questions for the Physician Quality Reporting System Program (PQRS) and a new webinar introducing the 2015 PQRS process. The PQRS FAQs include: avoiding the 2015 and 2016 penalties and suggested anesthesia-related quality measures. For more information on PQRS, please visit our Physician Quality Reporting System (PQRS) Quick FAQs today.

CPC Pulse

Information in this section is provided to help CRNAs keep their finger on the pulse of what’s happening with the NBCRNA’s Continued Professional Certification (CPC) program, which will launch on Aug. 1, 2016.
One of the considerations that reinforced the need for changes to the recertification process is the shift to continuing competency through lifelong learning. The Continued Professional Certification (CPC) Program supports lifelong learning beyond initial credentialing. The knowledge and skills of the nurse anesthesia profession will continue to evolve as our profession grows. The CPC Program supports assessed continuing education (Class A), professional activities (Class B), and evidence-based learning (core modules). More information about the CPC Program and the literature used to define it can be found in the CPC Report on the AANA and the NBCRNA websites.


The Pulse

  • February 25 AANA Board Meeting Open Session to be Live Streamed!
  • AANA Seeking Committee Members for Fiscal Year 2016
  • AANA Recognition Awards Nominations Due March 15
  • Severe Maternal Morbidity: Clarification of the New Joint Commission Sentinel Event Policy
  • The Joint Commission Launches Infection Prevention and HAI Portal
  • 2015 AAAHC Accreditation Standards Changes
  • Joint Commission Podcast on Tubing Misconnections
  • Learn to Advocate for Your Profession at the Mid-Year Assembly
  • Essentials of Obstetric Analgesia/Anesthesia
  • Registration Now Open for Spinal-Epidural Workshop
  • Save the Date -- August 29-September 1, 2015 -- for NAAC!
  • Business of Anesthesia Workshop Registration Opens in Spring

  • AANA Objects to Omission of CRNAs from Senate Bill Recognizing VHA APRNs; CRNAs Requested to Take Action Now
  • AANA Analysis of CRNA Issues in the President’s 2016 Budget Proposal
  • Medicare Adjusts Rules and Interpretive Guidelines for Discharge from ASCs
  • To Protect and Advance CRNA Practice, the CRNA-PAC Begins Its 2015 Development Campaign
  • Federal Trade Commission to Host Second Public Workshop on “Examining Health Care Competition”
  • AANA and APRN Groups Provide Comments on the Hospital Improvements for Payment 2014 Discussion Draft
  • AANA and Nursing Groups Urge Medicare to Remove its Physician Requirement in Accountable Care Organizations
  • Congressional Republicans Unveil Affordable Care Act Replacement Plan titled, “Patient CARE Act”
  • As Medicare Releases Schedule for Transitioning Payment Models; AANA Requests to Participate on New “Healthcare Learning and Action Network”
  • Amendments

Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

Inside the Association
February 25 AANA Board Meeting Open Session to be Live Streamed!
Due to the positive feedback received in November, the Open Session of the Feb. 25, 2015, AANA Board Meeting will be streamed live. AANA membership and pre-registration is required. More information is available at: http://www.aana.com/myaana/AANABusiness/governance/Pages/Open-Session-Board-Meeting-Agendas.aspx. Registration opens on Monday, Feb 16.
AANA Seeking Committee Members for Fiscal Year 2016
Positions are available on AANA Committees for CRNAs and student registered nurse anesthetists. Check out the committee page on the AANA website to read about the various opportunities. Deadline for submission of a committee request is May 15, 2015.  Please note: If you currently serve on a FY15 committee, you must reapply for FY16.
AANA Recognition Awards Nominations Due March 15
Nominations are being sought for the following awards, which are presented during the Annual Meeting: the Agatha Hodgins Award for Outstanding Accomplishment, the Helen Lamb Outstanding Educator Award, the Alice Magaw Outstanding Clinical Practitioner Award, the Ira P. Gunn Award, the Clinical Instructor of the Year Award, the Didactic Instructor of the Year Award, and the Program Director of the Year Award. For information, visit the AANA website at www.aana.com/awards.

Severe Maternal Morbidity: Clarification of the New Joint Commission Sentinel Event Policy
A joint statement released last week by the American College of Obstetricians and Gynecologists; the Association of Women's Health; Obstetric and Neonatal Nurses; The Joint Commission; and the Society for Maternal-Fetal Medicine, clarifies the definition of severe maternal morbidity as applied in The Joint Commission’s Sentinel Event Policy. Severe maternal morbidity is defined as a patient safety event that occurs intrapartum through the immediate postpartum period (24 hours) that requires the transfusion of four or more units of blood products (fresh frozen plasma, packed red blood cells, whole blood, platelets) and/or admission to the intensive care unit (ICU). Read more here.
The Joint Commission Launches Infection Prevention and HAI Portal
The Joint Commission is merging its two online infection prevention resources into one convenient, expanded tool. The new Infection Prevention and HAI Portal puts information from The Joint Commission, Joint Commission Center for Transforming Healthcare, and Joint Commission Resources in one place. In addition, it offers links to other nationally recognized resources on infection prevention issues. Visit the new Infection Prevention and HAI Portal.
2015 AAAHC Accreditation Standards Changes
The Accreditation Association for Ambulatory Health Care (AAAHC) has announced accreditation standard changes for 2015. These changes include more specific requirements concerning malignant hyperthermia preparedness. Read the changes here.
Joint Commission Podcast on Tubing Misconnections
The Joint Commission's Medical Director, Ronald Wyatt, MD, discusses new ISO tubing standards and ways to decrease the risk of tubing misconnections and increase patient safety. Listen to the podcast: Take 5: Managing risk during transition to new ISO tubing connector standards (mp3).

Learn to Advocate for Your Profession at the Mid-Year Assembly
The 2015 Mid-Year Assembly will provide you with the tools needed to understand regulatory issues and advocate for your profession through hands-on advocacy experience. The Mid-Year Assembly will be held in Arlington, Va., April 18-22, 2015. Register today.
The AANA Essentials of Obstetric Analgesia/Anesthesia Workshop
Building and maintaining knowledge of the parturient is critical to the success of CRNAs who work, or who are preparing to begin working, in the labor and delivery suite. AANA’s Essentials of Obstetric Analgesia/Anesthesia Workshop will be held on May 13, 2015, at the AANA’s offices in Park Ridge, Ill. Register here
Registration Now Open for Spinal-Epidural Workshop
The Spinal-Epidural Workshop, to be held May 14-16, 2015, in Park Ridge, Ill., provides a thorough overview using lecture and guided hands-on experiences of epidural and spinal anesthesia procedures. Register now—space is limited and this popular workshop fills up fast!
Save the Date— August 29-September 1, 2015— for NAAC!
Save the date for the 2015 Nurse Anesthesia Annual Congress, August 29-September 1, 2015, in Salt Lake City, Utah. Look for the preliminary program in your mailbox in mid-March—which is when registration opens!
Business of Anesthesia Conference Registration Opens Soon
Save the Date: The AANA Business of Anesthesia Workshop addresses critical business issues facing CRNAs and will be held June 26-27, 2015, in San Diego, Calif. Whether you are employed or have your own business, this workshop has the necessary information to help you navigate the changing business environment in healthcare.

AANA Objects to Omission of CRNAs from Senate Bill Recognizing VHA APRNs; CRNAs Requested to Take Action Now
The AANA has objected to recently-introduced legislation by Sens. Mark Kirk (R-IL) and Joe Manchin (D-WV) that recognizes three of four specialties of APRNs practicing in the Veterans Health Administration (VHA) to their full practice authority, but omits CRNAs. AANA urges its members to contact their U.S. Senators and request that they ensure that the “Frontlines to Lifelines Act” (S 297) is amended to recognize VHA CRNAs to their full practice authority.
In a letter to the chairman and ranking member of the Senate Veterans Affairs Committee, AANA President Sharon Pearce, CRNA, MSN, stated, “Ensuring that CRNAs may practice within the VHA to their full practice authority is a common-sense part of the solution to the well-documented problem of Veterans being denied or delayed access to care.” Take action today to request your U.S. Senators refrain from cosponsoring or supporting this legislation until it is amended to include CRNAs.   Click here: https://www.crna-pac.com/composeletters.aspx?AlertID=177  (requires AANA member login and password). See the AANA’s letter at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150209%20FINAL%20AANA%20ltr%20to%20SVAC%20re%20S%20297%20Sec%204.pdf. Text of S 297 is available at https://www.congress.gov/bill/114th-congress/senate-bill/297/text?q=%7B%22search%22%3A%5B%22s+297%22%5D%7D.
AANA Analysis of CRNA Issues in the President’s 2016 Budget Proposal
The President has issued his 2016 budget proposal and Congress has already held hearings analyzing the proposal. The AANA continues to monitor the process for critical CRNA impacts.
Released Feb. 2, the budget for Uncle Sam’s fiscal year beginning Oct. 1, 2015, represents an opening bid shaping congressional action throughout the year on spending, tax and other legislation affecting revenues. Of particular interest to CRNAs, the proposed budget includes a fix to the Medicare sustainable growth rate (SGR) problem that threatens a 21% Medicare CRNA and physician payment cut April 1 unless Congress acts to fix it first. But the administration’s solution includes pay-fors that Congress has not accepted in the past. Additionally, the budget allocates $14.2 billion to bolster the health workforce with support for more than 15,000 National Health Service clinicians, many of whom serving in rural communities. For the third year in a row, advanced nursing education workforce funding would be provided $63.581 million. To see the budget, go to: https://obamawhitehouse.archives.gov/node/320071, and to see the Health and Human Services budget specifically go to: http://www.hhs.gov/budget.
Medicare Adjusts Rules and Interpretive Guidelines for Discharge from ASCs
The Centers for Medicare & Medicaid Services (CMS) issued a memorandum on Jan. 30 revising interpretive guidelines for ambulatory surgical centers (ASCs). The change may affect CRNAs practicing in ASCs and helps underscore the safe and cost-effective care that CRNAs offer. The agency changed the ASC rules and corresponding interpretive guidelines for patient discharge so that a surgeon may comply by having a statement on record that the patient may be discharged when he or she is stable. This change indirectly affects CRNAs as the CRNA may be the last health care professional examining the patient for recovery prior to discharge and may be the one ascertaining that the patient is stable. Read the CMS memorandum at: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-22.pdf.
To Protect and Advance CRNA Practice, the CRNA-PAC Begins Its 2015 Development Campaign
Led by CRNA-PAC Chair Rick Jueneman, CRNA, the CRNA-PAC’s 2015 development campaign is under way! Focused on building member engagement to protect and advance CRNA practice through federal advocacy, the CRNA-PAC is undertaking its 2015 campaign in four major phases.
With the theme of #MyCRNACause, the first phase involves educating AANA members about the role and benefits of the CRNA-PAC to the nurse anesthesia profession and to CRNAs, particularly in a time of major health policy and industry change. The second phase will reach out to members via email, mail and telephone to ask for their support. In the third phase, the CRNA-PAC will undertake a new peer-to-peer Ambassador Program initiative to raise funds for both the CRNA-PAC and state PACs in 10 selected states. The campaign will conclude with “Great Moments in Time,” the CRNA-PAC gala event being held Sunday, April 19, in Washington, DC, at the Newseum.
Learn more about the CRNA-PAC or make a contribution at www.crna-pac.org (requires AANA member login and password). For more information please contact AANA Associate Director Political Affairs Kate Fry at kfry@aanadc.com
Federal Trade Commission to Host Second Public Workshop on “Examining Health Care Competition”
Healthcare reimbursement issues of interest to CRNAs will be addressed for the second consecutive year in a policy workshop scheduled for Feb 24-25, 2015, by the Federal Trade Commission (FTC) and the Department of Justice, Antitrust Division. The AANA is preparing testimony to submit in advance on behalf of CRNAs and will attend the workshop, which is being webcast live. Specific topics for discussion may include: early observations regarding accountable care organizations (ACOs); alternatives to traditional fee-for-service payment models; trends in provider consolidation; trends in provider network and benefit design strategies, as well as contracting practices and regulatory activity that may enhance or undermine these strategies; and early observations regarding health insurance exchanges.
View the Federal Register Notice of the announcement of the workshop and questions for comment at http://www.gpo.gov/fdsys/pkg/FR-2015-02-02/pdf/2015-01856.pdf. View the live webcast on the FTC’s Examining Health Care Competition Workshop webpage at http://www.ftc.gov/news-events/events-calendar/2015/02/examining-health-care-competition. View the AANA’s comments on the FTC’s 2014 workshop at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20140310_AANA-Cmt_FTC-Health_Care_Wrksp-FINAL.pdf (Member ID and password required).
AANA and APRN Groups Provide Comments on the Hospital Improvements for Payment 2014 Discussion Draft
Led by the AANA, a workgroup of APRN organizations submitted comments January 27th on the House Ways and Means Subcommittee on Health’s discussion draft of options aiming improve hospital payments. As the AANA had already done, the APRN organizations recommended that legislators eliminate a controversial provision that would allow anesthesiologists to receive rural pass-through Medicare payments. The APRN groups expressed support for extending non-enforcement of direct supervision of rural outpatient therapeutic services, and a provision adding nurse practitioners, physician assistants, clinical nurse specialists and midwives to the list of providers who can order hospital stays. See the AANA letter at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20141215%20FINAL%20AANA%20Concerns%20with%20HIP%20Act%20Sec%20211%20-%20Rural%20Anesthesia%20Provision%20Raises%20Costs%20Not%20Quality%20(2).pdf (AANA member login required) and view the APRN workgroup’s comments here: http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150116%20APRN%20Letter%20on%20HIP%20Act%20Discussion%20FINAL.pdf (AANA member login required). See the discussion draft section by section review here: http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/HIP%202014%20Sec%20by%20Sec.pdf.
AANA and Nursing Groups Urge Medicare to Remove its Physician Requirement in Accountable Care Organizations
The AANA, along with 10 national nursing organizations, has urged the Centers for Medicare & Medicaid Services (CMS) to remove the requirement that the medical director for clinical management and oversight in an accountable care organization (ACO) must be a physician. The coalition’s request was made in a comment letter submitted to the agency on Feb. 2 in response to CMS’s ACO proposed rule.
The coalition letter stated, “Increasingly, APRNs are recognized for a wide variety of leadership roles to which they have been entrusted in the healthcare industry, including in clinical, educational and academic, executive, board, legislative, and regulatory domains. … (W)e ask the agency to make policy consistent with the recommendations of the IOM and instead allow that this individual be a qualified and licensed healthcare professional such as an APRN.”  Read the coalition letter on the ACO proposed rule at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150202%20ACO%20Proposed%20Rule%20APRN%20Comment%20-%20FINAL.pdf. Read the ACO proposed rule at http://www.gpo.gov/fdsys/pkg/FR-2014-12-08/pdf/2014-28388.pdf.
Congressional Republicans Unveil Affordable Care Act Replacement Plan titled, “Patient CARE Act”
Leading Republican lawmakers released a proposal Feb. 4 to replace the Affordable Care Act weeks before the Supreme Court hears arguments on the issuing of health coverage subsidies in many states (King v. Burwell). Although President Obama would surely veto the measure if the Republican Congress passed it, the AANA is monitoring the proposal for its possible effects on CRNA practice and reimbursement. The proposal is backed by Senate Finance Chairman Orrin G. Hatch, (R-Utah), Finance member Richard M. Burr (R-NC) and House Energy and Commerce Chairman Fred Upton (R-MI-8). It includes a medical coverage tax on employer sponsored health plans over $12,000 for an individual and $30,000 for a family. The tax would raise revenue to help supplement removing the requirement that all adults obtain health insurance, and to hold down rising medical costs. Aspects of the plan that are similar to the ACA include: Medicare cuts to providers and hospitals, coverage of adult children up to age 26 years (unless the state opts out), a ban on lifetime limits on insurance coverage, and a ban on coverage denials for pre-existing conditions but a new exemption for certain lapses in insurance coverage is proposed. See the press release, here: http://www.finance.senate.gov/newsroom/ranking/release/?id=5cebe1e1-963f-4a4d-b613-0bd5aa0f2e3a. View the summary here: http://www.hatch.senate.gov/public/_cache/files/95dd4672-5012-4ae0-99b2-6b2d450df6d4/The%20Patient%20CARE%20Act%20-%20Summary.pdf.
As Medicare Releases Schedule for Transitioning Payment Models; AANA Requests to Participate on New “Healthcare Learning and Action Network”
On Jan. 26, Medicare proposed to have 85 percent of its provider payments made in relation to healthcare quality or value outcomes by the end of 2016, moving away from straight fee-for-service payment toward applying quality measures incentives, bundled payment systems, and reimbursements to providers (usually larger institutions) based on population health. With the agency also promoting the development of a “Healthcare Learning and Action Network” intended to address issues associated with new payment models, the AANA formally requested that Health and Human Services Secretary Sylvia Burwell include the AANA and CRNAs on the network in a Jan. 30 letter.
Though many CRNAs already submit reimbursements with PQRS quality measures codes included, the proposal may prove to be a game-changer for CRNAs and other providers by accelerating the use of alternative payment models. AANA member views on the CMS proposal are welcome. Please email them to info@aanadc.com and include “Payment Models” in the subject line. To read the AANA’s letter to Secretary Burwell: http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150129%20AANA%20Letter%20to%20Secretary%20Burwell%20re%20Health%20Care%20Payment%20and%20Learning%20Action%20Network%20-FINAL.pdf (AANA login required). To read a new Perspectives piece in the New England Journal of Medicine from Secretary Burwell: http://www.nejm.org/doi/full/10.1056/NEJMp1500445. To read more about why this matters: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-2.html. To read a fact sheet about the goals and Learning and Action Network: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html. To learn more about Better Care, Smarter Spending, and Healthier People: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26.html. A blog from Secretary Burwell is here: http://1.usa.gov/1CYFKAk
  • In an announcement released, Feb. 6, Food and Drug Commissioner Margaret Hamburg plans to step down at the end of March 2015. During her six- year tenure with the agency, Commissioner Hamburg has included CRNAs on a leadership panel reviewing usage of opioids, partnered with AANA and other organizations to help prevent drug shortages, up-scheduled prescription hydrocodone combination drug products, approved Ryanodex (dantrolene sodium) for treatment of malignant hyperthermia, and at AANA’s request declined gastrointestinal specialists’ demands to remove FDA’s black box warning restricting administration of propofol exclusively to general anesthesia professionals. Stephen Ostroff, the FDA’s chief scientist and a former official at the Centers for Disease Control and Prevention, will become the agency’s acting commissioner. To read more about Commissioner Hamburg see: http://www.washingtonpost.com/national/health-science/fda-head-margaret-hamburg-to-resign-in-march-ostroff-to-be-acting-chief/2015/02/05/0f05de26-ad3a-11e4-abe8-e1ef60ca26de_story.html?wprss=rss_homepage
  • Are you prepared for ICD-10 transition? It will take place Oct. 1, 2015. The AANA is scheduled to monitor a House Energy and Commerce Committee hearing on ICD-10 implementation scheduled for February 11th at 10:15am. Please share how the ICD-10 has impacted your practice by submitting comments to info@aanadc.com. To learn more about the hearing, see http://energycommerce.house.gov/hearing/examining-icd-10-implementation or to learn more about the ICD-10 transition, see http://www.aana.com/resources2/professionalpractice/Pages/ICD-10-Transition.aspx.
  • Legislation repealing the Affordable Care Act passed the House of Representatives on Tues., Feb. 3. Though congressional Republicans have tried and failed to repeal the ACA numerous times, the ACA repeal legislation (H.R. 596) will likely struggle to overcome a 60-vote parliamentary hurdle in the Senate. In the unlikely event that ACA repeal passes both chambers, President Obama will veto it, and Congress will not have the 2/3 majority vote necessary to overturn his veto. To learn more about the situation, see http://www.politico.com/story/2015/01/obamacare-alternative-gop-house-114763.html. To view how your Representative voted on H.R. 596 click here: http://clerk.house.gov/evs/2015/roll058.xml.
  • The Medicare agency will continue publishing CRNA and other healthcare professionals’ Medicare payment data annually, according to an announcement from Medicare published in the Wall Street Journal on Feb. 1. The last release occurred April 2014; Medicare has not given a date for its next release. To see how Medicare has published your CRNA payment data, see this link: http://projects.propublica.org/treatment/.
  • Subsidized health coverage offered through federal exchanges in states is at issue in a case the U.S. Supreme Court is scheduled to hear on March 4, 2015. The Obama Administration submitted its main brief to the Court on Jan. 21, arguing that Affordable Care act tax subsidies are meant to be available to individuals in all states regardless of who established the health insurance marketplace. The AANA is monitoring the King v. Burwell case because a Court ruling in favor of the plaintiff could eliminate federal subsidies for private plans marketed in states through federal or federally-facilitated exchanges, which is to say in most states. Such an outcome could eliminate the market for such plans and substantially disrupt coverage for several million Americans. By the end of 2014, 15 million people, out of 330 million people in the United States, enrolled in ACA plans of all types including Medicaid expansions, and not quite half of them had signed up through the federal exchange. To learn more, see http://www.scotusblog.com/case-files/cases/king-v-burwell/.
  • Rep. Alan Nunnelee (R-MS-1) died Feb. 6 at age 56. Having last November been elected to his third U.S. House term, the congressman was close to members of the Mississippi Association of Nurse Anesthetists from his service in Congress and in the state Senate. Gov. Phil Bryant (R-MS) has until early April to call an election 60 days following his order.
  • The AANA attended the National Health Policy Conference Feb. 9-10 in Washington to monitor developments in payment reform for CRNAs. Sponsored by AcademyHealth, the conference covered topics including updates on ACA implementation, challenges and innovations in payment reform, quality measurement, and delivery system transformation. To see more information about the conference or learn more about the speakers and topics please see: http://www.academyhealth.org/Events/content.cfm?ItemNumber=1551.
  • Register today for the AANA Mid-Year Assembly at http://www.aana.com/meetings/aanaassemblies/Pages/Mid-Year-Assembly-Registration.aspx.
  • See the Medicare 2015 anesthesia conversion factor list by locality at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/201411-anesthesia-conversion-factor-list.pdf (requires AANA member login and password). The new rates took effect for services on Jan. 1, 2015.
  • Stay up to date on CRNA reimbursement issues by obtaining Version 2.1 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20140225_AANA_Issue-Briefs_Re_Reimbursement-2.1.pdf (requires AANA member login and password).
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.


NCCIH Working Group Recommends Large-Scale Collaborative Research Into Pain Management
A National Institutes of Health working group has recommended large-scale research into pain management for active military and veterans. The report, from the National Center for Complementary and Integrative Health, said the feasibility of conducting research into nondrug approaches for pain management in cooperation with the U.S. Department of Defense and the Department of Veterans Affairs should be assessed. Among its recommendations, the working group said the proposed research should look at the impact of pain on patient function and quality of life as primary outcome measures, with changes in the use of opioids and other drugs as a secondary outcome, and evaluate an integrated package of nondrug treatments, an integrative model of care, or a holistic approach to care rather than individual approaches. The research should also focus on patients in the early stages of chronic pain. "Chronic pain is a major public health problem that affects more than 100 million Americans, and research shows that it may disproportionately affect military personnel and veterans," said Lloyd Michener, MD, Duke University and chair of the working group. "New strategies for managing this widespread condition are urgently needed," he added.

From "NCCIH Working Group Recommends Large-Scale Collaborative Research Into Pain Management"
NIH News (02/11/15)


Monitor Triglycerides to Avoid Propofol Infusion Syndrome
Patients who undergo propofol sedation for an extended period of time are at risk for developing propofol-related infusion syndrome (PRIS), often with a fatal outcome. The condition is difficult to diagnose, but researchers at Louisiana State University say they are making progress in identifying patients who are vulnerable to PRIS. In their study of 72 patients who received continuous propofol sedation over an average period of nearly seven days, three subjects presented with PRIS—one of whom expired. The investigators documented a link between the duration of propofol infusion and elevated triglyceride levels that may signal onset of PRIS. Based on the finding, they recommend that clinicians monitor triglyceride levels early and halt propofol infusion at once if those levels start to climb. LSU anesthesiology professor James Diaz, MD, MPH, DrPH, believes this is likely just a first step in how healthcare providers pinpoint at-risk patients in the future. "As we go further," he suggests, "there are going to be molecular biomarkers. We're not there yet, but we're already thinking about it."

From "Monitor Triglycerides to Avoid Propofol Infusion Syndrome"
Pharmacy Practice News (02/10/15) Vlessides, Michael


Long-Term Opioid Use Doubled in Peds With IBD
According to research from the University of North Carolina, a diagnosis of inflammatory bowel disease (IBD) in pediatric patients significantly increases their odds of chronic opioid painkiller use. Over a two-year period, the study found, 5.6 percent of children with IBD received at least three prescriptions for an opioid analgesic compared to just 2.3 percent of kids who did not have the condition. The medical community advises against prolonged use of such drugs in children due to the risk of adverse gastrointestinal events and the potential for dependency, among other complications; yet lead researcher Jessie Buckley, PhD, MPH, noted that chronic use is "common" in this patient population. "Describing the characteristics of children with IBD using long-term narcotics is important to define the magnitude of this problem in the pediatric population and to identify potential strategies or interventions to reduce narcotic use," he said.

From "Long-Term Opioid Use Doubled in Peds With IBD"
Gastroenterology (02/15)


Timing of Opioid Administration as a Quality Indicator for Pain Crises in Sickle Cell Disease
A recent study investigated whether time to opioid administration (TTO) was associated with emergency department (ED) visit outcomes for sickle-cell disease patients with vaso-occlusive crisis (VOC). TTO was not associated with admission, but it was independently associated with change in initial pain scores, area under the curve for pain scores at four hours, total ED length of stay, and total I.V. opioids. The association of TTO with these outcomes could encourage TTO reduction efforts in the ED. The study looked at 14 ED visits for VOC in 177 patients. The median TTO for admitted patients was 86 minutes and 87 minutes for those not admitted.

From "Timing of Opioid Administration as a Quality Indicator for Pain Crises in Sickle Cell Disease"
Pediatrics (02/09/15) Mathias, Melissa D.; McCavit, Timothy L.
Vocalising Can Help You Deal With Pain
Reporting in the Journal of Pain, researchers offer what they say is preliminary proof that yelling words like "ouch" and "ow" can help people better withstand pain. Vocalization serves as a distraction to the hurt, they speculate. The study performed by investigators in Singapore involved 56 subjects who were asked to submerge their hands in frigidly cold water. Participants either said "ow," heard a recording of themselves saying it, heard playback of someone else saying it, pressed a button, or sat passively. When they vocalized themselves, enrollees in the experiment tolerated the pain for nearly 30 seconds, seven seconds longer than if someone else said it.

From "Vocalising Can Help You Deal With Pain"
Business Standard (India) (02/02/15)

Distraction Techniques May Reduce Pain, Anxiety During Conscious Surgery
Focusing patients' attention elsewhere can alleviate pain or anxiety from a surgical procedure during which they remain awake, say U.K. researchers. The team studied 398 people having varicose vein surgery, which generally requires only a local anesthetic. Patients were assigned to one of four activities meant to distract them, and their responses to a post-surgery questionnaire were compared against those of patients who underwent the procedure with no distraction methods. Engaging in conversation with a nurse during the operation, watching a DVD, and squeezing stress balls reduced anxiety by 30 percent, 25 percent, and 18 percent, respectively, compared to the control group of patients. Stress balls and conversation with a nurse were associated with 22 percent less pain and 16 percent less pain, respectively. Watching a DVD did not ease pain, however, and listening to music had zero effect on pain or anxiety. According to the lead researcher, University of Surrey Prof. Jane Ogden, the results point to an easy and cost-effective way to treat a common problem. Distraction strategies could be used for many exploratory procedures—such as colonoscopy—that are performed while patients are conscious, she added. The findings are published in the European Journal of Pain.

From "Distraction Techniques May Reduce Pain, Anxiety During Conscious Surgery"
Medical News Today (02/01/15) Whiteman, Honor

The Impact of Targeted Therapies for Pulmonary Hypertension on Pediatric Intraoperative Morbidity or Mortality
Research shows that patients with pulmonary hypertension (PHT) are at high risk of major adverse events during anesthesia, even after the introduction of new, disease-modifying treatments that reduce mortality. Severity of PHT was one risk factor for complications, as was age—younger children with PHT experienced more complications. The research was based on data from 122 children with PHT who underwent a total of 284 noncardiopulmonary bypass procedures in 2008-2012. Results showed a 3.9 percent rate of minor complications and a 3.2 percent rate of major complications, which is no change since the introduction of disease-modifying treatments. Minor complications included transient, self-limiting disturbances in arterial blood pressure, oxygenation, or cardiac rhythm. Major complications included hypotension, hypoxia, or arrhythmia that required resuscitation and intervention.

From "The Impact of Targeted Therapies for Pulmonary Hypertension on Pediatric Intraoperative Morbidity or Mortality"
Anesthesia & Analgesia (02/15) Vol. 120, No. 2, P. 420 Taylor, Katherine; Moulton, Dagmar; Zhao, Xiu Yan; et al.


Study Hints at a Better Way to Lessen Prostate Biopsy Pain
The commonly accepted approach for alleviating pain from needle insertion during prostate biopsy is not actually the most effective, researchers in India have discovered. A team led by Tarun Jindal, MD, studied 139 men undergoing the procedure, 46 of whom received the standard approach of intrarectal local anesthesia (IRLA) with periprostatic nerve block (PNB). Another cohort of 47 patients received IRLA in addition to pelvic plexus block (PPB), while the remaining 46 study participants received IRLA with no nerve block of any kind. The patients reported pain levels during the biopsy as well as 30 minutes post-procedure. Both sets of patients who received blocks rated their pain during the biopsy significantly lower than the men in the IRLA-only group; but the PPB group also reported much lower pain levels during the procedure compared to PNB patients. The researchers speculate that the injection site—between the bladder, prostate, and seminal vesicle—for lidocaine delivery during PNB allows a few of the targeted nerve fibers to escape. In PPB, meanwhile, the anesthetic is injected directly into the pelvic plexus, thus blocking all nerve fibers.

From "Study Hints at a Better Way to Lessen Prostate Biopsy Pain"
Renal and Urology News (01/22/15) Charnow, Jody A.
Study Focuses on Predicting Poor Candidates for Cervical Facet Joint Block
Research carried out by a team of physiotherapists identified segments of the patient population for whom cervical facet joint blocks likely would be ineffective. Statistical analysis of 125 patients suffering from neck pain suggested that individuals who have negative results on a manual spine examination or palpation for segmental tenderness are not ideal candidates for this kind of block. "Based on these results, if you know the patient is negative on either of these, you should not refer [him or her] for cervical facet joint blocks," summarized lead study author Geoff Schneider, PT, PhD of the University of Alberta in Canada. He added that the findings, presented at the International Spine Intervention Society's annual scientific meeting last year, have not yet been independently validated by other groups.

From "Study Focuses on Predicting Poor Candidates for Cervical Facet Joint Block"
Pain Medicine News (01/01/2015) Vol. 13, No. 1 Frei, Rosemary

Ultrasound Accurately Predicts Difficult Intubations
The findings of a Canadian study suggest that ultrasound could have a promising future as an airway management tool. Difficult intubation can cause morbidity or mortality in anesthetized patients; however, current methods for assessing this complication are not exact. Using ultrasound for this purpose, according to University of Toronto assistant professor of anesthesia Faraj Abdallah, allows for visualization of the oral cavity in a fairly noninvasive manner. He and fellow researchers conducted a trial of 42 patients having CT scans of the neck and head. Tongue-to-oral cavity volume and tongue thickness-to-oral cavity height ratios were determined as part of the CT scans and also were measured independently by sonographers using ultrasound. Although the ultrasound proved to be an effective indicator, Abdallah acknowledges, "we are not drawing conclusions about difficult intubation yet; we are simply validating the use of ultrasound. This study served as a precursor for other studies on the utility of ultrasound in predicting difficult airway."

From "Ultrasound Accurately Predicts Difficult Intubations"
Anesthesiology News (01/01/15) Vol. 41, No. 1 Vlessides, Michael

Inpatient Falls Are Up, But Don't Blame the Epidural, Study Shows
The number of falls and other accidents among patients having thoracic and major abdominal surgery spiked between 2007 and 2011, but analysis indicates that neuraxial blocks are not at fault. The study led by Tiffany Williams, MD, PhD, from the University of Texas Southwestern Medical Center covered 36,595 cases of thoracic surgery and 25,537 major upper abdominal surgeries. "When we pulled out the data and looked at the group that received epidurals and the group that did not, there was actually no association with respect to falls in those patients," said Williams. "If you had an epidural, you didn't fall any more frequently than a patient who didn't have an epidural. So there's some other factor that we're not able to identify now that's contributing to patient falls."

From "Inpatient Falls Are Up, But Don't Blame the Epidural, Study Shows"
General Surgery News (01/01/15) Vol. 42, No. 1 Vlessides, Michael

Postop NSAID Use May Increase Risk for Anastomotic Leak
Research out of the University of Washington draws a correlation between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) following colorectal surgery and elevated risk for anastomotic leak. The study involved data covering more than 13,000 patients statewide who had bariatric or colorectal surgery involving anastomosis over a five-year period. Investigators tracked the patients through 90 days post-surgery. Their results pointed to a 24 percent higher risk for anastomotic leaks among patients who received NSAIDs after their procedure, specifically those who underwent nonelective colorectal surgery. "Given that other analgesic regimens are effective and well tolerated, these data may be enough for some surgeons to alter practice patterns," suggested researcher Timo Hakkarainen, MD, in JAMA Surgery. "To determine the role of NSAIDs in colorectal surgery, future evaluations should consider specific formulations, the dose effect, mechanism, and other relevant outcome domains, including pain control, cardiac complications, and overall recovery."

From "Postop NSAID Use May Increase Risk for Anastomotic Leak"
Medscape (01/22/15) Garcia, Jennifer
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