AANA Anesthesia E-ssential

Vital Signs

AANA, Coalition Correct the Record on House GOP Doctors’ Caucus Attack Against VHA APRN Full Practice Authority

Leading a coalition of organizations representing some 400,000 healthcare professionals, the AANA responded on Feb. 22 to 13 physician legislators’ attacks against the VHA adopting Full Practice Authority for APRNs, expressing “deep disappointment in your signing the House Republican Doctors Caucus letter of Feb. 12 that contained misinformation and misleading omissions in opposition to expanding Veterans access to care through Full Practice Authority for VHA APRNs. We write to correct the record and to invite your favorable reconsideration of this important proposal to benefit America’s Veterans.”

The House Republican Doctors Caucus letter said, “Quality may be compromised as there are no independent studies to support the idea that ‘full practice authority’ in anesthesia is safe for Veterans. Existing independent studies suggest better anesthesia outcomes with physician involvement.”

Much of the APRN groups’ letter to the lawmakers responded to specific claims they made against CRNA patient safety. The AANA and other APRN groups wrote, “By moving forward with a regulatory proposal and not an advisory handbook revision, the Secretary of Veterans Affairs (VA) is acting wisely to advance consistently high quality healthcare across the VHA system. Establishing Full Practice Authority for the APRNs who provide anesthesia care, Certified Registered Nurse Anesthetists (CRNAs), enables the agency to implement consistent care delivery models across the VHA, and to favorably strengthen the workforce and advance access to care in response to challenges….”

The APRN groups’ letter was sent to the House Republican Doctors Caucus members who wrote on Feb. 12: U.S. Reps. Andy Harris, MD, R-MD (the only anesthesiologist in Congress); Tom Price, MD, R-GA (the House Budget Committee chair, whose spouse is an anesthesiologist); David Roe, MD, R-IN; Bruce Babin, DDS, R-TX; Joe Heck, DO, R-NV; Larry Buschon, MD, R-IN; Dan Benishek, MD, R-MI (who chairs the House Veterans Affairs Health Subcommittee and is retiring from Congress); John Fleming, MD, R-LA (a candidate for U.S. Senate in Louisiana); Ralph Abraham, MD, R-LA; Paul Gosar, DDS, R-AZ; Charles Boustany, MD, R-LA; Scott DesJarlais, MD, R-TN; and Michael Burgess, MD, R-TX.

Meanwhile, the AANA urges members to use Veterans Access To Care to submit comments supporting CRNA and APRN Full Practice Authority, and to encourage their colleagues and friends to do the same.

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CPC Facts

“CPC Program for CRNAs” Webinar Recording Now Available

If you missed the Feb. 16 live webinar on the “CPC Program for CRNAs: What’s New, What’s the Same, What’s Next,” the recording is available for viewing at your convenience. As part of the NBCRNA’s CPC Program Discovery Series, the live webinar gives an overview of the program, provides a brief background on the program, and takes you through the components and timing. Additional live webinars will continue to be held in April, June, and August. Check the NBCRNA website and your email for dates and times as they become available.

For more information about the NBCRNA's Continued Professional Certification (CPC) Program, which will launch on Aug. 1, 2016, go to the cpc-facts.aana.com and NBCRNA websites.

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Hot Topics

Board Approves Three New Practice Documents at ASF

At their meeting at Assembly of School Faculty, the AANA Board of Directors approved the following professional practice documents:

  • Diversity, Inclusion and Equity – This vision and position statement outlines AANA’s vision to embrace the rich diversity of patients, the nurse anesthesia profession and communities to achieve new standards of excellence in anesthesia care, education and research through the organization’s strategic initiatives. The AANA embraces the value of diversity, inclusion and equity grounded in cultural awareness, sensitivity and competency to respect each individual’s knowledge, experience, values, ideas, attitudes, and skills.
  • Documenting Anesthesia Care – These practice considerations and considerations for policy development can serve as a resource for CRNAs and facilities in the development of policy to promote accurate documentation of care for clear communication, quality improvement activities and reimbursement.
  • Non-anesthesia Provider Procedural Sedation and Analgesia - The purpose of this document is to provide considerations for policy development for the safe administration of procedural sedation by a non-anesthesia sedation team in a hospital, ambulatory surgical center, or office setting.

The entire contents of the Professional Practice Manual for the CRNA can be accessed online or purchased though the AANA Store.        

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2016 PQRS Playbooks Now Available to AANA Members

As you may know, the Centers for Medicare & Medicaid Services (CMS) have added 5 new anesthesia specific measures to the 2016 PQRS measure set, all of which can only be reported via a CMS-qualified registry. As most CMS-qualified registries will not be accepting data submissions until later this year, the AANA Research and Quality Division has developed two PQRS Playbooks for Anesthesia-Specific Individual Measures and Anesthesia-Related Measures Groups to assist CRNAs with appropriate documentation of quality actions. Each of these PQRS Playbooks contains data collection forms for abstracting relevant information from patient charts that can later be transferred to registry templates of your choosing.

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AANA Past-President Brangman's Story Generates National Interest, Media Coverage

A first-person account of Goldie Brangman, MEd, MBA, CRNA, recounting her memories of the operation to save Dr. Martin Luther King, Jr., has appeared in Ebony’s [In My Lifetime] series for Black History Month. The narrative was compiled from comments made by Ms. Brangman on The Danny Tisdale Show on Harlem World Magazine Radio, and the article she co-authored with Evan Koch, MSN, CRNA, in the December 2015 AANA Journal, “Goldie Brangman Remembers the Operation to Save Dr King.” Interviews with USA Today and WNBC in New York are currently in development.

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Professional Practice

Maternal Mental Health Resources Now Available

The ACOG Council on Patient Safety in Women’s Health Care has released a Maternal Mental Health: Perinatal Depression and Anxiety Patient Safety Bundle. Download these complimentary resources, which include resources for readiness, recognition and prevention, response, and reporting/systems learning.

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                State Government Affairs

The Baltimore Sun Publishes an Opinion Editorial by MANA President

On Feb. 2, 2016, the Baltimore Sun published an opinion editorial (op-ed) titled “No room for error in the operating room” written by Jacqueline C. Mitchell, MSN, CRNA, president of the Maryland Association of Nurse Anesthetists. In the op-ed, Mitchell discusses her opposition to Maryland Senate Bill 30, which proposes to license anesthesiologist assistants in Maryland. Read the full op-ed.

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Meetings and Workshops

Save the Dates for These Popular Hands-On Workshops

Visit 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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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, D.C., 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 3. Also, travel discounts for major airlines are available with our promo codes available on our web site.

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Register Now for Business of Anesthesia Conference

On June 24-25, join the AANA for a two-day conference on Chicago’s Magnificent Mile that will arm you with critical tools for navigating the business aspects of anesthesia practice. Get real-world advice from expert speakers with experience in building and maintaining a successful practice.

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Foundation and Research

AANA Foundation Friends for Life Deadline – June 15

Friends for Life support the future of the nurse anesthesia profession through meaningful, lasting gifts that fund and sustain programs in anesthesia research and education.

The minimum gift commitment to join Friends for Life is $25,000. Members may fulfill this commitment through a cash gift, but there are many other ways to meet the commitment through planned gifts. Some of the most popular planned gift options for becoming a Friend for Life include:

  • A gift (bequest) in the will for a specific amount or a percentage of the total estate
  • Gift of personal property or real estate
  • Including the Foundation as a beneficiary on a retirement plan or a whole life insurance policy
  • Friends for Life receive a medallion at the AANA Annual Congress Opening Ceremonies, an engraved plaque in the AANA Park Ridge office and an invitation to the Annual Awards and Recognition Event.

For further information, please contact Nat Carmichael at (847) 655-1175 or ncarmichael@aana.com. The Friends for Life submission deadline for recognition at this year’s Annual Congress in Washington, D.C., is June 15, 2016

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AANA Foundation Student Opportunities

Attention students … Visit the AANA Foundation Student webpage for exciting opportunities for nurse anesthesia students. Applications are now available for the following:

  • Student Scholarship – Due March 1, 2016
  • AANA Foundation Student Advocates – Due March 1, 2016
  • “State of the Science” Oral Poster Presentation – Due April 1, 2016
  • “State of the Science” General Poster Presentation – Due May 1, 2016

If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com

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Federal Government Affairs

Final Rule Requires Medicare Providers to Report and Refund Overpayments within 60 Days; Self-Auditing Expected

Healthcare providers who discover that Medicare overpaid them for services must report and refund those overpayments within 60 days of finding them, according to a final rule that takes effect March 14, 2016. It is not sufficient for CRNAs or other Medicare providers to claim ignorance of overpayments; Medicare expects providers to self-audit their claims.

Located in the same rule that authorizes Medicare to look back as many as six years to recoup overpayments, this rule has important implications for CRNAs. It says that Medicare providers must use “reasonable diligence” to comply, noting that, “Providers and suppliers are responsible for ensuring their Medicare claims are accurate and proper and are encouraged to have effective compliance programs as a way to avoid receiving or retaining overpayments.” The rule applies equally to those providers and suppliers who are independent businesspeople as well as to employees who have assigned their billing rights to a hospital or group.

The AANA is reviewing this final rule further for CRNA impacts, and developing guidance to help CRNAs and anesthesia practices comply. Read the agency’s final rule

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AANA Backs Legislation to Strengthen Rural Healthcare

The AANA has expressed its support for two new bills pending in the U.S. House of Representatives that help strengthen our rural healthcare system. In many rural counties, CRNAs are the sole providers of 100 percent of anesthesia services.

The “Critical Access and Rural Equity (CARE) Act of 2016” (H.R. 4553), sponsored by Reps. Gregg Harper R-MS and David Loebsack D-IA, has drawn a letter of support from the AANA because it includes a provision restoring Medicare Part A rural pass-through for anesthesia services payments to also include payment for CRNA on-call or standby services. “We appreciate that your legislation would also restore nurse anesthetist standby and on-call payment eligibility within the program,” AANA President Juan Quintana, DNP, MHS, CRNA, wrote on Feb. 22. “Such payments are necessary to rural hospitals’ emergency care and trauma stabilization capabilities.”

The AANA has joined the National Rural Health Association in expressing support for the “Save Rural Hospitals Act” (H.R. 3225), sponsored by Reps. Sam Graves R-MO and David Loebsack D-IA. “Rural hospitals across the country are fiscally strapped, leading to the closure of at least 44 rural hospitals in the United States over the last four years,” wrote President Quintana on Feb. 22 “Your legislation would help to strengthen rural hospitals and enable such facilities to continue providing high-quality and cost-effective care to the nation’s most vulnerable populations.” The bill includes several provisions intended to alleviate fiscal stresses on rural hospitals. While it involves no direct CRNA-specific provisions, one provision (Sec. 302) relates to general supervision of outpatient therapeutic services such as dialysis, chemotherapy, immunizations, and not surgical services or anesthesia services, and is consistent with language that the AANA has supported in the past

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Death of Supreme Court Justice Scalia May Affect Some CRNA Policy Issues

The death of Supreme Court Justice Antonin Scalia on Feb. 14 has triggered numerous political outcomes in Washington that may affect progress on issues affecting CRNAs in 2016.

  • At press time the administration had not yet nominated a candidate to succeed Justice Scalia on the Supreme Court. However, the Senate Republican majority united against allowing his nomination to get a hearing or a vote in the Senate, and in favor of the next president nominating someone to fill the vacancy. In an election-shortened 2016 legislative season, the Senate Democratic minority may respond by holding up action on 2017 budget and appropriations legislation as leverage to gain a hearing or a vote on a Supreme Court nominee.
  • Any decisions not yet announced in the 2016-17 Supreme Court session will be made by a court of eight justices – and any ties in the divided court revert the case to the lower court’s decision. Among the pending cases that may interest CRNAs include one that further addresses the power of state professional licensing boards to govern commerce in a state (Sensational Smiles LLC vs Mullen), no oral arguments yet scheduled), and one that addresses the constitutionality of requiring public employees to pay labor union fees for collective bargaining (Friedrichs vs California Teachers Association).
  • Debates in election contests for the President and for U.S. Senators can reasonably be expected to focus more on the Supreme Court.
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Medicare Reminding All Healthcare Providers Who Prescribe Medications That They Must Be Enrolled in Medicare

If you are prescribing medications to Medicare beneficiaries whose medications are covered under a Medicare Part D prescription drug plan, you will need to be enrolled in Medicare in order for those beneficiaries to get their medications covered under their plans, according to a recent statement from the Medicare agency. Medicare Part D may no longer reimburse for medications that are prescribed by healthcare providers who are not enrolled in Medicare. CRNAs who prescribe medications to Medicare beneficiaries should be aware of their own enrollment status with Medicare.

For further information, visit CMS.gov.

To check to see if you are enrolled in Medicare, visit CMS.gov.

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Medicare, Health Plans Unite on Quality Measures Plan; Most Relate to Primary Care

On Feb. 16, the Core Quality Measure Collaborative, led by the America’s Health Insurance Plans (AHIP), leaders from CMS and the National Quality Forum (NQF), and other healthcare stakeholders released seven sets of clinical quality measures that support multi-payer alignment for reporting to physician quality programs. While they do not involve anesthesia directly, they do involve surgery and are being reviewed closely for any CRNA impacts.

This work is intended to inform CMS’s implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) through its measure development plan and required rulemaking, and is part of CMS’s commitment to ensuring programs work for providers while keeping the focus on improved quality of care for patients. The guiding principles used by the collaborative in developing the core measure sets are that they be meaningful to patients, consumers, and physicians, while reducing variability in measure selection, collection burden, and cost. The goal is to establish broadly agreed upon core measure sets that could be harmonized across both commercial and government payers. The core measures are in the following seven sets: Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMHs), and primary care; cardiology; gastroenterology; HIV and Hepatitis C; medical oncology; obstetrics and gynecology; and orthopedics.

View the CMS press release and the Core Measures.

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Next Presidential Votes Take Place March 1

The AANA encourages CRNAs to vote and be active in primary elections this winter and spring in support of candidates of their choice. If you are involved in one of the following early primary or caucus campaigns below, AANA DC would be delighted to hear from you. Tell your story or send your pictures to info@aanadc.com with “CRNAs in Campaigns” in the subject line.

  • March 1, presidential primaries in Alabama, Arkansas, Georgia, Oklahoma, Tennessee, Texas, Vermont and Virginia; presidential caucuses in Alaska (Republicans only), American Samoa (Democrats only), Colorado and Minnesota; congressional primaries in Arkansas, Alabama and Texas
  • March 5, Republican presidential caucuses in Kentucky and Maine, Democratic presidential caucus in Nebraska, and presidential primary elections in Louisiana
  • March 6, Democratic presidential caucus in Maine, and Republican presidential primary election in Puerto Rico
  • March 8, Republican presidential caucus in Hawaii, presidential primary elections in Idaho, Michigan and Mississippi

For an up-to-date list of 2016 election dates by state and by date, see: http://www.fec.gov/pubrec/fe2016/2016pdates.pdf.

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Book Your Meeting, Hotel and Travel Now for Mid-Year Assembly 2016 in Downtown Washington, D.C.

The AANA Mid-Year Assembly, to be held April 2-6, 2016, returns to downtown Washington, D.C.! But because our site and our dates coincide with additional major events in the nation’s capital—namely the 2016 Cherry Blossom Festival and parade—AANA members are encouraged to register and book their lodgings and air travel as early as possible.

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    The AANA congratulates AANA member Kate Kinslow, EdD, MBA, CRNA, on being selected to serve on the Population-Based Payment Work Group (PBP) of the Health Care Payment Learning & Action Network (LAN). Nominated by the AANA, Dr. Kinslow’s workgroup is focusing on the most effective way to align the nation’s payer and provider payment reform efforts around PBP models. The work group will focus on six “components” that comprise essential programmatic features of PBP models (e.g., patient attribution, quality measures, and financial benchmarking). For further information describing population based payment models, see this from Health Affairs, and this glossary of various models from the Kaiser Family Foundation.
  • Court-ordered redistricting in North Carolina is delaying congressional primary elections and driving at least two congressional incumbents to challenge each other in the same congressional district. The North Carolina congressional primary is now delayed from March 15 to June 7. However, the state’s primary election for President and other offices remains on March 15. On Feb. 22, Rep. George Holding (R-NC-13) announced his plan to challenge incumbent Rep. Renee Ellmers (R-NC-2), one of the few nurses in the U.S. House of Representatives. Read more.
  • Engage with your profession’s social media feed on Facebook and Twitter.
  • Keep up with the AANA’s new efforts for educating hospital administrators, healthcare policymakers and other health industry leaders about the role and value of CRNA care at The Future of Anesthesia Care Today.
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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 U.S. Citizen.

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

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Featured Career Opportunity

Nurse Anesthetist (OB Preferred) –
Union Hospital of Cecil County, Maryland

Baltimore, MD

Nurse Anesthetist (OB Preferred): Union Hospital of Cecil County MD seeks an AANA-certified RN w/ 2+ years of experience. Exceptional compensation/benefits plan.

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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.

Doctors Petition FDA for 'Black Box' Warning on Combining Opioid Analgesics, Tranquilizers

Thirty city and state health directors from around the nation are calling on the FDA to label opioid analgesics and benzodiazepines with its strongest warning. The directors are seeking a "black box" warning on the drugs. Local and state health directors "are on the front lines of the opioid epidemic," says Leana Wen, the Baltimore health commissioner. "All of us have seen the toll of overdose deaths." Adding a prominent warning to drug labels would alert both physicians and patients to the risks, according to Nicole Alexander-Scott, director of the Rhode Island Department of Health, who submitted a petition to the FDA Monday. She notes that the combination of opioid analgesics and benzodiazepines can cause people to stop breathing. A dozen additional doctors and health leaders cosigned the petition. "These kinds of warnings work," states Alexander-Scott. "Our voices are amplified if we all speak to FDA in unison."

From "Doctors Petition FDA for 'Black Box' Warning on Combining Opioid Analgesics, Tranquilizers"
USA Today (02/23/16) Szabo, Liz

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Ganglion Block Beats Blood Patch for Dural Puncture Headache

While epidural blood patch is the standard of care for treating postdural puncture headache (PDPH) in obstetric patients, researchers at Rutgers say there is a way to deliver relief faster and with fewer adverse effects. Blood patches involve an invasive procedure—drawing blood from the arm and injecting it into the spine to clot and seal a puncture—that can trigger complications such as subdural hematoma, seizure, and meningitis. Sphenopalatine ganglion block, however, is minimally invasive—lidocaine is injected into each nasal passage—and has been used for more than a century to treat various types of headache. Reviewing records for 72 patients who experienced PDPH from an accidental needle puncture during an epidural, lead investigator Preet Patel, MD, said: "We were able to show that the block works much faster than the blood patch in relieving the headaches," so much so that it should be considered the first line of treatment for laboring women. "We advocate that you do the block and if it doesn't work [because the ganglion was missed], to try it a second time, and maybe even third time," Patel concludes. "And if you have a failure at that point then you can move on the more invasive blood patch. There really is no downside to doing the block."

From "Ganglion Block Beats Blood Patch for Dural Puncture Headache"
Medscape (02/23/16) Anderson, Pauline

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Pain Treatment Oliceridine Wins Breakthrough Therapy Status

As it prepares to shift into Phase III development, intravenous oliceridine has been upgraded from the FDA's fast-track program to breakthrough therapy status. The drug, indicated for the management of moderate-to-severe pain, appears to work better than morphine but without the associated complications. Rodent studies revealed oliceridine to be more potent than morphine and to achieve peak analgesia more quickly while causing fewer gastrointestinal problems and a lower incidence of respiratory depression. In Phase II testing, meanwhile, it demonstrated analgesic efficacy with a reduced frequency of opioid-related adverse effects, including vomiting and nausea, compared to morphine. The drug's manufacturer, Trevena, is slated to launch the next round of studies in the second quarter.

From "Pain Treatment Oliceridine Wins Breakthrough Therapy Status"
Managed Care Magazine (02/16)

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OR-to-PACU Handoff Protocol Succeeds in Reducing Errors

A study at Baltimore's Johns Hopkins Hospital credits a new perioperative handoff process for lowering the number of errors that occur when transferring patients from the operating room to the post-anesthesia care unit (PACU). The protocol dictates that all team members—nurses, anesthesia providers, and surgeons—present their reports, including extensive checklists, together at the patient's bedside. Looking at 53 transfers completed before the new procedure and 50 after it was put into practice, researchers documented fewer technical defects, a smaller number of defects overall per handoff, and not as many missing items on surgery and anesthesia reports under the new procedure. While handoffs took about two minutes longer with the changes, patients got settled into the PACU a little faster. "The beautiful thing about this particular protocol is that it can be implemented in every center, whether it's a major academic medical center or a community hospital," notes Vinay Pallekonda, MD, a critical care specialist based in Michigan. "It's a simple tool."

From "OR-to-PACU Handoff Protocol Succeeds in Reducing Errors"
Anesthesiology News (02/19/16) Van Voorhis, Scott

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American Pain Society Releases New Post-Surgical Pain Management Guideline

Research shows most surgical patients are under-treated for pain, increasing the risk for long-term complications; but new guidance aims to help caregivers provide optimal postoperative pain management. The American Pain Society (APS) published 32 evidence-based recommendations in The Journal of Pain after convening an expert panel to review more than 6,500 scientific abstracts and clinical studies. According to lead author Roger Chou, MD, head of the Oregon Evidence-based Practice Center, APS endorses broader use of different analgesic medications and techniques. The guideline also calls for wider use of multimodal anesthesia, the incorporation of non-pharmacological treatments like transcutaneous elective nerve stimulation and cognitive behavioral therapies, preoperative administration of celecoxib in adult patients, oral opioid use over intravenous opioids for post-surgical analgesia, and spinal anesthesia for major thoracic and abdominal procedures, among other recommendations. See http://www.jpain.org/article/S1526-5900(15)00995-5/pdf

From "American Pain Society Releases New Post-Surgical Pain Management Guideline"
News-Medical.net (02/18/2016)

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Dexmedetomidine Effective for Stapes Microsurgery and Saves OR Time

Researchers say a combination of local anesthesia and sedation with dexmedetomidine is safe and effective for stapedotomy—a delicate microsurgery of the ear—and even offers a financial advantage over general anesthesia. The investigation was led by Lynnie Correll, MD, PhD, of the University of Rochester Medical Center, who presented the findings at the New York State Society of Anesthesiologists 69th Annual PostGraduate Assembly. The study included 52 stapes operations where patients received either standard general anesthesia or the dexmedetomidine protocol. No disparity was observed between the two cohorts in terms of hemodynamic instability or estimated blood loss; and patients in both groups consumed similar amounts of antiemetics and narcotics following surgery. The team noted, however, that operation time was shorter for dexmedetomidine patients, at 56 minutes on average versus 70 minutes for general anesthesia patients. With cost directly linked to the amount of time in the operating room, the savings potential with dexmedetomidine is significant. "Our next step is to analyze just what accounts for this difference in operative time," Correll indicated.

From "Dexmedetomidine Effective for Stapes Microsurgery and Saves OR Time"
Anesthesiology News (02/17/16) Duffy, Brigid

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The Effect of Medicinal Cannabis on Pain and Quality of Life Outcomes in Chronic Pain

Based on new findings, long-term use of medicinal cannabis appears to be an effective alternative for chronic pain sufferers who have not had success with other treatments. In 176 patients approved for the regimen, pain scores—rating symptoms, severity, and interference—improved markedly six months later, as did most social and emotional disability scores. In addition, the need for opioid relief declined 44 percent overall by the six-month mark; and only two people were forced to drop out due to adverse effects. Although the investigation is limited by its uncontrolled format, the researchers concluded the long-term treatment of chronic pain with medical marijuana is a viable option for some patients.

From "The Effect of Medicinal Cannabis on Pain and Quality of Life Outcomes in Chronic Pain"
Clinical Journal of Pain (02/16) Haroutounian, S.; Ratz Y.; Ginosar, Y.; et al.

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Morphine More Effective Than Weak Opioids for Cancer-Associated Pain

Italian researchers say low-dose morphine curbs moderate pain in cancer patients more quickly and to a greater extent than weak opioids such as tramadol. They compared pain intensity relief in 240 patients randomly assigned to follow one of the two protocols, noting that both groups achieved adequate pain control by the end of the 28-day study period and that both courses of treatment were well tolerated. More patients in the morphine cohort, however, reached the targeted 20 percent reduction in pain—and in as little as one week. The finding could have implications for the World Health Organization's (WHO) guidelines on palliative care for cancer patients—which currently recommend treating pain with nonopioids before stepping up to weak opioids and, finally, strong opioids. Some organizations, however, are now shifting toward a two-point approach. "To abolish the second step will simplify treatments and perhaps give patients with cancer better pain control," the Italian researchers report in the Journal of Clinical Oncology. "Whether the findings of this study, which are in favor of starting directly with a step three opioid, may contribute to changing the WHO guidelines must be confirmed by other phase 3b/phase 4 studies."

From "Morphine More Effective Than Weak Opioids for Cancer-Associated Pain"
Healio (02/16/2016) Kelsall, Cameron

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Anesthesia-Related Malpractice Claims Decrease Nearly 50 Percent in 10 Years

Medical malpractice claims linked to anesthesia services reportedly declined by 41.4 percent—a pace of roughly 4.6 percent per year—between 2005 and 2013. The trend was driven by falling inpatient claims, which were down 45.5 percent over the period compared to a decrease of 23.5 percent in outpatient claims. Researchers culled the results from claims reported to the National Practitioner Data Bank and presenting the findings at the 2015 Annual Meeting of the American Society of Anesthesiologists.

From "Anesthesia-Related Malpractice Claims Decrease Nearly 50 Percent in 10 Years"
Becker's ASC Review (02/16) Vaidya, Anuja

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Pre-op Trip to Anesthesia Evaluation Clinic Lowers Surgical Cancellations

Patients who visited an anesthesia evaluation clinic were less likely to have their surgery cancelled due to unchecked lab results and failure to fast or stop taking medications, among other reasons. Preoperative assessments were notably more effective for people who went to a clinic in person, according to a review of cancelled surgeries for nearly 38,000 patients at Houston's Memorial Hermann Hospital. The cancellation rate was only 1.9 percent for those who physically visited the hospital's Preoperative Anesthesia Clinic, compared with 2.8 percent for those who spoke with a nurse via telephone and 8.2 percent for those who received no assessment at all before surgery. According to medical director Davide Cattano, MD, PhD, the clinic improves patient risk stratification, patient optimization, and the use of health care resources by curtailing cancellation rates—which have fallen below 1.5 percent overall at Memorial Hermann from more than 4.5 percent overall in 2008. However, Cattano and colleagues stress that more needs to be done to understand the parameters of clinical deterioration of a patient's condition between the preop evaluation and the day of surgery. Additionally, they say more attention should be given to cancellations caused by financial snags.

From "Pre-op Trip to Anesthesia Evaluation Clinic Lowers Surgical Cancellations"
Anesthesiology News (02/16/16) Vlessides, Michael

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A Utah Senator Is Working on Legislation That Would Require Doctors to Administer Anesthesia to a Fetus Before an Abortion

In Utah, state Sen. Curt Bramble has ordered staffers to start drafting legislation mandating fetal anesthesia prior to an abortion—an option already available to women terminating a pregnancy after the first 20 weeks. The lawmaker said he is shifting focus from a measure that would have banned abortions after the period when a fetus can experience pain—like a dozen other states have already done—to one that focuses on anesthesia and is more likely to pass. A similar 2015 law in Montana, however, drew a veto from its governor, who said it put the Legislature's beliefs ahead of those of doctors and patients. It is still uncertain what stage of gestation will be targeted under Bramble's new proposal.

From "A Utah Senator Is Working on Legislation That Would Require Doctors to Administer Anesthesia to a Fetus Before an Abortion"
Associated Press (02/16/16) Price, Michelle L.

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Use of and Barriers to Access to Opioid Analgesics

A new analysis finds that use of opioid analgesics—which are critical for treating pain—increased significantly in North America, western and central Europe, and Oceania from 2001-2013. The same was not true for Africa, Asia, Central America, South America, Caribbean nations, or eastern and southeastern Europe—where use of such drugs has been checked by a lack of awareness and training, fear of dependence or diversion, financial limitations, and procurement snags, among other factors. The research, funded by the International Narcotics Control Board, recommends that governments and global agencies respond immediately to the barriers identified as blocking access to opioid analgesics in some parts of the world.

From "Use of and Barriers to Access to Opioid Analgesics"
The Lancet (02/03/2016) Berterame, Stefano; Erthal, Juliana; Thomas, Johny; et al.

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

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

If you are interested in advertising in Anesthesia E-ssential contact Slack Incorporated at 800-257-8290.

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

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

Attn: Linda Lacey
E–ssential Editor


February 29, 2016
Earn Your DNAP

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