AANA Anesthesia E-ssential

Malignant Hyperthermia-Times Have Changed

Vital Signs

#AANA2015: We Have an App for That!

The mobile app for the AANA 2015 Nurse Anesthesia Annual Congress is ready for download on both the iTunes and Google Play app stores—for free! The app is the go-to place for information regarding the Annual Congress—users can view every educational session, every speaker, and get general information about the convention and Salt Lake City—all within a few taps. Attendees can even personalize a schedule and save it within the app to make sure they never miss a session of interest.

To download, you can search for “AANA 2015” in both app stores on your mobile device, or iPhone users can click here, and Android users can click here.
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CPC Pulse

Value of Class B Requirements

By including professional development activities (Class B requirements), the CPC Program supports the expanding role of advanced practice registered nurses in the future of healthcare delivery and leadership. The Class B requirement acknowledges the diversity of professional activities and experiences of nurse anesthetists, who are increasingly called upon to attain competencies beyond clinical knowledge and practice. Examples of professional development activities that meet the Class B requirement include national or state nurse anesthesia association activities; committee work, review boards, or task forces at your facility or institution; university or college committee work; and more. 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

AANA and APRN Organizations Launch “Veterans Access to Quality Healthcare Alliance” Advocacy Site: Tell Your Friends

The AANA is excited to announce the new phase of our campaign to promote veterans access to quality healthcare through recognition of CRNAs and other APRNs to their Full Practice Authority: the formation of the “Veterans Access to Quality Healthcare Alliance” and a new professional advocacy website to share with colleagues in general and with veterans in particular—http://www.veterans-access-to-care.com.

The AANA is joined in this Alliance by our APRN colleagues with the common goal of recruiting and mobilizing individual veterans, family members of veterans, healthcare professionals, and others to promote veterans access to high-quality APRN services in the Veterans Health Administration (VHA).

Starting July 29, individuals from around the country can have their voice heard and support improving veterans access to care by advancing Full Practice Authority for all VHA APRNs. We encourage you to share this site with your colleagues, friends and family and urge them to take action by writing their member of Congress here. This site will also serve as a resource for veterans and other interested parties to learn more about the issue, write the VHA, and share their stories.

To date, more than 14,000 members have expressed their support for the Full Practice Authority of APRNs in the VHA. More support is needed to continue to encourage the VHA to complete its work on this important policy to help reduce veterans’ wait times for high quality healthcare that they need and deserve.

Share this website with your network and encourage their support today via: http://www.veterans-access-to-care.com.
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CMS Public Reporting and Quality

The demand for healthcare providers to promote transparency of clinical quality is accelerating through the use of public and private reporting. The Centers for Medicare & Medicaid Services (CMS), via different quality reporting programs, has been collecting a number of metrics, including performance measures and patient experience, and is now using them to report on healthcare provider and group practice performance—both publicly and privately. The AANA Research and Quality Division has developed a new FAQ page on the AANA Quality-Reimbursement website to help CRNAs better understand public reporting via Physician Compare and private reporting via Quality Resource Use Reports. Please visit our FAQ page to learn more about CMS Quality Public Reporting.
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Renew Your Membership Online: It's Easy!

Renewing your AANA membership for the fiscal year September 1, 2015, through August 31, 2016, is easy and convenient. Just click here (AANA member login and password required) and complete the online process using your credit card. You can also renew your membership using the paper forms sent to you through the mail. See the AANA website for further information about membership and its benefits. Installment payments and automatic renewal are now available!
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New CRNA Stories Featured on Future of Anesthesia Care Today Site

Bob Gauvin, CRNA, MS, and Mike MacKinnon, CRNA, MSN, APN, work in very different practice environments – one works in a large community and owns his own anesthesia company; the other works in a small rural hospital and is state president. Yet they both have achieved something most impressive. Learn more about these two amazing CRNAs in CRNA Stories.
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Proposed Bylaw Amendments and Resolutions Available Online

Due to the changed submission deadline that took effect this year, proposed AANA Bylaw Amendments and Resolutions are available online instead of in the July issue of AANA NewsBulletin because of a conflict with printing deadlines. The proposed Bylaw Amendments and Resolutions to be debated at the August 30, 2015, AANA Business Meeting can be viewed at: http://www.aana.com/myaana/AANABusiness/governance/Pages/AANA-Annual-Business-Meeting-Agenda-and-Information.aspx. In the event a member does not have online access, you may request that a hard copy be mailed to you via a message to mscheuermann@aana.com or phone (847) 655-1101.
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Professional Practice

Joint Commission, ASHE Launch Physical Environment Portal

The Joint Commission and the American Society for Healthcare Engineering (ASHE) launched a new Physical Environment Portal July 14 to provide online resources and tools for hospitals to be compliant with the eight most challenging Joint Commission Life Safety (LS) and Environment of Care (EC) standards. The portal is available to the public and includes resources for both facility managers and leadership.
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NIOSH Research Highlights Importance of Rigorous Standards for Gowns Used to Protect Healthcare Workers

Recent research performed at the NIOSH National Personal Protective Technology Laboratory (NPPTL), with support from Nelson Laboratories, suggests that some isolation gowns do not meet the performance standards established by the American National Standards Institute (ANSI)/Association for the Advancement of Medical Instrumentation (AAMI). Learn more at
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New Injection Safety Drug Diversion Graphic

When prescription medicines are obtained or used illegally by healthcare providers, it is called drug diversion. A new graphic on CDC’s Injection Safety website illustrates the risks of contracting an infection when a healthcare provider uses injectable drugs for his or her personal use. You can see the new drug diversion graphic by visiting CDC’s Injection Safety website.
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OSHA Adds Key Hazards for Investigators' Focus in Healthcare inspections

In a recent news release on healthcare inspections, the Occupational Safety & Health Administration (OSHA) put hospitals and nursing homes on notice. Inspectors will add new enforcement on some key hazards for healthcare workers, including musculoskeletal disorders, bloodborne pathogens, workplace violence, tuberculosis and slips, trips, and falls. Hospitals will be penalized for gaps in training, use of assistive devices, and low quality treatment for staff who move patients.
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Meetings and Workshops

Save the Dates for AANA Meetings and Workshops

Make the most of your professional development this fall! Check out what's coming up here, and find out more and register here.
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#NAAC2015: Online Pre-registration Deadline Approaching Fast

The 2015 Nurse Anesthesia Annual Congress is only four weeks away! (August 29 - September 1, in Salt Lake City.) Avoid the lines and register online by August 16. After that date, only onsite registration is available.
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Special Conference Rates on #AANA2015 Headquarters Hotel Extended!

Good news! #AANA2015 hotel group rates have been extended through Aug. 5. But don't wait! The Marriott and the Hilton are already sold out. Take advantage of the great rates at the Grand America. Enjoy luxury for less. Spas. Larger, more spacious rooms. Plus, the majority of attendees will stay here and you will receive free curbside shuttle service to the conference. Click here to find out more.
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Registration Open Now for Fall Leadership Academy

Join us at the 2015 Fall Leadership Academy, Nov. 6-8, in Rosemont, Ill. The Fall Leadership Academy will provide AANA members the knowledge and skills required to serve as leaders at all levels, in all practice settings. Register today.
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Register Now for the Upper and Lower Extremity Block Workshop

To be held Sept. 26-27, in Park Ridge, Ill., this program will expand the skills and expertise of CRNAs using upper and lower extremity block anesthesia. The program will include case studies, hands-on demonstrations, return demonstrations, and skill validation. Register now.
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Register Now for Popular Hands-On Workshops

Check out the Meetings and Workshops webpage on the AANA website and future issues of the AANA NewsBulletin and Anesthesia E-ssential for further information.
  • Essentials of Obstetric Analgesia/Anesthesia Workshop: October 21, 2015, Park Ridge, Ill. (Registration open now)
  • Spinal and Epidural Workshop: October 22-24, 2015, Park Ridge, Ill. (Registration open now)
  • Jack Neary Advanced Pain Management Workshop Part II, October 10-11, 2015, Rosemont, Ill. (Registration opens soon)
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Foundation and Research

AANA Foundation presents… Hollywood Revisited performing at One Night – Twice the Fun

Plan to attend a fabulous and fun event that offers something for everyone on Sunday, Aug.30, at the Grand American Hotel in Salt Lake City. One Night – Twice the Fun features fabulous live entertainment by Hollywood Revisited – click here for a sneak preview video.

Star-Studded Main Event and Shake It for a Cause Dance Party
Registration fee is $250
7 – 11:45 p.m.
Ticket includes dinner, drinks, entertainment featuring Hollywood Revisited, and the dance party.

Shake It for a Cause Dance Party
Registration fee is $50 for CRNAs and $25 for SRNAs
9:30 p.m. – 11:45 p.m.
Ticket includes the dance party only featuring a DJ playing all your favorite songs.

Please register today! Not only will you have fun, but a portion of your donation is tax deductible and will support the AANA Foundation and our grand profession.

Thank you in advance for your support!
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AANA Foundation to Host 18th Annual Golf Tournament

The AANA Foundation will host its 18th Annual Golf Tournament on Friday, August 28, 2015 at Eaglewood Golf Course with tee off at 1:30 p.m. Click here to visit the AANA Foundation 18th Annual Golf Tournament webpage for more details. Questions? Contact Luanne Irvin, AANA Foundation Development Officer, at (847) 655-1173 orlirvin@aana.com.
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Calling all Photographers and Artists: Art on Canvas Silent Auction and Contest Deadline is July 31

The AANA Foundation is hosting an Art on Canvas silent auction and contest at the 2015 AANA Nurse Anesthesia Annual Congress in Salt Lake City, Utah. Please print a favorite photo or paint a picture on canvas, and donate it to the AANA Foundation to be entered in the auction. If you would like to participate, contact Luanne Irvin at (847) 655-1173 or lirvin@aana.com by July 31, 2015. This opportunity is limited to the first 20 participants. Proceeds benefit the AANA Foundation and its mission to advance the science of anesthesia through education and research. Thank you in advance for participating!
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Federal Government Affairs

Senate Action on Veterans Health Bill Clears Way for Veterans Agency to Advance Full Practice Authority for CRNAs, APRNs

Action in the Senate Veterans Affairs Committee on July 22 helps to clear the way for the Veterans Health Administration (VHA) to publish in the Federal Register a proposed rule recognizing CRNAs and other APRNs to their Full Practice Authority, following extensive advocacy by the AANA and CRNAs.

By including parts of S 297, but not the problematic provisions that brought concern to AANA for excluding CRNAs from “independent practice” for APRNs in the VHA, into a new bill that the committee approved and moved to the full Senate (S 1203), the committee allows the VHA to move forward with publishing a proposed rule later this year. AANA President Sharon Pearce, CRNA, MSN applauded the committee’s actions in a statement saying, “I commend the Senate Veterans Affairs Committee for acting today on a bipartisan basis to allow the Veterans Healthcare Administration to promote veterans access to quality healthcare provided by all advanced practice registered nurses, including Certified Registered Nurse Anesthetists (CRNAs). By passing S 1203 and its provisions of the ‘Frontlines to Lifelines Act’ (S 297, Kirk, R-IL) without language that would have disrupted the VHA from recognizing CRNAs to their Full Practice Authority, the Committee is letting the VHA do the job it needs to do to protect and advance veterans’ access to quality healthcare.”

To view the President Pearce’s full statement, see: http://www.aana.com/veterans-access. To view AANA’s previous testimony on S 297, see:
(AANA member login required) and see the AANA and APRN letter here (AANA member login required).
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Update on AANA’s Efforts to Ensure Veterans Access to Quality Care

The AANA and its members continue to advocate for legislation and a Veterans Health Administration (VHA) proposal that would authorize all advanced practice registered nurses (APRNs), including CRNAs, to practice as Full Practice Providers in the VHA and help improve access to quality healthcare for all veterans. Here is a status update:
  • The AANA is supporting legislation in the House, HR 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). The bill has 35 bipartisan cosponsors. The AANA encourages members whose U.S. Representative has cosponsored this legislation to send a thank you note (here). Please continue to contact your U.S. Representative and encourage co-sponsorship of this bill (here). View the AANA and APRN Workgroup letter of support here and also view the Nursing Community letter here.
  • The AANA has expressed strong concerns about legislation in the Senate, S 297, sponsored by Sen. Mark Kirk (R-IL). Unlike the House bill (HR 1247), S 297 recognizes only three of the four APRN specialties for Full Practice Authority in the VHA, omitting CRNAs. On July 22, the Senate Veterans Affairs Committee held a markup on veterans healthcare legislation, but the problematic provision of S 297 that excluded CRNAs from practicing to their Full Practice Authority in the VHA was removed from the legislation. The AANA encourages CRNAs to contact their U.S. Senators and ask that they contact the VHA in support of Full Practice Authority in the VHA for all APRNs.
  • The AANA continues to strongly support the VHA’s efforts to recognize CRNAs and other APRNs to their Full Practice Authority, consistent with the recommendations of the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. According to the VHA, the agency intends to publish regulatory rulemaking later this year recognizing CRNAs and other APRNs as Full Practice Partners in the VHA. Thousands of AANA members have already contacted the VHA in support of this work.
Since mid-February, AANA members have sent more than 14,000 messages to their federal legislators expressing support for veterans access to quality healthcare.
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AANA Requests Medicaid Managed Care Organizations Fully Recognize CRNAs in All Network Plans

In a July 27 letter to the Centers for Medicare & Medicaid Services (CMS), the AANA requested that Medicaid managed care plans should fully recognize CRNAs by including CRNAs in all their network plans. The AANA’s action was in response to a proposed rule that the agency published reforming its rules for Medicaid managed care plans nationwide for the first time since 2002.

In the letter from AANA President Sharon Pearce, CRNA, MSN, the AANA also recommended that managed care plans adopt alternative payment systems that recognize and reward all qualified healthcare providers such as CRNAs for ensuring patient access to safe, cost-effective healthcare services. The AANA also supports the proposal that states should ensure nondiscrimination in access to provider services under managed care plans.

View the Medicaid Managed Care Proposed Rule here. View AANA Comments here.
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AANA Comments on Drugs of Abuse Testing Proposal to Medicare Contractor Novitas Solutions

On July 7, AANA urged the Medicare administrative contractor (MAC) Novitas Solutions to include provider neutral language in a draft local coverage determination (LCD) on drugs of abuse testing. Novitas administers the Medicare program in Arkansas, Colorado, Delaware, Louisiana, Maryland, Mississippi, New Jersey, New Mexico, Oklahoma, Pennsylvania, Texas, and the District of Columbia.

The AANA letter signed by President Sharon Pearce, CRNA, MSN, stated, “The AANA is concerned that the term ‘Physician’ is used throughout the draft LCD when in fact other practitioners may order or perform drug screening tests as allowed under state scope of practice…. The Centers for Medicare & Medicaid Services (CMS) in its 2013 final rule… concluded, “Anesthesia and related care means those services that a certified registered nurse anesthetist is legally authorized to provide in the state in which the services are furnished.” We therefore request that Novitas Solutions in its final LCD replace the term ‘physician’ with provider neutral or inclusive language such as ‘practitioners’ or ‘clinicians.’”

Read the AANA comment letter here. Read the draft LCD here.
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The Healthcare Payment and Learning Action Network Holds its Second Webinar and Introduces New Website

The federal government’s new panel for educating healthcare industry leaders about payment reform, the Healthcare Payment Learning and Action Network (LAN), held a webinar on July 21, and AANA was represented in the meeting which focused on alternative payment models (APMs).

Mark Smith, MD, MSc, who serves as co-chair of a 24-member committee guiding the LAN, announced that Sam Nussbaum, MD, Executive Vice President, Clinical Health Policy and Chief Medical Officer at Anthem, Inc., would be chair of the workgroup on APM definitions, though members of the workgroup are still yet to be named. Dr. Smith also announced an upcoming in person stakeholder meeting in Washington, DC scheduled for October 2015. Lee N. Newcomer, Senior Vice President, Oncology, Genetics and Women’s Health, UnitedHealthcare, presented on UnitedHealthcare’s pilot that explores a head and neck cancer care payment model focused on quality patient care and outcomes. Jennifer Malin, Staff Vice President, Clinical Strategy, at Anthem presented on Anthem’s pathway-oriented model, which provides certain treatment options and provider payment arrangements. Shelley Fuld Nasso, Chief Executive Officer of the National Coalition for Cancer Survivorship, provided a reaction to the presentations. The AANA continues to monitor the activities of the LAN and will continue to provide updates.

To learn more about the Health Care Payment Learning and Action Network, visit the new website: https://publish.mitre.org/hcplan/ and to register for the Health Care Payment Learning and Action Network, go to http://innovationgov.force.com/hcplan.
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AANA Urges the Senate to Confirm Mary Wakefield, PhD, RN, FAAN, and Andy Slavitt for Top Healthcare Leadership Positions

In letters to U.S. Senate Finance Committee leadership, the AANA urged prompt confirmation of Mary Wakefield, PhD, RN, FAAN, as Deputy Secretary for the U.S. Department of Health and Human Services and Andy Slavitt as Administrator for the Centers for Medicare & Medicaid Services (CMS). Now serving as Acting Deputy Secretary, Dr. Wakefield is the highest ranking nurse in the Administration and previously served Administrator for the Health Resources and Services Administration. Mr. Slavitt also has decades of experience in the healthcare industry including as Executive Vice President of Optum and as CMS Principal Deputy Administrator.

To read AANA’s letter of support for Dr. Wakefield, see here. To read AANA’s letter of support for Mr. Slavitt, see here.
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AANA 2013 NHLA Winner and Former CMS Administrator, Marilyn Tavenner, RN, MHA, FACHE, to Lead AHIP

Former Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner, RN, MPHA, FACHE, the 2013 winner of the AANA National Health Leadership Award, has been named America’s Health Insurance Plans’ (AHIP) next President and CEO. As the President and CEO of AHIP, Tavenner will be the organizations’ chief lobbyist advocating on behalf of the country’s largest health insurers who are devoting a larger share of their business to privatized managed care plans under Medicare and Medicaid.

As CMS Administrator, Tavenner was one of the highest ranking nurses in the Administration. Under her leadership the agency adopted many measures pertinent to CRNAs, such as recognizing Medicare CRNA services within their state scope of practice including pain management services, clarifying Medicare Part B policy so that only CRNAs may be reimbursed for “nonmedically directed” services and anesthesiologist assistants may not, and eliminating Medicare patient co-pays for separate anesthesia services for screening colonoscopies. The AANA awarded Tavenner with the 2013 National Health Leadership Award for her support of evidence-based policies that remove barriers to CRNA services.
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Be a Triple Crown Honoree this AANA Dues Season

While you’re paying your AANA member dues this summer, earn eligibility for AANA Triple Crown recognition and help build your profession’s future by also contributing to the AANA Foundation and to the CRNA-PAC, your profession’s voice in Washington.

At AANA meetings, Triple Crown members are recognized by a special Triple Crown ribbon. You will also be enrolled in a separate recognition program for the CRNA-PAC and the AANA Foundation. The Triple Crown signifies your commitment to three crucial aspects to the nurse anesthesia profession: (1) membership in the national association, (2) enrollment in the
Foundation in support of research and scholarships, and (3) participation in the CRNA-PAC, which helps elect and re-elect CRNA-friendly members of the U.S House and Senate who help shape CRNA reimbursement and practice.

A joint initiative of the AANA, CRNA-PAC, and AANA Foundation, Triple Crown recognition for 2016 is available for those members who have also given $250 to the CRNA-PAC and $250 to the AANA Foundation.

To renew your membership, click here and support the CRNA-PAC at www.crna-pac.com (requires AANA member login and password). Give to the AANA Foundation at here.
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Pearce Champions Full Practice Authority

At the Reserve Officers Association in Washington, DC, July 23, AANA President Sharon Pearce, CRNA, MSN, urged panelists at a Center to Champion Nursing in America forum on “The Culture of Health” to advance access to care for America’s veterans by supporting full practice authority for CRNAs and other APRNs in the Veterans Health Administration.
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  • The House and Senate start their August recesses Aug. 3 and Aug. 10 respectively, providing CRNAs a good opportunity to see their lawmakers at home. If you see your legislators or their staffs at home, let us know how your visits went by logging your visit on the CRNA-PAC website at https://www.crna-pac.com/legisreport.aspx (AANA login required) and sending us pictures to info@aanadc.com. To see when Congress is in Washington or at home, go to House schedule, Senate schedule.
  • The Journal of the American College of Surgeons recently released an article, “Improved Operating Room Efficiency via Constraint Management: Experience of a Tertiary-Care Academic Medical Center” that describes how, with the use of a CRNA as an OR manager, OR efficiencies and first-case on time rates were improved for a 400 bed hospital with a level-I trauma center. View the abstract here.
  • In response to a Washington Post article, “Do Cell Phones Belong in the Operating Room?” AANA President Sharon Pearce, CRNA, MSN, responded with a statement in support of mobile devices — but only in a manner that maintains vigilance and enhances patient care. The AANA’s Mobile Information Technology position statement states that “Certified Registered Nurse Anesthetists (CRNAs) have an ethical responsibility to provide safe patient care by avoiding non-essential distractions while caring for a patient. Non-essential distractions, especially those associated with use of mobile information technology, may lead to significant patient safety lapses.” Read the AANA’s response here and the original article here.
  • Continuing to advocate for APRN and nursing workforce development, House Nursing Caucus Co-Chair Rep. Lois Capps (D-CA) urged her colleagues to cosponsor the “Title 8 Nursing Workforce Reauthorization Act” (HR 2713) in a floor speech July 15. The legislation is supported by AANA. For CRNAs, the federal Title 8 program funds Advanced Nursing Education and Nurse Anesthesia Traineeships for qualifying programs. View Rep. Capps’ speech here.
  • Stay up to date on CRNA reimbursement issues by obtaining Version 3 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members here (requires AANA member login and password).
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The following is an FEC required legal notification for CRNA-PAC:

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

Certified Registered Nurse Anesthetist (CRNA) – U.S. Army Nurse Corp Nationwide

Provide specialized care to patients requiring general anesthesia, respiratory care, cardiopulmonary resuscitation and fluid therapy. Work as part of a multidisciplinary team, surrounded by dedicated professionals who share your values.

Read more about this position
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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.

Tourniquet Use During Ankle Surgery Leads to Increased Postoperative Opioid Use

Researchers analyzed data about the amount of opioids given to patients following ankle surgery with or without a tourniquet. They measured opioid use during the first 24 hours post-operation in 603 patients. Of those, 358 underwent surgery with a tourniquet. A correlation was found indicating an increase in postoperative opioid use by 0.43 mg for every 10 minutes using the tourniquet.

From "Tourniquet Use During Ankle Surgery Leads to Increased Postoperative Opioid Use"
Journal of Clinical Anesthesia (08/01/2015) Vol. 27, No. 5, P. 380 Kruse, Heidi; Christensen, Kristian P.; Møller, Ann M.; et al.

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Study: Women With Mild Memory Problem Worsen Faster Than Men

New research results show that women are more susceptible than their male counterparts to mild cognitive impairment later in life, including after a surgical procedure. One of three studies presented at the recent Alzheimer's Association International Conference found that patients who had an operation while under general anesthesia deteriorated faster mentally over a seven-year period than did patients who were not sedated. However, investigator Katie Schenning, MD, of the Oregon Health & Science University, reported that the pace was amplified in the female population. Although the anesthesia by itself is not the root of the problem, Schenning said, "It is worth letting our older patients know that they should perhaps talk about this with their practitioner, that this is a possibility and consider whether or not they need to undergo procedures that are considered to be elective."

From "Study: Women With Mild Memory Problem Worsen Faster Than Men"
Associated Press (07/23/15)

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Complications Higher With Regional Than General Anesthesia in Hip Fracture Surgery

Contrary to some previous studies, new research concludes that complications occur much more frequently in patients who receive regional anesthesia, versus general anesthesia, for hip fracture surgery. The database review looked at records for 7,764 patients, 75.2 percent of whom were administered general anesthesia and 24.8 percent of whom underwent regional anesthesia—either as a nerve block or as spinal anesthesia. The results revealed a higher probability among the regional anesthesia patients for both minor complications and total complications, although the difference in the rate of major complications among the cohorts was not statistically significant. Lead researcher Paul Whiting, MD, agreed with anesthesia providers not involved in the study that more investigation was needed. "Ultimately," he conceded, "prospective trials will be required to demonstrate definitively the preferred method of anesthesia for hip fracture patients." The findings were reported in International Orthopaedics.

From "Complications Higher With Regional Than General Anesthesia in Hip Fracture Surgery"
Anesthesiology News (07/01/15) Vol. 41, No. 7 Frei, Rosemary

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Location of Analgesic Injection Site Has No Effect on Pain Relief After Rotator Cuff Repair

Level of pain relief following rotator cuff surgery does not appear to be influenced by where the analgesic is injected, according to new data. The study included 121 patients who were randomly assigned to receive a mix of bupivacaine and lidocaine in the glenohumeral joint or the subacromial space. A third group was randomized to receive half of the analgesic dose in one area and half in the other area. VAS pain scores and need for rescue analgesic were evaluated at one, two, six, 12, and 24 hours after the rotator cuff repair, but researchers found no significant difference between any of the three groups during any of those time intervals.

From "Location of Analgesic Injection Site Has No Effect on Pain Relief After Rotator Cuff Repair"
Healio (07/23/2015) Jaramillo, Monica

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Inhaled Cannabis Promising for Painful Diabetic Neuropathy

Research suggests that inhaled cannabis may alleviate nerve pain—including, based on new findings, diabetic neuropathy. A total of 16 patients with type 1 or type 2 diabetes were enrolled in the study, all of whom had been suffering from pain in their feet for at least six months. Participants inhaled the cannabis at different dosages of delta-9-tetrahydrocannibol (THC) and rated their pain levels at regular intervals during a four-hour period afterwards. The results indicated that pain scores were statistically higher with the placebo dose of 0 percent THC compared to the medium and high doses. The investigators also concluded that the analgesic impact lasted the entire four hours and was achieved without seriously compromising cognitive function in the patients, although the euphoric feeling they experienced was strong enough to potentially impair their ability to drive. Still, Mark Ware, MD, an associate professor of anesthesia at Quebec's McGill University, said the study lays the groundwork for a larger trial. "It raises the question," he explains, "whether using lower doses may be able to get analgesic effects without causing excessive euphoria."

From "Inhaled Cannabis Promising for Painful Diabetic Neuropathy"
Medscape (07/23/15) Harrison, Laird

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Placebos Might Work Even When Unveiled as Fakes

New findings offer previously unknown insight into the "placebo effect" that occurs when patients report improved symptoms after taking what they believe is a real medication but is actually a fake and harmless substitute. University of Colorado Boulder graduate student Scott Schafer realized that some people still get pain relief from phony drugs even after becoming aware of their lack of medical value. Research participants were treated with a fake topical analgesic—petroleum jelly, dyed blue and enclosed in sham packaging—after their forearms were subjected to a ceramic heating element. Tested with and without the dummy gel at the same medium-intensity heat level, they reported less pain with it. Participants who were informed about the placebo after a single treatment no longer experienced relief; however, those who underwent four sessions became conditioned to believing in the efficacy of the fake medication and continued to report pain relief even after they were told the gel was nothing more than Vaseline. "What we think now is that [placebo effects] require both belief in the power of treatment and experiences that are consistent with those beliefs," concluded lead study author Tor Wager. "Those experiences make the brain learn to respond to the treatment as a real event. After the learning has occurred, your brain can still respond to the placebo if you no longer believe in it." The findings of the study are reported in The Journal of Pain.

From "Placebos Might Work Even When Unveiled as Fakes"
Denver Post (07/22/15) Draper, Electa

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Age, Spinal Anesthesia and Patient-Controlled Analgesia Increase Risk of Urinary Retention After THA

Researchers report that men are more likely to experience urinary retention following hip replacement if they underwent spinal anesthesia for the procedure. In the study of 376 males having total hip arthroplasty (THA), use of patient-controlled analgesia also was identified as a risk factor for this complication, as was age greater than 70 years. The investigators suspected—but did not prove—that BMI, hypertension, diabetes, smoking, and length of surgery also may elevate the risk of urinary retention in men following THA.

From "Age, Spinal Anesthesia and Patient-Controlled Analgesia Increase Risk of Urinary Retention After THA"
Healio (07/21/2015) Tingle, Casey

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Limited Role for Continuous Analgesic Pumps in Lap Sleeve Gastrectomy

While continuous analgesic pumps previously have demonstrated positive outcomes for patients undergoing a number of surgical procedures, researchers did not find this to be true in the case of laparoscopic sleeve gastrectomy. The team from William Beaumont Army Medical Center in El Paso, Texas, randomly assigned a population of such patients to receive either ropivacaine or a saline placebo through an intraoperatively placed continuous pain catheter. Unlike the earlier trials, there was no association between the pumps and lower pain scores, reduced need for opioids and antiemetics, and shorter length of stay (LOS) in the hospital. "In open surgeries, the catheters are placed directly in the incision, delivering local anesthetic into the operative site," said researcher Elaine Cleveland, MD, offering an explanation for the study results. "In laparoscopic surgeries, the catheters are placed near the incisions, but may not directly deliver anesthetic to these small trocar sites. Additionally, open surgeries tend to have increased pain compared to laparoscopic surgeries, and with that, local anesthesia can have a greater impact in reducing pain."

From "Limited Role for Continuous Analgesic Pumps in Lap Sleeve Gastrectomy"
Anesthesiology News (07/01/15) Vol. 41, No. 7 O'Rourke, Katie

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Methods of Anesthesia for Treating Juvenile Idiopathic Arthritis in Children

Children with juvenile idiopathic arthritis (JIA) usually receive a large number of injections, and a team of experts says providers should try to make procedures "as painless, stress free and even pleasant as possible." Researchers conducted a clinical review, published in Pediatric Rheumatology, evaluating the potential methods of intra-articular corticosteroid injection (IASI) in children with JIA. The review looked at several different approaches and then applied them to two case studies. In one case, a two-year-old girl diagnosed with oligoarticular JIA was due for IASI to her right knee. In the second case, a nine-year-old girl with a four-year history of oligoarticular JIA presented with exacerbation of left ankle arthritis after taking methotrexate for a year. She had an IASI to the same joint a year ago. The review examined techniques such as local anesthesia, nitrous oxide, benzodiazepines, propofol, fentanyl, general anesthesia, and distraction techniques. For the first case, the authors recommended general anesthesia or moderate sedation, partly because the patient is young and unlikely to cooperate. In the second case, the authors suggest nitrous oxide combined with a distraction technique, to avoid the risks of benzodiazepine sedation.

From "Methods of Anesthesia for Treating Juvenile Idiopathic Arthritis in Children"
MD Magazine (07/20/2015) Schu, Bill

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Acupuncture Reduces Pain After Surgery

Using acupuncture during surgery can help reduce pain, a team of Stanford University School of Medicine doctors has found. Writing in The Laryngoscope, the researchers say that acupuncture is "feasible, well tolerated, and results in improved pain and earlier return of diet postoperatively." The study was a randomized-controlled investigation of acupuncture's benefits to pediatric tonsillectomy patients. Electroacupuncture was applied intraoperatively to some patients at alternating frequencies with a Pantheon Research stimulator. Acupuncture patients had significantly less pain compared with controls. Oral intake also was significantly better in the acupuncture group starting at 24 hours after surgery. There were no significant differences between the acupuncture group and controls on measures of nausea and vomiting. There were also no adverse effects from acupuncture, possibly because only sterile disposable acupuncture needles were used, according to the researchers.

From "Acupuncture Reduces Pain After Surgery"
Epoch Times (07/13/15)

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The Effects of Adding Epinephrine to Ropivacaine for Popliteal Nerve Block on the Duration of Postoperative Analgesia

Research shows that adding epinephrine to ropivacaine for popliteal nerve block does not significantly increase the duration of postoperative analgesia. This may be due to ropivacaine's intrinsic vasoconstrictive properties. Investigators compared the duration of postoperative analgesia of 30 mL ropivacaine 0.75 percent with or without epinephrine for popliteal sciatic nerve block in 30 patients. Study participants were assigned to receive ultrasound guided continuous popliteal nerve block with ropivacaine 0.75 percent either without (ROPI) or with epinephrine 5 µg/mL (ROPI-EPI) for ankle fusion, subtalar fusion, or both. The study measured the duration of postoperative analgesia as reflected by the time to first request for postoperative analgesia (TTFR) through the popliteal nerve catheter. The median TTFR was 463 minutes and 830 minutes for the ROPI and ROPI-EPI groups, respectively. Researchers found no difference in any clinical outcome measure between the groups. The lack of significant difference may also be due to a type II error caused by a large variation in individual TTFR.

From "The Effects of Adding Epinephrine to Ropivacaine for Popliteal Nerve Block on the Duration of Postoperative Analgesia"
BMC Anesthesiology (07/15) Schoenmakers, Karin P.W.; Fenten, Maaike G.E.; Louwerens, Jan Willem; 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.

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