Anesthesia E-ssential

AANA Anesthesia E-ssential, March 21, 2019
 
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AANA Ends Monetary Donations to APSF

In response to an impasse between the AANA and the Anesthesia Patient Safety Foundation (APSF) created by the publication of an article in the February 2019 APSF Newsletter about the new World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia, the AANA has ended its annual donation of $150,000 to the foundation.

The content of the article, titled “The SAFE-T Summit and the International Standards for a Safe Practice of Anesthesia,” was deemed unacceptable by a large segment of the AANA membership. In addition, the article was reported to have been used by state societies of anesthesiologists in lobbying efforts against state associations of nurse anesthetists. AANA members emphatically demanded that the AANA Board seek a retraction and a public acknowledgement by the APSF of the article’s inaccuracies regarding CRNA practice. Leadership of the two organizations spoke numerous times to seek a mutually acceptable way to resolve the situation.

The offending content included the following statement: “Nevertheless, the WFSA views anesthesia as a medical practice, because of its complexity and potentially hazardous nature. Therefore, these WHO-WFSA Standards state that ‘its safe provision requires a high level of expertise in medical diagnosis, pharmacology, physiology, and anatomy, as well as considerable practical skill’ and ‘wherever and whenever possible, anesthesia should be provided, led, or overseen by an anesthesiologist,’ where anesthesiologist is defined as a ‘graduate of a medical school who has completed a nationally recognized specialist anesthesia training program.’”

The APSF proposed sending a letter of explanation to the AANA membership and allowing the AANA to publish a rebuttal in the June issue of the newsletter but would not agree to retract the article or acknowledge its inaccuracies. Ultimately, the AANA Board decided this was not sufficient to satisfy the requirements of the AANA membership and pulled the AANA’s funding from APSF.

As a result, AANA members will no longer receive a print copy of the APSF Newsletter. However, the newsletter is available to the public free of charge on the APSF website at https://www.apsf.org/. In the meantime, the AANA has agreed to allow APSF to pay for and send the remaining two issues of 2019 to AANA members. The AANA is unable to honor member requests to opt-out of receiving these last two issues.

At this time the AANA continues to be represented by a total of seven CRNAs on the APSF Board and various committees. The AANA and APSF representatives are also collaborating on various scheduled speaking engagements.
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Anesthesia Practice Standards Updated, Published by AANA

To ensure that patients continue receiving the highest quality anesthesia care possible, the American Association of Nurse Anesthetists (AANA) has published a comprehensive update to its Standards for Nurse Anesthesia Practice, the foundation of Certified Registered Nurse Anesthetist (CRNA) care delivery. The standards can be accessed at https://www.aana.com/standards.

As anesthesia experts with a 150+ year history, CRNAs are the hands-on providers of more than 45 million anesthetics each year in the United States, according to the AANA’s website (www.aana.com/crnafacts). The association represents approximately 53,000 CRNAs and student registered nurse anesthetists.

"The AANA's practice standards support the delivery of patient-centered, consistent, high-quality, and safe anesthesia care and assist the public in understanding the CRNA's role in patient care," said Jessica Poole, DNAP, CRNA, chair of the AANA Practice Committee which is comprised of eight nurse anesthetists and supported by AANA staff. "The association routinely reviews and updates our profession's practice standards, guidelines, and other critical documents based on the latest research to support CRNAs practicing at the peak of their knowledge and skills." Learn more.

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SAM Leads Coalition to Eliminate Preventable Death from Unplanned Extubation

The Society for Airway Management (SAM) leads a coalition of more than 15 healthcare and multispecialty medical professional societies, including the AANA, patient safety organizations, as well as quality improvement and advocacy organizations to launch a targeted effort to reduce the incidence of preventable death from unplanned extubation (UE). Researchers estimate that up to 33,000 adult deaths per year in U.S. hospitals can be attributed to unplanned extubation.

The SAM Special Projects II Committee launched an initiative that takes aim at raising awareness about how common and costly unplanned extubation is and to identify the extent of the problem.

The committee is calling upon organizations to begin tracking the occurrence of UE using a core data set for every intubated patient undergoing mechanical ventilation. It also takes aim at increasing prevention efforts through best practice tools that are being developed and will be made available to hospitals to facilitate their efforts in eliminating preventable harm and death from unplanned extubation. Learn more.
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CRNA Malpractice Insurer Capson Insurance Placed in Rehabilitation

Less than two years after Oceanus Insurance Company was declared insolvent, another malpractice insurance company insuring CRNAs has run into financial difficulties. Texas-based Capson Physicians Insurance Company (Capson) has been put under state control after the Texas Department of Insurance determined that Capson’s surplus and capital had fallen below minimum required levels.

If you currently have a policy with Capson or a Granite State Insurance Company policy through Capson and are seeking alternative coverage, AANA Insurance Services can help. Contact us to learn about prior acts coverage, alleviating the need to purchase a “tail” from Capson and convertible claims-made coverage that enables you to easily convert from claims-made to occurrence coverage.
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Hot Topics


"I AM ME" Campaign Kicks Off in April - Submission Deadline March 31

April is Celebrate Diversity Month, and the American Association of Nurse Anesthetists (AANA) is observing it with our second annual “I AM ME” campaign.

AANA's Diversity and Inclusion Committee is asking that Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) send a photo and one to three sentences about what makes you, you! The statements will be posted in English primarily; however, if you speak more than one language, please send it to us in that language as well.

Our goal is to post your personalized “I AM ME” statement on the AANA’s Twitter, Instagram, and Facebook channels the entire month of April. Please share widely with fellow CRNAs and SRNAs! #IAmMe 

The deadline for submissions is Sunday, March 31st, 2019.
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Board of Directors Candidate Forum Available Beginning April 8

The AANA Connect 2019 Board Candidate Forum will be available beginning April 8, 2019, for members to interact with candidates for the AANA Board of Directors. View the 2019 Election Slate and find information about voting in the Election Center on AANA.com.
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AANA Adds Educational Modules on 2019 MIPS Reporting

The AANA Research and Quality department added several video modules to the 2019 Quality Payment Program page, to help CRNAs understand merit-based incentive payment system (MIPS) reporting requirements for Year 3 of the Quality Payment Program. One provides an overview of MIPS, and the shorter videos explain the Quality and Improvement Activities performance categories. For more information, members also can refer to the 2019 Quality FAQs page or 2019 Improvement Activities FAQs page.
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2019 MIPS Participation and Eligibility Fact Sheet is Available

CMS has published a Fact Sheet that explains participation and eligibility requirements for reporting MIPS in 2019. It includes information for individual and group practices, and providers, including how CRNAs can opt-in or voluntarily report merit-based incentive payment system (MIPS) data if they do not meet all eligibility criteria. CRNAs can find their participation status by entering their National Provider Identification Number (NPI) in the QPP Participation Status Tool.
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PR Recognition Awards deadline: Here Before You Know It!

Each year 15-20 entries are received from state associations, CRNAs or SRNAs, educational programs, businesses and others for the PR Recognition Awards competition coordinated by the AANA Communications Committee. Awards are presented in four categories:
  1. Best overall public relations effort for the past year, to be awarded to an individual, organization, or state association.
  2. Best promotional effort for National CRNA Week, to be awarded to an individual, organization, or state association.
  3. Best public relations effort by an individual, small group, organization or company not affiliated with a state association.
  4. Best use of “CRNAs: The Future of Anesthesia Care Today” campaign to promote the nurse anesthesia profession by an individual, organization, or state association.
All entries are judged by the committee onsite the day before the opening of the Annual Congress, and the winners are recognized during Opening Ceremonies. Detailed information about the competition, along with entry guidelines, can be found on the AANA website.

Winners will receive a plaque to commemorate their achievement, and their names will be added to a PR Awards exhibit on permanent display in the AANA Executive Office in Park Ridge, Ill.

Please note:

  • The deadline for entries is earlier than usual because this year’s Congress is taking place in August rather than September. The deadline is Friday, June 7. Late entries will not be considered.

For additional information or answers to questions about the PR Awards, please contact PR Department Administrative Associate Karen Sutkus at klsutkus@aana.com or 847-655-1140.

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Nursing Workforce Development Funds Chopped from Trump Budget Proposal

In response to the March 12 release of President Trump’s proposed budget for Fiscal Year (FY) 2020, the American Association of Nurse Anesthetists (AANA) expressed deep concerns with some elements of the proposal.

The president’s budget proposes immense cuts to Title VIII Nursing Workforce Development funding, which supports federal healthcare workforce and research programs. The budget recommends to Congress that Title VIII funding be cut by $166 million, a decrease of almost 67 percent. This would take funding down from its current level of $249 million to $83 million and would eliminate almost all nursing workforce programs except NURSE Corps. Title VIII Funding remained flat in FY19 and has consistently fallen behind inflation. Read more.
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SRNA Excellence: Who is Deserving of the Student Excellence Award?

The Education Committee is looking for student registered nurse anesthetists (SRNAs) to consider for the Student Excellence Award. One student will be chosen from the nominees and receive the award at the 2019 AANA Annual Congress. The winner will be recognized at the Student Luncheon.

The student must be nominated by the program administrator or the program administrator’s faculty designee. All individuals who are a student at the time of the submission deadline are eligible.

Defining characteristics of nominees include:
  • Evidence of professional promise
  • Record of extracurricular activities or other contributions to the college or community
  • Consistent excellent performance in the clinical setting for at least two semesters
Award guidelines:
  • One submission per program.
  • Submission must be a narrative of no more than 1,000 words
  • The narrative should provide specific details on how the student demonstrates excellence in leadership, scholarship, service or a related area.
Nominations must be submitted via e-mail to the Education Department at education@aana.com by April 22, 2019. Please direct any questions to the Education Department by e-mail or at 847-655-1161.
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Council on Accreditation (COA) Seeks Nominations for Two CRNA Director Openings

The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is seeking nominations for one CRNA Educator director and one CRNA Practitioner director. Candidates must be available to attend three-day COA meetings, typically held in January, May and October. The term of office is three years, beginning Fall 2019 through Fall 2022.

The elected candidates then would be eligible to be considered for reelection to a second three-year term. The deadline to apply has been extended to April 1, 2019. For position criteria and application requirements, please visit www.coacrna.org.
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Make a Difference by Serving Your Profession, Collaborating with Colleagues on an AANA Committee

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 committee request submissions has been extended to April 15, 2019. Please note: If you currently serve on a fiscal year 2019 committee, you must reapply for fiscal year 2020.
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Meetings and Workshops


Students and CRNAs Needed for the Anesthesia College Bowl!

The Anesthesia College Bowl is a spirited event held every year at the AANA Annual Congress. Six teams of six students each compete to answer questions about anesthesia that have been submitted by nurse anesthesia program directors. The winning student team then plays the six-member CRNA Challenge Team to determine the ultimate winner of the College Bowl. The winners hold bragging rights until the following year!

Students wishing to play must inform their program administrator, who can submit a maximum of two students to participate. The submission form is available on the AANA website under CE & Education > Education > Opportunities for Educators.

CRNAs who wish to play must submit the Challenge Team sign-up form available on the AANA website under CE & Education > Education > Opportunities for Educators.

The submission deadline for students and CRNAs is May 6, 2019. Please direct any questions to the Education Department at education@aana.com or 847-655-1161.
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AANA Member Benefits


Home Maintenance You Should Be Tackling This Spring!

You may be ready to enjoy the warm spring weather, but is your home? Nationwide put together a spring home maintenance checklist to help ensure a smooth seasonal transition. Learn more.

March Spring Cleaning
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Jobs


CRNA: Banner University Medical Center, Tucson, Arizona

If You’re One of the Best, Come Work for the Top-Rated Team at Banner University Medical Center – Tucson (BUMC-T). BANNER UNIVERSITY MEDICAL GROUP (BUMG) is seeking a CRNA to join our team at Banner University Medical Center – Tucson (BUMC-T). You’ll be involved in clinical management of patients, performance of therapeutic and diagnostic procedures, interpretation of diagnostic tests, prescribing medications, patient education, consultation, and research. Must be able to work autonomously as well as part of an integral team of clinicians and physicians. Learn more.
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CRNAs (Multiple Needs): Wake Forest Baptist Health, Winston-Salem, North Carolina

Due to our continued growth, Wake Forest Baptist Health (WakeHealth.edu) has multiple needs for adult and pediatric Certified Registered Nurse Anesthetists across our system. We are offering a $20K sign-on bonus and provide an additional $5K that may be used for relocation or other expenses. These positions offer opportunities for onsite continuing education and are allowed up to five days of paid time for offsite education (in addition to regular PTO). Learn more.
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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.

Volatile Anesthetics Vs. Total Intravenous Anesthesia for Cardiac Surgery

Researchers tested a theory that using volatile or inhaled anesthetics, which have a protective effect on the heart, would improve survival after coronary-artery bypass grafting (CABG). As part of the multinational MYRIAD trial, they recruited 5,400 patients with similar demographic and clinical traits. After randomization, 2,709 participants underwent CABG with intraoperative anesthesia care that included desflurane, isoflurane, or sevoflurane. The other 2,691 participants received total intravenous anesthesia (TIVA), with no volatile anesthetics at all. Investigators expected any-cause mortality at 1 year—the primary prespecified outcome—to be 2 percent for the inhaled anesthetics group versus 3 percent for the TIVA group. While the TIVA prediction was on target, death for any reason affected 2.8 percent of patients who received volatile anesthetics—more than expected, and not much different than the incidence in TIVA patients. Secondary outcomes, including 30-day mortality, and rate of adverse effects also were not meaningfully different between groups. At the time of the second interim analysis, the data and safety monitoring board recommended that the study be terminated due to futility.

From "Volatile Anesthetics Vs. Total Intravenous Anesthesia for Cardiac Surgery"
New England Journal of Medicine (03/19/19) Landoni, Giovanni; Lomivorotov, Vladmir V.; Neto, Caetano Nigro; et al.

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Standardized Concentrations of Morphine Infusions for Nurse/Patient-Controlled Analgesia Use in Children

Researchers collaborated to identify, implement, and assess standardized concentrations of morphine in pre-filled syringes (PFS) for infusions delivered via pediatric nurse/patient-controlled analgesia (N/PCA). The approach benefits patient safety by avoiding significant deviations from prescribed concentrations, a mistake that can happen when infusions are individually prepared on surgical wards or in operating theatres. The team identified standardized concentrations of 3 mg, 10 mg, and 50 mg of morphine in 50 mL of sodium chloride 0.9% for N/PCA use. To implement the approach, 175 pre-prepared infusions were given to 157 children. Based on direct observation of health care professionals (HCPs), an HCP survey, focus groups, medication incident reports, and analysis, the investigators found morphine PFS to be easier and safer than the previous system. Not only did it take less time to set up an N/PCA, but preparation errors were eliminated and there were significantly fewer incidents associated with the infusions. The results were published in BMC Anesthesiology.

From "Standardized Concentrations of Morphine Infusions for Nurse/Patient-Controlled Analgesia Use in Children"
Medscape (03/19/19)

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New Score Uses Intra-op Variables to Predict Respiratory Complications

Researchers report that they have improved on the Score of Prediction of Postoperative Respiratory Complications (SPORC), which was based on five preoperative variables when first developed. To update it, they pored over more than a decade's worth of hospital registry data from adult patients who had noncardiac surgery with endotracheal intubation and were extubated in the operating room. Ultimately, 90,893 patients—699 of whom were reintubated within three postoperative days—were included in the score development cohort. Analysis revealed seven intraoperative predictors of value: early post-intubation desaturation, prolonged duration of surgery, high median fraction of inspired oxygen, high vasopressor dose, blood transfusion, absence of volatile anesthetic use, and absence of protective ventilation. Those seven variables, added to the original five—ASA physical status greater than III, emergency procedure, high-risk surgery, history of chronic pulmonary disease, and history of congestive heart failure—embody SPORC II. Testing of the instrument in an independent setting revealed the revised tool to be even more accurate than the original, with more than 16,000 patients correctly reclassified into a lower risk category and more than 200 rightly reclassified into a higher category. "In summary, we developed a new prediction model for early reintubation after surgery that utilized anesthesia- and surgery-related risk factors," explained Charlotte Lukannek, a medical student at Beth Israel Deaconess Center and Harvard Medical School. "By the intraoperative data, we were able to create a substantially improved prediction model."

From "New Score Uses Intra-op Variables to Predict Respiratory Complications"
Anesthesiology News (03/19/19) Vlessides, Michael

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Evaluation of Postoperative Analgesia in Pediatric Patients After Hip Surgery: Lumbar Plexus Versus Caudal Epidural Analgesia

Findings from a retrospective study point to a modest benefit of caudal epidural anesthesia (CEA) over lumbar plexus blockade (LPB) during elective pediatric hip surgery. The study involved 61 patients at Nationwide Children's Hospital in Columbus, Ohio, who shared similar demographic profiles. The review considered whether they received CEA or LPB and also looked at their postoperative pain scores and opioid demand during the first 48 hours after the procedure. Intraoperative and postoperative opioid consumption were not markedly different between the CEA and LPB groups, at 0.6 versus 0.7 mg/kg of oral morphine equivalents (MEs) and 2 versus 4 mg/kg of oral ME, respectively. CEA had something of an edge, however, in terms of postoperative pain scores, which were measured at a median rating of 3 compared to 5 in the LPB patients.

From "Evaluation of Postoperative Analgesia in Pediatric Patients After Hip Surgery: Lumbar Plexus Versus Caudal Epidural Analgesia"
Journal of Pain Research (03/19) Vol. 12, P. 997 Villalobos, Mauricio Arce; Veneziano, Giorgio; Miller, Rebecca; et al.

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Pain Care Bundles Associated with Decreased Opioid Use After Outpatient Procedures, Study Suggests

New research finds that standardized pain care bundles significantly curtail opioid prescribing for outpatient procedures, including open hernia repair and laparoscopic cholecystectomy. Investigators worked with a group of 224 patients who underwent their procedures before the new intervention was implemented. Another 192 patients underwent their procedures after introduction of the multimodal intra- and postoperative analgesic bundle—which is geared toward encouraging co-analgesia, reducing opioid prescriptions, and promoting patient education. All reported their pain during the first week after surgery, which was comparable between the two sets of patients. Pain control quality, however, improved with the bundles; and the amount of opioids filled was markedly lower for the intervention group. In fact, only 78 of those 192 patients went on to fill their opioid prescription. The findings appear in the Journal of the American College of Surgeons.

From "Pain Care Bundles Associated with Decreased Opioid Use After Outpatient Procedures, Study Suggests"
Becker's Clinical Leadership & Infection Control (03/18/19) Popa, Rachel

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Rise in Pediatric IV Acetaminophen Use Drives Up Costs

A study out of Boston Children's Hospital finds that while giving acetaminophen intravenously is convenient and perceived by some as faster-acting and more effective, the associated costs should give clinicians pause. A pediatric dose of oral acetaminophen costs just 2 cents wholesale, versus $13.51 for a single IV dose, Florence Bourgeois, MD, and colleagues report in JAMA Pediatrics. They add that use of IV acetaminophen for hospitalized children increased at a pace of about 2 percent per year at 34 U.S. hospitals from 2010 to 2017, with a corresponding six-fold spike in price to $16 million annually. As of 2017, the IV formulation accounts for 13 percent of pediatric hospitalizations. Use of oral acetaminophen held steady, by comparison, and still represented a bigger share—41 percent—of all hospitalizations; yet its mean annual cost of $2.2 million was significantly lower than that of IV acetaminophen. In light of the findings, Bourgeois recommends that hospitals adopt guidelines limiting IV acetaminophen to patients who cannot tolerate the drug in the oral or rectal formulations.

From "Rise in Pediatric IV Acetaminophen Use Drives Up Costs"
Reuters Health (03/14/19) Harding, Anne

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News summaries © copyright 2019 SmithBucklin



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

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

If you are interested in advertising in Anesthesia E-ssential contact HealthCom Media at 215-489-7000.

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

AANA
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Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
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Attn: Cathy Hodson
E–ssential Editor
chodson@aana.com
March 21, 2019
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