March 30, 2015
Business of Anesthesia Conference: Building a Successful Practice
A Look at Core Modules
CPC Sound Bite: Will I Really Have to Take an Exam to be Recertified?
- New Free CE Opportunity: October 2014 AANA Journal Course Exam Now Available at AANALearn
- Register Now for Mid-Year Assembly
- ISMP Warns of Potential Confusion between Bloxiverz and Vazculep Injection
- ANA Issues Call for Public Comment on Draft Nursing: Scope and Standards of Practice, Third Edition
- Need CE Credits for Recertification?
- AANA Student Writing Contest Deadline is April 13
- Students and CRNAs Needed for Anesthesia College Bowl
- Nominees Sought for Student Excellence Award
- Award Nominations - Last Call
- Student Rep Position on Board of Trustees Available for 2015-2017
- Apply Today: "State of the Science" Oral and General Poster Presentations
- Registration Now Open for Jack Neary Pain Management Workshop, Part 1
- U.S. House Approves AANA-backed Permanent SGR Repeal, Medicare Reforms on Huge Bipartisan Vote; Senate Action Next
- What Does Permanent SGR Repeal Bill Do for CRNAs?
- House Bill Authorizing Full Practice Authority for CRNAs and other APRNs Providing Care to Our Veterans Gains Cosponsors
- What Is the Current Status of AANA's Efforts to Ensure Veterans Access to Quality Care?
- President Obama Nominates New Veterans Affairs Under Secretary for Health
- HHS Launches Healthcare Payment Learning and Action Network and AANA is Serving as a Stakeholder
- Register Now for the 2015 AANA Mid-Year Assembly, the CRNA-PAC Event, and the First-Ever Capitol Hill Rally
- FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
Healthcare HeadlinesHealthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.
Inside the Association
New Free CE Opportunity: October 2014 AANA Journal Course Exam Now Available at AANALearn
Register Now for Mid-Year Assembly
ISMP Warns of Potential Confusion between Bloxiverz and Vazculep Injection
ANA Issues Call for Public Comment on Draft Nursing: Scope and Standards of Practice, Third Edition
Need CE Credits for Recertification?
Students and CRNAs Needed for Anesthesia College Bowl
Nominees Sought for Student Excellence Award
Award Nominations – Last Call
- Advocate of the Year
- John F. Garde Researcher of the Year
- Rita L. LeBlanc Philanthropist of the Year
- Janice Drake CRNA Humanitarian Award
Student Rep Position on Board of Trustees Available for 2015-2017
Apply Today: “State of the Science” Oral and General Poster Presentations
- Oral Poster Presentation – April 1 Deadline – Up to $1,000 accompanies oral presentation
- General Poster Presentation – May 1 Deadline
Business of Anesthesia Conference: Building a Successful Practice
Registration Now Open for Jack Neary Pain Management Workshop, Part 1
U.S. House Approves AANA-backed Permanent SGR Repeal, Medicare Reforms on Huge Bipartisan Vote; Senate Action Next
What Does Permanent SGR Repeal Bill Do for CRNAs?
House Bill Authorizing Full Practice Authority for CRNAs and other APRNs Providing Care to Our Veterans Gains Cosponsors
What Is the Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care?
- The AANA is supporting new legislation in the House, H.R. 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). AANA is requesting that AANA members contact their U.S. Representatives to cosponsor this bill. Please do so here.
- The AANA has expressed strong concerns about legislation in the Senate, S. 297, the “Frontlines to Lifelines Act,” sponsored by Sen. Mark Kirk (R-IL). Unlike the House bill, H.R. 1247, S. 297 recognizes only three of the four APRN specialties for full practice authority in the VHA, omitting CRNAs. The AANA encourages CRNAs to contact their U.S. Senators with similar concerns about S 297, and to request that the bill be amended to include CRNAs. Please do so here.
- The AANA continues to strongly support the VHA’s efforts to update its Nursing Handbook 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 to their full practice authority in the VHA.
Since mid-February, AANA members have sent over 12,000 messages to their federal legislators expressing support for H.R. 1247 and concern for S. 297 as written. Your voice matters today!
If you have not yet contacted your Senators, take action today and request that they refrain from cosponsoring or supporting S 297 until it is amended to include CRNAs: https://www.crna-pac.com/actionalerts.aspx (requires AANA member login and password). See the AANA’s letter at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150209%20FINAL%20AANA%20ltr%20to%20SVAC%20re%20S%20297%20Sec%204.pdf. Text for S. 297 is available at https://www.congress.gov/bill/114th-congress/senate-bill/297/text?q=%7B%22search%22%3A%5B%22s+297%22%5D%7D.
President Obama Nominates New Veterans Affairs Under Secretary for Health
HHS Launches Healthcare Payment Learning and Action Network and AANA is Serving as a Stakeholder
- To learn more about the Health Care Payment Learning and Action Network, visit http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-02-27.html.
- To register for the Health Care Payment Learning and Action Network, go to http://innovationgov.force.com/hcplan.
Register Now for the 2015 AANA Mid-Year Assembly, the CRNA-PAC Event, and the First-Ever Capitol Hill Rally
for the AANA Mid-Year Assembly, April 18-22, 2015, in Arlington, VA. For the first time ever, our Capitol Hill advocacy days starting Tuesday, April 21, will kick off with a CRNA rally with members of Congress at the foot of Capitol Hill.
- Both the House and Senate are on recess through April 13, when the Senate will return to complete work on HR 2 repealing the Medicare SGR payment cuts and the House will start work on FY 2016 appropriations bills. If you see your legislators or their staff 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 email@example.com. To see when Congress is in Washington or at home, go to House schedule, Senate schedule.
- Stay up to date on CRNA reimbursement issues by obtaining Version 2.1 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20140225_AANA_Issue-Briefs_Re_Reimbursement-2.1.pdf (requires AANA member login and password).
- Engage with your profession’s social media feed on Facebook at https://www.facebook.com/AmericanAssociationofNurseAnesthetists and Twitter at https://twitter.com/aanawebupdates.
- 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 http://www.future-of-anesthesia-care-today.com.
Visit the CRNA Career Center
Graduate faculty position with specialization in Nurse Anesthesia- National University
A discovery by researchers at Johns Hopkins may represent a breakthrough in the quest for less-concentrated anesthetics with fewer adverse outcomes. The study identified postsynaptic density protein (PSD95) as a key player in how well inhalational anesthetic works. Reporting in Anesthesiology, the team revealed that molecules found in inhaled anesthetics bind on PSD95 to stop excitatory neurons from sending signals. When blocked, the protein prevents some forms of chronic pain and curtails the amount of anesthesia needed to be effective. "The current findings could help to design new or more specific anesthetics or allow us to lower the anesthetic concentration needed for anesthesia," said senior author Johns Hopkins anesthesiology professor Roger Johns. Because PSD95 also plays a role in connecting neurons in the brain during early development, the research could have implications for pediatric anesthesia.
Outpatient Surgery (03/23/15) Cook, Daniel
Postop Cognition in Elderly Improved With Dexamethasone
Older surgical patients are vulnerable to postoperative cognitive dysfunction (POCD), but Brazilian researchers say this elevated risk can be mitigated with the use of dexamethasone in conjunction with general anesthesia. Of 170 patients aged 60 to 87 years old, half were randomized to receive IV dexamethasone along with light or deep general anesthesia; the other half received just general anesthesia. Neurological tests indicated that, among the anesthesia-only group, 68.2 percent of deep-anesthesia and 27.2 percent of light-anesthesia patients presented with POCD on the third day following surgery. Those numbers dropped to 25.2 percent and 15.3 percent, respectively, for patients in the dexamethasone cohort. "We conclude that dexamethasone can reduce the incidence of postoperative cognitive dysfunction in noncardiac surgical patients undergoing general anesthesia, especially if the depth of anesthesia is light and the patients are elderly," said Livia Valentin, PhD, from the University of Sao Paulo. "It remains to be seen why this association exits, and further research is certainly warranted."
General Surgery News (03/01/15) Vol. 42, No. 3 Vlessides, Michael
A Faster, Better, Cheaper Path to Filling the Doctor Shortage
By one estimate, the United States is facing a shortage of 62,900 physicians this year—a figure that could more than double to 130,600 in another decade. How to narrow the void has become a very real issue, as training new doctors would be highly time- and cost-intensive, particularly in the specialty fields. Expanding the scope of practice for advanced practice nurses (APRNs), including nurse anesthetists, is one alternative that would cost less, take less time, and be more effective. To accomplish this, North Carolina and many other states must eliminate legislative hurdles that keep them from practicing to the full extent of their capability. A study on that state's restrictive regulations governing APRNs concluded that loosening these rules would eliminate no less than 85 percent of the anticipated shortage of anesthesiologists there, in addition to putting a 41 percent dent in the overall shortage of nonfederal physicians. What is more, the research found that APRN practice outcomes are of at least the same quality as those of the physicians against whom they are measured. And for some metrics, like patient satisfaction, APRNs actually rate higher.
Forbes (03/16/15) Conover, Chris
Risk for Anesthesia Complications Still High in Children With Pulmonary Hypertension
Disease-modifying drugs have slashed the mortality rate for untreated pediatric cases of pulmonary hypertension in recent years, but researchers say children with the condition still face an elevated risk for complications while anesthetized. The team from Toronto's Hospital for Sick Children looked at data from 284 noncardiopulmonary bypass procedures performed over a period of about two years on 122 patients, with 121 of the procedures involving disease-modifying treatment. The results showed that complication rates declined in patients who received the drugs compared to those who did not. While airway type and the kind of anesthetic used seemed to have no impact, the researchers discovered that age was a significant factor. Children younger than five months old, as well as those aged six months to 24 months, both were more likely to experience adverse outcomes during surgery; and those five months and under also were more likely to experience severe complications.
Anesthesiology News (03/01/15) Vol. 41, No. 3
The Web-based Tailored Intervention Preparation for Surgery (WebTIPS) project, featured in the April issue of Anesthesia & Analgesia, aims to prepare both children and their parents ahead of a pediatric surgery. The user-friendly interactive site dispenses personalized information and advice, based on parental feedback on a child's coping style, anxiety level, and apprehension about an upcoming procedure. In addition, there is a section that uses games and animation to introduce children to elements—such as an anesthesia mask—that they likely will encounter as part of their surgery. A preliminary assessment of the new resource indicates that WebTIPS alleviates anxiety for parents as well as pediatric patients before the procedure and possibly even curbs "emergence delirium," the agitated state that some children experience during anesthesia recovery. "WebTIPS has the potential to transform the delivery of behavioral interventions for children and families undergoing surgery, will likely reduce hospital costs, and can reach a broad health care provider and patient base," according to University of California, Irvine researchers who evaluated the program.
Researchers in Pennsylvania enrolled 87 patients in a study designed to gauge and compare depth of sedation in colonoscopy patients who were put under with and without propofol. Forty-four subjects received endoscopist-guided sedation with no propofol, and an anesthesia provider administered propofol to the other 43. Using an electroencephalogram-based monitor, investigators confirmed that the propofol patients spent much more time in the deepest stages of sedation. "Most [propofol] patients were in the range of general anesthesia, whereas those with IV conscious sedation were mostly in the moderately sedated range," explained researcher and Drexel medical student Augustus Carlin. Patients who received propofol also were under sedation longer. Although none of the study participants experienced aspiration, researcher Basavana Goudra, MD, of the University of Pennsylvania emphasized that deeper sedation under propofol inherently means higher risk of aspiration. However, he suggested that "with appropriate titration, all the benefits of propofol sedation can be realized, with a possible reduction in risk."
Gastroenterology & Endoscopy News (03/15) Vol. 66, No. 3 Helwick, Caroline
Multimodal Antiemesis Protocol Loses Efficacy Post-Discharge
Le Fort I osteotomy patients, whose jaws are held together by elastics, suffer disproportionately from postoperative nausea and vomiting (PONV); but recent research suggests a multimodal antiemetic regimen can alleviate the side effects. Prolonged surgical times, swallowed blood, altered diets, and other factors increase the probability of PONV in this patient population. Hoping to address the problem, which can lead to more serious complications and lower patient satisfaction, UNC-Chapel Hill investigators tested a protocol that eliminated aspects of anesthesia proven to promote nausea and vomiting. Half of the 230 study enrollees received the regimen, which was heavily based on total IV anesthesia and opioid-sparing analgesia; while the other half was treated mainly with volatile anesthetics and standard narcotics. Based on patients' journal records, the protocol reduced PONV by a statistically significant margin immediately after surgery. The efficacy of the multimodal antiemetic protocol was not repeated during the post-discharge period, however, to the researchers' disappointment.
Anesthesiology News (03/01/15) Vol. 41, No. 3 Leung, Martin
Study Investigates Effects of Antidepressant Treatment in Pain Catastrophizing Patients
Early administration of an antidepressant treatment could help reduce pain after surgery in patients with pain catastrophizing disorder, a new study has found. With pain catastrophizing, an irrational thought process can make patients think that their pain is worse than it really is. While antidepressant medications could help limit this thought process, the study found that it may not help for acute pain. The researchers write in the April edition of Anesthesiology that antidepressant treatment did not reduce pain 24 hours after total-knee replacement surgery, but it did reduce overall pain scores on days two through six after surgery. In the study, 120 patients were given either placebo or escitalopram, a type of selective serotonin reuptake inhibitor, every day from the day of surgery to the sixth day after surgery, in addition to pain medication. The study findings suggest that initiating the antidepressant treatment even earlier may help reduce pain within 24 hours after surgery.
Researchers are trying to determine whether pharmaceutical companies can develop new analgesics that do not cause euphoria or lead to abuse—an urgent need amid a growing crisis of the drugs' misuse. Abuse of such medication has increased dramatically in recent years, prompting stricter Drug Enforcement Agency regulations that make some analgesics tough to prescribe and refill. Biotech startups and pharmaceutical firms including Pfizer and Biogen Idec are developing new classes of analgesics, often based on different mechanisms than traditional opioids like morphine. Industry experts believe a safer analgesic could achieve annual sales totaling many billions of dollars. The most widely abused analgesics currently are opioids, such as morphine, oxycodone, or hydrocodone. They work by activating mu-opioid receptors on the surface of cells in the brain, spinal cord and other organs, which are responsible for modulating pain perception. Some companies are attempting to trigger different opioid receptors, known as kappa- and delta-opioid receptors, that they hope will have similar properties without the euphoric effects.
Wall Street Journal (03/18/15) Whalen, Jeanne
DEA Issues Nationwide Alert on Fentanyl as Threat to Health and Public Safety
The U.S. Drug Enforcement Agency (DEA) has issued a nationwide alert about the risks of fentanyl and fentanyl analogues/compounds. "Drug incidents and overdoses related to fentanyl are occurring at an alarming rate throughout the United States and represent a significant threat to public health and safety," said DEA Administrator Michele M. Leonhart. "Often laced in heroin, fentanyl and fentanyl analogues produced in illicit clandestine labs are up to 100 times more powerful than morphine and 30–50 times more powerful than heroin." The drug, a Schedule II narcotic, is used as an analgesic and anesthetic. DEA also warned law enforcement officials about the risks of absorbing the drug through the skin and accidentally inhaling airborne powder. Data from the National Forensic Laboratory Information System show that state and local labs reported more than 3,300 fentanyl submissions in 2014, an increase from 942 in the previous year. DEA has also identified 15 other fentanyl-related compounds.
DEA Press Release (03/18/15)
DEA Contributes to Shortages of Drugs With Controlled Substances: Report
A new report from the U.S. Government Accountability Office (GAO) finds that the Drug Enforcement Agency (DEA) has contributed to a noticeable shortage of prescription drugs containing controlled substances, such as narcotics and stimulants, causing difficulties for both patients and physicians. Controlled substances are regulated by DEA, and to prevent diversion, the agency sets quotas that limit the amount that can be produced. DEA, however, has not effectively managed the quota process and this has contributed to product shortages, according to the GAO report. "Each year, manufacturers apply to DEA for quotas needed to make their drugs," the report states. "DEA, however, has not responded to [the drug makers] within the timeframes required by its regulations for any year from 2001 through 2014. ... Manufacturers who reported quota-related shortages cited late quota decisions as causing or exacerbating shortages of their drugs." DEA disputes some of the findings and argues that some of the problems stem from disagreements with the Food and Drug Administration—notably, that the two agencies have differing views on how to define prescription drug shortages.
Wall Street Journal (03/11/15) Silverman, Ed
Label Design Affects Medication Safety in an Operating Room Crisis: A Controlled Simulation Study
The redesign of medication labels can help prevent some types of medication errors. In one study, 96 anesthesia trainee participants were randomly assigned to either a current or a redesigned label condition. Each participant was the sole anesthesia provider in a simulated operating room scenario and was asked by the surgeon to administer hetastarch to the simulated patient. The anesthesia cart's fluid drawer contained three 500 ml I.V. bags of hetastarch and one 500 ml I.V. bag of lidocaine. The redesigned labels were intended to help participants correctly select hetastarch or to detect incorrectly selected lidocaine before it was administered. Among the participants who correctly selected hetastarch, 63 percent had been given the redesigned labels and 40 percent had been given the current labels. Of the participants who incorrectly selected lidocaine, the percentage who noticed it before administration did not differ by label condition.
Journal of Patient Safety (03/07/2015) Estock, Jamie L.; Murray, Andrew W.; Mizah, Margaret T.; et al.