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See You at AANA Mid-Year Assembly, April 2-6 – In Person or Virtually
 
In just a couple of days, over a thousand AANA members are expected to converge on Washington, D.C., for the AANA Mid-Year Assembly health policy and advocacy conference. All other AANA members will be extended an opportunity to amplify their colleagues’ voices on Capitol Hill by participating in a virtual Mid-Year Assembly advocacy activity during the week of April 4.
  • Meeting materials have been posted to the AANA Advocacy site at
    https://www.crna-pac.com/content.aspx?page=midyearassemblyin
    formation
    (requires AANA member login and password) and are available on the AANA Meetings mobile app.
  • Tickets are going fast for the CRNA-PAC Bootlegger’s Ball. Tickets at the student discounted rate have already sold out, but a few CRNA tickets remain and will be on sale on-site.
  • Join us for the second annual CRNA rally on Capitol Hill! This energetic event will take place on the grounds of the U.S. Capitol the morning of April 5 and is an easy 5-minute walk to your House and Senate appointments.
  • Watch your email inbox for AANA Virtual Mid-Year Assembly advocacy actions you can take to ensure the voice of nurse anesthesia is strong in Washington.
  • All AANA members can engage with Mid-Year Assembly on social media for live updates beginning on April 2. Follow us at @AANAWebUpdates with the hashtags #AANAMYA and #CRNAs4Vets.
 
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CPC Facts

 
The CPC Program Exam: It’s NOT Another NCE
 
The myth is that "The CPC exam is going to be another NCE!" It is important to note that the CPC Exam is not the National Certification Exam (NCE). The Continued Professional Certification (CPC) examination content outline, available on the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) website, is different than the NCE's and was informed by a professional practice analysis done by CRNAs. The input from these practicing nurse anesthetists helped define the knowledge required of an experienced practitioner, and reinforced the understanding that the knowledge they acquire and refine over years of nurse anesthesia practice is different from the knowledge required of a new practitioner. The professional practice analysis surveyed hundreds of practicing nurse anesthetists to identify just what they did in the course of practice. The goal was to make sure that the knowledge tested is common to all CRNAs, regardless of practice focus. It is not the NCE.
 
Many people have asked if the NBCRNA will be offering practice questions for the CPC Program exam. The answer is yes! The NBCRNA will be offering practice questions. CRNAs will be surveyed, with feedback helping to determine the delivery and format of the questions. Stay-tuned…there is much more to come on this topic as the first CPC exam (performance standard…NOT PASS/FAIL) becomes available in about four years. For more information about the NBCRNA's 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

 
Members Welcome at Open Session of Upcoming AANA Board Meeting
 
The Board of Directors of the American Association of Nurse Anesthetists will be meeting in Open Session on Saturday, April 2, 2016, at the Renaissance Washington DC Downtown Hotel. The Board invites AANA members to audit the Open Session starting at 9:45 a.m.
 
The Open Session will be live audio streamed. Register to receive the audio information at the link below. All members are welcome either in person or listening to the audio stream. The preliminary agenda and background material are available on the members’ side of the website at
on-Board-Meeting-Agendas.aspx (member login required). Please contact mscheuermann@aana.com if you have any questions.
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AANA Election Ballot Information Available Online
 
The AANA Nominating Committee, after reviewing the nominations for elected positions for the upcoming election at its February meeting, has announced the slate of candidates for the 2016 election of the AANA Board of Directors, Nominating and Resolutions Committee members. AANA 2016 Election Slate Announced. View the complete slate of candidates and further information about the upcoming elections. (Member login and password required.) The order of names was determined randomly on the ballot by the Nominating Committee. Those elected will begin their fiscal year 2017 terms of office at the conclusion of the AANA 2016 Nurse Anesthesia Annual Congress in Washington, D.C.
 
2015-2016 Nominating Committee
Serving on the fiscal year 2016 Nominating Committee are: Michele Ballister, DNP, CRNA (Chair); (Region 2), Ann Bassett, MS, CRNA, APRN (Region 1); Timothy Finn, CRNA (Region 3); Garrett Peterson, DNP, CRNA (Region 4); Matthew Bishop, DNP, CRNA, APRN (Region 5); Michael Ruebusch, MSN, CRNA (Region 6); and Catherine Gabel, CRNA (Region 7)
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Coming Soon: AANA Connect Community for Candidates for the AANA Board of Directors
 
The AANA Connect Community for Candidates for the AANA Board of Directors will become available on April 4, 2016, after candidates are introduced at the Mid-Year Assembly. All AANA members will be able to interact with Board candidates during the voting cycle. This community will be available until the voting cut-off date of May 17, 2016.
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Health Services Research (HSR) Webinars Now Available on myAANA
 
The AANA Research and Quality Division has prepared three separate HSR webinars to assist aspiring investigators with different steps in the research process from conceptualizing a study design to writing a grant proposal and reporting findings in their manuscripts. These prerecorded webinars in addition to the downloadable PDF presentations are available to AANA members on the myAANA Health Services Research (HSR) Webinar Series page (login required). Be sure to check it out!
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SEDASYS® Computer-Assisted Personalized Sedation System Pulled from Market
 
Johnson & Johnson has stopped marketing and supporting SEDASYS®, a computer-assisted personalized sedation system used for endoscopy and colonoscopy procedure sedation. The decision was first reported on March 10 by Outpatient Surgery. First approved by the U.S. Food and Drug Administration in 2013, SEDASYS® was used for IV administration of 1% propofol by non-anesthesia professionals to provide minimal to moderate sedation with comprehensive patient monitoring to limit depth of sedation. For further information, read the article in the March 14 issue of the Wall Street Journal.
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Professional Practice

 
FDA Issues New Safety Warnings to Prescription Opioid Medications
 
The US Food and Drug Administration has announced class-wide safety labeling changes for immediate-release opioid pain medications. Among the changes, the FDA is requiring a new boxed warning about the serious risks of misuse, abuse, addiction, overdose and death. Read more about FDA’s recommendations and information for patients and healthcare providers.
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FDA Proposes Ban on Most Powdered Medical Gloves
 
The US Food and Drug Administration announced a proposal to ban most powdered gloves in the United States. While use of these gloves is decreasing, they pose an unreasonable and substantial risk of illness or injury to healthcare providers, patients and other individuals who are exposed to them, which cannot be corrected through new or updated labeling. The proposed ban applies to powdered surgeon’s gloves, powdered patient examination gloves, and absorbable powder for lubricating a surgeon’s glove. Read more in the FDA’s press release.
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HVO Launches New Anesthesia Projects in Cambodia and Laos
 
Health Volunteers Overseas (HVO) has launched two new anesthesia projects in Cambodia and Laos. HVO volunteers will contribute to improving the quality of patient care and availability of anesthesia providers at the Sonja Kill Memorial Hospital in Kampot, Cambodia and Lao Friends Hospital for Children in Luang Prabang, Laos. Both locations will work to prepare nurses with the knowledge and skills to practice as nurse anesthetists. Read HVO’s announcement for more information and volunteer opportunities.
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Joint Commission Appoints New AANA Representatives to Hospital and Ambulatory Care PTACs
 
AANA is pleased to announce the appointment of three new members to The Joint Commission’s Professional and Technical Advisory Committees (PTACs). The Joint Commission appoints CRNA representatives on behalf of the AANA to its Hospital and Ambulatory Care PTACs. The Hospital PTAC deals with both the hospital and critical access hospital (CAH) accreditation programs. The Ambulatory Care PTAC deals with the ambulatory care and office-based surgery accreditation programs.
 
Mark Antoszyk, BS, CRNA, succeeds Dean Mazurek, CRNA, APN, as the Hospital PTAC AANA alternate representative. Garry Brydges, DNP, MSN, CRNA, ACNP-BC, continues to serve as the Hospital PTAC AANA representative.
 
Lucy Glover, MSNA, CRNA, succeeds Jay Horowitz, BSN, CRNA, ARNP, as the Ambulatory Care PTAC AANA representative. Brian Kasson, MHS, CRNA, succeeds Roger Strand, MAE, CRNA, ARNP, as the Ambulatory Care PTAC AANA alternate representative.
 
We thank Dean, Jay, and Roger for their years of service representing the AANA on the Joint Commission PTACs.
 
The PTACs include multiple healthcare organizational representatives who offer their expertise and advice to The Joint Commission on standards development, environmental trends, educational needs, and other important issues.
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Webinar: Zika Virus Disease - What You Need To Know
 
Presented as part of Premier's Advisor Live® series and co-sponsored by the Society for Healthcare Epidemiology of America and the Association for Professionals in Infection Control and Epidemiology, this complimentary webinar will provide updates and late breaking information on the Zika virus outbreak, lab diagnosis and travel; issues for reproductive age and pregnant women, including evaluation, management, counseling, and congenital findings; and implications and risks for healthcare personnel.
 
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Meetings and Workshops

 
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. Get the details and register here.
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SAVE THE DATE for #AANA2016!
 
The 83rd AANA Annual Congress will be held September 9-13, 2016, in Washington, D.C. Look for the Preliminary Program with your copy of the April AANA Journal.
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Save the Dates for These Popular Hands-On Workshops
 
Visit www.aana.com/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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Foundation and Research

 
Dean Hayden Student Research Scholarship Application Due April 15
 
The Dean Hayden Student Research Scholarship is open to students who can present the anticipated value of their research findings for nurse anesthetists and meet the following criteria: 1) Nurse anesthesia student in good academic standing, 2) Member of the AANA. This research scholarship is awarded up to $5,000. Don’t delay; Click here to access the Application webpage on the AANA Foundation website at www.aanafoundation.com.
 
Please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com if you have any questions.
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Post-Doctoral and Doctoral Fellowship Applications Due May 1
 
Attention Researchers…Post-Doctoral and Doctoral Fellowship applications are available on the AANA Foundation website at www.aanafoundation.com. The deadline for submission is May 1, 2016. Click here to be linked directly to the application. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
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Research Grant Applications Due May 1
 
The mission of the AANA Foundation is to advance the science of anesthesia through education and research. As the philanthropic arm of the AANA, the Foundation raises funds and invests in projects that directly support the nurse anesthesia profession.
 
One of the goals of the AANA Foundation is to support new and seasoned investigators in nurse anesthesia through grants and fellowships. The AANA Foundation sets a broad research agenda that includes the following areas:
  • Healthcare policy
  • Science of anesthesia
  • Education
  • Practice/Clinical
  • Leadership
Spring Research Grant applications are currently available on the AANA Foundation website at www.aanafoundation.com. General research grants are awarded to AANA member CRNAs in good standing. Research funding priorities change annually.
 
Click here to access the 2016 research agenda and link to the application page.
 
If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
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“State of the Science” Oral Presentations Due April 1; General Poster Presentations – Due May 1
 
“State of the Science” offers an opportunity for CRNAs and SRNAs to present their research findings and innovative educational approaches at the AANA Nurse Anesthesia Annual Congress in Washington, D.C., September 9-13, 2016.
 
Research, literature reviews, and innovative, creative techniques in anesthesia are appropriate topics. Click here to access the applications which are currently available on the AANA Foundation website at www.aanafoundation.com.
 
Oral Poster Presentation – April 1 Deadline – An award of up to $1,000 accompanies oral presentation
 
General Poster Presentation – May 1 Deadline
 
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

 
Update: Expand Veterans Access to Care through Full Practice Authority for VHA CRNAs, APRNs
 
The AANA continues to work with a broad coalition of groups in support of improving Veterans access to care through Full Practice Authority for CRNAs and other APRNs at the VHA. Here is a brief rundown of activities to keep members apprised of current actions.
  • Legislation: The AANA continues to encourage members of the House of Representatives to cosponsor the “Improving Veterans Access to Quality Care Act” (H.R. 1247) and members of the Senate to cosponsor the “Veterans Health Care Staffing Improvement Act” (S. 2279). The bills currently have 46 and 8 bipartisan cosponsors respectively.
  • Hearing Activity: During a joint hearing of the House and Senate Veterans Affairs Committees on March 16, Robert Frank, CMSGT (Ret.), CEO of the Air Force Sergeants Association, and Rene Campos, USN (Ret.), Deputy Director of Government Relations at the Military Officers Association of America, testified in support of Full Practice Authority for all VHA APRNs, including CRNAs. For further information, read the Air Force Sergeants Association testimony and the Military Officers Association of America testimony.
  • Regulation: The White House Office of Management and Budget (OMB) continues to evaluate a proposed rule on APRN Full Practice Authority submitted by Veterans Affairs Secretary Robert McDonald in early January. The OMB has until April to publish the rule in the Federal Register and trigger a 60-day public comment period or return it to the VHA for more work. AANA continues urging all members to use www.Veterans-Access-to-Care.com to submit regulatory comments ahead of time in support of improving Veterans access to quality healthcare through CRNA and APRN Full Practice Authority. AANA members can also share the site with colleagues, friends, and family—especially Veterans—to take action.
 
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AANA Leaders Advocate for CRNAs, Patients in Washington


AANA leaders traveled to Washington, D.C., March 14-15, to meet with representatives from the federal government and major health plans shaping CRNA practice and reimbursement, helping to advance patient access to CRNA care. AANA leaders in attendance included (pictured left to right) President-elect Cheryl Nimmo, DNP, MSHSA, CRNA; President Juan Quintana, DNP, MHS, CRNA; and Executive Director/CEO Wanda Wilson, PhD, MSN, CRNA.

 

 

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CDC Releases Final Opioid Guidelines for Chronic Pain
 
The Centers for Disease Control and Prevention (CDC) released final opioid guidelines for chronic pain in the March 18 edition of Morbidity and Mortality Week Report (MMWR), continuing to focus on prescribing efforts by primary care providers in the outpatient setting. The AANA had recommended that the agency harmonize specialty and care setting guidelines and that primary care providers work with chronic pain specialists such as CRNAs within three months of initiating opioid therapy.
 
In the AANA’s comments to the agency on Jan.11, AANA President Juan Quintana, DNP, MHS, CRNA, wrote, “[w]hile we agree with the CDC that it is reasonable to focus the guideline on primary care providers, the AANA believes the guideline should be inclusive of all prescribers across settings to optimize the impact on safe and appropriate use of opioids for chronic pain…. As there is no bright line between acute and chronic pain, opioid use disorder may originate or become evident in many care settings. We therefore recommend that the CDC harmonize the guidelines across care settings and specialties.”
 
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Senate Passes Legislation to Combat Opioid Abuse, Diversion
 
On March 10, the U.S. Senate 10 passed a sweeping bill authorizing new grants and programs intended to combat opioid abuse and diversion on a vote of 94-1. Issues relating to opioid abuse and diversion are clinically relevant to CRNAs as persons with addictions arrive in the operating room, and in professional practice as CRNAs administer or in some circumstances prescribe opioids. CRNAs also provide comprehensive pain management services that may help reduce pain patients’ need for opioid painkilling medications.
 
The bipartisan “Comprehensive Addiction and Recovery Act” (S. 524) authorizes about $78 billion annually through 2020 for grants from the Department of Health and Human Services and the Justice Department to expand the availability of naloxone to law enforcement agencies and first responders, boost prescription drug monitoring programs, increase drug treatment for incarcerated persons, and prohibit the Education Department from including questions on the federal financial aid application about possession or sale of illegal drugs. Identical legislation, H.R. 953, was introduced in the U.S. House on Feb. 12, 2015. and awaits committee consideration
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NIH Releases Final National Pain Strategy
 
On Friday, March 18, the National Institutes of Health (NIH) released its final National Pain Strategy plan. The HHS Office of the Assistant Secretary for Health (OASH) will now consider the recommendations included in the strategy and develop an implementation and evaluation plan.
 
As authorized by the Affordable Care Act, the Assistant Secretary for Health and Human Services (HHS) asked the NIH Interagency Pain Research Coordinating Committee (IPRCC) to oversee the creation of the National Pain Strategy. Six expert working groups explored important areas of need identified in the recommendations in the Institute of Medicine’s 2011 report “Relieving Pain in America” — population research, prevention and care, disparities, service delivery and reimbursement, professional education and training, and public awareness and communication. Two AANA members, Margaret Faut-Callahan, PhD, CRNA, FNAP, FAAN, and AANA Past President Jackie Rowles, MBA, MA, CRNA, ANP-BC, FAAPM, DPNAP, FAAN, were nominated by the AANA and appointed to two of the expert working groups to the IPRCC.
 
The AANA had provided comments on the draft last May and is reviewing the final draft for impact on CRNA practice.
 
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AANA Comments on Lumbar Epidural Injection Proposal to Medicare Contractor WPS
 
Promoting Medicare coverage of CRNA services in six Midwestern states was the objective of comments the AANA submitted March 17 to Medicare administrative contractor Wisconsin Physicians Service (WPS) concerning draft local coverage determinations (LCD) on lumbar epidural injections. WPS administers the Medicare program in Indiana, Iowa, Kansas, Michigan, Missouri, and Nebraska.
 
The AANA letter signed by President Juan Quintana, DNP, MHS, CRNA, stated, “The Provider Qualifications section of this draft LCD states, ‘[p]atient safety and quality of care mandate that healthcare professionals who perform epidural steroid injections are appropriately trained and/or credentialed by a formal residency/fellowship program and/or certified by either an accredited and nationally recognized organization or by a post-graduate training course accredited by an established national accrediting body or accredited professional training program.’ We understand this section to clearly state that on behalf of the Centers for Medicare & Medicaid Services (CMS), Wisconsin Physicians Service Insurance Corporation (WPS) covers all Medicare CRNA services within their state scope of practice, including the services described in this LCD…. All CRNAs are certified and recertified to practice by an accredited nationally recognized organization, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).”
 
For further information, read the AANA comment letter and the draft LCD.
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Medicare Meets Goal for Transitioning Payment Models
 
The Medicare agency recently announced that it met its goal proposed back in January 2015 of tying 30 percent of fee-for-service Medicare payments to quality or value through alternative payment models by the end of 2016. The agency attributed this earlier-than-scheduled accomplishment to 121 new accountable care organizations (ACOs) that joined the Medicare program, along with new participants in other models, such as bundled payment. The announcement also pointed out that more providers will be encouraged to participate in alternative payment models as the Medicare Access and CHIP Reauthorization Act of 2015 is implemented. Furthermore, the announcement highlighted the efforts across different payers and health systems in developing alternative payment models. CRNAs should be aware of the accelerated use of alternative payment models and the changing payment landscape.
 
Read the Medicare press release here.
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AANA Past-President Pearce Places Third in Republican Primary for North Carolina House District 81
 
On March 15, AANA Past-President Sharon Pearce, MSN, CRNA, placed third in the Republican primary election to represent the people of North Carolina’s 81st Assembly District. Past President Pearce faced a number of attacks from the anesthesiology community and its super-PACs, and distinguished herself with her professionalism, commitment, and diligence throughout the campaign.
 
Please join the AANA in thanking Past-President Pearce for her political leadership on behalf of CRNAs. You can read more about the race here.
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Upcoming Presidential and Congressional Elections
 
The AANA encourages CRNAs to vote and be active in primary elections this spring in support of candidates of their choice. If you are involved in one of the following 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.
  • April 2, Republican presidential convention in North Dakota
  • April 5, presidential primary in Wisconsin
  • April 16, Republican presidential convention in Wyoming
  • April 19, presidential primary in New York
  • April 26, presidential primaries in Connecticut, Delaware, Maryland, Pennsylvania, and Rhode Island; Congressional primaries in Maryland and Pennsylvania
For an up-to-date list of 2016 election dates by state and by date, go to http://www.fec.gov/pubrec/fe2016/2016pdates.pdf.
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CRNAs Attend Democratic and Republican Presidential Debates in Miami


Leading up to a March 15 primary election in delegate-rich Florida, Democratic and Republican presidential candidates faced off in Miami, Fla. last week for the latest round of debates. In attendance at the Univision/The Washington Post Democratic debate March 9 were Florida Association of Nurse Anesthetists (FANA) President Debra Diaz, DNP, CRNA, and FANA Secretary/Treasurer Johanna Newman, DNAP, CRNA. FANA Federal Political Director Spencer Harvey, CRNA, attended the CNN/Salem Radio/Washington Times Republican Debate on March 10.

 

 
Florida Association of Nurse Anesthetists (FANA) President Debra J. Diaz, DNP, CRNA and FANA Secretary/Treasurer Johanna C. Newman, DNAP, CRNA at the Democratic Presidential Debate in Miami, Fla. on March 9.

 

 

 

 

 
 

 

FANA FPD Spencer Harvey, CRNA, and Kate Fry, AANA Associate Director of Political Affairs, at the Republican Presidential Debate at the University of Miami on March 10.
    
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Amendments
 
 
  • The Medicare Payment Advisory Commission (MedPAC) released its March 2016 Report to Congress. AANA staff is reviewing the report and will provide more details in a future edition of the Hotline. The full report can be viewed here
  •  
  • President Barack Obama nominated Merrick Garland to the Supreme Court. Garland is currently the chief judge of the U.S. Court of Appeals for the District of Columbia Circuit. Senate Majority Leader Mitch McConnell (R-KY) has stated that his nomination should not be considered by the Judiciary Committee or Senate as a whole until a new President is in office. Read the White House’s press release here
  •  
  • Engage with your profession’s social media feed on Facebook at
  •  
  • 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.
 
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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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Jobs

 
Visit www.crnacareers.com to view or place job postings
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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.
 
Anticonvulsant Medication Gabapentin Effectively Reduces Common Complication of PONV
 
Johns Hopkins researchers have discovered that gabapentin, previously shown to stave off chemotherapy-related nausea, also suppresses postoperative nausea and vomiting (PONV). The drug is classified as an anticonvulsant but has proven to be an effective component of post-surgery pain management, especially for its role in curtailing the need for opioids. Its newest benefit was confirmed after the Baltimore team analyzed dozens of existing trials. They calculated an estimated 60 percent lower risk of PONV within 24 hours after surgery for patients who received the drug beforehand. Further study is needed, however, to determine exactly how gabapentin reduces PONV and to explore potential side effects. The data suggests a 20 percent higher risk of excessive sedation or sleepiness in the postoperative period; but it is unknown whether this elevated risk causes adverse events, like an extended stay in the postanesthesia care unit. The findings are published in Anesthesia & Analgesia.
 
From "Anticonvulsant Medication Gabapentin Effectively Reduces Common Complication of PONV"
News-Medical.net (03/23/2016)
 
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Peripheral Nerve Blocks Linked to Improved Outcomes in Hip and Knee Arthroplasty
 
Patients who receive peripheral nerve blocks (PNBs) for hip or knee replacement have fewer complications, researchers say. The neuraxial approach, in which anesthetic is injected near specific nerves around the surgical site, allows patients to remain awake. The new study considered more than 1 million hip or knee arthroplasties, approximately 18 percent of which involved PNBs. The rate of heart attack, stroke, infection, clots, falls, death, and other complications was lower in the PNB cohort compared with all other types of anesthesia. "Resource utilization" also was better for PNB patients—who were less likely to require blood transfusion, be admitted to intensive care, or need opioid pain relief. The length and cost of hospital stay also were shorter and less expensive for this group. The findings are slated for presentation during the 41st Annual Regional Anesthesiology and Acute Pain Medicine Meeting taking place in New Orleans March 31-April 2.
 
From "Peripheral Nerve Blocks Linked to Improved Outcomes in Hip and Knee Arthroplasty"
Newswise (03/23/16)
 
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Medical Marijuana Reduces Opioid Use for Chronic Pain
 
The validity of medical marijuana continues to be hotly debated, with new research from the University of Michigan bolstering arguments in favor of its use. Based on a study of chronic pain sufferers, the study concluded that medicinal cannabis reduced their need for opioids. Out of 185 subjects, 118 reported an average 64 percent decline in prescription painkillers and a 45 percent improvement in quality of life while using medical marijuana, which also was associated with fewer side effects than other treatments. Surprisingly, though, it was the patients with less severe chronic pain—rather than those with more acute symptoms—who benefited most. "We would caution against rushing to change current clinical practice towards cannabis," said lead study author Daniel Clauw, MD, professor of pain management anesthesiology at the university's medical school, "but note that this study suggests that cannabis is an effective pain medication and agent to prevent opioid overuse."
 
From "Medical Marijuana Reduces Opioid Use for Chronic Pain"
HCPLive (03/23/16) Fitzpatrick, Caitlyn
 
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Preop Evaluation Clinics Reduce Readmission Rates and Hospital Stays
 
Building on the previous finding that 30-day readmission rates are lower for patients who attend a Preoperative Evaluation Clinic (PEC), researchers say this intervention also reduces hospital length of stay (LOS). Led by Jeanna Blitz, MD, of New York University School of Medicine, the single-site study covered nearly 29,000 surgeries over two years. The observed-to-expected LOS ratio, which Blitz called a "more revealing metric" than observed LOS, was 0.18 lower in patients evaluated in the PEC than in those who were not. Further analysis also identified a disparity in the variable direct cost of care, with a cost savings of $1,373 per case for PEC patients. "Presenting the observed length of stay in the context of the expected length of stay provides information about an intervention's relative impact on hospital efficiency," Blitz explained. "And given that the length of stay is increased in patients who experience postoperative complications, the PEC clinic may also contribute by identifying patients at higher risk for complications early enough in the surgical process to intervene. This may ultimately result in better surgical candidate selection and fewer postoperative complications."
 
From "Preop Evaluation Clinics Reduce Readmission Rates and Hospital Stays"
Anesthesiology News (03/23/16) Vlessides, Michael
 
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ACOG: Opioids Still Needed During, After Pregnancy
 
To avert misconceptions linked to the Centers for Disease Control and Prevention's (CDC) updated opioid guidelines, the American College of Obstetricians and Gynecologists (ACOG) has clarified that the drugs still have relevance for some pregnant women and new mothers. "ACOG agrees with the CDC that opioids should only be used for treatment of pain when alternatives are not appropriate or effective," ACOG President Mark S. DeFrancesco wrote in a statement, "but we also know that there are times, including during pregnancy and the postpartum period, when such use is both appropriate and safer than the alternative." Specifically, he identified analgesic opioids as critical in treating acute pain stemming from cesarean births, kidney stones, sickle cell crisis, or trauma in pregnancy. Additionally, ACOG recommended that substance abusers continue opioid agonist therapy despite the risk of neonatal abstinence syndrome, which is treatable. The group worries that CDC is playing up this and other risks but downplaying the potential consequences of opioid withdrawal—including fetal death—if treatment is discontinued. In its statement, it urges "an evidence-based approach to opioid use during pregnancy that supports the ability of pregnant women to access appropriate care." ​http://www.acog.org/About-ACOG/News-Room/Statements/2016/ACOG-Statement-on-Opioid-Use-During-Pregnancy
 
From "ACOG: Opioids Still Needed During, After Pregnancy"
Healio (03/21/2016) Laday, Jason
 
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Scientists Discover Non-opioid Pain Pathway in the Brain
 
New research indicates that using mindfulness-based and pharmacologic/nonpharmacologic pain-relieving strategies that rely on opioid signaling may be effective in treating pain. The study, funded in part by the National Center for Complementary and Integrative Health, discovered that mindfulness meditation uses a different pain pathway in the brain than opioid analgesics. Researchers recorded pain levels for about 80 adults during a meditation or non-meditation control in response to painful heat stimuli and intravenous administration of naloxone or placebo saline. Compared with those who did not meditate while receiving saline, patients who meditated while receiving the placebo reported significantly lower pain intensity and discomfort ratings. In addition, the researchers determined that naloxone did not hinder the pain-relieving effects of meditation. Individuals who meditated while receiving naloxone had much lower reductions in pain intensity and unpleasantness than those in the control groups. The new research is published in The Journal of Neuroscience.
 
From "Scientists Discover Non-opioid Pain Pathway in the Brain"
NIH News (03/17/16)
 
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Effectiveness of Non-Steroidal Anti-Inflammatory Drugs for the Treatment of Pain in Knee and Hip Osteoarthritis
 
Researchers tapped 74 randomized trials for a meta-analysis comparing the efficacy of different non-steroidal anti-inflammatory drugs (NSAIDs) in treating pain from osteoarthritis. The study considered various doses of the NSAIDs diclofenac, etoricoxib, rofecoxib, celecoxib, and naproxen as well as of paracetamol. All 23 preparations yielded improvement of pain symptoms; but the difference from placebo was not clinically meaningful for six of them. Among the others, a daily dose of diclofenac 150 mg emerged as the best NSAID preparation for both alleviating pain and improving function. The researchers also determined that paracetamol taken alone, no matter the dose, is not an effective pain-relief option for patients with osteoarthritis. The study was funding by Switzerland's Arco Foundation and by the Swiss National Science Foundation.
 
From "Effectiveness of Non-Steroidal Anti-Inflammatory Drugs for the Treatment of Pain in Knee and Hip Osteoarthritis"
The Lancet (03/17/2016) da Costa, Bruno R.; Reichenback, Stephen; Keller, Noah; et al.
 
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More Opioids After Hip Replacement Means Higher Risk of Revision
 
Opioid use beyond the first three months following total hip replacement is associated with a greater likelihood of revision surgery later for older adults. Based on a retrospective study, patients who continued opioid analgesia in the second 90-day postoperative period were more than twice as likely to require revision one year after their operation as those who had stopped opioid therapy by that point. At five years postoperatively, meanwhile, they were almost twice as likely to need revision. The research also revealed a correlation between the amount of opioid consumed in days 91–180 after surgery and risk for revision. The conclusions were drawn from analysis of nearly 1,000 Australian patients from 2001–2012 and reported in BMC Musculoskeletal Disorders. Investigators did not suggest a causal relationship between opioid consumption after total hip replacement and the need for revision later. Rather, they said the findings point to persistent pain tied to the underlying disease or to the procedure itself.
 
From "More Opioids After Hip Replacement Means Higher Risk of Revision"
MedPage Today (03/16/16) Kuznar, Wayne
 
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Studies Say Opioids Overprescribed After Surgery
 
The Journal of the American Medical Association has published a pair of studies that further suggest a trend toward opioid over-prescribing after dental surgery and other low-risk procedures. The first study, involving more than 2.7 million Medicaid subscribers, found that 42 percent of patients who had a tooth removed filled a narcotic painkiller prescription within seven days. The researchers concluded that "disproportionately large amounts of opioids are frequently prescribed given the expected intensity and duration of the post-extraction pain" and that nonsteroidal medications in conjunction with acetaminophen could be more effective. The second study considered operations for carpal tunnel syndrome, gall bladder removal, hernia repair, and knee arthroscopy. It found that 80 percent of roughly 14 million patients studied filled an opioid prescription within a week of hospital discharge.
 
From "Studies Say Opioids Overprescribed After Surgery"
Pain News Network (03/16/16) Anson, Pat
 
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Delivering Safe and Effective Analgesia for Management of Renal Colic in the Emergency Department
 
Emergency departments have several analgesic choices for quickly treating severe pain in patients with renal colic, the efficacy of which were compared in a new study. Researchers in Qatar randomized patients presenting with the condition to receive one of three pain regimens: I.V. morphine, I.V. paracetamol, or intramuscular diclofenac. For the intent-to-treat cohort, which included all 1,644 participants, morphine and paracetamol were similarly effective in achieving a 50 percent or greater reduction in initial pain score within 30 minutes of administration. Diclofenac, however, was much more effective than both I.V. analgesics. In the per-protocol group, populated by the 1,316 patients with confirmed calculus of the urinary tract, diclofenac and paracetamol curbed pain faster and more effectively than morphine—which also was associated with more acute adverse events. The investigators conclude that intramuscular NSAIDs such as diclofenac are superior for emergency department cases of renal colic and appear to produce fewer adverse events.
 
From "Delivering Safe and Effective Analgesia for Management of Renal Colic in the Emergency Department"
The Lancet (03/15/2016) Pathan, Sameer A.; Mitra, Biswadev; Straney, Lahn D.; et al.
 
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Dexmedetomidine Increases Ventilator-Free Time in Patients With Agitated Delirium
 
A research team out of Australia and New Zealand reports that dexmedetomidine can be of benefit for patients with agitated delirium who are receiving mechanical ventilation in the ICU. The study involved 74 adults for whom extubation was considered inappropriate due to the severity of agitation and delirium. Patients received dexmedetomidine (or placebo) initially at a rate of 0.5 µg/kg/h and then titrated to rates between 0 and 1.5 µg/kg/h to achieve physician-prescribed sedation goals. Treatment was continued until no longer required, or up to seven days. The researchers found that dexmedetomidine increased the number of ventilator-free hours at seven days compared with placebo, a median of 144.8 hours vs. 127.5. In addition, none of the 21 secondary outcomes were significantly worse with dexmedetomidine, the researchers report, noting that some showed statistically significant benefit, including reduced time to extubation. An editorial accompanying the study, from researchers at Vanderbilt University School of Medicine, concludes that the Dexmedetomidine to Lessen ICU Agitation (DahLIA) trial "provides important information regarding the treatment of agitated delirium in patients receiving mechanical ventilation." Patients randomized to receive dexmedetomidine "not only experienced reduced agitated delirium, more ventilator-free days, and use of fewer other psychoactive medications, but also rarely experienced the bradycardia sometimes seen when dexmedetomidine is used earlier in the course of mechanical ventilation," the authors note.
 
From "Dexmedetomidine Increases Ventilator-Free Time in Patients With Agitated Delirium"
Journal of the American Medical Association (03/15/16) Reade, Michael C.; Eastwood, Glenn M.; Bellomo, Rinaldo; et al.
 
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Effective Nerve Blocks Might Be the Answer to Opioid Abuse
 
Hoping to slow the snowball effect of the opioid epidemic, University of Cincinnati (UC) Health researchers are exploring nerve blocks as an alternative solution for treating chronic pain. Based on a finding that some people turn to prescription narcotics after a nerve block is administered too late and ultimately fails, UC's Jun-Ming Zhang, MD, aims to pinpoint the optimal dosage and timing for administering effective blocks. He points to a German study that delivered 100 percent pain relief to 200 patients who received prolonged nerve block rather than a one-time injection. Lead investigator Zhang also is teaming up with Dr. James Fortman, UC Health anesthesiologist and pain management assistant professor, on clinical trials—when they reach that stage—involving the roles of the nervous and immune systems in back and neuropathic pain. Fortman stresses that pain medications have an important role, but only in the short term. "What's inappropriate is to say you should be on this for the next 10 years," he says. "You don't need that because your ankle was broken."
 
From "Effective Nerve Blocks Might Be the Answer to Opioid Abuse"
WVXU.com (OH) (03/15/16) Thompson, Ann
 
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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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