AANA Anesthesia E-ssential
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Board Adopts New Documents at FLA: Advanced Directives and Specialty Clinical

At Fall Leadership Academy, the Board of Directors adopted the following documents:
  • Reconsideration of Advance Directives - These practice guidelines and considerations for policy development provide a resource for nurse anesthetists, healthcare professionals, healthcare facilities, patients and families to integrate the patient’s advance directive wishes with interventions that are core to safe anesthesia care.
  • CRNA Specialty Clinical Practice, Position Statement – This position statement addresses that, during their career, CRNAs may advance specialty clinical practice expertise and competency through various pathways. The AANA supports the CRNA’s choice of the learning pathway for specialty practice. AANA does not require specialty fellowship or certification for practice or licensure.
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CPC Facts

Activities that Qualify for Class B Credit

Do you participate in mission work related to nurse anesthesia or advanced practice nursing? These service activities would qualify for Class B credit. Five Class B credits can be reported for each mission activity in which you participate. The Class B requirement of the CPC Program recognizes that nurse anesthetists participate in a wide range of professional activities and experiences beyond clinical knowledge and practice. Recognizing professional activities as a component of the credential supports the expanding role of advanced practice registered nurses in the future of healthcare delivery and leadership. For more information about the NBCRNA's Continued Professional Certification (CPC) Program, which will launch on August 1, 2016, go to the cpc-facts.aana.com and NBCRNA websites.
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Hot Topics

Are You Receiving a PQRS Penalty for 2014 Reporting?

The Centers for Medicare & Medicaid Services (CMS) has been sending out notifications to eligible professionals (EPs) or group practices that did not satisfactorily report to PQRS for the 2014 reporting period. Individuals and groups that did not meet the reporting criteria or did not report at all will receive a 2 percent penalty on their 2016 Medicare Part B reimbursement. CMS has extended the informal review period. If you believe that you have been incorrectly assessed the 2016 PQRS penalty, you may request an informal review and investigation of your PQRS reporting performance by going to the CMS PQRS Informal Review Request page . You must submit your informal review request by 11:59 p.m. Eastern Time on December 11, 2015. Although the 2014 reporting year has passed, it is not too late to avoid the 2 percent penalty for the 2015 reporting period ending on December 31, 2015. To learn how you can avoid the 2 percent penalty in 2017, please visit our PQRS FAQs page available via the Quality-Reimbursement section of the AANA website.
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Important CRNA Week Deadlines: Order Your Promo Items Soon!

Thinking about ordering promotional items for CRNA Week 2016? Then here are some important deadlines you need to know about as 2016 approaches: 1) The AANA offices, including the Bookstore, will be closed for the holidays December 24-January 4. Orders received by close of business on Friday, December 18, will be guaranteed to ship before December 24. 2) National CRNA Week will be celebrated January 24-30, 2016. The last orders for remaining promotional items will be accepted on Wednesday, January 20. Please note: Inventory does start to run out after the first week in January, so if there are pens, buttons, posters, or other items you simply must have to complete your promotional plans, visit here to place your order today!
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Get Your Questions Answered at AANA Live PQRS Chat

Do you have questions about reporting to PQRS for 2015? The AANA Research and Quality Division will a one-hour live PQRS Chat session via GoToMeeting on Thursday, December 10, at 6 p.m. CST. First, our experts will briefly review the five most important things that CRNAs should know about PQRS reporting and then members will have the opportunity to participate in a live question-and-answer session. If you have questions that you would like addressed during this live chat, please submit them to research@aana.com by Tuesday, December 8, 2015, 4 p.m. CST.
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Nomination Deadline for Daniel D. Vigness Federal Political Director Award is January 15

Is your state’s Federal Political Director (FPD) awesome? Then nominate him or her for the Daniel D. Vigness Federal Political Director Award, which is presented during AANA Mid-Year Assembly in April 2016. Named for the late Dan Vigness, CRNA, of South Dakota, the first AANA FPD of the Year, this honor recognizes a CRNA who has been involved in federal political campaigns, developed close working relationships with federal officials, led successful CRNA advocacy efforts, helped contribute and raise funds for the CRNA-PAC, and helped recruit CRNAs to participate in political campaigns. To learn more and to submit a nomination, go here.
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Nomination Deadline for Service on the 2016-17 CRNA-PAC is January 31

If you or a colleague would like to serve on the CRNA-PAC Committee, Jan. 31 is the deadline for submitting an application online. In September 2016, the nine-member committee will have two CRNA vacancies, each for three-year terms. One student registered nurse anesthetist vacancy will also open for a one-year term. Two members of the AANA Board of Directors serve on the CRNAPAC Committee, each for a one-year term that may be renewed for one additional year while the member also serves on the Board.

To learn more about the CRNA-PAC Committee and access applications for both the CRNA and student positions, visit http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Pages/Join_CRNA_PAC.aspx (AANA login required).
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Open Position on the COA

The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is seeking nominations for a CRNA Educator Director. Candidates must be available to attend three-day COA meetings, typically held in January, May, and October. The elected candidate will complete the remaining term of a current vacancy, i.e., Spring 2016 through Fall 2018, and then be eligible to be considered for reelection for an additional three-year term. The COA’s Spring 2016 meeting will be held June 1-3, 2016.

CRNA Educator Director

Candidates for CRNA educator director must meet the following criteria:
  • Holds one or more graduate degrees from an institution or institutions of higher education accredited by a regional accrediting agency.
  • Holds certification or recertification as a nurse anesthetist.
  • Has current experience as an educator and/or administrator in a nurse anesthesia education program.
  • Successfully completed the Council’s accreditation process through self-evaluation and onsite review.
  • Is actively involved in the profession, as evidenced by such things as:
    • Attendance at the Assembly of School Faculty.
    • Attendance at professional nurse anesthesia meetings.
    • Completion of professional anesthesia continuing education offerings.
    • Election or appointment to a position in professional nurse anesthesia organizations.

To apply, e-mail the following by December 11, 2015, with the subject line Educator Director to accreditation@coa.us.com. The election will be held at the COA’s January 2016 meeting. Only complete applications will be considered.
  • Letter of Intent to Serve
  • Current Curriculum Vitae (resume)
  • Letter of Recommendation
  • Biographical Form – available on the COA’s website at http://home.coa.us.com
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AANA Connect is Here—Join the Conversation!

AANA Connect is now up and running. Three online communities—General, Practice Management, and SRNA-Only—will allow you to connect with, learn from, and share with your nurse anesthesia colleagues from around the country. Click here and join the conversation now!
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Registry Reporting Live Demo for PQRSwizard

The AANA has partnered with the CMS-qualified CECity registry, which provides the PQRSwizard service for CRNAs. CECity's PQRS experts will provide a live, guided tour of the PQRSwizard on Monday, December 7, 2015. Additional topics to be covered include site navigation, account creation and registration. Click here to register. If you would like to learn more about registry reporting and the services that the CECity Registry has to offer, please visit our Registry Reporting for CRNAs page housed under the myAANA Research and Quality Resources section of the AANA website (member login required).
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Professional Practice

FDA Approves Nasal Spray to Treat Opioid Overdose

The FDA recently approved Narcan nasal spray, the first FDA-approved nasal spray version of naloxone hydrochloride, a life-saving medication that can stop or reverse the effects of an opioid overdose. Until this approval, naloxone was only approved in injectable forms, most commonly delivered by syringe or auto-injector. In August, 2015, the AANA submitted a letter to the FDA supporting the increased public availability of naloxone to treat opioid-related overdoses and encouraging public education and awareness initiatives. Read more about this approval at
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Joint Commission seeks Public Comments on Proposed Antimicrobial Stewardship Standard

The Joint Commission seeks comments on a proposed standard that would require organizations to establish antimicrobial stewardship programs. The standard’s purpose is to reduce antimicrobial use to prevent the creation of drug-resistant disease strains. The deadline for comments or survey responses is December 30. Read the proposed standard and submit your comments here.
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The Accreditation Association Acquires HFAP Accreditation Program

The Accreditation Association has purchased the Health Facilities Accreditation Program (HFAP) from the American Osteopathic Association (AOA) for an undisclosed amount. The purchase received approval from the Centers for Medicare & Medicaid Services (CMS). The Accreditation Association’s subsidiary, The Accreditation Association for Hospitals and Health Systems (AAHHS), will manage and operate HFAP. Read more about this development here.
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The Joint Commission Releases Sentinel Event Data Through Third Quarter 2015

The data (from 2004 through 3Q 2015) shows the continuing need to address these serious adverse events. Summarized events include:
  • Anesthesia-related events: 2 in 2015 vs 6 in 2014 and 8 in 2013
  • Op/postop complications: 56 in 2015 vs 52 in 2014 and 77 in 2013
  • Infection-related events: 7 in 2015 vs 12 in 2014 and 13 in 2013
  • Wrong-patient, wrong-site, wrong-procedure: 92 in 2015 vs 67 in 2014 and 109 in 2013
  • Medication errors: 28 in 2015 vs. 18 in 2014 and 38 in 2013
  • Medical equipment-related events: 7 in 2015 vs. 9 in 2014 and 20 in 2013
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Upcoming Complimentary Webinar: Presentation of Venous Thromboembolism Prevention in Pregnancy

The next Safety Action Series webinar titled Presentation of Maternal Venous Thromboembolism Prevention Patient Safety Bundle will be held on Thursday, December 3, 2015 at 11:00 a.m. ET. Visit the Council on Patient Safety in Women’s Health Care for more information and registration.
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Meetings and Workshops

Registration Open for Assembly of School Faculty

We're excited to announce that advance registration is now open for the 2016 Assembly of School Faculty. Join us in historic San Antonio on February 25-27, 2016, for the premier convergence of nurse anesthesia program faculty. Register Now!
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Registration Now Open! COA/AANA Doctoral Workshop at ASF

Don’t miss out on the COA/AANA 1.5 day-workshop, 2022 is Closer than You Think: Transitioning to the Doctoral Degree, on Sunday-Monday, February 28-29, 2016, in San Antonio, Texas. Key activities to establish doctoral degree offerings consistent with the COA’s Practice Doctorate Standards and COA Policies and Procedures will be covered. The content is valuable for programs establishing both entry-level and CRNA post-master’s doctoral degrees. Topics include key considerations in getting started, review of the Practice Doctorate Standards, developing requirements for the scholarly work/doctoral project, developing and mapping the curriculum to COA and national standards, and tips for success in the submission and review of doctoral applications. Who should attend:
  • Nurse anesthesia program administrators
  • Deans of academic units affiliated with nurse anesthesia programs
  • Nurse anesthesia faculty
The fee is $295 per person by January 26 and $350 per person thereafter. CE credits can be earned. Program details are available on the COA website at http://home.coa.us.com. Registration information is available at
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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

Support the AANA Foundation on December 1: #GivingTuesday

December 1t is #GivingTuesday - a special call to action to create a global day of giving that brings diverse organizations and communities around the world together to give back. #GivingTuesday is the perfect opportunity to make your donation to the AANA Foundation and support nurse anesthesia research and education which helps make the world a better and safer place. #GivingTuesday celebrates generosity by providing people everywhere with an opportunity to give more, give smarter, and give great. You don’t have to be a world leader or a billionaire to give back. #GivingTuesday is about ordinary people coming together doing extraordinary things. Join other CRNAs and SRNAs and make your donation today.
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Make Your Year-End Donation to the AANA Foundation Today!

Your donation to the AANA Foundation supports important research that advances the nurse anesthesia profession. Evidence provides proof and proof is power! Take a moment today to make your year-end, tax-deductible gift to AANA Foundation’s Proof is Power campaign – click here to access the Foundation’s secure donation page. To maximize your opportunity for 2015 tax benefits, please submit your gift before 11:59 p.m. on Wednesday, December 31, 2015. Thank you for your support!
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Sponsor a Student for 2016

December 1 is the deadline to sponsor a nurse anesthesia student. Click here to visit our website and access the Fellowship and Scholarship Sponsorship Application. Complete the application and email to foundation@aana.com or mail with your tax-deductible donation to the AANA Foundation, Scholarship Sponsor, 222 S. Prospect Ave., Park Ridge, IL 60068. Thank you in advance for having a positive impact on the life of a future nurse anesthetist.
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Federal Government Affairs

Bipartisan Bill Supporting CRNA, APRN Full Practice Authority in the VHA Draws Support from AARP

Bipartisan legislation expanding veterans access to quality healthcare by supporting full practice authority for CRNAs and other APRNs in the Veterans Health Administration has drawn major support from the AARP and a senior member of the Senate leadership.

“On behalf of our over 38 million members, we are writing to express AARP’s support for the ‘Veterans Health Care Staffing Improvement Act,’ wrote AARP Senior Vice President Government Affairs Joyce Rogers in a letter to bill sponsor Sen. Jeff Merkley (D-OR). “This bill would improve access to and choice of health care available to our nation’s veterans by recognizing all Veterans Health Administration (VHA) Advanced Practice Registered Nurses (APRNs) as full practice authority clinicians.”

The AANA-backed legislation (S 2279) also drew the additional cosponsorship of Sen. Patty Murray (D-WA), a former chair of the Senate Veterans Affairs Committee and a member of the Senate Democratic leadership. The measure now has eight cosponsors from both parties. Together with a similar House bill (HR 1247, Graves-Schakowsky) which has 41 bipartisan cosponsors, the bills demonstrate bipartisan support for expanding veterans’ access to care through extending full practice authority to CRNAs and other APRNs.
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Update on AANA’s Efforts to Ensure Veterans Access to Quality Care

The AANA and its members continue to advocate for legislation and a Veterans Health Administration (VHA) proposal that would authorize all advanced practice registered nurses (APRNs), including CRNAs, to practice as full practice providers in the VHA and help improve access to quality healthcare for all veterans. Here is a status update:
  • The AANA continues urging the U.S. Department of Veterans Affairs to publish a regulatory proposal for public comment that supports strengthening veterans’ access to quality healthcare by adopting full practice authority for CRNAs and other APRNs serving in VHA healthcare facilities. Take action here and encourage your friends and family to also take action through the Veterans Access to Quality Healthcare Alliance microsite.
  • Engage your colleagues, friends and family to take action by writing their member of Congress and the VA Secretary through the Veterans Access to Quality Healthcare Alliance microsite.
  • The AANA is supporting legislation in the House, HR 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). The bill now has 41 bipartisan cosponsors. The AANA also backs legislation in the Senate, S 2279, the “Veterans Health Care Staffing Improvement Act,” sponsored by Sens. Jeff Merkley (D-OR) and Mike Rounds (R-SD). The AANA encourages members whose legislators have cosponsored these bills to send a thank-you note (here). Please continue to contact your U.S. Representative and encourage co-sponsorship of this bill (here). View the AANA and APRN Workgroup letter of support here and also view the Nursing Community letter here.
  • An independent assessment of the VHA completed by the RAND corporation recommended the Agency move forward with the full practice authority proposal for APRNs in the VHA and touted the policy as a cost saving measure. To read the full recommendation starting on p. 266 of the document, see here. The AANA and APRN organizations have supported the independent assessment in a letter to the VA Secretary and Chair and Ranking Member of the House Veterans’ Affairs Committee, which can be read here (AANA member login required).
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Medicare Final Rule for Bundled Payment Program for Hip and Knee Replacements Keeps Door Open for Waivers Promoting Safe, Cost-Effective CRNA Care

The Medicare final rule establishing a bundled payment program for hip and knee replacements leaves the door open to an AANA request that the initiative enable hospitals and health systems to waive burdensome and costly Medicare regulatory requirements that do not improve patient safety, including the requirement for physician supervision of nurse anesthetists in states that have not opted out.

The preamble to the final rule, published in preview on Nov. 16, states, “We appreciate the information provided by the commenters and, as discussed in the proposed rule, we will consider the comments we received during the public comment period and our early model implementation experience and may make future proposals regarding program rule waivers during the course of the model test… We decline at this time to waive any additional Medicare programmatic requirements. We will review the information provided by the commenters and our early model experience and may consider waiving additional requirements during the course of the model test.”

In other provisions affecting CRNAs, Medicare said the final rule would take effect April 1, 2015, not Jan. 1, 2015, as proposed. Medicare said that participants in the program, called “Comprehensive Care for Joint Replacement” or CJR, would qualify as participants in Alternative Payment Models (APMs) under provisions of the Medicare Access and CHIP Reauthorization Act (MACRA), and thus would be exempt from reporting such cases under MACRA’s Merit-based Incentive Payment Systems (MIPS) program. Medicare also said it “do(es) not believe that the CAHPS (Consumer Assessment for Healthcare Providers and Systems) Surgical Care Survey measure is feasible or appropriate to adopt for the CJR model,” a finding that agrees with AANA’s longstanding viewpoint.

Learn more about CJR here. Read the CMS final rule here. Read the CMS fact sheet here. Read the AANA comment letter on the CMS proposed rule here (requires AANA login and password).
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AANA and APRN Colleagues Request that MACRA Implementation Ensure Robust Patient Access to APRN Services

On Nov. 17, the AANA joined with eight other nursing organizations in issuing comments in response to the Centers for Medicare & Medicaid Services (CMS) Request for Information (RFI) on Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) implementation. The AANA-backed MACRA legislation, enacted this past spring, permanently repealed Medicare Sustainable Growth Rate (SGR) cuts and reforms Medicare payment.

The Advance Practice Registered Nursing (APRN) coalition letter stated that “the Medicare agency should use its full authority to waive policy barriers to the use of APRNs, particularly as it carries out Alternative Payment Models (APMs). Such barriers include physician supervision requirements, narrow definitions of the term “physician” that exclude APRNs otherwise acting within their scope of practice in a state, and impairments to credentialing and privileging APRNs and to applying their full leadership capabilities in Medicare facilities. Waiving such burdensome barriers to the use of APRNs will enhance access to care, ensure quality healthcare delivery, and contribute to cost savings. The need for access to APRN services is crucial for the 40 million beneficiaries now in Medicare and for the 80 million beneficiaries who are expected to be in Medicare in the future. APRNs are the solution to developing improvements to quality, access, and cost-efficiency in healthcare. Implementation should be executed in that light.”

Read the APRN coalition comment letter here. (requires AANA password and login). Read the CMS request for information here.
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AANA Provides Comments on Facet Joint Injections Proposal to Medicare Contractor Palmetto GBA

On Nov. 17, AANA submitted to Medicare administrative contractor (MAC) Palmetto GBA comments on a draft local coverage determination (LCD) on facet joint injections affecting coverage of CRNA pain management services in four states of North Carolina, South Carolina, Virginia, and West Virginia where Palmetto administers the Medicare program. In this comment letter, the AANA stated that CRNAs are educated and certified to provide pain management services, asked Palmetto to clarify its decision to grandfather the training requirement at 10 years, and to justify its requirement that a practitioner be credentialed in the hospital and outpatient settings.

The AANA letter signed by President Juan Quintana, CRNA, DNP, MHS, stated, “Nurse anesthesia education, clinical practice experience, and skill development to practice pain management are core elements of nurse anesthesia education programs.”

The AANA comment letter also requested:
  • Clarification on how Palmetto arrived at its decision to grandfather the training requirement at 10 years;
  • Clarification on its requirement that a practitioner be credentialed in the hospital and outpatient settings; and,
  • Reimbursement for facet joint interventions performed under ultrasound guidance.
Read the AANA comment letter here (requires AANA password and login). Read Palmetto’s draft LCD on facet joint injections here.
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AANA Joins APRN Organizations in Requesting that the Health Care Payment LAN's APM Framework Note and Address Barriers to the Use of APRNs

On Nov. 20, the AANA joined with eight other nursing organizations in requesting that the Health Care Payment and Learning Action Network’s (LAN) draft white paper on the Alternative Payment Model (APM) Framework highlight barriers to the use of Advance Practice Registered Nurses (APRNs) with an eye toward improving patient access to cost-effective care. The purpose of the LAN’s draft white paper is to create a framework for categorizing APMs and establishing a standardized and nationally accepted method to measure progress in the adoption of APMs across the U.S. healthcare system.

The APRN coalition letter stated, “While we support the seven principles listed in the framework, we request that the framework highlight the barriers to the use of APRNs and include ways to address these barriers. We note that the bulk of the principles of the framework relate to access to providers, placing a premium on patient access to APRNs. The need for access to APRN services is crucial, and APRNs are the solution to developing improvements to quality, access, and cost-efficiency in healthcare. However, the framework does include the significant barriers to the use of APRNs. These barriers include burdensome physician supervision requirements, not credentialing APRNs in health plans, which results in APRNs being excluded from health plan networks, and not reimbursing for services that are within an APRN’s state scope of practice. Waiving such burdensome barriers to the use of APRNs will enhance access to care, ensure quality healthcare delivery, and contribute to cost savings.”

Read the APRN coalition comment letter here (Requires AANA password and login). Read the LAN draft white paper here.
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  • When Congress returns from Thanksgiving recess, lawmakers have until Dec. 11 to complete unfinished appropriations work. If you’ve seen your legislators at home, let us know at info@aanadc.com.
  • U.S. Sen. David Vitter (R-LA) lost his bid for the Louisiana governorship Nov. 21 to State Rep. John Bel Edwards (D-LA) and announced that evening that he would resign his Senate seat at the end of his current term and not run for reelection in 2016. Sen. Vitter has long been regarded as an ally of the ASA. Possible candidates for the Senate contest include sitting U.S. Reps. Charles Boustany MD (R-LA) and John Fleming MD (R-LA), and New Orleans Mayor Mitch Landrieu (D-LA).
  • Rep. Patrick Tiberi (R-OH) is succeeding Rep. Kevin Brady (R-TX) as chair of the Medicare-writing House Ways & Means Subcommittee on Health. Rep. Brady moved up to serve as full committee chairman following the election of Rep. Paul Ryan (R-WI) as Speaker of the House. Tiberi, first elected to the U.S. House in 2001, represents a district north and east of Columbus, Ohio, and was not otherwise a member of the Health Subcommittee during the current 114th Congress. Follow Chairman Tiberi on Twitter at https://twitter.com/pattiberi.
  • Additional lawmakers have recently announced their retirement from Congress and are not running for reelection in 2016. They include Reps. Sam Farr (D-CA); Cynthia Lummis (R-WY); Joe Pitts (R-PA), who chairs the House Energy & Commerce Health Subcommittee; and Ed Whitfield (R-KY), who is a senior member of the House Energy & Commerce Committee.
  • While the switch to the ICD-10 coding system took place Oct. 1, Congress is monitoring the transition and so is the AANA, which is backing legislation to ease the switch. If you or your facility encounters any issue with the ICD-10 transition, please email info@aanadc.com.
  • Stay up to date on CRNA reimbursement issues by obtaining Version 3 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members here (requires AANA member login and password).
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The following is an FEC required legal notification for CRNA-PAC:

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

Seizure Risk of Anti-Shivering Agent Meperidine Greatly Overstated

A review of existing literature has produced little proof to support the claim that meperidine, an opioid analgesic used to control shivering during hypothermia, elevates the risk of seizure. California-based researchers Konrad Schlick, MD, Patrick Lyden, MD, and Thomas Hemmen, MD, PhD, pored over 45 years of medical findings but found relatively few cases of seizure linked to meperidine. Moreover, in many of the cases they did uncover, the higher risk of seizure may have been explained by other factors, including coexisting medical conditions. Meperidine is being used less and less for pain relief, but the study authors believe it is an effective anti-shivering agent whose use should continue to be explored.

From "Seizure Risk of Anti-Shivering Agent Meperidine Greatly Overstated"
Therapeutic Hypothermia and Temperature Management (Fall 2015) Ryan, Katherine

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New Analgesic May Be Alternative to Opioids for Sedation and Anesthesia

A report in Anesthesia & Analgesia suggests that a new type of analgesic, one that acts on GABAB receptors instead of the usual GABAA receptors, holds promise as an alternative to opioids for anesthesia and sedation. Researchers led by Dr. Bernard A. MacLeod of the University of British Columbia, Vancouver, studied the use of the new analgesic, isovaline, in mice. The mice were given propofol, along with either isovaline or the opioid fentanyl. With an effective dose of propofol, isovaline produced both general anesthesia and conscious sedation. The researchers note that propofol by itself produced hypnosis but it did not block responses to pain, while propofol plus fentanyl produced general anesthesia but also carried a greater risk of respiratory depression. Isovaline did not lead to respiratory depression or other adverse events, even at the highest dose. "The margin of safety for propofol-isovaline was considerably higher than for propofol-fentanyl," the authors report.

From "New Analgesic May Be Alternative to Opioids for Sedation and Anesthesia"
Newswise (11/20/15)

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Public Health Group Calls for Action to Curb Opioid Abuse

The American Public Health Association (APHA) has called for stronger efforts to decrease overdose deaths linked to prescription opioids. The association's Prevention and Intervention Strategies to Decrease Misuse of Prescription Pain Medications policy statement was announced at the APHA 2015 Annual Meeting in Chicago, and will be published on the APHA website in 2016. The statement calls for wider access to naloxone for first responders and caregivers of people who may be misusing opioids. The statement also recommends several actions for health care providers, lawmakers, and the general public. Practitioners are advised to implement evidence-based provider training programs regarding mental health and substance abuse. The statement also suggests continuing education at licensing renewal, coordinated pain management among care providers, and the routine use of state-based prescription drug monitoring programs. Patients and the public should be educated about taking prescription pain medication only as directed. In addition, providers are advised to address pain first with non-narcotic medications and alternative treatments, such as acupuncture. The statement suggests that providers be required to perform mental and physical examinations before prescribing pain medications.

From "Public Health Group Calls for Action to Curb Opioid Abuse"
Medscape (11/20/15) Louden, Kathleen

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Blood Test May Predict Post-Surgery Recovery Time

Having already shown that checking the behavior of white blood cells in surgical patients right after a procedure can help gauge recovery time, researchers now say the same is true for blood tests conducted before doctors even operate. In a trial of 32 healthy patients who underwent hip surgery without complication, the team from Stanford University discovered that those with significantly more active monocytes immediately afterwards took weeks longer to regain abilities like standing and walking. For the new study, blood samples were extracted from 25 of those same participants roughly an hour before their procedures and mixed with signaling molecules in order to trigger immune responses like those that occur naturally before surgery. According to the investigators, pre-surgery activity accurately reflected how quickly patients would return to normal. The team, which reported its results in Anesthesiology, is now preparing a larger study of 80 surgery patients to affirm the findings.

From "Blood Test May Predict Post-Surgery Recovery Time"
United Press International (11/19/15) Feller, Stephen

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Paravertebral Blocks Reduce PONV and Pain Following Percutaneous Nephrolithotripsy

Insufficient pain relief after percutaneous nephrolithotripsy (PCNL), a procedure for removing large or complex kidney stones, often leaves patients in the hospital for longer than the normal one- to three-day period. Based on new research, however, treating PCNL patients with paravertebral blocks is an effective approach to managing their post-surgical pain. A team from Massachusetts General Hospital analyzed the medical charts of 45 consecutive patients who received low-thoracic paravertebral block for PNCL from the same surgeon from 2013 to 2014. The findings showed that the block curtailed post-operative nausea and vomiting (PONV)—a major reason that surgery patients are declined release from the hospital—and also curtailed patients' need for intraoperative morphine use. Additionally, the time that patients had to remain in the hospital after PCNL was reduced to 29.8 hours from 37.2 hours with paravertebral block. "In this retrospective study, paravertebral block was associated with significant improvements in postoperative nausea/vomiting and PACU pain scores," the investigators reported. "Future randomized studies are planned."

From "Paravertebral Blocks Reduce PONV and Pain Following Percutaneous Nephrolithotripsy"
Anesthesiology News (11/01/15) Vol. 41, No. 11 Agres, Ted

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Pre-op Anesthetic Eases Post-op Pain, Cuts Hospital Stay of Hernia Patients

Patients who received local anesthetics prior to laparoscopic ventral hernia repair benefited from improved outcomes and shorter hospital stays, according to researchers from the University of Tennessee. Over a three-year period, 101 patients participating in a continuous quality improvement initiative to lower postoperative pain underwent transversus abdominis plane block with bupivacaine to control somatic pain. They also were subjected to a low-pressure pneumoperitoneum system to minimize visceral and shoulder pain before having hernia repair. As a result, opioid pain medication consumption was curtailed by 74 percent, hospital length of time was slashed by 72 percent, and time in the post-anesthesia care unit was cut practically in half. "The most noteworthy finding is that we can achieve little or even no pain after laparoscopic ventral hernia repair, a major and traditionally very painful operation," said study author Bruce Ramshaw, MD.

From "Pre-op Anesthetic Eases Post-op Pain, Cuts Hospital Stay of Hernia Patients"
Pain Medicine News (11/01/2015) Vol. 13, No. 11 Bufano, Paul

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Mindfulness Is Found to Be 'Twice as Effective Than Drugs' for Pain Relief

In an effort to quantify the power of meditation as a pain relief solution, 75 healthy and pain-free volunteers were divided into four groups and subjected to a heated probe. One cohort practiced mindfulness meditation as the instrument heated up to 129 degrees Fahrenheit while another practiced "sham" meditation, a third received a placebo cream, and a control group had no intervention at all. Brain scans performed on volunteers who were coached on proper breathing and relaxation techniques reflected a calming in regions of the brain that react to pain. The patterns of brain activity were different from those produced by the placebo cream, which curbed the sensation of physical pain by only 11 percent. According to the Wake Forest Baptist Medical Center researchers, the placebo cream was not as effective as morphine, which has been shown to reduce pain intensity by 22 percent. The morphine, in turn, was not as effective as mindfulness meditation, which alleviated pain by 27 percent. "This study is the first to show that mindfulness meditation is mechanistically distinct and produces pain relief above and beyond the analgesic effects seen with either placebo cream or sham meditation," said lead researcher Dr. Fadel Zeidan. "Based on our findings, we believe that as little as four 20-minute daily sessions of mindfulness meditation could enhance pain treatment in a clinical setting."

From "Mindfulness Is Found to Be 'Twice as Effective Than Drugs' for Pain Relief"
Daily Mail (United Kingdom) (11/17/15) Pickles, Kate

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Does Anesthesia Type Affect Infection Risks?

New findings appear to debunk earlier research that proposed a correlation between type of anesthesia used in joint replacements and risk of surgical site infection (SSI). The retrospective study, reported in Anesthesia & Analgesia, analyzed 11 years worth of data from total hip or knee replacement patients who developed SSIs. Of the 202 SSIs that were identified, investigators could find no difference in the rate of post-operative infection among those who received neuraxial anesthesia, regional anesthesia, or general anesthesia. What they did find, however, is that patients who had total knee arthroscopy and who also smoked or had body mass indexes of 35 or greater were at a much higher risk of post-op SSIs.

From "Does Anesthesia Type Affect Infection Risks?"
Outpatient Surgery (11/16/15) Cook, Daniel

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Effect of I.V. Acetaminophen on Total Hip or Knee Replacement Surgery

In an effort to determine the effects of I.V. acetaminophen on various factors related to total hip or knee replacement surgery, researchers from the University of California analyzed matched pairs of adult inpatients who underwent elective total hip arthroplasty or total knee arthroplasty. The study sought to determine the effects of I.V. acetaminophen on adverse events, hospital length of stay (LOS), and overall hospital costs for these procedures. The surgeries were conducted in hospitals participating in the Premier Healthcare Alliance from January 2011 through November 2012. Each patient who received I.V. acetaminophen on the day of surgery was matched to a control patient within the same hospital who did not receive it, for a total of 22,146 cases and controls. Researchers found that overall adverse events were significantly lower with I.V. acetaminophen (24.3%) than with controls (26.3%). I.V. acetaminophen also was associated with shorter LOS and lower average hospital costs.

From "Effect of I.V. Acetaminophen on Total Hip or Knee Replacement Surgery"
American Journal of Health-System Pharmacy (11/15/15) Vol. 72, No. 22, P. 1961 Apfel, Christian; Jahr, Jonathan R.; Kelly, Colleen L.; et al.

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Post-op Delirium in Cardiac Patients Halved With High Spinal

Canadian researchers report that high spinal anesthesia significantly reduces postoperative delirium after cardiac surgery, possibly by calming down an overactive inflammatory response that often occurs in this subset of patient. The team compared 137 cardiac patients who received high spinal anesthesia against 130 controls, finding that delirium occurred at a rate of 8 percent versus 18 percent, respectively. Although it was not an outcome established for the purpose of this study, the University of Manitoba investigators also discovered that the high spinal anesthesia group required only about half the opioid consumption as the control patients in the week following surgery. Lead researcher Andrea Petropolis, MD, stressed that clinicians who opt for this approach will need to thoroughly screen patients and also use the technique in tandem with general anesthesia, which actually should reduce the overall anesthetic requirement. She added that prospective research needs to be conducted, in part to determine if the lower incidence of delirium after cardiac surgery is the result of a reduced inflammatory and stress response, or if it is actually due to a reduction in anesthetic exposure.

From "Post-op Delirium in Cardiac Patients Halved With High Spinal"
Anesthesiology News (11/01/15) Vol. 41, No. 11 Vlessides, Michael

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FDA Gives 'Tentative' Approval to Abuse-Deterrent Xtampza ER

Collegium Pharmaceuticals reports that the Food and Drug Administration (FDA) has given tentative approval to its extended-release abuse-deterrent oxycodone (Xtampza ER). The tentative decision comes after FDA's Anesthetic and Analgesic Drug Products Advisory Committee and the Drug Safety and Risk Management Advisory Committee announced their support of the product for the management of chronic, severe pain. Collegium explained that the approval is tentative because although the drug meets all of the requisite standards for approval, litigation filed earlier this year by Purdue Pharma means that it must follow an automatic stay of up to 30 months. The charges allege that the extended-release abuse-deterrent oxycodone infringes on three Orange Book-listed patents that were recently ruled to be invalid in a U.S. District Court and are currently being appealed.

From "FDA Gives 'Tentative' Approval to Abuse-Deterrent Xtampza ER"
Medscape (11/09/15) Anderson, Pauline

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Medical Schools to Bolster Opioid Lessons

As part of Gov. Charlie Baker of Massachusetts' effort to combat opioid addiction, the state's four medical schools have agreed to incorporate into their curriculum instruction on the prevention and treatment of prescription drug misuse. Under the agreement, the students enrolled in the medical schools at the University of Massachusetts and Boston, Harvard, and Tufts universities will be taught skills designed to prevent opioid analgesics from being misused. Students will learn how to evaluate the risk of addiction before prescribing opioid analgesics, how to treat patients at risk of substance use disorders before they become addicted, and how to understand and manage substance abuse as a chronic illness.

From "Medical Schools to Bolster Opioid Lessons"
Boston Globe (11/09/15) Freyer, Felice

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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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