AANA Anesthesia E-ssential
Malignant Hyperthermia Times Have Changed

Vital Signs

AANA Diversity Task Force Announced

The AANA Board of Directors is proud to announce we have engaged with nurse anesthetists and external experts in creating the AANA Diversity Task Force to develop the strategic framework to make recommendation to implement cultural sensitivity and diversity initiatives for our profession. This work addresses each of the AANA Core Values of diversity, quality, professionalism, compassion, collaboration, and wellness. For more information, see www.aana.com/diversity.
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CPC Facts

Activities that Qualify for Class B Credit

Are you a program administrator, program director, or chief nurse anesthetist? These clinical administrative activities qualify for Class B credit. Five Class B credits can be reported for each year in a clinical administrative role. 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 Aug. 1, 2016, go to the cpc-facts.aana.com and NBCRNA websites.
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Hot Topics

AANA President Interviewed by BizCast for NBC5

AANA President Juan Quintana, CRNA, DNP, MHS, discusses CRNAs, diversity, and more during a BizCast interview posted by NBC5 Chicago. Watch the interview.
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NBCRNA Seeks CRNA Applicants for Certificant Elected Director

The NBCRNA is seeking Certified Registered Nurse Anesthetist (CRNA) applicants for the certificant elected director on the NBCRNA Board of Directors. Applicants will be nurse anesthetists who have at least five years of nurse anesthesia experience. Interested individuals should submit their application, curriculum vitae, and one letter of recommendation on or before October 30, 2015 to nominations@nbcrna.com. The election for certificant elected director will take place from February 1, 2016 through February 29, 2016 and the successful candidate will begin a 3-year term in September 2016. For more information and the application, visit the NBCRNA website at www.NBCRNA.com/election.
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2014 PQRS Measure Data to Be Released on Physician Compare

The Centers for Medicare and Medicaid Services (CMS) has opened the 30-day preview period (ending November 6, 2015) for the 2014 quality measures that will be reported on Physician Compare later this year. You can access the secured measures preview site through the PQRS portal-Provider Quality Information Portal (PQIP). To learn more about which measures will be publicly reported and how to preview your measures, visit our Public Reporting FAQ page or the Physician Compare Initiative page on the CMS website.
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October 31st Deadline to Renew AANA Membership

This is the last month to renew for the 2015-2016 AANA membership year. After October 31st, there is an additional administrative fee to reinstate your membership. Not sure if you renewed? Visit www.aana.com/renewal or call (847) 655-1150.
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Resources Available for International Infection Prevention Week - October 18-24

International Infection Prevention Week (IIPW) kicks off next week, with the theme “Promoting engagement between patients, visitors and healthcare professionals around infection prevention”. A promotional toolkit, merchandise, and IIPW resources are available from the Association for Professionals in Infection Control and Epidemiology (APIC). In recognition of IIPW, the AANA encourages members to stay up to date on the latest evidence-based infection prevention and control techniques, especially with regards to practices such as hand hygiene, cleaning or sterilization of equipment, and safe injection practices. Members are also encouraged to engage in infection control and prevention initiatives within their facility and involve patients in such initiatives.
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Now Available! Ira P. Gunn, Nurse Anesthetist

No nurse anesthetist should be without a copy ofIra P. Gunn, Nurse Anesthetist: Writings and Wisdom from a Legendary Nursing Leader. This collection of articles, letters, and editorials is a tribute to a legend in nurse anesthesia and a goldmine of wisdom for CRNAs and SRNAs who want to understand the challenges that continue to shape their profession. Recommend it to your institution's librarian or send a gift to your colleague! Free DVD included with purchase.
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2015 CRNA Compensation and Benefits Report

Whether you’re negotiating your own salary, benchmarking salaries for your staff, or conducting research, the AANA provides a comprehensive and reliable source of CRNA-specific compensation and benefits data in an easily digestible 170-page report. AANA Members receive 50% off! Download your CRNA-specific compensation and benefits report today! www.aana.com/compensationreport
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Professional Practice

New Sentinel Event Alert Focuses on Preventing Patient Falls

Preventing patient falls and fall-related injuries is the focus of the new Sentinel Event Alert: Issue 55 released by The Joint Commission. The new alert examines the contributing factors to patient falls and includes suggested solutions to be implemented by health care organizations to help reduce patient falls and falls with injury. Learn more on the Joint Commission’s website.
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Complimentary Webinar: National Improvement Challenge Obstetric Hemorrhage Winning QI Programs

Join the Council on Patient Safety in Women’s Health Care for the next Safety Action Series webinar, titled National Improvement Challenge Obstetric Hemorrhage Winning QI Programs on Oct. 28 at 1 p.m. ET. Hear from the winners of the National Improvement Challenge focused on obstetric hemorrhage. Learn how these winning institutions successfully implemented quality improvement programs and demonstrated multidisciplinary collaboration. More information and registration are available HERE.
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FDA Orders Duodenoscope Manufacturers to Conduct Postmarket Surveillance studies

The U.S. Food and Drug Administration (FDA) has ordered the three manufacturers of duodenoscopes marketed in the U.S. to conduct postmarket surveillance studies to better understand how the devices are reprocessed in real-world settings. Manufacturers must detail their plans to conduct studies to evaluate how well health care personnel are following instructions to clean and disinfect duodenoscopes between patients and to better understand the rate of contamination of clinically used duodenoscopes. Read the FDA News Release for more details.
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Meetings and Workshops

Fall Leadership Academy, November 6-8

As a CRNA, you have the clinical training and the hands-on experience that makes you a confident practitioner. How confident are you in leading change or being an influencer? The Fall Leadership Academy is the AANA conference that develops your leadership abilities through hands-on skills building. Featuring 30 expert speakers and five educational tracks, this conference is for all stages of your career. Single day registration and post-conference workshops are available. Travel discounts available. www.aana.com/leadership.
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Foundation and Research

AANA Foundation Health Service Research Video Available Online

This AANA Foundation webinar discusses health service research (HSR) topics and Foundation support opportunities for research through fellowships and grants. This resource is intended as:
  • an introduction for CRNAs who are interested in learning more about health service research (HSR),
  • as a tool for identifying national priorities and framework from which nursing scholars can identify HSR topics, and
  • information on how the AANA Foundation supports HSR through fellowships and grants.
Click here to learn more (member login required).
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Sponsor a Student Scholarship for 2016 - Deadline is December 1

In 2015, the AANA Foundation’s Student Scholarship Program awarded 62 scholarships totaling $127,500. Thank you to all those who sponsored a student! We are once again seeking sponsors to support nurse anesthesia students through their nurse anesthesia program. The deadline date for sponsoring a student scholarship for 2016 is Dec. 1, 2015. If you wish to be part of this important program, 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. Please note that the minimum donation to sponsor a student is $3,000 per scholarship. Thank you in advance for impacting the life of a future nurse anesthetist.
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Federal Government Affairs

House Veterans’ Affairs Committee Holds Hearing on VHA Independent Assessment Recommending APRN Full Practice Authority Policy Implementation

The House Veterans’ Affairs Committee met on Oct. 7 to discuss an independent assessment of the Veterans Health Administration (VHA), which included a recommendation for the VHA to recognize APRNs to their full practice authority in order to improve care for the nation’s veterans. The AANA and APRN groups were present at the hearing and also submitted letters of support for the report’s APRN full practice authority recommendation.

Testifying before the committee were Veterans Affairs Secretary Robert McDonald, Under Secretary for Health David Shulkin, MD, and others. During the hearing, VA Health Subcommittee Chair Dan Benishek, MD (R-MI) said anesthesiologists had expressed concerns about CRNAs gaining full practice authority. In response, Secretary McDonald said that he too had heard from physicians concerned about the proposal, but had also heard from nurses and their advocates in support, and said that research evidence was favorable to APRNs. He also acknowledged that the agency is moving forward with publishing a proposal for public comment to grant VHA APRNs in the VHA full practice authority.

The rule is not yet published, however, and anesthesiologist representatives continue marshalling opposition against it. CRNAs continue being asked to contact Congress and the VA in support of reducing wait times for our veterans healthcare by supporting full practice authority for CRNAs and other APRNs in the VHA.

The healthcare portion of the VHA independent assessment can be read here:
(the APRN full practice authority proposal begins on p. 266 of the document). To support veterans’ access to quality care by backing full practice authority for CRNAs and other APRNs, see www.Veterans-Access-To-Care.com and urge your veteran colleagues and friends to do the same. Learn more about the Oct. 7 hearing here:
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AANA and APRN Groups Support VHA Independent Assessment Recommending APRN Full Practice Authority Policy Implementation

On Oct. 6, the AANA and 10 APRN organizations joined in supporting the findings of an independent assessment of the Veterans Health Administration (VHA) that recommended the Veterans Health Administration (VHA) recognize APRNs to their full practice authority in order to improve care for the nation’s veterans. The APRN groups’ letters were delivered prior to the House Veterans’ Affairs Committee hearing scheduled for Wednesday, Oct. 7, where the committee discussed the recommendations with Veterans Affairs Secretary Robert McDonald, Under Secretary for Health David Shulkin MD, and others.

In letters to the VA Secretary and the Chair and the Ranking Member of the House Veterans’ Affairs Committee, the APRN groups wrote, “Our veterans must not be forced any longer to wait for these critical services that they deserve and have earned. Granting all VHA APRNs full practice authority will help alleviate the physician shortage in the VA and also increase the productivity of the VA’s workforce while also reducing costs. Our nation’s veterans deserve optimal healthcare and the VA should take every step to address the immediate and long-term efficacy of the VHA.”

Ordered by Congress, the independent assessment of the VA recommends that the VHA should “formally grant full practice authority for all advanced practice nurses (APNs) (that is, nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives) across VA….” Referencing both the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health and current AANA backed legislation (HR 1247, the “Improving Veterans Access to Care Act”) the report says that allowing APRNs to practice as full practice providers may favorably improve veterans’ access to care and produce cost savings for the VA.

To read the AANA and APRN Workgroup letters, see here.
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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:
  • 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 is supporting legislation in the House, HR 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). The bill has 37 bipartisan cosponsors. The AANA encourages members whose U.S. Representative has cosponsored this legislation to send a thank-you note (here). Please continue to contact your U.S. Representative and encourage co-sponsorship of this bill (here). View the AANA and APRN Workgroup letter of support here and also view the Nursing Community letter here.
  • The AANA continues to strongly support the VHA’s efforts to recognize CRNAs and other APRNs to their full practice authority, consistent with the recommendations of the Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health.” The VHA says that it intends to publish a regulatory rulemaking later this year recognizing CRNAs and other APRNs as full practice partners in the VHA, and inviting the public to comment.
  • Since mid-February, AANA members have sent more than 14,000 messages to their federal legislators expressing support for full practice authority for CRNAs and other APRNs in the VHA. Even more CRNAs are encouraging their 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.
  • Have you seen Letters to the Editor from veterans published in newspapers recently? They appeared in the Mansfield News Journal (OH) by Jim Bernholtz, a Veteran who is President of the Ohio Fallen Heroes Memorial and a Gold Star Father; and in the County Journal and North County News from Illinois State Rep. Jerry Costello, a former paratrooper in the Army 82nd Airborne Division during Operation Desert Storm and member of the Veterans of Foreign Wars and Catholic War Veterans. Additional letters were published in the Daily Southtown (IL), Delaware Gazette (OH), Tallahassee Democrat, Tinley Park Patch, Steubenville Herald Star, Columbus Dispatch, Palm Beach Post, and Chicago Tribune.
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Federal Government Issues Final Stage 3 Health IT Meaningful Use Rule; Announces New Comment Period for Future EHR Incentive Programs

The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) released final rules with comment period on Oct. 6 for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Programs. The final rules are intended to simplify requirements and for healthcare providers and consumers to be able to safely and securely exchange health information.

As part of these final regulations, CMS announced a 60-day public comment period to gather additional feedback about future EHR Incentive Programs, in particular in relation to implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This legislation established the Merit-based Incentive Payment System (MIPS) and consolidates certain quality measurements and federal incentive programs into one framework. The AANA is reviewing the final rule for possible comment.

View the preview to the final rule (the link expires when the rule is published in the Federal Register on Friday, Oct. 16) here. View the CMS Fact Sheet here.
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AANA President Quintana to Serve on U.S. Chamber Health Policy Summit Panel in Washington Oct. 20

AANA President Juan Quintana, CRNA, DNP, is slated to appear as a panelist in Washington at the U.S. Chamber of Commerce 4th Annual Health Policy Summit, on Tuesday, Oct. 20, a significant opportunity to educate major employers and industry leaders about the role and value of CRNAs in changing economic times.

Titled “Optimizing the Next Generation of Health Care,” the nation’s largest business federation will also hear from panelists from the worlds of health plans, major employers and industry, and academia. Current panel discussions will include topics like health data and cyber-security challenges, how our habits can be leveraged to improve wellness, the role of economics in health care, and how transparency can drive health care innovation, according to the Chamber.

Learn more about the summit here and its agenda here. Connect with the summit on social media with #Health15, @USChamber and @AANAWebUpdates.
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Considering Running for Public Office? Agenda Released for AANA’s Nov. 6-8 First-Ever Campaign School for CRNAs

The AANA invites members interested in running for public office to learn the ins and outs of elected government leadership and political campaigning at our first-ever CRNA Campaign School Nov. 6-8 in Rosemont, Ill., immediately following the AANA 2015 Fall Leadership Academy.

For the CRNA considering the leadership step of elective public office, our AANA Campaign School will provide practical understanding of how campaigns are run and the skills needed to win. Through a dynamic interactive agenda led by internationally renowned elections and campaigns expert Nancy Bocskor, attendees will learn about creating and executing a strategic campaign plan, raising funds and marshaling coalitions, and communicating effectively.

Download the agenda here. For more information on the inaugural AANA Campaign School and to register, see here. Register for the AANA 2015 Fall Leadership Academy, Nov. 6-8, 2015, in Rosemont, Ill., here and our AANA Campaign School here.
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Are You Registered for AANA Fall Leadership Academy and Attending the CRNA-PAC Event?

Federal Political Directors (FPDs) and State Reimbursement Specialists (SRSs) are invited to register today for the AANA Fall Leadership Academy, Nov. 6-8, 2015, in Rosemont, Ill., and to plan on joining us for an exciting evening titled “CRNAs Celebrate Chicago” to benefit the CRNA-PAC.

For FPDs, our just-for-you educational track includes updates on federal legislative and regulatory policy, guidance for identifying and mobilizing your AANA member delegation for the Mid-Year Assembly meeting in 2016, and a review of the role of the CRNA-PAC in keeping our profession’s voice strong in our Nation’s Capital. Completion of this track will enable an FPD to effectively organize and activate the AANA’s professional grassroots network in his or her state, develop effective professional relationships among FPDs nationwide, and strengthen the profession’s influence on Capitol Hill.

For SRSs, a special educational track devoted to reimbursement issues and professional network development will focus on Medicare, Medicaid and commercial health plans, and strategies for monitoring and effectively advocating for appropriate coverage of CRNA services.

If you’re not an FPD or SRS but may become one in the future, or if you are interested in getting more involved in federal issues, advocacy and reimbursement policy, you are invited to join, too!

During the Fall Leadership Academy, the CRNA-PAC’s “CRNAs Celebrate Chicago” event will take place Sat., Nov. 7, from 6:30-9:00 p.m., at the Westin O’Hare in Rosemont, Ill. Come celebrate all that Chicago has to offer and network with your AANA member colleagues! All the proceeds benefit the CRNA-PAC, the one PAC in America that focuses entirely on strengthening the nurse anesthesia profession’s voice in Washington. Register for the CRNA-PAC event here.

Register today for the AANA 2015 Fall Leadership Academy, Nov. 6-8, 2015, in Rosemont, Ill., here.
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  • The House and Senate are spending time in their districts the week of Oct. 12 marking the Columbus Day holiday. If you saw your legislators or their staffs at home, let us know how your visits went by logging your visit on the CRNA-PAC website at https://www.crna-pac.com/legisreport.aspx (AANA login required) and sending us pictures to info@aanadc.com. To see when Congress is in Washington or at home, go to House schedule, Senate schedule.
  • House GOP leaders are looking for a person to succeed resigning Rep. John Boehner (R-OH) as Speaker of the House, after his preferred successor, Majority Leader Kevin McCarthy (R-CA), withdrew from consideration on Thursday, Oct 8. Though Republicans hold a large 247-188 House majority over the minority Democrats, some 40 “Freedom Caucus” Republicans declined to support McCarthy and would have denied him a majority vote for Speaker in the full House. Speaker Boehner announced he would stay in his post until a new Speaker is named, even if that means staying past his scheduled departure date of Oct. 30. The new Speaker will have to move legislation increasing the nation’s $17 trillion debt limit and enacting FY 2016 budget legislation, already two weeks overdue, by a new Dec. 11 deadline. Your AANA Washington team is monitoring the situation closely with CRNA interests in mind.
  • Democratic presidential candidates Hillary Clinton, Bernie Sanders, Martin O’Malley, Jim Webb and Lincoln Chaffee squared off at the first 2016 Democratic presidential debate in Las Vegas on Tuesday, Oct. 13, at 8:30 pm Eastern. A third Republican debate follows, on Oct. 28 at 8 pm Eastern. The AANA encourages CRNAs to engage with the presidential campaign of their choice, particularly in the early caucus and primary states of Iowa, New Hampshire, South Carolina and Nevada. Neither the AANA nor the CRNA-PAC support or endorse candidates for president. If you have any questions, contact your AANA team in Washington at info@aanadc.com.
  • A shutdown of the Federal government was averted on Sept. 30 after both the U.S. House and Senate passed and the president signed into law a “continuing resolution” keeping Uncle Sam open for business through Dec. 11. The measure passed the Senate by a vote of 78-20 and passed the House by a vote of 277-151. To keep Medicare, Medicaid, drug regulation and CRNA workforce development programs running past mid-December, lawmakers must complete unfinished budget business before then.
  • The Congressional Budget Office (CBO) announced the federal deficit is estimated at $435 billion, which is the lowest deficit since before the financial crisis in 2007. The CBO also announced the deficit would be 2.4 percent of gross domestic product, which is slightly below the historic average. The Treasury Department is expected to report the actual deficit numbers later this month. Read the CBO report at https://www.cbo.gov/publication/50724.
  • The AANA attended the October monthly MedPAC meeting Oct. 8, where the Commissioners discussed Medicare’s new Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). The AANA is currently preparing comments on how CRNAs should be treated in these new payment systems and is following the development of both payment methods closely. We will continue to provide you with updates as more information is available. To read more about the MedPAC meeting, see here.
  • 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. To learn more, see an AANA compilation of CRNA-focused ICD-10 materials here. The New York Times covered the issue Sept. 14 in an article here. And AANA supported legislation, HR 3018, which eases the transition to ICD-10, can be read here (member login and password required).
  • Stay up to date on CRNA reimbursement issues by obtaining Version 3 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members here (requires AANA member login and password).
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The following is an FEC required legal notification for CRNA-PAC:

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

Excellent CRNA Opportunity in Greenville SC – Greenville Health System
Greenville, SC

Patewood Outpatient Surgery Center is looking for a CRNA with pediatric experience to join our team. An ACT practice with a congenial work group. Share your talent with Greenville Health System.
Read more about this position
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Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

99 Percent of ASCs Use CMS-Mandated Checklists

Based on 2012 data, almost all Medicare-certified ambulatory service centers use a surgical checklist. According to the Centers for Medicare & Medicaid Services, 99 percent of ASCs have adopted the tool, one of 10 measures that Medicare-certified facilities must report on to avoid Medicare payment cuts. The checklist covers practices ahead of anesthesia administration, before the incision is made, during closing, and prior to the patient being wheeled out of the operating room.

From "99 Percent of ASCs Use CMS-Mandated Checklists"
Outpatient Surgery (10/12/15) Burger, Jim

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Self-Contamination High Among Healthcare Workers

When removing personal protective equipment (PPE), such as gloves or gowns, healthcare workers (HCWs) often contaminate their skin and clothing, a new study says. Dr. Myreen E. Tomas, of the Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, and colleagues, report that 2 percent to 5 percent of personnel caring for patients colonized with multidrug-resistant bacteria get the bacteria on their hands when removing gloves. Their study, reported in JAMA Internal Medicine, examined skin and clothing contamination among HCW who used PPE at four Northeast Ohio hospitals from October 2014 through March 2015. HCW at one medical center participated in an intervention that included a 10-minute instructional video and practice in removing contaminated PPE, with immediate visual feedback based on fluorescent lotion contamination of skin and clothing. Skin and clothing contamination during PPE removal was 60 percent before the training intervention and 18.9 percent after the intervention; this was sustained after one and three months with no further training. Other strategies to reduce contamination could include disinfection of PPE before removal, monitoring of removal, or a redesign of PPE.

From "Self-Contamination High Among Healthcare Workers"
Medscape (10/12/15) Barclay, Laurie

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F.D.A. Approval of OxyContin Use for Children Continues to Draw Scrutiny

Amid soaring rates of prescription opioid abuse, the Food and Drug Administration's (FDA's) approval this summer of oxycodone hydrochloride (OxyContin—Purdue Pharma) for certain children continues to draw criticism from legislators and public officials. At issue is whether the expanded approval—for children aged 11 years or older in severe pain who have already been taking an opioid for at least five days—will result in more oxycodone prescriptions for young patients. The drug has been prescribed off-label for years to very sick children. With FDA's approval, those doctors will now have "information about how to do it appropriately," said Stephen Ostroff, FDA's acting commissioner, in an interview. Ostroff noted that while contentious, the issue "needs to be understood in the context of why this was done." The drug's new labeling will specify who it should be used for. It is not meant to be a first-line opioid analgesic, nor is it meant to treat short-term pain. Although some industry observers have expressed concern about Purdue Pharma's motives, the company "will not promote the new pediatric safety and dosing information for OxyContin to pediatricians or other physicians," according to spokesman Robert Josephson.

From "F.D.A. Approval of OxyContin Use for Children Continues to Draw Scrutiny"
New York Times (10/09/15) Saint Louis, Catherine

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Delays as Death-Penalty States Scramble for Execution Drugs

Some states that allow the death penalty are postponing executions due to troubles with obtaining the proper chemicals to use in the procedure. The Supreme Court in June ruled in favor of the use of midazolam in Oklahoma's three-drug protocol, but several states are reluctant to use it due partly to the sedative's involvement in several executions in which prisoners appeared to suffer. This hesitancy, along with shortages caused by manufacturers no longer producing certain chemicals, and limitations on the chemicals' use, has made it more difficult for states to carry out executions. Lethal injections are increasingly varied in the type, combination, and source of chemicals used. In January 2014, six executions conducted in six states used four different protocols, the Death Penalty Information Center reported. After Ohio officials said they would no longer use the combination of midazolam and hydromorphone, the state has searched for alternatives. Ohio attempted to acquire sodium thiopental from overseas, as it is no longer available in the United States, but the Food and Drug Administration warned that it would be illegal to import.

From "Delays as Death-Penalty States Scramble for Execution Drugs"
New York Times (10/09/15) P. A1 Fernandez, Manny

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Increased Use of Hydromorphone Over Morphine Ups Adverse Events, Study Finds

While morphine has long been the standard for analgesic care in U.S. hospitals, researchers report that many are now favoring the much more potent drug hydromorphone to treat pain. They reached this conclusion after analyzing data from more than 1.3 million patients who received either of the two drugs at any of 38 hospitals included in the study. During the evaluation period, from October 2010 to September 2013, hydromorphone use increased 17 percent among medical patients and 22 percent among patients having surgery. Although side effects like itching and nausea were comparable for both painkillers and patients who received hydromorphone tended to have shorter hospital stays, key patient outcomes were better for those who were administered morphine. Not only were adverse events fewer among the morphine population, these patients were less likely to be readmitted to the hospital within 30 days than those who were treated with hydromorphone. "There is really no benefit here, and potentially the downside is that we are using stronger and more potent opioids and contributing to the opioid tolerance in our society," said lead study author Padma Gulur, MD. The study results were reported at the Regional Anesthesiology and Acute Pain Medicine's 2015 annual meeting.

From "Increased Use of Hydromorphone Over Morphine Ups Adverse Events, Study Finds"
Anesthesiology News (10/01/15) Vol. 41, No. 10 Van Voorhis, Scott

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Long-Term Opioid Therapy Relieves Chronic Pain in Only 20 Percent of Women

A new study shows that women are less likely than men to experience relief of chronic, non-cancer pain with lengthy opioid use. A study in Journal of Women's Health found that only one in five women reported low levels of pain and high levels of function with chronic opioid therapy. For the study, researchers evaluated global pain status among long-term opioid users. Young and middle-aged women were found to be at particularly high risk for unfavorable global pain status. This population also faces unique opioid-related risks, such as reduced fertility and pregnancy complications. "Given the high rates of chronic opioid use in women along with evidence of poor relief from pain and concerning risks, particularly in reproductive-aged women, we need more effective and safer options for managing pain in this population," said Susan G. Kornstein, MD, the editor-in-chief of the journal.

From "Long-Term Opioid Therapy Relieves Chronic Pain in Only 20 Percent of Women"
EurekAlert (10/08/15) Liebert, Mary Ann

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Epidural, Spinal Anesthesia Safe for Cesarean Deliveries, Study Finds

The rate of anesthesia-related complications in women who received epidural or spinal anesthesia for cesarean delivery has declined by 25 percent over the past decade, a study of New York state hospitals shows. Practice guidelines from the American Society of Anesthesiologists say that spinal or epidural anesthesia is preferred for most cesarean deliveries, but general anesthesia may be used in some cases. The study, published in Anesthesiology, looked at trends in anesthesia-related complications, perioperative complications unrelated to anesthesia, and overall mortality in more than 785,000 cesarean deliveries between 2003 and 2012. Among the deliveries studied, 5,715 had at least one anesthesia-related complication. The overall rate of anesthesia-related complications in women who received spinal or epidural anesthesia during c-section decreased from 8.9 per 1,000 in 2003 to 6.6 per 1,000 in 2012. There was no complication decrease in cesareans performed under general anesthesia. However, the rate of perioperative complications unrelated to anesthesia has risen 47 percent over the last decade, which may be due to more women having serious preexisting medical conditions before undergoing c-section. The number of cesarean deliveries also increased, from 29 percent in 2003 to 35 percent in 2012.

From "Epidural, Spinal Anesthesia Safe for Cesarean Deliveries, Study Finds"
Newswise (10/07/15)

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Study Shows High Rates of Opioid Prescribing in Pediatric Headache

Research presented at the American Headache Society's 2015 annual meeting found that many children are prescribed an opioid as a first-line treatment for migraine or headache. The study analyzed data from 21,015 patients aged 6-17 years to examine opioid-prescribing patterns for pediatric migraine or headache. Most of the patients were female, and the average age was about 12 years. Overall, the researchers found that 15.8 percent of children were prescribed an opioid, compared with 9.7 percent who were prescribed a triptan. Older age was associated with a greater likelihood of being prescribed an opioid. The findings also indicate that emergency department physicians and specialists were almost twice as likely as primary-care physicians to prescribe opioids for pediatric migraines and headaches. The researchers, led by Dr. Robert Nicholson, director of behavioral medicine at Mercy Clinic Headache Center and Mercy Health Research in St. Louis, expressed concern that high rates of opioid prescribing increases the risk of headaches associated with medication overuse, safety issues, and the migraines becoming chronic.

From "Study Shows High Rates of Opioid Prescribing in Pediatric Headache"
Pain Medicine News (10/07/2015) Vol. 13, No. 10 Frei, Rosemary

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Marijuana Extract Doesn't Reduce Postoperative Nausea and Vomiting

As the debate continues over the medical benefits of marijuana, new findings indicate that the plant's compounds—known as cannabinoids—do not reliably prevent postoperative nausea and vomiting (PONV). Swiss researchers launched the clinical trial, in which surgical participants were randomized to receive a "relatively high" dose of tetrahydrocannabinol (THC) or a placebo toward the end of a procedure with a high risk of PONV. The study ground to a halt, however, after enrolling just 40 subjects—some 60 percent to 70 percent of whom experienced PONV within the first 24 hours following anesthesia emergence. The delivery of intravenous THC lowered risk of PONV by a statistically insignificant 12 percent, and even less after factoring in differences in anesthesia time. Moreover, patients receiving THC took longer to emerge from anesthesia, were more sedated after their procedure, and remained in the recovery room for a longer period of time. Side effects involving mental state and mood, meanwhile, were unpredictable and volatile. "Due to an unacceptable side effect profile and uncertain antiemetic effects, intravenous THC administered at the end of surgery prior to emergence from anesthesia cannot be recommended for the prevention of PONV in high-risk patients," lead researcher Dr. Lorenz Theiler reported in Anesthesia & Analgesia.

From "Marijuana Extract Doesn't Reduce Postoperative Nausea and Vomiting"
Newswise (10/06/15)

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Lower Pain Scores Seen With Continuous Peripheral Nerve Block vs. Single Injection Block

Among patients who underwent surgery for ankle fracture, those who received perioperative analgesia through a continuous peripheral nerve block experienced lower pain scores and took less pain medication after surgery than patients who received single-shot peripheral nerve block. The study, published in the Journal of Orthopaedic Trauma, included 21 patients randomized to receive general anesthesia with a single-shot peripheral nerve block. Another 23 patients were randomized to receive general anesthesia with a continuous peripheral nerve block, using I-Flow's On-Q pump. Researchers assessed postoperative pain and satisfaction at from 7-72 hours after surgery. Patients also were evaluated for pain, infection, satisfaction, and residual neurologic symptoms at weeks 2, 6, and 12 after surgery. The continuous peripheral nerve block group had a longer time to discharge than the single-shot group. In addition, the continuous group took significantly fewer pain medication than the single-shot group in the first 72 hours. Satisfaction ratings at 72-hours postoperatively were similar between the groups.

From "Lower Pain Scores Seen With Continuous Peripheral Nerve Block vs. Single Injection Block"
Orthopedics Today (10/15) Jaramillo, Monica

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High Rates of Agitation Seen in Young Tonsillectomy Patients

Researchers at Boston Children's Hospital sought to determine predisposing factors that contribute to emergence agitation, a relatively common outcome among pediatric surgical patients. Being able to identify at-risk kids could potentially help anesthesia providers take proactive measures and improve the quality of the surgical experience overall. Led by Patcharee Sriswasdi, MD, the investigators analyzed preoperative data—including age, gender, weight, kind of anesthesia used, and type of operation, among others—from more than 600 pediatric patients undergoing a range of different procedures. "What I've seen from the database," according to Sriswasdi, an anesthesia instructor at the hospital, "is that 67 percent of the children who are between 2 and 6 and undergo tonsillectomy/adenoidectomy at our institution have agitation." High readings on the Pediatric Anesthesia Emergence Delirium (PAED) scale, which gauges agitation level, also were associated with high levels of preoperative pain.

From "High Rates of Agitation Seen in Young Tonsillectomy Patients"
Anesthesiology News (10/01/15) Vol. 41, No. 10 Vlessides, Michael

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Intraurethral Lidocaine for Urethral Catheterization in Children

New research shows that topical and intraurethral lidocaine is not associated with significant pain reduction during urethral catheterization (UC) in children compared with a nonanesthetic lubricant (NAL). Lidocaine is associated with significantly more pain during instillation, however. In a study to compare lidocaine with NAL for relieving pain during UC, researchers randomized 133 children up to two years of age to either NAL or topical and intraurethral 2-percent lidocaine gel. The primary outcome was facial grimacing before and during drug administration and catheterization. According to the results, there were no significant differences in mean scores during UC between lidocaine and NAL, but there was a significantly greater difference in mean scores during instillation of lidocaine compared with NAL. The authors suggested that clinicians consider using noninvasive pain-relieving strategies in children undergoing UC.

From "Intraurethral Lidocaine for Urethral Catheterization in Children"
Pediatrics (10/01/15) Vol. 136, No. 4 Poonai, Naveen; Li, Jennifer; Langford, Cindy; et al.

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

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