AANA Anesthesia E-ssential
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Vital Signs

New Member Benefit Coming Soon: AANA Connect!

The AANA proudly presents a powerful new member benefit: AANA Connect. Three online communities—General, Practice, and SRNA only—will allow you to connect with, learn from, and share with your nurse anesthesia colleagues from around the country. Watch your inbox for your invitation to join!
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CPC Facts

Recertification Timeline

If you currently recertify in even years, then you will recertify by July 31, 2016 under the current two-year recertification program. Once you have recertified in 2016, you will enter into the CPC Program on August 1, 2016. If you currently recertify in odd years, then you will recertify by July 31, 2017, under the current two-year cycle program. Once you have recertified in 2017, you enter into the CPC Program on August 1, 2017. For students who are initially certified in 2015, you will first recertify under the current requirements in 2017, and then enter the CPC Program in 2017. For students initially certified in 2016, you will enter the CPC Program in 2016. 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

AANA Celebrates 75th Anniversary of Partnership with American Hospital Association

Over the last 75 years, the American Hospital Association (AHA), and the AANA have worked together to ensure access to safe, high-quality healthcare in communities everywhere. A ceremony and plaque presentation to commemorate the occasion was held Monday, October 26, at the AANA headquarters.

“The advances in anesthesia and healthcare that patients enjoy today are a testimony to the diligent work of the AANA and AHA over the years,” said AANA Executive Director and CEO Wanda Wilson, CRNA, PhD. “Every day, Certified Registered Nurse Anesthetists (CRNAs) work with hospital executives around the country to ensure all patients have access to safe, high-quality care.”

The AANA, originally named the National Association of Nurse Anesthetists (NANA), was founded June 17, 1931. However, it was the invitation of Bert W. Caldwell, MD, then executive secretary of the AHA, to nurse anesthetist Gertrude Fife, secretary of NANA in 1931, to hold NANA’s first meeting simultaneously with the AHA sessions that signaled the importance of nurse anesthesia to America’s healthcare system. This mutually beneficial relationship led to the AANA’s first annual meeting, Sept. 13-15, 1933, in Milwaukee, Wis., and solidified the collaboration between the two associations.

“Just as Dr. Bert Caldwell recognized the valuable contributions of nurse anesthetists to both the advancement of surgery and healthcare overall, the AHA remains supportive of CRNAs for making patient safety and access to care their first priority decades later,” said Kim Byas, PhD, MPH, FACHE, AHA Regional Executive.

AHA Regional Executive Kim Byas, PhD, MPH, FACHE (right) presents a plaque commemorating the 75th anniversary of the AANA-AHA partnership to AANA Executive Director and CEO Wanda Wilson, CRNA, PhD.
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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 Thursday, November 5, 2015, at the O’Hare Westin Hotel in Rosemont, Ill. The Board invites AANA members to audit the Open Session starting at 1 p.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
(member login required). Please contact mscheuermann@aana.com if you have any questions.
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Coming Soon: Online Video Chat with President Quintana

On Nov. 6, President Juan Quintana, CRNA, DNP, MHS, will be joined by AANA Senior Director, Federal Government Affairs, Frank Purcell, for "30 minutes with the President," the AANA’s 21st Century answer to Franklin Delano Roosevelt’s “Fireside Chats.” A maximum of 300 participants will be able access the online video chat session at
(member login and password required) at 8 p.m. CST.

This session will focus on federal government-related issues. Participants will have the opportunity to ask President Quintana and Frank Purcell questions via online chat. They will answer as many as possible during and after the chat.

The AANA plans to offer online video chat sessions periodically as a vehicle for effective two-way communication between the president and members, as well as an opportunity to try out new communication technology for the future.
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Two Months Left in the 2015 PQRS Reporting Period

The 2015 PQRS countdown is coming to an end on December 31, 2015. Do you know if you or your group practice is reporting? If not, you should first check with your employer and/or biller. To learn more about how to avoid the 2017 negative payment adjustment on your Medicare Part B reimbursement, the AANA Quality and Research Division has developed Quality Reporting Toolkit, which contains numerous resources including an interactive guide titled 2015 PQRS Guide for CRNAs—5 Things You Should Know. The toolkit and other useful resources are available on the Quality-Reimbursement resource page of the AANA website.
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PQRS Informal Review Process for 2016 Payment Adjustments

The Centers for Medicare & Medicaid Services (CMS) has begun issuing notifications for 2016 negative payment adjustments to individual eligible professionals (EPs) and group practices that did not satisfactorily report to PQRS in 2014. EPs and group practices that believe they have been incorrectly assessed for the 2016 PQRS negative payment adjustment may submit an informal review by Nov. 9, 2015. All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page under the Related Links section of the Physician and Other Health Care Professionals Quality Reporting Portal. Informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final, and there will be no further review.
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Nominations for 2016 AANA Elections Due December 1

Nominations for AANA elected offices and consent forms from nominees are due in the AANA office by December 1, 2015. Each state association may submit one nominee for president-elect, vice president, and treasurer. In addition, state associations may submit one nominee for a director for their region. In 2016, directors from Regions 2, 3, 6, and 7 are eligible for election. Finally, state associations may nominate one member from their region for the AANA Nominating Committee and one member for the Resolutions Committee. Members are also allowed to self-nominate or nominate another member as long as the nominee meets the qualifications for office found in the AANA Bylaws and Standing Rules. For information regarding the electoral process, visit
. (Member login and password required.)
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Fallacaro, Gould, and Krogh Named Fellows of the American Academy of Nursing

The AANA congratulates three CRNAs on their recent induction as fellows of the American Academy of Nursing (AAN). Michael Fallacaro, CRNA, DNS, FAAN; Wallena Gould, CRNA, EdD, FAAN; and Mary Anne Krogh, CRNA, PhD, FAAN; were among 163 nurse leaders inducted during the academy’s 2015 Annual Policy Conference in Washington, D.C., Oct. 17. They joined ranks of an elite group of just over 2,000 nursing professionals, and only 25 CRNAs, who have been elected as AAN fellows since the academy was established in 1973.

The AAN is an organization of distinguished nursing leaders who are recognized for their outstanding contributions to the profession through publications, research, awards and honors, professional activities, and community service. The academy’s Fellows represent all 50 states, the District of Columbia, and 24 countries.
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State Government Affairs

New Laws Advance Delaware APRN Practice

Effective September 1, 2015, two new Delaware laws implement changes that advance APRN (including CRNA) practice. The changes include APRN title, removal of collaborative agreement requirement after two years/4,000 hours of practice, and positive changes concerning prescriptive authority and independent practice. Information regarding how the new laws affect APRN practice is posted on the Delaware Board of Nursing website.
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Meetings and Workshops

Countdown to the Fall Leadership Academy

Last chance to register for the conference designed to engage and empower attendees to emerge a stronger leader. Register online by Monday, November 2.
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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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Foundation and Research

AANA Foundation Board of Trustees Elects Kathryn Cowap Student Representative

The AANA Foundation Board of Trustees has elected Kathryn Cowap, RN, as its third consecutive student representative to serve on the board. Recognizing that today’s student registered nurse anesthetists (SRNAs) are tomorrow’s CRNA leaders, the Foundation is focused on building enhanced relationships with this extremely important and vibrant constituency. Cowap was elected to the board for fiscal years 2016 and 2017. Click here to visit the AANA Foundation Student Webpage and read more about Katie.
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AANA Foundation Sponsor a Student 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 December 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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Support the AANA Foundation FY16 Annual Giving Campaign

Please make your FY16 donation to the AANA Foundation today! Your support is critical to advancing the nurse anesthesia profession through education and research that validates quality and cost-effective anesthesia care.
  • Visit www.aanafoundation.com to make an online donation, or
  • Mail your donation to AANA Foundation, 222 S. Prospect Avenue, Park Ridge, IL 60068
All donations of $100+ will be recognized in print and on the website. AANA members who make donations of $250+ to both the AANA Foundation and CRNA-PAC will be recognized as Triple Crown members. Thank you in advance for your support. It is greatly appreciated!
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Federal Government Affairs

Congress Unveils Two-Year Budget Agreement that Allows Boost to Domestic Spending, but Extends Out-Year Sequestration Cuts

The White House and Congressional leaders unveiled a two-year bipartisan budget agreement with an increase in discretionary spending that allows final appropriations bills to support Title 8 nurse workforce development and other programs important to CRNAs. However, the measure also extends the out-years of certain budget sequestration cuts through the mid-2020s, keeping in place a problematic policy that has kept Medicare payments depressed by 2% since 2013.

With House votes scheduled for Oct. 28 to be followed by Senate action, the proposal includes neither anti-CRNA provisions nor any provisions relating to anesthesiologists or anesthesiology directly. It does include an increase to Uncle Sam’s statutory debt limit to a level anticipated to be reached in March 2017 – and which must be raised by Nov. 3 or risk default. In the additional years that the bill extends budget sequestration, CRNAs and physicians would see their sequestered-level payment continue, and not have a bounce-back of plus-2% to pre-sequestration levels. A two-year budget agreement also reduces risk of government shutdown later this year, as federal appropriated programs are now funded by “continuing resolution” through Dec. 11, 2015. According to House Appropriations Committee Chair Rep. Hal Rogers (R-KY), enactment of this budget measure would allot sufficient time to complete an omnibus appropriation for enactment by that deadline.

Though this agreement was developed between bipartisan congressional leadership and the White House its future is not guaranteed. If it clears the House, it has to move through the Senate where five members – four GOP, one independent Democrat – are running for president and have a Senator’s parliamentary rights to slow legislation from moving. So, stay tuned.
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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 American Society of Anesthesiologists at its 2016 annual meeting last weekend urged its members to contact the VHA in opposition to full practice authority by CRNAs. The AANA encourages members to ensure that members of Congress hear from you and your colleagues and to get the full story – that CRNAs and other APRNs are working to end veterans’ waits for high-quality care that they deserve and have earned. Take action here and encourage your friends and family to also take action through the Veterans Access to Quality Healthcare Alliance microsite.
  • Have you seen Letters to the Editor from veterans published in newspapers recently? Two additional Letters to the Editor were published in The Tampa Tribune (FL) by E.J. Otero, a retired Air Force Colonel and President of the Hispanic Republicans group in Hillsborough, and also in the Lombardian (IL) by Illinois state Sen. Chris Nybo, who serves on the Veterans Affairs Committee. Additional letters have appeared in the Mansfield News Journal, County Journal, North County News,Daily Southtown, Delaware Gazette, Tallahassee Democrat, Tinley Park Patch, Steubenville Herald Star, Columbus Dispatch, Palm Beach Post, and Chicago Tribune.
  • 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.
  • 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 39 bipartisan cosponsors, with Reps. Danny Davis (D-IL-7) and Tammy Duckworth (D-IL-8) adding their support most recently. 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.
  • 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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AANA President Quintana Joined U.S. Chamber Health Policy Summit Panel in Washington Oct. 20

On Oct. 20, AANA President Juan Quintana, CRNA, DNP, MHS, appeared as a panelist at the U.S. Chamber of Commerce 4th Annual Health Policy Summit in Washington, D.C., 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 also heard from panelists from the worlds of health plans, major employers, industry, and academia. Other panel discussions examined topics such as health data and cyber-security challenges, how habits can be leveraged to improve wellness, and how transparency can drive healthcare innovation.

During the panel, President Quintana stressed the importance of eliminating barriers that limit patient access to safe, high quality, cost effective CRNA and APRN services. With an aging population that is rapidly growing, the time is now to improve access to care and better coordinate healthcare services by allowing all APRNs to practice to their full scope of practice, remarked President Quintana. President Quintana also commented on his experiences as a small business owner and the need for small businesses to embrace wellness initiatives for employees and patients.

AANA also released a news release stating, “CRNAs are perfectly suited to meet today’s healthcare challenge of delivering safe, high-quality care, while helping to control rising healthcare costs. The Health Care Summit represents all aspects of the healthcare industry and hopefully the beginning of many solutions.”

If you missed the panel discussion, see an archived copy here (President Quintana’s panel discussion begins at 1:52:31). Read the AANA’s press release here. View the summit coverage on social media with #Health15, @USChamber and @AANAWebUpdates.

AANA President-elect Cheryl Nimmo, CRNA, DNP, MSHSA, and President Juan Quintana, CRNA, DNP, MHS, attended the U.S. Chamber of Commerce 4th Annual Health Care Summit in Washington where President Quintana was a panelist.
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AANA Joins 40 Healthcare Organizations in Support of White House Drug Abuse and Prevention Initiative

The AANA joined 40 healthcare professional organizations on Oct. 21 in supporting a new public-private Administration initiative to address prescription drug abuse and heroin use. Recognizing the leadership role of CRNAs, the AANA has committed to promote the use of regional anesthesia where appropriate to enhance recovery and reduce complications associated with general anesthesia, to continue supporting and advancing multimodal pain care models, and to continue promoting awareness and wellness among our members and the public on issues involving prescription drug abuse and heroin use prevention.

The White House released a statement on the initiative describing the endeavor as a “federal, state, local and private sector effort aimed at addressing the prescription drug abuse and heroin epidemic. These include commitments by more than 40 provider groups – representing doctors, dentists, advanced practice registered nurses, physician assistants, physical therapists and educators – that more than 540,000 healthcare providers will complete opioid prescriber training in the next two years.” To read more about the initiative, see here.
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Medicare Administrative Contractor Palmetto GBA Issues Draft Local Coverage Determination on Pain Care; AANA Responding

On Oct. 13, the Medicare Administrative Contractor (MAC) Palmetto GBA issued a draft local coverage determination (LCD) affecting coverage of CRNA pain management services in four states where Palmetto administers the Medicare program. The AANA is reviewing the proposals and preparing a response to protect patient access to care provided by CRNAs.

Palmetto’s draft LCD affects Medicare coverage in North Carolina, South Carolina, Virginia, and West Virginia. The AANA is preparing comments to the draft LCD, which involves facet joint injections. The LCD language relating to provider qualifications is being evaluated for possible impact on CRNAs, and to make sure the language is consistent with provider-neutral language issued by other MACs. Comments to Palmetto are due on Nov. 27. Members with any questions or comments regarding these LCDs are invited to contact AANA DC at info@aanadc.com; please include the words “Palmetto LCD” in the subject line.

To read the draft LCD on facet joint injections, see here.
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CMS Calls for Comments and Information on the Graduate Nursing Education Demonstration

On Oct. 16, the Centers for Medicare & Medicaid Services (CMS) announced its plans to collect information on the outcomes of the Graduate Nurse Education (GNE) demonstration program, which was authorized and funded under the Affordable Care Act (ACA). CMS will collect information about how the five demonstration sites have: (1) increased the number of APRNs practicing overall as a result of a specific demonstration site; (2) increased the number of providers for each APRN specialty (CRNAs, NPs, CNMs, and CNSs), and (3) improved Medicare costs as result of the demonstration. Under the ACA, each of the five demonstration sites have received payments for the hospital's reasonable costs for the clinical training of APRNs.

The AANA is working with our coalition partners to prepare a response to CMS and reaching out to CRNA educational programs that are involved in the GNE demonstration program. If you have information to share, please email info@aanadc.com with “GNE Demo” in the subject line.

To see more information regarding the request from CMS, go here.
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Considering Running for Public Office? Agenda Released for AANA’s First-Ever Campaign School for CRNAs Nov. 6-8

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. Download the agenda here. For more information on the inaugural AANA Campaign School and to register, see 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. Get your tickets here to this exciting event!

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. 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.

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. 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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AANA Participates in Summit Focusing on Healthcare Payment Innovations at the 2015 Health Care Payment Learning & Action Network Summit

To monitor innovations in private healthcare payment models affecting CRNA reimbursement and practice, the AANA was present at the federal Health Care Payment Learning and Action Network (LAN) stakeholder summit Oct. 26 in suburban Washington, DC. Hearing from Acting CMS Administrator Andy Slavitt, CMS Chief Medical Officer Patrick Conway MD, and other health industry leaders, an AANA staff and member team evaluated the role of the LAN in implementing major Medicare payment reforms that will affect CRNAs and other healthcare professionals in the future. LAN Guiding Committee co-chair Mark Smith MD concluded the meeting by confirming what AANA has said – that the voices of nursing and other healthcare professionals must be more effectively and deeply included development and implementation of LAN activities. LAN representatives also discussed its draft white paper describing an alternative payment model framework, which the AANA is evaluating for possible comment by a Nov 20 deadline. Please share your comments on the paper to info@aanadc.com with “LAN White Paper” in the subject line.

To see more information on the LAN Summit, see here. To review the LAN white paper, see here.
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  • AANA awaits publication of several major Medicare rules affecting CRNA practice. They include the 2016 physician fee schedule, the Comprehensive Care for Joint Replacement pilot, and the Hospital Outpatient Prospective Payment System and ASC Payment proposed rules, expected on or about Nov. 2. When these rules were proposed by the Medicare agency last summer, AANA and its coalition partners worked to protect and advance CRNA and APRN practice by submitting comments educating agency officials about the role and value of CRNAs and APRNs for Medicare beneficiaries, and urging policymakers to eliminate barriers to the use of CRNA and APRN services.
  • Leadership elections to succeed resigning House Speaker John Boehner (R-OH) were set to take place Wed., Oct. 28 among House Republicans, and Thurs., Oct. 29 in the whole House as Ways and Means Committee chair Rep. Paul Ryan (R-WI) agreed to be nominated for the post. If Rep. Ryan is elected Speaker he vacates his chairmanship of the House Ways and Means Committee, setting off a contest to succeed him. Rep. Kevin Brady (R-TX), current Chair of the House Ways and Means Subcommittee on Health has expressed interest, as has Rep. Pat Tiberi (R-OH) who is Chair of the House Ways and Means Subcommittee on Trade.
  • To support funding for the Agency for Health Research and Quality, the AANA has signed onto two letters to the House and Senate Appropriations Chairs and Ranking Members requesting that funding levels for this critical agency be restored to $364 million. The AANA and 195 other healthcare organizations expressed concern for the Senate Appropriations Committee’s proposed 35% cut to AHRQ, as well as the House recommendation to completely de-fund the agency. Dissolving AHRQ or dramatically reducing its funding would be a significant blow to activities that help constrain healthcare cost growth and promote quality outcomes. See the letter to the Senate here (AANA login and password required).
  • Presidential candidates from both sides of the aisle have debates scheduled and AANA President Juan Quintana, CRNA, DNP, MHS, has plans to attend one from each major party in-person to help promote the role and value of CRNAs among national leaders present. The third Republican debate took place on Wed., Oct. 28, in Boulder, Colo., on CNBC, and President-elect Cheryl Nimmo, CRNA, DNP, MSHSA, joined President Quintana there. The second Democratic debate is scheduled for Sat., Nov. 14 in Des Moines, Iowa. 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, plus the “Super Tuesday” states of Alabama, Alaska, Arkansas, Colorado (caucus), Georgia, Massachusetts, Minnesota (caucus), North Carolina, Oklahoma, Tennessee, Texas, Vermont and Virginia. 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. To see a full list of debates schedule, 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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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.

Study: Pharmacist intervention improves post-surgery outcomes for diabetics

A pharmacy-based glycemic control program may improve outcomes for surgical patients with diabetes and those who develop stress-induced hyperglycemia or high glucose levels after surgery. These findings come from a new study, conducted by Kaiser Permanente, which funded the intervention, and published in the American Journal of Pharmacy Benefits. Researchers compared patients who underwent surgery after the glycemic control program began with patients who underwent surgery prior to the program's launch. Those in the glycemic control program were more than twice as likely to have well-controlled glucose levels after surgery, and they tended to have fewer post-surgical complications, hospital readmissions, or emergency department visits. As part of the intervention, launched in 2009, every surgical patient at the Kaiser Permanente Sunnyside Medical Center in Portland, Ore., received a glucose screening when admitted to the hospital. Those with known diabetes or surgery-induced stress hyperglycemia were referred to a group of inpatient pharmacists called the Glycemic Control Team. The pharmacists worked with surgeons, hospitalists, endocrinologists, diabetes educators, and nutritionists to develop a protocol for the patients.

From "Study: Pharmacist intervention improves post-surgery outcomes for diabetics"
Drug Store News (10/27/15) Johnsen, Michael

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Hispanic, Medicaid Patients Less Likely to Receive Regional Anesthesia During Hip and Knee Replacement Surgery

Some patients—depending on their ethnic background and insurance status—are less likely to receive regional anesthesia during knee and hip replacements, research finds. The study, reported at the ANESTHESIOLOGY 2015 annual meeting, reviewed data from more than 1 million such surgeries nationwide between 2006 and 2013. Patients underwent neuraxial anesthesia, peripheral nerve blocks, or general anesthesia. The investigators determined that blacks were 10 percent less likely to receive either type of regional anesthesia; and the numbers rose to 16 percent for uninsured patients, to 20 percent for Medicaid patients, and to 24 percent for those of Hispanic descent. "There is increasing evidence that regional anesthesia could reduce the risk of death or blood clots, compared to general anesthesia, during hip and knee replacement surgery," said lead researcher Jashvant Poeran, MD, PhD, of the Icahn School of Medicine at Mount Sinai in New York. "Specific patient groups are significantly less likely to receive regional anesthesia, and this disparity may have a negative impact on their outcomes."

From "Hispanic, Medicaid Patients Less Likely to Receive Regional Anesthesia During Hip and Knee Replacement Surgery"
News-Medical.net (10/26/2015)

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Prescription Opioids in Adolescence and Future Opioid Misuse

Even when used legitimately, opioid use is associated with a risk of long-term use and possibly misuse in adults. Researchers, led by Richard Miech, PhD, from the Survey Research Center, University of Michigan, Ann Arbor, conducted a study to estimate the risk of future opioid misuse among adolescents. The analysis used data from the Monitoring the Future study, including a nationally representative sample of 6,220 individuals surveyed in 12th grade and then followed up through age 23 years. The main outcome was nonmedical use of a prescription opioid at ages 19–23 years. According to the results, receipt of a legitimate prescription for opioids before the 12th grade was independently associated with a 33% increase in the risk of future opioid misuse, particularly among individuals with little to no history of drug use and strong disapproval of illegal drug use at baseline. The researchers suggest that clinic-based education and prevention efforts could help reduce future opioid misuse in this population.

From "Prescription Opioids in Adolescence and Future Opioid Misuse"
Pediatrics (10/26/15) Miech, Richard; Johnston, Lloyd; O'Malley, Patrick M.; et al.

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Increases in Fentanyl Drug Confiscations and Fentanyl-Related Overdose Fatalities

The Centers for Disease Control and Prevention (CDC) and Drug Enforcement Administration (DEA) report that they are looking in to recent increases in unintentional overdose fatalities stemming from use of fentanyl, a synthetic and short-acting opioid analgesic that is 50–100 times more potent than morphine. The drug is approved for managing acute or chronic pain associated with advanced cancer; however, most cases of fentanyl-related morbidity and mortality are associated with illegally manufactured fentanyl and fentanyl analogs, known as nonpharmaceutical fentanyl (NPF). DEA warned earlier this year that fentanyl is a threat to public health and safety, and data from the agency's National Forensic Laboratory Information System show that the number of fentanyl drug seizures is increasing to more states. Ohio had 1,245 fentanyl seizures in 2014, nearly two times the number recorded in the second-place state, Massachusetts. Ohio also recorded 514 fentanyl-related fatal overdoses last year, up from 92 in 2013, while Maryland saw sharp increase from 58 fatal fentanyl overdoses 2 years ago to 185 in 2014. In response to the increases in fatal overdoses, CDC is recommending improved detection of fentanyl outbreaks, providing guidance for public health departments, health care providers, first responders, and medical examiners and coroners. In addition, CDC is calling for expanded use of naloxone and training for administering the drug to help reduce opioid-related overdose deaths.

From "Increases in Fentanyl Drug Confiscations and Fentanyl-Related Overdose Fatalities"
CDC Health Alert Network (10/26/2015)

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Lidocaine Reasonable Alternative to Epidural Analgesia After Major Abdominal Surgery

Lidocaine infusion is a viable alternative to epidural analgesia following major abdominal surgery, report University of Virginia researchers, who analyzed case histories of 216 patients. The subjects were divided equally between the two protocols, and investigators focused on postoperative pain and opioid use to cull their findings. The review indicated that lidocaine was not inferior to epidural, plus patients in the lidocaine cohort had superior recovery outcomes—including a lower incidence of hypotension, postoperative nausea and vomiting, and urinary retention. At the same time, however, the team discovered that the lidocaine patients needed more narcotic pain medication than their counterparts in the epidural group. "This is not 'new news' because it's been studied by other groups, but it certainly adds to our understanding of this important analgesic tool," said the University of Michigan's Paul Hilliard, MD, who was not involved in the research. "Lidocaine infusion should be considered as a good alternative in patients who have contraindications to epidural analgesia."

From "Lidocaine Reasonable Alternative to Epidural Analgesia After Major Abdominal Surgery"
Anesthesiology News (10/01/15) Vol. 41, No. 10 Frei, Rosemary

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Magnesium Sulfate Has Protective Effect on Maternal Fever During Labor

Research indicates that laboring mothers who received magnesium sulfate were less likely to present with maternal fever, a condition that has been linked to epidural and spinal anesthesia. Led by Elizabeth Lange, MD, the study combed data from almost 63,000 live births at Chicago's Northwestern Memorial Hospital over a seven-year period. Of 6,163 women who developed maternal fever, the incidence was higher among those who were not administered intravenous magnesium during labor. Nearly 10 percent of expectant mothers who did not receive the therapy ran a fever of 100.4 Fahrenheit or greater, more than double the rate of those who did. "By reducing the incidence of maternal fever, magnesium sulfate therapy may also reduce the incidence of complications in newborns," including cerebral palsy and respiratory problems, Lange reported. The retrospective study was presented at the ANESTHESIOLOGY 2015 annual meeting in San Diego.

From "Magnesium Sulfate Has Protective Effect on Maternal Fever During Labor"
News-Medical.net (10/26/2015)

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Medication Errors Happen in Half of All Surgeries

A study from the anesthesiology department at Massachusetts General Hospital indicates that about 50% of all surgeries involve some kind of medication error or unintended adverse events. This rate, based on 277 observed procedures and published in Anesthesiology, is much higher than those of earlier studies. More than one-third of the observed medication errors led to some harm to the patient. Although hospitals have been working to reduce medical errors since 1999, when the Institute of Medicine reported that they led to at least 44,000 U.S. deaths a year, mistakes involving medication used in surgery have not been systematically studied, according to lead researcher Karen Nanji, MD. Drugs delivered during surgery lack many of the same safeguards that other medication orders, such as being double-checked by pharmacists before they reach the patient. Nanji pointed out that only three of the errors observed in the study were considered life-threatening, and no patients died from the errors. Many errors involved properly labeling drugs when they are drawn into syringes for delivery.

From "Medication Errors Happen in Half of All Surgeries"
Bloomberg (10/25/15) Tozzi, John

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Eating During Labor May Not Be So Bad, Study Suggests

Contrary to decades of practice, new research raises the possibility that having a little food or drink during labor may actually benefit mothers-to-be. Investigators say old rules requiring women to fast during labor have become archaic as anesthesia has advanced. Before, health care providers were particularly concerned about patients inhaling food or liquid into the lungs while under general anesthesia. But most women today receive epidural anesthesia or spinal block, eliminating much of the risk of aspiration. The American Society of Anesthesiologists team, after reviewing hundreds of recent studies, determined that women in labor require the same level of energy and calories as someone running a marathon. Falling short of that need can cause their bodies to turn to fat to get energy—which in turn can reduce contractions, prolong labor, and lower neonatal health scores. The finding is not likely to reverse the clinical standard, but it could mean a change for some healthy pregnant women. Experts say obstetricians and expectant mothers should talk before the delivery date about the patient's individual health and risk factors for eating and drinking once labor begins.

From "Eating During Labor May Not Be So Bad, Study Suggests"
CBSNews.com (10/25/15) Brewer, Contessa

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Patients More Engaged in Their Anesthesia, Pain Relief Options When Given 'Decision Aids' or Brochures

Surgical patients often have little understanding about anesthesia and pain management, but researchers say informational brochures can help start the patient-doctor conversation on what should be a shared decision. The study involved 126 patients scheduled for surgery under regional anesthesia, 67 of whom were provided with literature explaining the different kinds of anesthesia as well as the risks and benefits of each. The brochures also left room for patients to take notes and write down questions. All participants were assessed immediately after clinical evaluation to determine their knowledge of regional anesthesia and gauge their level of apprehension. The findings indicated that patients who received "decision aids" were more likely than those who did not to talk about anesthesia options during clinic visits and to ask questions. Although the written materials discussed risk, patients who read them were no more anxious or uncertain than study participants who were not given decision aids. "Clearly, more information is always helpful," according to Karen Posner, PhD, of the University of Washington, Seattle. "Helping patients understand their choices allows them to feel fully prepared to discuss their options and make a mutually agreed upon decision" with their anesthesia provider.

From "Patients More Engaged in Their Anesthesia, Pain Relief Options When Given 'Decision Aids' or Brochures"
Newswise (10/25/15)

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General Anesthesia Causes No Cognitive Deficit in Infants

While earlier studies have drawn a correlation between infant exposure to anesthesia and cognitive problems, an international team of researchers now has concluded the opposite. Their investigation—the first randomized anesthesia trial involving pediatric patients—covered more than 500 children younger than 60 weeks old, half of whom received general anesthesia for hernia repair and half of whom underwent regional anesthesia. At age two years, the toddlers in both cohorts performed similarly on neurocognitive tests. "This is the strongest evidence we have to date that a brief anesthetic exposure likely isn't a problem," reported lead researcher Andrew Davidson of the Melbourne Children's Trials Center in Australia. It remains to be seen, however, if prolonged or repeated exposures to anesthesia hurt brain function or if subjecting kids to anesthesia early in life contributes to cognitive issues that surface beyond age two. "There are some aspects of development—like high executive function, reasoning skills and memory—that you don't actually acquire until you are older," Davidson explains. With that in mind, the children in the current study, which was published in The Lancet, will be tested again at age five.

From "General Anesthesia Causes No Cognitive Deficit in Infants"
Scientific American (10/24/15) Maron, Dina Fine

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Federal Authorities Seize Lethal Injection Chemical Shipments

The Food and Drug Administration said on Oct. 23 that it has impounded orders of sodium thiopental, an anesthetic that has been used in past executions in combination with drugs that paralyze the muscles and stop the heart. "Courts have concluded that sodium thiopental for the injection in humans is an unapproved drug and may not be imported into the country," FDA spokesman Jeff Ventura said in a statement. Arizona and Texas had tried to bring in the lethal injection chemical from abroad. Corrections Department spokesman Andrew Wilder said the department "is contesting FDA's legal authority to continue to withhold the state's execution chemicals." In Texas, the Department of Criminal Justice said it went through proper channels, obtaining an import license from the Drug Enforcement Administration and notifying FDA and Customs. Department spokesman Jason Clark said the state is awaiting a decision from the FDA on the legal status of the imports. The shortage of execution chemicals has been building for the past few years, ever since European companies started refusing to sell them to the United States. States have had to change drug combinations or put executions on hold while they look for other options.

From "Federal Authorities Seize Lethal Injection Chemical Shipments"
Associated Press (10/23/15)

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Obese Pregnant Women Drive Up Health Care Cost

A new Australian study reports that expectant mothers who are obese are a financial strain on the healthcare system—particularly in terms of their anesthetic needs. Obstetricians say Cesarean section is safer for overly heavy pregnant women; and, indeed, a third of mothers who deliver a baby this way are obese. These patients require more anesthesia, however, which in turn means more time sedated. While a normal-weight woman would spend an average of 72 minutes under the care of anesthesia providers during her C-section, anesthesia time is extended by up to 18 minutes for obese women. According to the research out of the University of Melbourne, healthcare costs can be expected to rise an extra A$25—or US$18—for every additional minute that a patient is under anesthesia.

From "Obese Pregnant Women Drive Up Health Care Cost"
Tech Times (10/16/15) Navarro, Alyssa

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Pyramidal Protocol Promotes Opioid-Sparing Analgesia

The ComfortSafe anesthetic protocol can help with postoperative pain relief and recovery and prevent complications associated with opioids. The technique, developed by Dr. Joseph Myers of Georgetown University Medical Center, is based on the ComfortSafe Pyramid. This is a checklist for anesthesia and surgical teams to complete before wound closure. The analgesic choices near the base of the pyramid have the fewest side effects, beginning with reduced-sensation patients, followed by wound infiltration with a local anesthetic, and ending with opioids as the last resort. At the 2015 World Congress of Enhanced Recovery After Surgery and Perioperative Medicine, Myers described three diverse cases in which the ComfortSafe protocol was used. In one case, a patient underwent general anesthesia with propofol and sevoflurane for above-the-knee amputation. The patient was also infiltrated with 20 mL of bupivacaine liposome injectable suspension, and only required two 0.5-mg doses of hydromorphone in the post-anesthesia care unit.

From "Pyramidal Protocol Promotes Opioid-Sparing Analgesia"
Anesthesiology News (10/13/15) Vol. 41, No. 10 Vlessides, Michael

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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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