AANA Anesthesia E-ssential
Introducing the Shiley Laryngeal Mask

Vital Signs

Medicare and Medicaid EHR Incentive Programs—Do They Apply to CRNAs?

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals (EPs) to adopt, implement, upgrade, and demonstrate the meaningful use (MU) of certified Electronic Health Record (HER) technology. Beginning in 2015, EPs who do not comply with MU objectives will be subject to negative payment adjustments. CRNAs are not currently defined as EPs for the EHR Incentive/MU Programs; therefore, CRNAs are not eligible for incentives or subject to penalties. As the adoption of health information technology (HIT) continues to increase across the healthcare industry, it is likely that the program eligibility requirements for CRNAs will change in the near future. The AANA Research and Quality Division has created a new EHR Incentive/MU programs FAQ page for CRNAs to familiarize themselves with these CMS initiatives, which can be accessed along with other useful resources on the Quality-Reimbursement page of the AANA website.
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CPC Facts

The CPC Exam in Focus

The focus of the CPC exam is different from the focus of the National Certification Examination (NCE). The NCE assesses your knowledge at the time you enter into practice. The CPC exam will assess the knowledge that you develop over time, through clinical practice, continuing education, and evidence-based literature. This is the knowledge that all nurse anesthetists would be expected to know, regardless of practice focus. The content focus is not on subspecialty knowledge, but rather on four areas of nurse anesthesia practice: airway management, applied clinical pharmacology, physiology and pathophysiology, and anesthesia equipment and technology. You will find more information on the AANA (cpc-facts.aana.com) and NBCRNA (www.nbcrna.com) websites, or contact the NBCRNA to learn more.
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Hot Topics

AANA and Others Endorse Four Core Messages to Drive a Cultural Transformation in the Way Pain is Perceived, Judged and Treated

At the PAINS’ (Pain Action Alliance to Implement a National Strategy) Collaborators Meeting held in Washington, D.C., from June 27-28, four core messages originally developed by the Consumer Pain Advocacy Task Force (CPATF) were presented by Cindy Steinberg in her “call to action.” The State Pain Policy Advocacy Network (SPPAN) convened CPATF in March 2014. The task force is comprised of national leaders and decision-makers from 17 nonprofit consumer advocacy organizations, including PAINS, all dedicated to patient well-being, effective pain treatment methods, and promoting the National Pain Strategy Report. Since then, these core messages have been endorsed by more than 50 national leaders and organizations, including the AANA.

The four core messages are:
  • Chronic pain is a real and complex disease that may exist by itself or be linked with other medical conditions.
  • Chronic pain is both an under-recognized and under-resourced public health crisis with devastating personal and economic impact.
  • Effective chronic pain care requires access to a wide range of treatment options, including biomedical, behavioral health and complementary treatment.
  • Denying appropriate care to people with chronic pain is unethical and can lead to unnecessary suffering, depression, disability and even suicide.
For more information, visit http://www.painsproject.org/news-alert.
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Must-Read New Book Available Now: Ira P. Gunn, Nurse Anesthetist

The AANA is proud to announce the publication of Ira P. Gunn, Nurse Anesthetist: Writings and Wisdom from a Legendary Nursing Leader. A fierce defender of the profession and the AANA, Gunn passed away in 2011 but her impact lives on—now in the pages of this important collection of articles, letters, papers, and personal correspondence. Gunn’s unique perspective as a clinician, educator, military veteran, historian, and AANA member is invaluable to all nurse anesthetists, including practicing CRNAs and students just starting their careers. She expressed herself as only she could—with passion, strength, exacting knowledge, wisdom, and humor. Included in the book is a tribute DVD of her Memorial Service at Arlington National Cemetery on April 16, 2012. Total pages: 768. Price: $59.50 (plus shipping/handling). Available at www.aana.com/bookstore. Order your copy today!        
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Nurse Anesthesia Annual Congress Photo Scrapbook Available Online

Reminisce or see what you missed by checking out the scrapbook from this year's Nurse Anesthesia Annual Congress.
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Award Winners Announced at Annual Banquet

Four CRNAs were honored for their outstanding contributions at the Nurse Anesthesia Annual Congress Annual Banquet, held September 1, in Salt Lake City. Read on to find out about the winners of the Agatha Hodgins Award for Outstanding Accomplishment, the Helen Lamb Outstanding Educator Award, The Alice Magaw Outstanding Clinical Practitioner Award, and the Ira P. Gunn Award for Outstanding Professional Advocacy.

Agatha Hodgins Award
To recognize Certified Registered Nurse Anesthetists who have furthered the art and science of nurse anesthesia, the Agatha Hodgins Award, the highest accolade given by the AANA, was established in the mid 1970s.

The 2015 Agatha Hodgins Award goes to Linda Williams, CRNA, JD. Williams currently enjoys a private anesthesia practice, delivering anesthesia in the office setting and ambulatory surgery centers. She is also an attorney, and works as a medical-legal consultant.
Throughout her career, as one chapter ended, another started, demonstrating her passion for nurse anesthesia. However, before she was CRNA, Williams served as a Captain in the United States Air Force Reserves, where she functioned as a flight nurse. A nationally sought after speaker for decades due to her exceptional delivery and knowledge, her expertise ranges from current clinical advances to legal issues faced by healthcare professionals in all aspects of practice.
Said to have influenced the frontlines of anesthesia, Williams was the first CRNA to be appointed to the West Virginia Board of Examiners for Registered Professional Nurses, a position she held for seven years. In addition, she served as the Assistant Program Director of the Mountain State Graduate School of Nurse Anesthesia, and was elected president of the Colorado Association of Nurse Anesthetists in 1986. And of course, Williams represented the profession nationally as the 1998-1999 president of the AANA. Williams' visionary spirit is motivated by the idea that our legacy must be to hand over a stronger profession to the next generation, just as Agatha did in her time. Linda coined the phrase so often repeated by CRNAs, “Students are 10 percent of our membership, but 100 percent of our future.”

Helen Lamb Outstanding Educator Award
The Helen Lamb Award was established in 1980 in memory of Helen Lamb Frost, an AANA founding member, past president, and nurse anesthesia educator. This award recognizes the commitment of an individual to the educational standards of nurse anesthesia.

The 2015 recipient of the award, Sass Elisha, CRNA, EdD, is the assistant director of the Kaiser Permanente School of Anesthesia in Pasadena, California. A CRNA for nearly 15 years, Elisha has already established quite a presence in the nurse anesthesia community. He is a national lecturer, author, researcher, excellent clinician, and nurse anesthesia program administrator. His pivotal role as Council Director for the Council on Accreditation of Nurse Anesthesia Programs complements his dynamic approach to education.

What makes professor Sass Elisha such an effective educator? His students say that he provides a learning environment that is cohesive to a variety of learning styles, because Elisha understands that not all students learn the same way. His methods provide his students the tools and resources to think critically within the clinical arena. By staying abreast of the latest trends in education, Elisha has inspired many of his colleagues to revise their instructional methods and follow his lead.
He has published peer-reviewed articles in the AANA Journal, written notable chapters in anesthesia textbooks, authored, “Case Studies in Nurse Anesthesia,” and co-authored, “Critical Events in Anesthesia: A Clinical Guide for Nurse Anesthetists."

Alice Magaw Award
The Alice Magaw Clinical Anesthesia Practitioner Award was established in 1986 to recognize the accomplishments of Certified Registered Nurse Anesthetists who are involved in direct patient care. The 2015 Alice Magaw Outstanding Clinical Anesthesia Practitioner Award goes to James Furstein, CRNA, DNAP, MSN. Furstein is the lead CRNA at Cincinnati Children’s Hospital Medical Center, and adjunct faculty at the University of Cincinnati Nurse Anesthesia Program.
Over the past 10 years, Furstein has made a tremendous impact in anesthesia care, specifically in the area of pain management, while balancing his roles as educator, clinical coordinator and clinician. He has mastered the art and science of pediatric anesthesia, and has become the resource person for ultrasound guided regional anesthesia for CRNAs and many anesthesiologists.

Carolyn Nicholson, the first-ever recipient of the Alice Magaw Award, wrote in her letter of nomination, “My former student Jamie has demonstrated his passion for ensuring that pediatric patients not only receive a safe anesthetic but also has improved recovery with his focus on regional anesthesia and multi modal pain management.”

Currently the principle investigator in several ongoing research projects, Furstein is pursuing a Post-Master’s Certificate as a Pediatric Acute Care Practitioner so that he may be part of the Pain Management Team that will be starting at his hospital in the future.

Ira P. Gunn Award
The Ira P. Gunn Award was established in 2000 to recognize Certified Registered Nurse Anesthetists or other persons who make significant contributions to promoting and/or protecting the legal, legislative, and regulatory practice rights of nurse anesthetists. The 2015 Ira P. Gunn Award is given to W. Keith Barnhill, CRNA, PhD, ARNP. Barnhill is the director at Pain Care Clinics in Manchester, Iowa. Described by colleagues as an expert practitioner, and researcher, he co-authored the AANA’s education modules for radiation safety, fluoroscopy and pain management techniques. This lead Barnhill to assist in the AANA and Hamline University’s development of the advanced pain management program, post-graduate certification in pain management.

In Iowa, Barnhill started several pain clinics that became extremely successful due to his treatment of patients with difficult pain conditions. This success made him a target for organized medicine and anesthesia competitors who filed lawsuits to stop him from practicing pain management. After years and several lawsuits later, most cases were dismissed. However, the final lawsuit went all the way to the Iowa Supreme Court.

The Iowa Association of Nurse Anesthetists and the Iowa Board of Nursing prevailed, which affirmed that professional nursing has the right to determine the practice of nursing, and not the medical profession. Because Barnhill won, all CRNAs around the country won, too.

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Exemplary Educators Honored at Annual Congress Opening Ceremonies
A major part of every Opening Ceremonies event is the honoring of outstanding contributors to the nurse anesthesia profession. Award recipients were recognized for their exemplary and significant impact on nurse anesthesia.

Program Director of the Year

The Program Director of the Year recognizes a CRNA who has made a significant impact on a nurse anesthesia educational program. The 2015 award was presented to Steve Alves, CRNA, PhD, FNAP. Alves is the program administrator for Northeastern University in Boston, Mass. A visionary leader, Steve led the expansion of the Northeastern program more than 10 years ago from a small program with one clinical site, to more than 20. He has designed the model that will be used to transition the program from a master’s, to a doctorate-level program. Alves shined a light on the contributions of military CRNAs by designing a doctorate curriculum model to accommodate nurse anesthesia students and faculty from the U.S. Army Program. He recognizes the link between curriculum and advocacy and, in 2014, led the legislative campaign that removed all supervision language from the Nurse Practice Act.

Didactic Instructor of the Year

The Didactic Instructor of the Year Award is presented to an individual who has made a significant contribution to the education of student registered nurse anesthetists in the classroom. The 2015 winner is Tomas Ceremuga, CRNA, PhD. Ceremuga is professor at the United States Army Graduate Program in Anesthesia Nursing Academy of Health Sciences in Fort Sam Houston, Texas. He has increased the visibility of the Army’s nurse anesthesia program among the national scientific community. In one academic year alone, he obtained and currently manages more than $500,000 in TriService Nursing Research Program grant funds. Annually, Ceremuga provides over 150 hours of simulation training, and teaches more than eight semester hours of doctoral-level courses. Although retired, Ceremuga has not forgotten his military background, which helps him to impart relevant academic and clinical information that helps his students to learn and function in the intense environment of civilian and combat operative healthcare.

Clinical Instructor of the Year

The Clinical Instructor of the Year Award is presented to an individual who has made a significant contribution to the teaching of student registered nurse anesthetists in the clinical area. The 2015 awardee is Charles Fisher, CRNA, BS. Described as legendary throughout the New York metropolitan area, Fisher was the chief CRNA at the internationally recognized Memorial Sloan-Kettering Cancer Center. During his tenure there he expanded the department from eight to more than 60 CRNAs. Fisher utilized his staff to provide students with more advanced airway techniques than their physician colleagues. As you can imagine, Sloan Kettering was one of the most requested clinical sites in Columbia University’s anesthesia program. Fisher is responsible for several generations of CRNAs who have defined their ever-expanding professional roles because of his own clinical excellence.
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AANA Foundation Award Winners Honored at the AANA 2015 Nurse Anesthesia Annual Congress

The 2015 AANA Foundation award winners were honored at the AANA Annual Congress held in Salt Lake City, Utah.

John F. Garde Researcher of the Year: Bonnie Molloy, CRNA, PhD
Molloy’s research on IOP during robotic laparoscopic surgery for postoperative vision loss has had a strong impact on safety in anesthesia. Her studies have been published in the AANA and other journals, and she has traveled to national and international venues to present her research.

Advocate of the Year: Russell Lynn, CRNA, APN, MSN (presented posthumously)
Lynn believed it was his job to keep the CRNA profession growing and strong. He encouraged his students to become actively engaged in the AANA and led by example. Lynn was a brilliant mind, an outstanding educator, a tireless contributor to the nurse anesthesia profession and impacted countless lives. He was proud of being a CRNA and said it was a “gift” to be an educator and mentor of those wishing to enter the profession that he loved so much.

Rita L. LeBlanc Philanthropist of the Year: Elizabeth “Betty” Abrams, CRNA, MS
Abrams has been volunteering her services to the Healing the Children (NJ) organization since 1997. She volunteers her time and expertise as a CRNA traveling to different countries providing much needed anesthesia services for children needing multiple types of surgeries. She has made 20 trips to countries and has touched the lives of thousands of children with her generosity and expert anesthesia skills.

Janice Drake CRNA Humanitarian Award: Mary Kay Thomas, CRNA, BS
Thomas is a dedicated volunteer who co-founded MIMA FOUNDATION, a non-profit, non-denominational volunteer organization that sends health care workers to the underserved and needy in developing countries. The MIMA philosophy is to provide medical care to indigent populations and underserved individuals who cannot otherwise access health care, and to share medical knowledge with local health care providers to insure continuity of care.

For a complete listing of AANA Foundation award recipients including fellowship and scholarship awardees, please view the AANA Foundation FY15 Annual Report by visiting www.aanafoundation.com.
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Congratulations to AANA Public Relations Recognition Award Winners

The 2015 Public Relations Recognition Awards were announced at the Nurse Anesthesia Annual Congress Opening Ceremonies, held on August 29, 2015. Now in its 35th year, the AANA Public Relations Recognition Award was established to recognize outstanding public relations efforts. Entries were judged by members of the AANA Public Relations Committee on the basis of their objectives, execution, and results. The 2015 winners are:
  • Best Overall Public Relations Effort for the Past Year, to be awarded to an individual, organization, or state association: Michigan Association of Nurse Anesthetists
  • Best Public Relations Effort by a Small State Association (as defined by the Ad Hoc State Organizational Development Committee): Maine Association of Nurse Anesthetists
  • Best Promotional Effort for National CRNA Week: New York State Association of Nurse Anesthetists
  • Best Use of "CRNAs: The Future of Anesthesia Care Today" campaign: Alabama Association of Nurse Anesthetists
  • Best Public Relations by an Individual, Small Group, Organization, or Company not Affiliated with a State Association: Memphis Student Nurse Anesthetist Foundation?
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AANA Marks 23rd Successful Year as Exhibitor at NCSL Summit

The AANA welcomed approximately 5,000 state legislators, legislative and executive agency staff, and representatives from trade and professional associations to its booth at the National Conference of State Legislatures (NCSL) Legislative Summit in Seattle, Wash., from Aug. 4-6. The 2015 meeting was an invaluable opportunity for local nurse anesthetists, student nurse anesthetists and AANA State Government Affairs staff to visit informally with legislators and their staff from all 50 states. An estimated 20 percent of all state legislators attend the NCSL’s Legislative Summit. The AANA exhibit booth was staffed by local CRNAs and student registered nurse anesthetists: Ashley Fedan, CRNA; Ken Plitt, CRNA; Melissa Hudson, CRNA; David Golembiowski, RN; and Christa Brown, RN. Sarah Chacko, JD, assistant director of State Government Affairs and Legal, also represented the AANA at the exhibit booth. The State Government Affairs Division would like to thank the Washington Association of Nurse Anesthetists for coordinating local volunteers and thank all of our local volunteers for making this a successful event.
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ISMP seeks input on Draft Guidelines for the Safe Electronic Communication of Medication Information

The Institute for Safe Medication Practices (ISMP) released new Draft Guidelines for the Safe Electronic Communication of Medication Information, which are posted for comments through Oct. 16, 2015. As electronic health records (EHRs), computerized prescriber order entry (CPOE) systems, electronic medication administration records (eMARs) and electronic prescribing (e-prescribing) systems become more widely accepted by health care providers, ISMP notes that if this information is not carefully considered, these forms of health information technology can contribute to — instead of mitigate the risk of — medication errors. ISMP has compiled these guidelines to identify potential confusion that is unique to electronic communication and covers issues that deal with how information about medications is communicated in electronic formats.
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AANA Staff and Their Families Volunteer to Help a Local Charity

AANA Park Ridge office opened its doors on a weekend to help a local charity, Compass to Care, package shoe laces to be sold during the month of September which is a Pediatric Cancer Awareness Month. Selling ‘gold’ shoe laces helps raise awareness about and funds for kids battling cancer. Compass to Care is a charity that helps kids who are battling cancer travel to receive treatment. With many employees brining their spouses and children, this was truly a family affair! For more information please visit www.compasstocare.org or http://compasstocare.org/replacethelace/
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Professional Practice

AHRQ Safety Primer Examines Impact of Patient Errors, Adverse Events on Clinicians

Involvement in medical errors and adverse events can take a significant toll on clinicians, with as many as half of all clinicians estimated to be involved in a serious adverse event at least once during their career, according to a new primer posted on AHRQ’s Patient Safety Network. The primer, “Support for Clinicians Involved in Errors and Adverse Events (Second Victims),” addresses clinician responses to their involvement in errors and adverse events while offering resources that can be put in place to respond to such events. When a medical error or patient harm occurs, the first priority is to attend to the patient and family members. However, damage from errors and adverse events can occur at three levels – patients, clinicians and health care organizations. The primer describes six stages of recovery for clinicians following an adverse event.
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CDC provides Ebola PPE Guidance Clarifications to Assist U.S. Healthcare Personnel

The Centers for Disease Control and Prevention (CDC) has clarified its guidance regarding personal protective equipment (PPE) for healthcare personnel caring for suspected and confirmed Ebola patients in U.S. healthcare facilities. Based on feedback from healthcare facilities that have implemented the current guidance (originally posted October 2014), the guidance clarifies the use of fluid-resistant and impermeable gowns and coveralls. Specifications are provided in the guidance to assist facilities in selecting and ordering the recommended garments. The updated CDC resources are linked below:
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The Role of a Human Factors Engineer

When a patient safety incident occurs, human factors experts can examine what went wrong and propose ways to prevent such an incident from re-occurring in the future. Erin Lawler, Human Factors Engineer in the Office of Quality and Patient Safety, Division of Healthcare Improvement for The Joint Commission discusses more in the podcast Take 5: The Role of a Human Factors Engineer.
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Meetings and Workshops

Register Now for AANA Fall Leadership Academy

Find out why past attendees rave about our Fall Leadership Academy conference. Join us Nov. 5-8 for three days of intense leadership training just for CRNAs. Learn to lead change and become an influencer with expert speakers and five educational tracks including Business and Facility Leadership, Federal Political Director, State Grassroots Advocacy, State President-Elect, and State Reimbursement Specialist. Pre-conference workshops also available. Register today and save more than 10 percent! Single-day registration also available. www.aana.com/leadership. www.aana.com/leadership
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Register Now for Popular Hands-On Workshops

Check out the Meetings and Workshops webpage on the AANA website and future issues of the AANA NewsBulletin and Anesthesia E-ssential for further information.
  • Essentials of Obstetric Analgesia/Anesthesia Workshop: October 21, 2015, Park Ridge, Ill. (Register here)
  • Jack Neary Advanced Pain Management Workshop Part II, October 10-11, 2015, Rosemont, Ill. (Register here)
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Foundation and Research

AANA Foundation Kicks Off FY16 Annual Campaign

The AANA Foundation officially kicked off FY16 and program and fundraising efforts are well underway. For a quick recap: Program application deadlines are as follows:
  • November 1, 2015 – Research Grants (General)
  • December 1, 2015 – Student Scholarship Donors
  • February 1, 2016 – Award Nominations; Post-Doctoral and Doctoral Fellowships; Palmer Carrier, CRNA Scholarship
  • March 1, 2016 – Student Scholarship Applications; Dean Hayden Student Research Scholarship
  • April 1, 2016 – “State of the Science” Oral Poster Presentation
  • May 1, 2016 – “State of the Science” General Poster Presentation; Research Grants (General)
  • June 15, 2016 – Friends for Life
  • Open Submission – Program Administrator’s Outstanding Student Researcher Award; Office Based Research Grant; Veterans Research Grant
Please be a part of our success and support nurse anesthesia research and education today! It’s easy to make your tax-deductible donation:
  • online at www.aanafoundation.com
  • mail to AANA Foundation at 222 S. Prospect Avenue, Park Ridge, IL 60068
  • call the Foundation at (847) 655-1170.
Thank you in advance for your continued support of our profession!
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Announcing the AANA Foundation 2015-2016 Board of Trustees

The AANA Foundation welcomes the Board of Trustees for the 2015-2016 year. Read on for a full list of this year's board members.

Wilma K. Gillis, CRNA, BSN, APNP

Monica G. Masemer, CRNA, MSN

Co-Vice Chair Professional Development
Ladan Eshkevari, CRNA, PhD, Lac

Co-Vice Chair Fundraising
Stephanie E. May, CRNA, DNAP

John A. Jelinek, BS

  • Ronald R. Castaldo, CRNA, MBA, MS, CCRN
  • Vicki C. Coopmans, CRNA, PhD
  • Charles A. Griffis, CRNA, PhD
  • Amy Langan, BA
  • Cheryl L. Nimmo, CRNA, DNP, MSHA
  • Sandra K. Tunajek, CRNA, DNP
  • Donna I. Vierthaler, CRNA, MHS
  • Wanda O. Wilson, CRNA, PhD, MSN
Student Representative
Kathryn A. Cowap, BSN

The Foundation would like to thank the following outgoing Board of Trustee members for sharing their time and expertise:
  • Todd W. Herzog, CRNA, BSNA, ARNP, Treasurer
  • Normalynn Garrett, CRNA, PhD, COL(R)
  • Juan F. Quintana, CRNA, DNP, MHS
  • Christopher Reed, CRNA, MSN, MPH, Student Representative

The AANA Foundation greatly appreciates their board participation, leadership, and insights and looks forward to continuing to work together in the future.
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Federal Government Affairs

AANA Advises CMS to Support Cost-Effective Models of Healthcare Delivery Such as CRNA Services

Supporting reimbursement of safe, high quality CRNA practice in every environment, the AANA advised the Centers for Medicare & Medicaid Services in an Aug. 19 regulatory comment letter that the agency should encourage the use of innovative cost-effective models in healthcare delivery such as anesthesia services provided by CRNAs. Writing in response to the Medicare Hospital Outpatient Prospective Payment (HOPPS) and Ambulatory Surgical Center Payment Systems CY 2016 proposed rule, the AANA stated that anesthesiologist medical direction reimbursement models contribute to increased healthcare system costs without improving access or quality, and also present fraud risk when medical direction requirements are not met by the anesthesiologist submitting a claim for such services.

In the letter signed by AANA President Sharon Pearce, CRNA, MSN, the AANA called for removal of the costly and unnecessary requirements relating to physician supervision of CRNA services as a method of regulatory reform that will support quality healthcare, reduce healthcare expenditures, and increase access for patients. In the Ambulatory Surgical Center Quality Reporting Program, the AANA supported the agency’s proposal to introduce a normothermia measure. This measure assesses the percentage of patients having surgical procedures under general or neuroaxial anesthesia of 60 minutes or more in duration who are normothermic (having normal body temperature) within 15 minutes of arrival in the post-anesthesia care unit, so long as the Ambulatory Surgery Center Quality Reporting (ASCQR) definition of normothermia is consistent with the other quality reporting programs. The AANA also requested the agency include CRNAs on the list of providers who may bill and be reimbursed by Medicare for chronic care management services. Medicare is slated to review the AANA’s comment alongside other public comments and render a final rule in October that takes effect January 2016.

Read the AANA comment letter here (requires AANA member login and password). Read the proposed rule here.
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AANA Supports Legislation for ICD-10 Coding Flexibility

With ICD-10 coding taking effect Oct. 1, 2015, the AANA expressed support on Aug. 26 for legislation that would give providers and group practices additional flexibility as they implement the new ICD-10 coding system.

Legislation introduced by Reps. Marsha Blackburn (R-TN) and Tom Price (R-GA), titled the “Coding Flexibility in Healthcare Act of 2015” (H.R. 3018), would grant a 90-day grace period where both ICD-9 and ICD-10 codes could be submitted for Medicare reimbursement. In a letter signed by AANA Immediate Past President Sharon Pearce, CRNA, MSN, the AANA stated, “Transition to ICD-10 coding requires planning and coordination to ensure smooth processing of claims and payments necessary to sustain healthcare practices and facilities and to ensure patient access to care. The grace period in H.R. 3018 gives CRNAs and other professional practices extra flexibility in transitioning to ICD-10.”

Without the passage of H.R. 3018, the Centers for Medicare & Medicaid Services (CMS) will require ICD-10 codes for processing claims beginning Oct.1, 2015, and will reject any claims without a valid ICD-10 code for dates of service after Sept. 30, 2015. CMS will not deny claims billed under Part B based solely on the specificity of the ICD-10 diagnosis code as long as the practitioner used a code from the right family, but the AANA has requested CMS provide additional flexibility to providers and group practices undergoing this transition. If your facility is currently finalizing the ICD-10 coding transition and could use additional resources, please see AANA materials on ICD-10 (AANA login and password required).

Read the AANA letter in support of H.R. 3018. (AANA login and password required.)
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AANA Warns Medicare Against Devaluing Anesthesia Codes Associated with Colorectal Cancer Screening

Medicare should not devalue anesthesia procedure CPT codes 00740 and 00810, the codes associated with colorectal cancer screenings, AANA stated in a comment letter submitted to the agency on Sept. 4 in response to its Physician Fee Schedule (PFS) CY 2016 proposed rule.

As stated in a letter signed by AANA President Juan Quintana, CRNA, DNP, MHS, “…the AANA has concerns about the agency’s proposal to include anesthesia procedure CPT codes 00740 and 00810 for the misvalued code list (p.41707). The AANA has an interest in improving patient outcomes by delivering colonoscopies safely, comfortably, and efficiently, and we caution the agency not to devalue these codes… Furthermore, as the AANA is excluded from the AMA Relative Value Update Committee (AMA-RUC) process, and initial input on these codes is so critical, we strongly urge that CMS convene CRNAs and other qualified professionals to develop a recommendation and examine the issue more closely. We stand ready to work with the agency and would be happy to answer any questions to help with this process.”

The 2016 Physician Fee Schedule Proposed Rule is a major rule, and the AANA comment letter made several additional recommendations, including to:
  • Request from Medicare the opportunity to examine data used for anesthesia malpractice (MP) relative value unit (RVU) update for anesthesia services.
  • Exclude moderate sedation from value of the procedure when separate anesthesia service is furnished, but recommend that surgeons be allowed to use a special modifier in certain circumstances. CMS seeks approaches to valuing certain procedures, such as endoscopic procedures, that would allow Medicare to pay accurately for moderate sedation when it is furnished while avoiding potential duplicative payments when separate anesthesia is furnished and billed.
  • Include CRNAs as practitioners who provide advance care planning.
  • Finalize a CMS proposal to include CRNAs among the list of telehealth providers, and to prohibit wasteful “tele-supervision” of CRNA services from being included among the list of telehealth services. Such anesthesiologist tele-supervision of CRNAs is not included in this proposed rule.
  • With respect to the CMS Physician Quality Reporting System (PQRS), support three new individual anesthesia-specific quality measures proposed for reporting in PQRS that have been vetted by the AANA. They are Perioperative Temperature Management; Post-Anesthetic Transfer of Care Measure: Use of Checklists or Protocol for Direct Transfer of Care from Procedure Room to Intensive Care Unit; and Prevention of Post-Operative Nausea and Vomiting (PONV)-Combination. CMS should exclude from PQRS two anesthesia-specific quality measures that have not been vetted by the AANA: Anesthesiology Smoking Abstinence; and Post-Anesthetic Transfer of Care Measure: Procedure Room to a Post-Anesthesia Care Unit (PACU). AANA also supports removal of Measure #193 as long as it is replaced with newly proposed AANA-vetted Perioperative Temperature Management Measure and provide clarification on how inclusion of new anesthesia-specific PQRS measures will affect the Measure Applicability Validation Process.
Read the AANA comment on the PFS proposed rule and the text of the PFS proposed rule.
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AANA and 16 Nursing Groups Request that CMS Involve APRNs in the Development of Alternative Payment Models and Promote Full Scope of Practice

The AANA along with 16 national nursing organizations requested the Centers for Medicare & Medicaid Services (CMS) involve CRNAs and other Advance Practice Registered Nurses (APRNs) in the development and vetting of alternative payment models (APM), according to a comment letter submitted to the agency on Sept. 8 in response to its Physician Fee Schedule CY 2016 proposed rule.

The coalition letter stated, “…in the development of alternative payment models and advisory groups we cannot stress enough the importance of including eligible professionals as defined in section 1848(k)(3)(B), other than physicians, in the APM vetting and decision making processes…Second, as we note that CMS references ‘physician-focused payment models,’ in the preamble regarding discussion on APMs, we remind the agency that models of care continue to shift towards community based practices, which APRNs often lead. Therefore, we request that CMS allow for provider-focused payment models led by APRNs and other types of eligible professionals. APRNs practicing to the full extent of their training, education, and licensure (consistent with state law) would be ideal leaders for these innovative models. Limiting APRNs’ ability to participate in these new reimbursement models will produce inefficiencies in care and potentially delay critical treatments to patients, especially those in rural areas with limited access to physicians.” Of interest to CRNAs, the letter also recommends that CMS establish modifiers on claims to identify incident-to billing and to acknowledge the licensure of the rendering provider.

Read the coalition letter on the PFS proposed rule (AANA member login and password required).
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AANA to Medicare: Direct Hospitals to Treat CRNAs, APRNs and Physicians Equally in the Comprehensive Care for Joint Replacement Payment Model

As Medicare considers implementing a new Comprehensive Care for Joint Replacement (CCJR) Payment Model, the AANA has requested that Medicare advise hospitals participating in this payment model to treat CRNAs and physicians the same, according to a letter AANA submitted to the agency on Sept. 4.

The letter, signed by AANA President Juan Quintana, CRNA, DNP, MHS, stated, “Every episode of care for hip and knee procedures involves the use of anesthesia services. Payment should recognize and account for the qualified healthcare professionals who delivered care to the patient, in part so that the healthcare professionals themselves can be held accountable.”

The AANA also asked that Medicare:
  • Ensure that anesthesia providers are included in the development of CCJR sharing arrangements in order to ensure equity and fairness.
  • Warn hospitals against payment policies and anesthesia delivery modalities that needlessly drive up healthcare costs without improving quality.
  • Include in the CCJR waiver list the elimination of unnecessary supervision requirements, and language encouraging safe and cost-efficient anesthesia delivery models.
  • Provide monitoring and safeguards to prevent denials for payment for medically necessary services provided by CRNAs under the CCJR.
  • Prohibit wasteful anesthesiologist “tele-supervision” of CRNA services under the CCJR.
Read the AANA comment on the CCJR proposed rule and the text of the proposed rule.
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Anesthesiologists Overbilled Pittsburgh VA Hospital, Says Inspector General Report

Contract anesthesiologists at the Veterans Affairs Pittsburgh Health System (VAPHS) billed for services they did not perform and oversaw the anesthesia service though they were contractors, according to an Aug. 7 report by the U.S. Department of Veterans Affairs Office of Inspector General (OIG). The OIG reported that wrongdoing was found within contracts valued at $5.4 million involving 4.575 contract anesthesiologists – about $1.2 million of contract value per anesthesiologist – over 32 months ending in August 2013. For CRNAs, the OIG report underscores the importance of ethical behavior in documenting patient care and an example of the types of wrongdoing that the OIG is investigating in the Veterans Health Administration (VHA).

According to the OIG report, a review of 20 random entries for invoiced anesthesiologist services found that “for two of the 20 entries there were more than seven unsupported hours for each entry. These are hours that exceeded the hours in the OR records after including an additional two hours for pre- and post-surgery time that the physician may have been in the VA.” The report also stated that the Pittsburgh VA “serves as Chief of Anesthesiology and Director of Pain Services at VAPHS, but is not a VAPHS employee. We note that VA does have anesthesiologists on staff but a UPP (University of Pittsburgh Physicians, Inc.) physician serves as VA’s Chief of Anesthesiology.”

The report also said that a CRNA helped shine the light on misappropriation in the anesthesiology department. “During our site visit, a VA Certified Registered Nurse Anesthetist (CRNA) stated that he had concerns with UPP anesthesiologists signing in hours prior to their being needed in surgery,” the report said. “He stated that these were transplant surgeries and that many times the exact start time of the surgery was unknown because they were dependent on the organ harvest preparation time. However, physicians were not required to wait at VAPHS, but were given the choice to go home and would be notified when they were needed. He also stated that UPP anesthesiologists remained signed in because it was inconvenient for them to go home and return. The 20 entries that we examined included instances where a physician had signed in many hours before the surgery began.”

Read the VA OIG report here. To submit a complaint to the VA OIG, see http://www.va.gov/oig/hotline/.
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Considering Running for Public Office? The AANA’s First Ever Campaign School Nov. 8-9 is for You

The AANA invites members interested in running for public office the opportunity to learn the ins and outs of elected government leadership and political campaigning at our first-ever CRNA Campaign School on Nov. 8-9, in Rosemont, Ill., immediately following the AANA 2015 Fall Leadership Academy.

There are 535 members of Congress and 7,382 state legislators – but no CRNA currently holds either office. Government policy shapes the practice and reimbursement of CRNAs, and there is no better way to advocate for your profession than being part of this process.

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.

Register for the AANA 2015 Fall Leadership Academy, Nov. 6-8, 2015, in Rosemont, Ill., here. If you’d like to learn more about the CRNA Campaign School, please email info@aanadc.com.
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Support Your CRNA-PAC; Become a Triple Crown Honoree this AANA Dues Season

When you pay your AANA member dues this summer, earn eligibility for AANA Triple Crown recognition and help build your profession’s future by also contributing to the AANA Foundation and to the CRNA-PAC.

At AANA meetings, Triple Crown members are recognized by a special Triple Crown ribbon. You will also be enrolled in a separate recognition program for the CRNA-PAC and the AANA Foundation. The Triple Crown signifies your commitment to three crucial aspects to the nurse anesthesia profession: (1) membership in the national association, (2) enrollment in the Foundation in support of research and scholarships, and (3) participation in the CRNA-PAC, which helps elect and re-elect CRNA-friendly members of the U.S House and Senate who help shape CRNA reimbursement and practice.

A joint initiative of the AANA, CRNA-PAC, and AANA Foundation, Triple Crown recognition for 2016 is available for those members who have also given $250 to the CRNA-PAC and $250 to the AANA Foundation, in a given AANA fiscal year.

To renew your membership, click here and support the CRNA-PAC www.crna-pac.com (requires AANA member login and password). Give to the AANA Foundation http://www.aana.com/aanaaffiliates/aanafoundation/Pages/default.aspx.
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Thanks to CRNAs and Student Registered Nurse Anesthetists for Participating in AANA Annual Congress

Thanks to thousands of CRNAs and student registered nurse anesthetists who participated in the AANA Annual Congress in Salt Lake City!

During the AANA Annual Congress:
  • CRNAs and SRNAs took action in support of CRNAs and APRNs practicing to their full practice authority in the VHA through a new action site, www.Veterans-Access-To-Care.com and encouraged their friends, family, and coworkers to do the same;
  • AANA President Sharon Pearce, CRNA, MSN, was recognized in a speech entered into the Congressional Record by Rep. Richard Hudson (R-NC) and presented at the Annual Banquet. President Pearce resides in Rep. Hudson’s 8th Congressional District;
  • Federal Political Directors (FPDs) met from around the country to discuss current issues and political trends as well as discuss the upcoming FPD education program at the AANA Fall Leadership Academy this November. State Reimbursement Specialists (SRS) also met to network and get the latest news about reimbursement issues impacting CRNA practice as well as also make plans for the AANA Fall Leadership Academy SRS track;
  • The AANA welcomed incoming President Juan Quintana, CRNA, DNP, MHS, as well as all new members of the AANA Board of Directors and AANA Committees.

    Ralph Kohl, Kate Fry, and Frank Purcell from the AANA Washington, D.C., office educated members about federal advocacy at the AANA Annual Congress meeting in Salt Lake City.

    SRSs and FPDs are invited to register today for the AANA 2015 Fall Leadership Academy, Nov. 6-8, 2015, in Rosemont, IL, at http://www.aana.com/meetings/aanaworkshops/Pages/Fall-Leadership-Academy.aspx.
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The House and Senate have returned to Washington from the summer recess and Labor Day holiday spent in their districts. Congress has a full September agenda: Time is running out to pass spending bills before the end of the fiscal year, Sept. 30. If Congress fails to pass a continuing resolution or its spending bills, Uncle Sam will shut down Oct. 1 until an agreement is reached. 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 at info@aanadc.com. To see when Congress is in Washington or at home, go to House schedule, Senate schedule.
  • America’s largest business association will host AANA President Juan Quintana, CRNA, MHS, DNP, slated to speak at the U.S. Chamber of Commerce’s 4th Annual Health Care Summit in Washington, D.C., Oct. 20. This year’s topic is “Optimizing the Next Generation of Health Care,” where panelists will discuss the role of economics in healthcare, how transparency can drive healthcare innovation, as well as many others. See a full list of speakers and topics here.
  • Republicans will conduct their second 2016 presidential primary candidate debate on Wednesday, Sept. 16, on CNN. The Democratic National Committee has announced six debates which will begin in October, with the first debate occurring on Oct. 13. 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.
  • 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 (requires AANA member login and password).
  • Engage with your profession’s social media feed on Facebook at https://www.facebook.com/AmericanAssociationofNurseAnesthetists and Twitter at https://twitter.com/aanawebupdates.
  • Keep up with the AANA’s new efforts for educating hospital administrators, healthcare policymakers and other health industry leaders about the role and value of CRNA care at http://www.future-of-anesthesia-care-today.com.
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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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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.

Why FDA Approved OxyContin for Kids as Young as 11

The Food and Drug Administration (FDA) last month approved oxycodone hydrochloride (OxyContin—Purdue Pharma) for children as young as 11 years who need "daily, round-the-clock, long-term" pain relief that cannot be treated adequately with other medications. The decision was welcomed by some pediatricians and pain specialists, but also provoked fierce criticism. FDA, in its defense, says the approval was not intended to expand the use opioids in children, but rather to give clinicians better guidelines about how to use oxycodone hydrochloride safely in pediatric patients. Prior to the approval, the agency asked Purdue to perform studies evaluating the safety and effectiveness of the drug in pediatric patients. Officials said the results supported the use of the drug in limited situations—such as in­trac­table pain that could not be treated effectively with less powerful painkillers. "We understand there is a terrible problem with opioid abuse and addiction," said Janet Woodcock, director of FDA's Center for Drug Evaluation and Research. "But this is about evidence-based medicine for children—seriously ill children who are suffering pain."

From "Why FDA Approved OxyContin for Kids as Young as 11"
Washington Post (09/10/15) P. A3 Dennis, Brady

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AKI Risk Lower With Propofol for ICU Sedation

Brazilian researchers spearheaded a study that identified propofol as safer than midazolam in terms of sedating critically ill patients on mechanical ventilators. The team analyzed data from an estimated 1,400 ICU patients, approximately half of whom were sedated using one method and half using the other. The propofol group experienced a much lower rate of mortality, acute kidney injury (AKI), and oliguria than those who received midazolam. Additionally, patients in the propofol cohort required renal replacement therapy less frequently and were prescribed diuretics less often than their counterparts who were sedated with midazolam. The study is published in the Clinical Journal of the American Society of Nephrology.

From "AKI Risk Lower With Propofol for ICU Sedation"
Renal and Urology News (09/09/15) Charnow, Jody A.

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Medicare Coverage of Anesthesia Services During Screening Colonoscopies for Patients at Low Risk of Sedation-Related Complications

A recent study investigated the costs and potential benefits of a 2014 Centers for Medicare & Medicaid Services decision to waive patient cost-sharing for anesthesia services during screening colonoscopies. Researchers quantified the costs based on published articles on the volume of screening colonoscopy, rate of anesthesia use, proportion of services performed in low-risk patients, and average costs per anesthesia service. Compared with a scenario without the rule change, the incremental cost to Medicare would be $5.5 million per year based on the 2013 rate of anesthesia use of 50 percent, or $16.7 million if the rate increases to 70 percent. About two-thirds of the incremental costs to Medicare would be for low-risk patients. According to the authors, the findings raise questions about the value of Medicare coverage of anesthesia services during screening colonoscopies for patients at low risk of sedation-related complications. The researchers suggest that one possible solution is for payers to create payment bundles for endoscopy procedures that include anesthesia services in a fixed fee, so that physicians who perform endoscopic procedures would have incentives to use these services only when medically necessary.

From "Medicare Coverage of Anesthesia Services During Screening Colonoscopies for Patients at Low Risk of Sedation-Related Complications"
JAMA Internal Medicine (09/08/15) Liu, Hangsheng; Mattke, Soeren; Predmore, Zachary Scott

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Anesthetics: Children's Teeth Development Affected by Anesthesia

Dental anesthesia practices overseas may affect tooth development in pediatric patients in China, the United Kingdom, and Switzerland, according to new research. The study was conducted using pig teeth as well as pulp cells from the permanent teeth of young humans. The results, published in Cell Death Discovery, indicated that being exposed to higher concentrations of local anesthetics for a prolonged period of time appears to have a negative impact on the function of mitochondria in the tooth cell. Upon additional investigation, lead author Bing Hu, MD, of Plymouth University, believes clinical guidelines will eventually evolve based on the findings. "We accept that we need to carry out further clinical studies and we do not wish for our findings to alarm parents unnecessarily," he said, "but we do expect, in time, to improve clinical guidelines through our research to minimize the dosage of local anesthetic drugs."

From "Anesthetics: Children's Teeth Development Affected by Anesthesia"
Science World Report (09/07/15)

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Infant Exposure to Anesthesia Linked With Changes in Emotional Behavior

Each year, an estimated 1 million children younger than age four years have surgical procedures requiring general anesthesia; but new research adds to speculation that early exposure to anesthetics may have a negative cognitive effect. Investigators from Atlanta and New York City teamed up for the study, which evaluated the socioemotional behavior of infant monkeys repeatedly exposed to anesthetic. Mimicking the approach used to gauge anxiety and behavioral disposition in human children, the team used an unknown human as a mild stressor to assess the primates' socioemotional state. Test subjects exposed to anesthetic at seven days, two weeks, and four weeks after birth displayed significantly more anxious behaviors, which lingered for at least five months, compared with healthy control monkeys. Although the monkeys were exposed to anesthetic, they never actually underwent a surgery—an important aspect of the experiment, according to New York researcher and study author Mark Baxter. "The major strength of this study is its ability to separate anesthesia exposure from surgical procedures, which is a potential complication in the studies conducted in children," explained Baxter, an anesthesiology and neuroscience professor. Previous studies of humans have suggested a potential link between learning disabilities and multiple exposures to anesthesia during infancy. The new research, published in Anesthesiology, will continue in an effort to determine how long the anxious behavior lasts and whether it eventually dissipates.

From "Infant Exposure to Anesthesia Linked With Changes in Emotional Behavior"
Medical News Today (09/04/15) McIntosh, James

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CDC Funding Helps States Combat Prescription Drug Overdose Epidemic

The Centers for Disease Control and Prevention (CDC) has awarded 16 states a total of $20 million to help combat prescription drug overdoses. The funding will be used for CDC's new Prescription Drug Overdose: Prevention for States program. The program, part of the Health and Human Services Department's Opioid Initiative, will give states the resources and expertise they need to help prevent overdose deaths related to prescription drugs. The 16 states were selected through a competitive application process. HHS Secretary Sylvia M. Burwell said, "With this funding, states can improve their ability to track the problem, work with insurers to help providers make informed prescribing decisions, and take action to combat this epidemic." CDC will give the states annual awards of up to $1 million over the next four years for prevention efforts including enhancing prescription drug monitoring programs; putting prevention into action in communities nationwide and encouraging education of providers and patients about the risk of prescription drug overdose; working with health systems, insurers, and professional providers to help them make informed decisions about prescribing pain medication; and responding to new and emerging drug overdose issues through innovative projects.

From "CDC Funding Helps States Combat Prescription Drug Overdose Epidemic"
CDC News Release (09/04/15)

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Study in Mice Suggests How Anesthesia May Fight Lung Infections

There is growing proof that inhaled anesthetics, already heralded for their performance during surgery, may also play a key role in fending off lung infections. A team of researchers assembled from Johns Hopkins, the University of Buffalo, and elsewhere is the latest to suggest that volatile anesthetics pump up the antibacterial immune response, allowing the body to fight off pneumonia and the flu. Reporting in the September issue of Anesthesiology, they said that giving mice halothane or another volatile anesthetic after exposing them to viral and bacterial infections lowered bacterial load and lung injury. In addition, mice that received halothane were markedly less likely to suffer impaired gait, labored breathing, lethargy, and weight loss. That finding appears to be in line with earlier research showing that children with upper viral respiratory tract infections had fewer and shorter-lasting respiratory side effects from minor surgery if they received halothane during the procedure than if they did not. "Our study is giving us more information about how volatile anesthetics work with respect to the immune system," said Krishnan Chakravarthy, MD, PhD, of Johns Hopkins. "Given that these drugs are the most common anesthetics used in the operating room, there is a serious need to understand how they work and how we can use their immune effects to our advantage."

From "Study in Mice Suggests How Anesthesia May Fight Lung Infections"
Newswise (09/01/15)

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Lower-Back Work Injury Claimants Treated With Opioids Stay Off Work Longer, Study Finds

Employees unable to work because of pain in the low back are more likely to remain on disability if they receive opioid therapy, Canadian researchers report. The team from McMasters University performed an analysis of more than 1,400 claims, discovering a correlation between reimbursement for early painkillers and longer claim duration. Lead researcher Jason Busse called the finding "worrisome" but theorized that study participants who received opioids may have been in more pain—which explains why they received the drugs in the first place—and suggested that may be the reason for the delay in settling claims. "On the other hand," said Busse, an assistant anesthesia professor, "adverse effects of opioids on mental and physical function could be the reason. Definitive research studies—ideally randomized trials—need to sort this out." The findings are published in BMJ Open.

From "Lower-Back Work Injury Claimants Treated With Opioids Stay Off Work Longer, Study Finds"
Medical Xpress (08/28/15)

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Research Reveals Why Older Adults Who Undergo General Anesthesia Experience Postoperative Delirium

According to Rowan University researchers, administering less-potent and slower-acting anesthetics could reduce the risk of postoperative delirium in older surgery patients. Based on animal studies using sevoflurane and isoflurane, the team discovered that both agents disrupt the blood-brain barrier which, in turn, causes vascular leaking. "Our research shows that when the blood-brain barrier breaks down, various plasma components, such as immunoglobulin, gain access into the brain and selectively bind to pyramidal neurons," explained lead author Nimish Acharya, PhD. "This may disrupt normal neuronal activity and could cause the onset [of] the symptoms that define postoperative delirium." While the phenomenon occurred with both types of anesthetic tested, the level of disruption created by fast-acting sevoflurane in older animals was "dramatic and significant," according to the report. No age-related disparity was observed, however, in the density or extent of vascular leaks in older animals treated with isoflurane. "Extrapolating this data to humans suggests that older patients who will be exposed to inhaled anesthetics during surgery would benefit from a less potent anesthetic that would presumably pose less risk of blood-brain barrier compromise and minimize the risk of subsequent postoperative delirium," according to study author Robert Nagele, PhD.

From "Research Reveals Why Older Adults Who Undergo General Anesthesia Experience Postoperative Delirium"
News-Medical (08/26/15)

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Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis

In light of increasing use of epidural corticosteroid injections, researchers reviewed evidence on their benefits and harms in adults with radicular low back pain or spinal stenosis. Investigators examined randomized trials of epidural corticosteroid injections compared with placebo interventions, or trials that compared epidural injection techniques, corticosteroids, or doses. The analysis included 30 placebo-controlled trials that evaluated epidural corticosteroid injections for radiculopathy and eight trials that were conducted for spinal stenosis. For radiculopathy, epidural corticosteroids were associated with greater immediate-term reduction in pain, function, and short-term surgery risk. The effects, however, were below clinically important difference thresholds, and there were no longer-term benefits. According to the authors, "Limited evidence suggested no effectiveness for spinal stenosis."

From "Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis"
Annals of Internal Medicine (08/25/15) Chou, Roger; Hashimoto, Robin; Friedly, Janna; et al.

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Development of a Computerized Monitoring Program to Identify Narcotic Diversion in a Pediatric Anesthesia Practice

An operational reporting dashboard was developed to correlate data to help detect potential drug diversion by automated dispensing cabinet (ADC) users. The "narcotic reconciliation dashboard" links information from a hospital's pharmacy information management system (PIMS) and anesthesia information management system (AIMS) in an associative data model, and can generate reports to find outlier activity associated with ADC dispensing of controlled substances and medication waste processing. The dashboard was evaluated by back-testing the program with historical data on an episode of diversion by an anesthesia provider that had not been detected through traditional PIMS and AIMS data monitoring. Dashboard-generated reports on key metrics, such as ADC transaction counts and PIMS–AIMS documentation mismatches, clearly indicated the diverter's outlier status relative to other authorized ADC users. Researchers concluded that such a dashboard program that correlates ADC transaction data with pharmacy and patient care data may effectively help detect patterns of ADC use that suggest drug diversion.

From "Development of a Computerized Monitoring Program to Identify Narcotic Diversion in a Pediatric Anesthesia Practice"
American Journal of Health-System Pharmacy (08/15/15) Vol. 72, No. 16, P. 1365 Brenn, B. Randall; Kim, Margaret A.; Hilmas, Elora

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Health Care-Associated Infections: More Work, More Recognition Still Needed

Despite progress, healthcare-associated infections (HCAIs) persist in the United States, where an estimated one in 25 patients each day develops complications such as a surgical site infection or hospital-acquired Clostridium difficile. In an effort to understand the role that anesthesia providers play, recent studies have tackled the issue. In one, more than 800 anesthesia providers responded to a poll—which determined that most of them recognize the risk to patient safety posed by poor hand hygiene but also acknowledge that there is room for improved compliance. The results found that nearly 82 percent of survey participants were not fully familiar with the World Health Organization's "5 Moments for Hand Hygiene," which outlines ways that clinicians can sanitize before touching a patient or performing an aseptic procedure and after touching a patient, touching a patient's surroundings, or being exposed to bodily fluids. Meanwhile, a series of investigations conducted jointly by Dartmouth-Hitchcock Medical Center, University of Iowa Hospitals and Clinics, and the University of Massachusetts Memorial Medical Center explored transmission of three common causes of HCAIs. The findings indicated that 86 percent of cases of enterococcus originated from the hands of anesthesia providers. "The two additional studies we published ... also demonstrated the need for better decontamination of environmental sites and patient skin sites, which are significant reservoirs of Staphyloccus and gram-negative organisms," wrote Sundara Reddy, MBBS, FRCA, a University of Iowa anesthesiology professor who was involved in the research.

From "Health Care-Associated Infections: More Work, More Recognition Still Needed"
Anesthesiology News (08/01/15) Vol. 41, No. 8 Wild, David

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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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