AANA Anesthesia E-ssential
AANA Anesthesia E-ssential
When it comes to intubation, tools matter

Vital Signs

Name Your AANA Member Community–Win a Free #AANA2016 Registration!

Coming soon! Enjoy the latest AANA Member benefit that allows you to network with your peers like never before. Get the support of your professional community, meet CRNAs from across the country, and share best practices in a secure and private environment. We just have one question: What should we name it?

Enter up to five suggestions for naming the new private community. If your entry is selected, you’ll get a free 2016 AANA Annual Congress registration! Enter now! (Member login and password required.)       
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CPC Facts

When Will You Enter the CPC Program?

Your initial year of certification will determine when you enter the Continued Professional Certification (CPC) Program. If you were initially certified in even years, you will start the CPC Program on August 1, 2016. If you were initially certified in odd years, you will start on August 1, 2017. Please note that the recertification cycle is changing from the current two-year cycle to a four-year cycle with the CPC program. A special note for students: It is your year of certification, and not your year of graduation, that determines when you enter the CPC Program. If you are initially certified in 2015, you will complete a two-year recertification cycle with 40 CE credits and then enter in the CPC Program in 2017. If you are initially certified in 2016, you will start the CPC Program in 2016. 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

President Quintana Nominated for Place on Dr. Oz Team of Core Experts

On September 21, the Dr. Oz television program announced an initiative to find a nurse to join Dr. Oz’s team of core experts, which currently does not have a nurse expert. The initiative arose after the social media backlash to offensive comments about the nursing profession made by two co-hosts on The View.

Using the hashtag #NurseSearch, anyone from the general public can nominate a nurse they feel is worthy of the position in 150 words or less. A movement quickly formed to nominate AANA President Juan Quintana, CRNA, DNP, MHS, as a candidate.

President Quintana has now been accepted into Round 2 of the search process, and the show has asked for further video nominations from his supporters, and a video statement from Quintana himself. The videos are beginning to take shape and be sent to the program, and at press time, AANA is awaiting news of the results.

As a member of the Dr. Oz team, Quintana would have a larger forum to which he could expound on issues facing the nursing profession at large and nurse anesthesia in particular. Nominations are still being taken. For further information, see http://www.doctoroz.com/page/nominate-your-favorite-nurse-nursesearch                        

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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, please visit
. (Member login and password required.)
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New 2015 PQRS Guide and Infographic

There are fewer than 100 days left in the 2015 PQRS reporting period! The AANA Quality and Research Division has developed two new tools to help CRNAs avoid the 2017 PQRS penalty: 1) 2015 PQRS Guide for CRNAs—5 Things You Should Know and 2) 2015 PQRS Checklist for CRNAs Infographic. These new tools along with other resource materials and educational webinars can be accessed on the “Quality-Reimbursement” resource page of the www.aana.com website.
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IOM Report Explores Diagnostic Error; Makes Many Recommendations for Improvement

The National Academy of Medicine (formerly the Institute of Medicine) has released a new report, titled Improving Diagnosis in Health Care, describing that available evidence suggests that most Americans will experience a missed or delayed diagnosis in their lifetime. The committee makes several recommendations to improve diagnosis, including promoting teamwork among interdisciplinary healthcare teams, enhancing patient engagement in the diagnostic process, implementing large-scale error reporting systems with feedback and corrective action, and improving health information technology. Longer-term recommendations include establishing a work system and safety culture that foster timely and accurate diagnosis, improving the medical liability system to foster learning from missed or delayed diagnoses, reforming the payment system to support better diagnosis, and increasing funding for research in diagnostic safety. The report emphasizes the need for much more effort, and far more resources, at the practice, policy, and research levels to address this pressing safety problem.
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Your Membership Matters

Support your profession, your state and national associations, and fellow CRNAs around the country. Renew your membership for September 2015. It’s not too late! www.aana.com/renewal
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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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New Member Spotlight Story Posted

A new story has been posted in the Member Spotlight section about Anita Lesko, CRNA, MS. Lesko, at the age of 50, received a diagnosis of Asperger syndrome. That knowledge changed her life, and she made it her mission to inform other people with Asperger’s, as well as parents of children with the condition, that people can live normal lives with it. To read the story, click here.
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2015 CRNA Compensation and Benefits Report

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

The Anesthesia Patient Safety Foundation (APSF) is soliciting applications for training grants to develop the next generation of patient safety scientists. APSF will fund one ($150,000 over two years) Safety Scientist Career Development Award (SSCDA) to the sponsoring institution of a highly promising new safety scientist. The award will be scheduled for funding to begin July 1, 2016. Please contact Stoelting@apsf.org to request the SSCDA Grant Guidelines and Application.
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Professional Practice

AHRQ Releases New Patient Safety Primer on High-Reliability Organizations

Organizations that operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures are known as high-reliability organizations. The concept of high reliability is attractive in health care due to the complexity of operations and the risk of significant and even potentially catastrophic consequences when failures occur. A new Patient Safety Primer on High Reliability, posted on AHRQ’s Patient Safety Network, takes a deeper look into what makes a high-reliability organization. The primer provides a detailed overview of the different characteristics that make up high-reliability organizations. For example, such organizations use systems engineering techniques to evaluate and design for safety but are keenly aware that safety is an emergent, rather than a static, property. Another example is that high-reliability organizations work to create an environment in which potential problems are anticipated, detected early, and virtually always responded to quickly enough to prevent catastrophic consequences.
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Complimentary Webinar: Safe Reduction of Primary Cesarean Births Bundle

Join the Council on Patient Safety in Women’s Health Care for the next Safety Action Series webinar, titled Safe Reduction of Primary Cesarean Births Bundle on October 14 at 1 pm ET. The session will: (1) provide an in-depth overview of the Safe Reduction of Primary Cesarean Births Bundle, (2) take a look at the processes, methods, and tools that were used to develop the bundle; (3) give suggestions for how to effectively implement and utilize the bundle within your organization; and (4) identify resources to customize for use within your organization. More information and registration are available HERE.
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The Joint Commission Releases Sentinel Event Statistics Through Second Quarter 2015

The Joint Commission updated its sentinel event statistics through the second quarter of 2015. Data from the 9,119 incidents reviewed from 2004 through the second quarter of 2015 show that a total of 9,384 patients have been affected by these events, with 5,383 (57.4 percent) resulting in the patient’s death, 847 (9.0 percent) resulting in permanent loss of function, and 2,778 (29.6 percent) resulting in unexpected additional care and/or psychological impact. View sentinel event statistics on the Joint Commission’s Sentinel Event webpage.
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State Government Affairs

State Advising Sessions Held During Annual Congress

Staff from the AANA’s State Government Affairs and State Management Affairs divisions met with state leaders at the 2015 Nurse Anesthesia Annual Congress. Leaders from 20 state nurse anesthetist associations took advantage of these advising sessions this year. The sessions focused on government relations issues (e.g. relationship with lobbyist or legal counsel, legislative or regulatory) and infrastructure issues (e.g. relationship with association management, financial management, governance).
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Meetings and Workshops

Fall Leadership Academy, November 6-8

As a CRNA, you have the clinical training and the hands-on experience that makes you a confident practitioner. How confident are you in leading change or being an influencer? The Fall Leadership Academy is the AANA conference that develops your leadership abilities through hands-on skills building. Featuring 30 expert speakers and five educational tracks, this conference is for all stages of your career. Single day registration and post-conference workshops are available. Register by Oct. 6 to save! 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 Research Grants Application Deadline: November 1

Research Grants for FY2016 are due November 1, 2015 and/or May 1, 2016. Applications are available on the AANA Foundation website at www.aanafoundation.com. Contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
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Donate to the AANA Foundation’s FY16 Annual Giving Campaign

Join thousands of other CRNAs who support the AANA Foundation by making a tax-deductible donation to the FY16 Annual Giving Campaign today. Your support is critical to advancing the nurse anesthesia profession and will be focused on
  • National research projects
  • Scholarships, fellowships and grants
  • Doctoral education
  • “State of the Science” research poster presentations
Donations to the AANA Foundation can be made in the following ways:
  1. FY2016 AANA Dues Statement – include your gift on the form mailed to you from AANA
  2. AANA Membership Renewal online – include your gift when renewing your membership online by visiting www.aana.com and accessing your renewal form through the Member Login section
  3. AANA Foundation Website – make a gift by visiting www.aanafoundation.com
  4. AANA Foundation via Mail – send your gift to AANA Foundation, 222 S. Prospect Avenue, Park Ridge, IL 60068
  5. AANA Foundation via Phone – call (847) 655-1170 and Foundation staff will be happy to assist you
All donations of $100+ will be recognized in the AANA Foundation Annual Report, at the AANA Annual Congress in Washington, D.C., at AANA assemblies, and on the AANA Foundation 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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Annual Congress Thank You!

The 2015 AANA Nurse Anesthesia Annual Congress was a huge success for the AANA Foundation. Thank you to all CRNAs and SRNAs who
  • made a donation to the AANA Foundation in support of nurse anesthesia research and education
  • volunteered their time and energy to make this a great meeting
  • attended or sponsored our fundraising event, One Night – Twice the Fun
  • stopped by the Foundation booth to say hello or ask a question
  • presented or visited our “State of the Science” general and oral poster presentations
  • donated and/or bid on our Art on Canvas and silent auction items

Thank you from the AANA Foundation staff!


AANA Foundation Staff – Bonnie Lowth, Dr. Lorraine Jordan, Nat Carmichael, and Luanne Irvin

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Federal Government Affairs

VHA Independent Assessment Recommends Implementing APRN Full Practice Authority Policy

A major independent assessment of the Veterans Health Administration (VHA) issued in September recommends that the VHA recognize nurses to their Full Practice Authority in order to improve care for the nation’s Veterans. The assessment, ordered by Congress as part of the Veterans Access, Choice and Accountability Act and conducted by the RAND Corporation, is being reviewed by the House Veterans Affairs Committee at a hearing on Oct. 7 – and is a significant new impetus for the VHA to publish an APRN Full Practice Authority rule now.

Within the VHA healthcare system assessment’s section on increasing productivity within existing resources, the first recommendation is to “formally grant Full Practice Authority for all advanced practice nurses (APNs) (that is, nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives) across VA, superseding individual state laws governing scope of practice where applicable.” The report states, “Allowing full nursing practice authority is often raised as a key approach to addressing physician workforce shortages and access problems in non-VA contexts….” Referencing both the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health and current AANA backed legislation (HR 1247, the “Improving Veterans Access to Care Act”) the report says that allowing APRNs to practice as Full Practice Providers may favorably improve Veterans access to care and produce cost savings for the VA.

Underscoring one significant reason for AANA and CRNAs to continue engaging their own legislators on this issue, the report also says that the proposal “could face strong political resistance from physician advocates within and outside the VA,” adding that “physician reluctance to accept the role of nonphysician practitioners remains a persistent cultural barrier that will require sustained and intensive attention by VA leadership and beyond to overcome.” It adds, “Physician organizations often state that substituting APNs for physicians may put patients at risk for poorer outcomes despite a lack of evidence to support this claim.”

To read the healthcare portion of the VHA independent assessment, see:
(the APRN Full Practice Authority proposal begins on p. 266 of the document). To support Veterans access to quality care by backing Full Practice Authority for CRNAs and other APRNs, see www.Veterans-Access-To-Care.com and urge your Veteran colleagues and friends to do the same.

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Medicare Issues Request for Information on Implementation of Payment Reforms

On September 28, the Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) on implementation of Merit-based Incentive Payment Systems (MIPS) and promotion of Alternative Payment Models, which is part of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. As CRNAs are eligible professionals under these programs, the AANA is reviewing the RFI and preparing comments in time for the October 30 public comment period deadline.

Your comments to AANA are welcome via email to info@aanadc.com; please use the term “MACRA RFI” in the subject line. Read a preview of the request for information at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-24906.pdf. The link expires on Oct. 1 when the request is published in the Federal Register.

Learn more at

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Congress to Take Up Funding Measure to Avoid Government Shutdown

Congress is moving a short-term spending measure to keep the government funded and open through December 11, then send the “continuing resolution” (CR) to the House where it is expected to pass and be sent to the President for his signature into law. Meanwhile, three House committees the week of Sept. 28 are proposing to repeal several parts of the Affordable Care Act (ACA) through a “budget reconciliation” legislative. The ACA provisions on the chopping block include the individual and employer mandate, the so-called Cadillac tax on health coverage, and the Independent Payment Advisory Board. In the unlikely event the provisions repealing the ACA pass Congress and reach the President’s desk, President Obama is certain to veto them. The Center for Medicare & Medicaid Services has also announced that it will transition to the ICD-10 coding system as scheduled on Oct. 1. If you or your facility needs additional resources on the transition to ICD-10, see AANA materials here.
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Update on AANA’s Efforts to Ensure Veterans Access to Quality Care

The AANA and its members continue to advocate for legislation and a Veterans Health Administration (VHA) proposal that would authorize all advanced practice registered nurses (APRNs), including CRNAs, to practice as Full Practice Providers in the VHA and help improve access to quality healthcare for all Veterans. Here is a status update:
  • The AANA is supporting legislation in the House, H.R. 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). The bill has 37 bipartisan cosponsors. The AANA encourages members whose U.S. Representative has cosponsored this legislation to send a thank you note here. Please continue to contact your U.S. Representative and encourage co-sponsorship of this bill here. View the AANA and APRN Workgroup letter of support here and also view the Nursing Community letter here
  • The AANA continues to strongly support the VHA’s efforts to recognize CRNAs and other APRNs to their Full Practice Authority, consistent with the recommendations of the Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health.” The VHA says that it intends to publish a regulatory rulemaking later this year recognizing CRNAs and other APRNs as Full Practice Partners in the VHA, and inviting the public to comment.
  • More CRNAs are encouraging their colleagues, friends and family to take action by writing their member of Congress and the VA Secretary through the Veterans Access to Quality Healthcare Alliance microsite.
  • Have you seen Letters to the Editor from Veterans published in newspapers recently? They appear in the Tallahassee Democrat (FL) by a respected Veteran and grassroots leader in the Tallahassee area who is a member of the Stand Up for Seniors Coalition and Vice President of Citizens for Florida Prosperity; and in the Tinley Park Patch (IL) by State Sen. Michael Hastings, a member of the Senate Veterans Affairs Committee and a former Army Captain. Additional letters were published in the Columbus Dispatch, the Palm Beach Post, and the Chicago Tribune.
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Limitations on Pain Care Reimbursement Proposed by Novitas Medicare Administrative Contractor; AANA Responding

On September 17, the Novitas Medicare Administrative Contractor (MAC) issued two draft local coverage determinations (LCD) affecting coverage of CRNA pain management services in 11 states and the District of Columbia where Novitas administers the Medicare program. The AANA is reviewing the proposals and preparing a response to protect patient access to care provided by CRNAs. Novitas’ draft LCDs affect Medicare coverage in the following states: Pennsylvania, New Jersey, Maryland, Delaware, Washington D.C. (Jurisdiction L), Colorado, Oklahoma, New Mexico, Texas, Arkansas, Louisiana, and Mississippi (Jurisdiction H).

The AANA is preparing comments to the draft LCDs involving facet joint injections and nerve blockade for treatment of chronic pain and neuropathy. Both include language relating to provider qualifications that is being evaluated for possible impact on CRNAs, and that is different from language issued by other MACs. Comments to Novitas are due on Nov. 5. Members with any questions or comments regarding these LCDs are invited to contact AANA DC at info@aanadc.com and include the words “Novitas LCD” in the subject line.

To read the two LCDs, see: - Facet Joint Injections and 
Nerve Blockade for Treatment of Chronic Pain and Neuropathy (DL35033)        

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HRSA Announces Funding Opportunities for CRNA Educational Programs

For accredited CRNA educational programs, the following are funding announcements to consider:
  • HRSA is accepting applications for Nurse Anesthetist Traineeships (NAT) now through November 20, 2015. HRSA plans to award 80 grants totaling $2.55 million to accredited nurse anesthesia programs. The NATs are meant for qualifying accredited programs to provide financial assistance to SRNAs to help cover their tuition, books, and other school related expenses. For more information, see http://www.grants.gov/web/grants/view-opportunity.html?oppId
  • HRSA has released the FY 2016 funding announcement for the Nursing Workforce Diversity (NWD) program. The purpose of the program is to increase educational opportunities in nursing for students from disadvantaged backgrounds. Applications for the NWD programs are due November 16, 2015. Accredited schools of nursing, nursing centers, academic health centers, and state or local governments are eligible to apply. HRSA plans to award 12 grants totaling $4 million with a program start date of July 1, 2016. For more information and details on a technical assistance webinar, see
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Considering Running for Public Office? The AANA’s First Ever Campaign School Nov. 6-8 is for You

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.

There are 535 members of Congress and 7,382 state legislators, but no CRNA currently holds 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.

For more information on the inaugural AANA Campaign School and to register, see: http://www.aana.com/meetings/aanaworkshops/Pages/AANA-Campaign-School.aspx.

Register for the AANA 2015 Fall Leadership Academy, Nov. 6-8, 2015, in Rosemont, Ill., at http://www.aana.com/meetings/aanaworkshops/Pages/Fall-Leadership-Academy.aspx. If you’d like to learn more about the CRNA Campaign School, please email info@aanadc.com.

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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, November 6-8, 2015, in Rosemont, Ill., and to plan on joining us for an exciting evening titled “CRNAs Celebrate Chicago” to benefit the CRNA-PAC.

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

For SRSs, a special educational track devoted to reimbursement issues and professional network development will focus on Medicare, Medicaid and commercial health plans, and strategies for monitoring and effectively advocating for appropriate coverage of CRNA services. If you’re not an FPD or SRS but may become one in the future, or if you are interested in getting more involved in federal issues, advocacy and reimbursement policy, you are invited to join, too! During the Fall Leadership Academy, the CRNA-PAC’s “CRNAs Celebrate Chicago” event will take place Sat., Nov. 7, from 6:30-9:00 pm, at the Westin O’Hare in Rosemont, Ill. Come celebrate all that Chicago has to offer and network with your AANA member colleagues! All the proceeds benefit the CRNA-PAC, the one PAC in America that focuses entirely on strengthening the nurse anesthesia profession’s voice in Washington.

Register for the CRNA-PAC event here: http://aptify.aana.com/aptify/meetings/newmeetingregistratio

Register today for the AANA 2015 Fall Leadership Academy, Nov. 6-8, 2015, in Rosemont, Ill., at

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U.S. House Speaker John Boehner to Step Down Oct. 30

On September 25, House Speaker John Boehner (R-OH) announced that he plans to retire from Congress at the end of October, setting off leadership election contests among the House Republican majority and throwing into some question the orderly completion of congressional budget business over the end of this year – budget work that is already overdue for completion. As of September 29, Majority Leader Kevin McCarthy (R-CA) is a leading candidate to succeed Speaker Boehner. If Rep. McCarthy is elected Speaker, he will vacate his Majority Leader post, which may be contested by Majority Whip Steve Scalise (R-LA) and House Budget Committee Chair Tom Price MD (R-GA). House Republican leadership elections have not been scheduled. The AANA and CRNAs have relationships with all of these legislators.      

Maricel Isidro-Reighard, CRNA, MSNA, DNAP, of Bakersfield, Calif., who has served as Federal Political Director for the California Association of Nurse Anesthetists, has worked to build an effective professional CRNA relationship with her hometown member of Congress, Rep. Kevin McCarthy (R-CA, pictured left), a candidate to succeed Rep. John Boehner (R-OH) as Speaker of the House of Representatives.

The remaining fiscal and policy deadlines due in 2015 including fiscal 2016 appropriations for the year beginning Oct. 1, an increase in Uncle Sam’s statutory debt ceiling, and reversing the expiration of highway funding and tax provisions.        

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Federal Laws Limit CRNA-PAC Fundraising on Social Media

With more AANA members than ever professionally active on social media, now is a good time to provide a reminder that there are unique federal laws that restrict how the CRNA-PAC can be referenced on Facebook, Twitter and other social media platforms. Because the Federal Election Commission (FEC) restricts the CRNA-PAC from soliciting donations from anyone other than AANA members, staff and their immediate households, social media that reaches worldwide is a problematic platform for some PAC messages. Unfortunately, if the FEC rules on this topic are broken, the CRNA-PAC may be subject to penalties and fines. So to keep AANA members and our CRNA-PAC in the clear, below is some guidance for mentioning the CRNA-PAC on platforms visible to others outside the AANA. Any posting or comment stating historical, factual or statistical information about the CRNA-PAC is acceptable to post on social media. But postings, or member comments on postings, that state anything similar to “Give to CRNA-PAC,” are prohibited. So what is ok and not ok in your social media postings?
  • OK: “The CRNA-PAC contributed to 350 candidates.” It’s historical, factual and statistical.
  • OK: Videos urging support of the CRNA-PAC that are housed behind a member login and password.
  • OK: A fun picture of an AANA member at a CRNA-PAC event, so long as there is not a solicitation in the message or the picture.
  • Not OK: “The CRNA-PAC strengthens our voice in Washington.” While it is the reason CRNAs contribute to CRNA-PAC, the FEC considers this type of comment a kind of solicitation for funds.
  • Not OK: Videos urging support of the CRNA-PAC that nonmembers can see.
  • Not OK: “Give to CRNA-PAC!”
  • A good alternative: “For members to learn more about CRNA-PAC, click www.crna-pac.com and enter your login and password.” This language is factual and keeps all solicitations solely to AANA members.

When one is giving a presentation at a national and state meeting of AANA members, it is ok to urge financial support for the CRNA-PAC, since the audience is almost entirely AANA members, staff and their immediate households. This is also true for AANA or state association newsletters. Please make sure that any spoken or written encouragements to members to give to the CRNA-PAC also include our official legal disclaimer:

“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.” If you see any postings that you think are questionable or if you have any questions about what is appropriate to post, please contact Frank Purcell, Senior Director Federal Government Affairs at fpurcell@aanadc.com or Associate Director Political Affairs Kate Fry kfry@aanadc.com.        

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The House and Senate are in session this week and are working to avoid a government shutdown. If you saw your legislators or their staffs at home, let us know how your visits went by logging your visit on the CRNA-PAC website at https://www.crna-pac.com/legisreport.aspx (AANA login required) and sending us pictures to info@aanadc.com. To see when Congress is in Washington or at home, go to House schedule, Senate schedule.
  • A House Judiciary subcommittee received testimony on Sept. 29 from Aetna, Anthem, American Medical Association, the Heritage Foundation, the American Hospital Association, and others on an examination of healthcare competition in the wake of recent health insurance mergers. For more information on the hearing, see: http://judiciary.house.gov/index.cfm/hearings?ID=020363B9-F9EF-4623-8E67-28A0B260675A.
  • While the switch to the ICD-10 coding system is taking place on time Oct. 1, Congress is monitoring the transition and so is the AANA, which is backing legislation to ease the switch. To learn more, see an AANA compilation of CRNA-focused ICD-10 materials here: http://www.aana.com/resources2/professionalpractice/Pages/ICD-10-Transition.aspx. The New York Times covered the issue Sept. 14 in an article here: http://www.nytimes.com/2015/09/14/us/politics/one-symptom-in-new-medical-codes-doctor-anxiety.html?_r=0. And AANA supported legislation, H.R. 3018, which eases the transition to ICD-10, can be read here: http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150818%20FINAL%20AANA%20Support%20for%20HR%203018%20Code%20Flex.pdf
  • (member login and password required).
  • Congressman Ed Whitfield (R-KY) announced Tues., Sept 29 he plans to retire from Congress and not run for reelection in 2016. Rep. Whitfield, a senior member of the Medicare-writing House Energy & Commerce Committee, has had a long professional relationship with Kentucky CRNAs and the AANA.
  • President Obama on Sept. 16 nominated Dr. Robert Califf to be the next commissioner of the Food and Drug Administration. Dr. Califf has served as the agency's deputy commissioner for medical products and tobacco since January 2015. If confirmed, Dr. Califf would succeed Acting Commissioner Stephen Ostroff who replaced Commissioner Margaret Hamburg after she stepped down in March. Learn more about Dr. Califf at http://www.dddmag.com/news/2015/09/obama-nominates-fdas-no-2-official-lead-agency.
  • Health Affairs. “Black and Hispanic adults have long experienced higher uninsurance rates than white adults,” states the study abstract. “Under the Affordable Care Act, differences in uninsurance rates have narrowed for both black and Hispanic adults compared to their white counterparts, but Hispanics continue to face large gaps in coverage.” To read the study, see: http://content.healthaffairs.org/lookup/doi/10.1377/hlthaff.2015.0757.
  • 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 at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150413%20AANA%20Issue%20Briefs%20Regarding%20Reimbursement%203d%20ED%20FINAL.pdf (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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    Certified Registered Nurse Anesthetist (CRNA) – U.S. Army Nurse Corps

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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.

    Neosaxitoxin Provides Long-Lasting Anesthesia With Minimal Adverse Events

    New research has confirmed that subcutaneous injections of neosaxitoxin (NeoSTX) with bupivacaine achieve long-lasting anesthesia with no serious adverse outcomes. The discovery, reported in Anesthesiology, is significant because amino ester and amino amide local anesthetics currently provide analgesia for only about eight to 12 hours following subcutaneous infiltration or single-shot peripheral nerve block. The randomized study involving 84 healthy males compared outcomes from active sites treated with NeoSTX plus a saline solution, NeoSTX in conjunction with bupivacaine, or a saline placebo only with outcomes from controls who received just bupivacaine. The results indicated no serious adverse events or clinically significant physiologic impairments—although the bupivacaine did cause some perioral numbness and tingling, which was resolved without intervention. NeoSTX with bupivacaine prolonged cutaneous block duration, at all doses, compared to bupivacaine alone, NeoSTX with saline, or placebo. In the second part of the trial, active sites were exposed to either NeoSTX with bupivacaine and epinephrine, which is known to decelerate drug uptake from the injection site, or placebo. When bupivacaine and epinephrine were combined with the sodium channel blocker, sensory block lasted even longer and perioral tingling and numbness was reduced; but recovery time was markedly longer. "These results are consistent with previous animal studies that showed that neuromuscular, respiratory, and cardiovascular effects of NeoSTX were mild and dose dependent using the dose range anticipated for clinical use."

    From "Neosaxitoxin Provides Long-Lasting Anesthesia With Minimal Adverse Events"
    MD Magazine (09/25/2015) Schu, Bill

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    Pain Overlooked in Premature Infants

    In the largest study of its kind, encompassing 6,700 premature infants born in Europe, researchers estimated that slightly more than half were never evaluated for pain and 20 percent never received any type of pain relief. "Proper pain assessment is the basis for a good treatment," remarked Orebro University researcher Mats Eriksson, who participated in the study with colleagues from across the continent. "By checking the baby's facial expressions, heart rate and breathing, the amount of analgesic needed can be estimated." Routinely administering pain relief or sedating infants as a precaution, meanwhile, is a risky solution since excessive analgesia or pain relief at the wrong time could compromise their still-developing brain and nervous systems. A good balance between analgesia and sedatives, as well as alternative methods such as a sucrose solution, promise to deflect future problems—including enhanced sensitivity to pain or development of ADHD. The findings are published in The Lancet Respiratory Medicine.

    From "Pain Overlooked in Premature Infants"
    Medical Xpress (09/24/15)

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    New Research Examines Complications Related to Labor Anesthesia in Women With Thrombocytopenia

    Anesthesia providers routinely administer epidural or spinal analgesia to women in labor; however, they must carefully weigh the risk of complications when a mother-to-be suffers from thrombocytopenia. Low platelet count affects 7 percent to 10 percent of pregnancies, and the threat of abnormal blood clotting can create some reluctance to perform neuraxial anesthesia on these patients. Researchers at Medical University of South Carolina followed 280 women in labor with platelet counts of less than 100,000 per square millimeter. None of the 62 percent who received an epidural despite their condition experienced spinal epidural hematoma, the most-dreaded adverse outcome. The data was then combined with cases from previous studies to further refine the risk estimate, which ultimately was narrowed down to a rate of zero to 0.6 percent. That compares to a 6.5 percent rate of complication associated with pregnant women who undergo general anesthesia for C-section. While relatively low in comparison, the risk to women whose platelet counts fall below the range of 75,000 to 80,000 per square millimeter is still a concern. Writing in Anesthesia & Analgesia, the researchers commented, "Remaining uncertainties at lower platelet counts make a national 'low platelet' registry critical to a more accurate assessment of the risk of epidural hematoma and would aid in standardization of anesthesia practices."

    From "New Research Examines Complications Related to Labor Anesthesia in Women With Thrombocytopenia"
    News-Medical (09/24/15)

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    Oxycodone for Cancer Pain in Adult Patients

    U.K. researchers attempted to determine whether oxycodone is associated with greater efficacy and fewer adverse effects compared with alternative analgesics for adult patients with cancer pain. Their JAMA Clinical Evidence Synopsis looked at a Cochrane literature review that included nearly 1,400 patients. No significant differences in pain scores were found between controlled-release (CR) and immediate-release (IR) oxycodone, or between CR oxycodone and CR morphine. There were only minor or insignificant differences in adverse event rates, treatment acceptability, or quality of life ratings. Noting the "low-quality evidence," the researchers concluded that oxycodone is not associated with better adult cancer pain relief, compared with other potent analgesics such as morphine, and they said more research is needed.

    From "Oxycodone for Cancer Pain in Adult Patients"
    Journal of the American Medical Association (09/22/15) Vol. 314, No. 12, P. 1282 Schmidt-Hansen, Mia; Bennett, Michael I.; Hilgart, Jennifer

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    Tramadol: Drug Safety Communication - FDA Evaluating Risks of Using in Children Aged 17 and Younger

    The Food and Drug Administration (FDA) reports that it is looking into the "rare but serious" risk of slowed or difficult breathing in children aged 17 years and younger who were treated with tramadol. The agency suggested that the "risk may be increased in children treated with tramadol for pain after surgery to remove their tonsils and/or adenoids." The opioid analgesic is not approved for use in children, but data suggest it is being used off-label among children. According to FDA, "Health care professionals should be aware of this and consider prescribing alternative FDA-approved pain medicines for children." As an example, FDA cited the case of a five-year-old in France who was hospitalized due to severely slowed and difficult breathing after taking a single prescribed dose of tramadol oral solution after adenotonsillectomy. The child was later determined to be an ultra-rapid metabolizer and had increased levels of the active form of the opioid, O-desmethyltramadol, in his body.

    From "Tramadol: Drug Safety Communication - FDA Evaluating Risks of Using in Children Aged 17 and Younger"
    FDA MedWatch (09/21/15)

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    Many Babies in Clinical Trials Experience Unnecessary Pain

    A large majority of newborns enrolled as controls in clinical trials involving minor painful procedures like heel pricks and vein punctures do not receive any analgesia, researchers report. The finding followed a review of 46 studies that were completed during a two-and-a-half-year period ended this past June. No pain relief was administered to infants in the control groups for 32 of those 46 studies, for a rate of 70 percent. The practice defies international standards that dictate babies should not be subjected to unnecessary pain. "The progress of neonatal analgesia accounted for this behavior," remarked Dr. Carlo Bellieni, lead author of the Acta Paediatrica review. "Now is the moment for a reflection: even minor procedures can induce pain, and every avoidable pain is unjust." To discourage this treatment of infants going forward, the researchers are pressing ethical committees to turn down clinical trials that needlessly cause babies pain and urging medical journals not to publish those that do.

    From "Many Babies in Clinical Trials Experience Unnecessary Pain"
    EurekAlert (09/21/15)

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    Immersive Program Shown to Help Reduce Pain, Opioid Use

    An intensive biopsychosocial chronic pain and recovery program could significantly reduce pain and opiate use, researchers reported at the American Academy of Pain Management 2015 Annual Meeting. The residential program, which has been in operation in Connecticut for about 3.5 years, aims to engage patients with chronic pain in a variety of therapeutic activities for up to 12–14 hours a day. The activities work on improving self-management skills, to reduce pain and increase function, with an overall goal of reducing dependence on medication and boosting quality of life. "We have found that 63 percent of our chronic pain patients who come in on opiates are leaving without opiates and with a 25 percent reduction in pain," said lead author Bruce Singer, director of the Chronic Pain and Recovery Center at Silver Hill Hospital in New Canaan. The recovery center teamed up with the Yale University School of Medicine and the Geisel School of Medicine at Dartmouth College to evaluate the program and found significant declines in average pain level, interference with of pain with enjoyment and activities, anxiety, depression, and opioid use.

    From "Immersive Program Shown to Help Reduce Pain, Opioid Use"
    Medscape (09/21/15) Melville, Nancy A.

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    Buccal Fentanyl May Be Valid Option During Placement of Indwelling Central Venous Access Port

    While local anesthesia provides some pain relief during the placement of implantable central venous access systems in cancer patients, researchers wanted to identify an alternative that would completely eliminate pain associated with this procedure. They recruited 65 patients needing an indwelling vascular access port and administered a fentanyl buccal tablet to each 10 minutes before preparation of the operating field. The overwhelming majority underwent the procedure with little to no pain, with none of the test population experiencing very severe pain. While the results suggest fentanyl buccal tablets may be a good procedural analgesia option for cancer patients, nausea and vomiting were flagged as a potential issue—especially as these side effects worsened four hours postoperatively. "It will be necessary to perform future studies, taking into account the need for standard antiemetic premedication to [minimize] the incidence of nausea and vomiting," the study authors wrote online in Supportive Care in Cancer.

    From "Buccal Fentanyl May Be Valid Option During Placement of Indwelling Central Venous Access Port"
    Oncology Nurse Advisor (09/16/15)

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    Racial Gap in Management of Pediatric Appendicitis Pain

    New research finds that while pediatric patients of all ethnic backgrounds are often under treated in emergency departments (EDs) for pain from appendicitis, minorities are even more likely not to receive appropriate analgesic care. According to the investigators, who analyzed data from nearly 1 million children diagnosed with the condition during ED visits, just 20.7 percent of black kids received opioids to alleviate severe pain compared with 43.1 percent of white kids. Even after factoring in confounders—including pain score, insurance status, and age—white children still were more likely to undergo opioid management than black children, at 33.9 percent compared to 12.2 percent. "Black children had one-fifth the odds of receiving opioid analgesia than white children, even after adjustment for potential confounders," the investigators wrote online in JAMA Pediatrics this month. "Our findings suggest that there are racial disparities in opioid administration to children with appendicitis ... More research is needed to understand why such disparities exist."

    From "Racial Gap in Management of Pediatric Appendicitis Pain"
    Medscape (09/16/15) Parry, Nicola M.

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    Draft CDC Guideline for Prescribing Opioids for Chronic Pain

    The Centers for Disease Control and Prevention (CDC) unveiled on Sept. 16 new draft guidelines for the prescription of opioids for chronic pain. The guidelines aim to provide recommendations for the prescribing of opioid analgesics for adults in primary care settings. Clinical practices addressed in the guidelines include determining when to start or continue opioids for chronic pain outside of end-of-life care; opioid selection, dosage, duration, follow-up, and discontinuation; and assessing the risk and harms of opioid use. CDC noted that more than 250 million prescriptions for opioid pain relievers were issued in 2012. In addition, although prescription opioid sales have increased 300 percent since 1999, there has not been an overall increase in the amount of pain reported. Statistics also show that nearly 2 million individuals aged 12 years and older abused or were dependent on opioid analgesics in 2013.

    From "Draft CDC Guideline for Prescribing Opioids for Chronic Pain"
    Centers for Disease Control and Prevention (09/16/15)

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    Mortality Risk of Opioid Substitution Therapy With Methadone vs. Buprenorphine

    Researchers looked to determine whether buprenorphine treatment has a lower mortality risk than methadone treatment for people with opioid dependence. They conducted a retrospective cohort study of patients with opioid dependency in New South Wales, Australia. Then, they compared all-cause mortality rates and drug-related overdose mortality at treatment induction, after in-treatment medication switches, and following treatment cessation. Patients who initiated with buprenorphine had lower all-cause mortality and drug-related rates during the first four weeks compared with those who initiated with methadone. Drug-related mortality risk did not differ for the rest of the treatment period. Four weeks after treatment cessation, all-cause mortality did not differ, but methadone patients experienced lower drug-related mortality. Patients who switched from buprenorphine to methadone during treatment achieved lower mortality in the first four weeks compared with patients who received methadone only. Beyond the first four weeks after any switch, no differences were noted. According to the researchers, in the initial weeks of opioid substitution therapy, buprenorphine reduced mortality risk, but little difference was noted beyond that period.

    From "Mortality Risk of Opioid Substitution Therapy With Methadone vs. Buprenorphine"
    The Lancet Psychiatry (09/15/15) Kimber, Jo; Larney, Sarah; Hickman, Matthew

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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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