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Certified Registered Nurse Anesthetist

M J Harris, R A Gabriel, R P Dutton, R D Urman
INTRODUCTION: Accurately predicting cesarean delivery case duration is an integral component of designing appropriate workflow protocols and ensuring adequate provider availability. Our primary objective was to describe the variability of case duration, based on factors that we hypothesized would be influential, such as hospital facility type, United States region, time of day, case volume, and patient and provider characteristics. METHODS: We analyzed hospital-, patient-, and provider-level variables from the National Anesthesia Clinical Outcomes Registry, a voluntary registry created to share anesthesia-related data and outcomes...
January 13, 2018: International Journal of Obstetric Anesthesia
N'Diris Barry, Joshua C Uffman, Dmitry Tumin, Joseph D Tobias
OBJECTIVES: Neuromuscular blocking agents (NMBAs) are administered to facilitate endotracheal intubation and provide skeletal muscle relaxation in surgical procedures. Sugammadex (Bridion) recently received approval by the United States Food and Drug Administration for reversal of rocuronium and vecuronium-induced neuromuscular blockade thereby providing an alternative to acetylcholinesterase inhibitors such as neostigmine. This quality improvement analysis sought to investigate the clinical reasons and common clinical perceptions for choosing sugammadex over neostigmine to reverse NMBAs...
January 2018: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Juan Duchesne, Chad Majoue, Marquinn Duke, Rosemarie Robledo, Chad Achord, Leslie McHale, Brandy Davis, Lusine Nahapetyan
A Trauma Certified Registered Nurse Anesthetists Team (TCT) was created and trained to provide trauma-focused anesthesia and resuscitation. The purpose of this study was to examine patient outcomes after implementation of TCT. We conducted retrospective analyses of trauma patients managed with surgical intervention from March to December 2015. During the first five months, patients managed before the development of TCT were grouped No-TCT, patients managed after were grouped TCT. To assess outcomes, we used hospital and intensive care unit length of stay, ventilator days, and a validated 10-point intraoperative Apgar score (IOAS)...
January 1, 2018: American Surgeon
Michael C Grant, Andrew Hanna, Andrew Benson, Deborah Hobson, Christopher L Wu, Christina T Yuan, Michael Rosen, Elizabeth C Wick
INTRODUCTION: To determine if the establishment of a dedicated operating room team leads to improved process measure compliance and clinical outcomes in an Enhanced Recovery After Surgery (ERAS). ERAS programs involve the application of bundled best-practices to improve value of the perioperative care. Successful implementation and sustainment of ERAS programs has been linked to compliance with protocol elements. METHODS: Development of dedicated teams of anesthesia providers was a component of the ERAS implementation...
December 21, 2017: Journal of the American College of Surgeons
Scott Feyereisen, Joseph P Broschak, Beth Goodrick
We further our understanding of jurisdictional disputes between established professional groups through a 10-year longitudinal analysis of the differential adoption by U.S. states of policies expanding Certified Registered Nurse Anesthetists' (CRNAs) autonomy. In the United States, CRNAs are trained to deliver anesthetics to patients in the same way as physician anesthesiologists but have more restrictions in practice. Following a 2001 federal decision regarding Medicare reimbursement, states were permitted but not required to allow CRNAs to practice without physician supervision, potentially reducing health care costs...
January 1, 2017: Medical Care Research and Review: MCRR
Milo Engoren, Lauryn R Rochlen, Matthew V Diehl, Sarah S Sherman, Elizabeth Jewell, Mary Golinski, Paul Begeman, John M Cavanaugh
BACKGROUND: While most Direct laryngoscopy leads to dental injury in 25-39% of cases. Dental injury occurs when the forces and impacts applied to the teeth exceed the ability of the structures to dissipate energy and stress. The purpose of this study was to measure strain, (which is the change produced in the length of the tooth by a force applied to the tooth) strain rate, and strain-time integral to the maxillary incisors and determine if they varied by experience, type of blade, or use of an alcohol protective pad (APP)...
November 7, 2017: BMC Anesthesiology
Mary Scott-Herring, Sarabdeep Singh
Little evidence exists to support the effects of a preceptor-mentor program for orienting newly hired certified registered nurse anesthetists (CRNAs). The literature suggests that participation in a preceptorship-mentorship program will increase the satisfaction, confidence, and comfort of both preceptors and newly hired orientees. The purpose of this project was to determine the effects of these outcomes. This program was developed based on best evidence and implemented as a quality improvement project. Three sessions were held to educate preceptors (N = 12) in the following areas: communication skills, providing constructive feedback, and assessing learner's styles and needs...
October 1, 2017: Journal of Continuing Education in Nursing
Donald Boyd, Lusine Poghosyan
BACKGROUND AND PURPOSE: No tool exists measuring certified registered nurse anesthetist (CRNA) organizational climate. The study's purpose is to adapt a validated tool to measure CRNA organizational climate. METHODS: Content validity of the Certified Registered Nurse Anesthetist Organizational Climate Questionnaire (CRNA-OCQ) was established. Pilot testing was conducted to determine internal reliability consistency of the subscales. RESULTS: Experts rated the tool as content valid...
August 1, 2017: Journal of Nursing Measurement
Heather Schoonover
PURPOSE: The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007...
May 2017: Clinical Nurse Specialist CNS
Gregory M Bruno, Mary Elizabeth Betsy Guimond
PURPOSE: The goal of this project was to improve the process of transferring patient information between certified registered nurse anesthetists and postanesthesia care unit registered nurses using an evidence-based handoff checklist and evaluate completeness and accuracy of transferred information. DESIGN: A convenience sample of 14 certified registered nurse anesthetists and 7 registered nurses working at a single regional health system was recruited. METHODS: The Handoff Accuracy Scoring Tool was developed to include a pre-/postinterventional design to compare scores of verbal handoffs conducted in the preintervention phase without checklist (n = 20) and postintervention phase with checklist (n = 20)...
April 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Desiree Hensel, Rachel Cooper, Neil Craney
The purpose of this project was to explore what attitudes physicians, nurses, and operating room technicians had about working with Certified Registered Nurse Anesthetists (CRNAs) to better understand practice barriers and facilitators. This Q methodology study used a purposive sample of operating room personnel from four institutions in the Midwestern United States. Participants completed a -4 to +4 rank-ordering of their level of agreement with 34 attitude statements representing a wide range of beliefs about nurse anesthetists...
December 1, 2016: Western Journal of Nursing Research
Donald E Beissel
STUDY QUESTION: What is the complication rate for Certified Registered Nurse Anesthetists (CRNAs) performing fluoroscopic guided lumbar epidural steroid injections (LESIs)? METHODS: CRNA pain practitioners responded to questionnaires regarding their education level, experience, and practice locations. Participants also collected data on number of fluoroscopic guided LESIs performed and each of 20 complications for a 6-month period, and answered a poll regarding satisfaction with the data collection process...
November 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
Sherine F Hanna, Marianne Mikat-Stevens, James Loo, Raj Uppal, W Scott Jellish, Matthew Adams
STUDY OBJECTIVE: To compare the use of LMA Fastrach intubating laryngeal mask airway (ILMA) to flexible bronchoscopy (FB) for awake intubation in patients with difficult airways. DESIGN: Randomized prospective study. SETTING: Large academic medical center. PATIENTS: Forty adult patients, American Society of Anesthesiologists I-IV, meeting the criteria for awake intubation based on history and physical examination. INTERVENTIONS: After sedation and airway topicalization, patients were randomized to either FB group, n=19, or ILMA group, n=21...
February 2017: Journal of Clinical Anesthesia
Dalia Sofer
But certified registered nurse anesthetists are excluded.
March 2017: American Journal of Nursing
(no author information available yet)
The Department of Veterans Affairs (VA) is amending its medical regulations to permit full practice authority of three roles of VA advanced practice registered nurses (APRN) when they are acting within the scope of their VA employment. Certified Registered Nurse Anesthetists (CRNA) will not be included in VA's full practice authority under this final rule, but comment is requested on whether there are access issues or other unconsidered circumstances that might warrant their inclusion in a future rulemaking...
December 14, 2016: Federal Register
Amanda C Faircloth
Palliative care teams require multidisciplinary support. While this is an emerging area in anesthesia practice, there are many avenues for certified registered nurse anesthetists (CRNAs) to share their unrivaled clinical knowledge. CRNAs may become involved with or consult on palliative sedation, medical management, interventional pain management, terminal wean/extubation, and organ donation. Additionally, CRNAs need to understand the unique needs of this patient population so that they can appropriately care for palliative care patients presenting to the operating room for palliative surgery...
January 2017: Annual Review of Nursing Research
Susan P McMullan, Charlotte Thomas-Hawkins, Maria R Shirey
Certified registered nurse anesthetists (CRNAs) provide more than 40 million anesthetics each year in the United States. This article describes a study that investigates relationships among CRNA organizational structures (CRNA practice models, work setting, workload, level of education, work experience), CRNA ratings of patient safety culture, and CRNA adverse anesthesia-related event (ARE) reporting. This is a cross-sectional survey study of 336 CRNAs randomly selected from American Association of Nurse Anesthetists database...
January 2017: Nursing Administration Quarterly
Linda Stone, Diana Quinlan, Julie A Rice, Elizabeth Laura Wright
The American Association of Nurse Anesthetists has a long history of providing peer support for its members with substance use disorder (SUD). The American Association of Nurse Anesthetists' Peer Assistance Advisors Committee (PAAC) is a group of certified registered nurse anesthetist volunteers who strive to promote the awareness of SUD through education and research and provide support to certified registered nurse anesthetists and students with this disease. During the committee's 33-year history, educational outreach to nurse anesthesia educational programs and anesthesia workplaces has expanded, the peer support network has been strengthened, resources and guidelines have been developed, and research related to SUD has been conducted in an effort to accomplish these goals...
July 2016: Journal of Addictions Nursing
Jessica Mayeux, Kathy Alwon, Shawn Collins, Ian Hewer
Blood loss during surgical procedures poses a grave risk to the patient, but transfusion is costly and associated with adverse outcomes. Antifibrinolytics, however, offer an economical and effective means of decreasing blood loss associated with surgical procedures. Tranexamic acid (TXA) is an antifibrinolytic that blocks lysine-binding sites of fibrinogen and fibrin, preventing the breakdown of existing clots. This journal course reviews extensive research demonstrating that antifibrinolytics such as TXA decrease blood loss and in some studies reduce allogeneic transfusion requirements...
June 2016: AANA Journal
Emmanuel Olushola Shobowale, Benjamin Adegunle, Ken Onyedibe
BACKGROUND: Hand hygiene has been described as the cornerstone and starting point in all infection control programs, with the hands of healthcare staff being the drivers and promoters of infection in critically ill patients. The objectives of this study were to access healthcare workers compliance with the World Health Organization (WHO) prescribed five moments of hand hygiene as it relates to patient care and to determine the various strata of healthcare workers who are in default of such prescribed practices...
May 2016: Nigerian Medical Journal: Journal of the Nigeria Medical Association
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