Enhancing the Preanesthesia Evaluation: Consensus Development of the Cannabis Use and Behaviors Assessment Tool (CUBAT).

PURPOSE: This project aimed to develop an evidence-based preanesthesia cannabis use assessment tool to acquire complete and accurate patient history and develop a best-informed, individualized anesthesia and analgesia care plan. DESIGN: Modified Delphi. METHODS: Using an evidence synthesis and multistage, modified Delphi process, eight experts from across the United States developed a consensus-based tool to aid in developing a best-informed, individualized plan for anesthesia and analgesia care. FINDINGS: Two survey rounds integrated informed evidence-based tool revisions. The final tool included instructions for use, a glossary of terms, and seven key assessment items aimed at gathering the most influential information regarding cannabis use. CONCLUSIONS: The Cannabis Use and Behaviors Assessment Tool is a first-of-its-kind tool providing an essential framework for preanesthesia cannabis use assessment.

Board Leaders' Perspectives of the Impact of Nurses on Boards.

OBJECTIVE: The purpose of the study was to explore the impact of nurses on boards (NOBs) from the perspectives of board leaders who are not nurses. BACKGROUND: Research about the impact of NOBs derives from nurses' recall of board experiences. No studies explore the impact of NOBs from perspectives other than nurses. METHODS: Researchers used an exploratory qualitative design with purposive sampling and interviewed 16 participants. RESULTS: According to participants, NOBs impact board governance as boundary spanners within the healthcare ecosystem. The overarching pattern is supported by 6 traversing themes. CONCLUSIONS: Board leaders' perspectives of NOBs as boundary spanners illustrate the far-reaching impact nurses have in the board role and on the direction of healthcare organizations.

Predictors of Burnout, Job Satisfaction, and Turnover Among CRNAs During COVID-19 Surging.

This study examined the relationship between demographic factors, job characteristics, relations between Certified Registered Nurse Anesthetists (CRNAs) and administration, and conflict between work and personal responsibilities using structural equation modeling to determine levels of burnout, job satisfaction, and turnover intention among CRNAs during COVID-19 surges. Survey data were collected from CRNAs practicing in Massachusetts and Texas through an email link distributed by their respective state associations of nurse anesthetists. Results of the structural equation modeling showed a decrease in feedback, low CRNA-administration relations scores, and prioritizing work over personal responsibilities were predictive of CRNA burnout. In addition, burnout levels were correlated with job satisfaction and turnover intention. Based on these findings, employers could decrease CRNA burnout and turnover by creating organizational strategies focused on improving job feedback, relationships between CRNAs and administrators, and work-life integration. Through these approaches, healthcare managers and leaders may support CRNA resiliency and retention, particularly during times of professional change, such as the COVID-19 pandemic.

COVID-19 Preprocedure Testing Considerations.

The COVID-19 pandemic has presented significant patient and provider safety concerns, notably for clinicians involved in aerosol-generating procedures. Healthcare systems established new and innovative ways to function safely and maintain operations, including mandatory preoperative testing, changes to patient scheduling, infection control practices, staffing, surgical prioritization, environmental cleaning, and operating room processing. This article provides practice and policy considerations for preprocedure COVID-19 testing, taking into consideration the available evidence and variability in community prevalence, rate of vaccinations, and new COVID-19 variants.

Considerations for Management of Bupivacaine Formulation Shortage Affecting Obstetric Anesthesia Services.

Healthcare facilities across North America are experiencing a shortage of several formulations of bupivacaine affecting analgesia and anesthesia care, particularly for obstetric services. This editorial will discuss evidence-based considerations to address the bupivacaine shortage including interprofessional team engagement for planning, alternative anesthetic and analgesic management strategies for the obstetrical patient, and safe drug preparation. As leaders in healthcare, nurse anesthetists are encouraged to work closely with their anesthesia, pharmacy, obstetric, and facility leadership to develop best alternative solutions during this drug shortage to provide safe analgesic and anesthetic care.

Serotonin syndrome: fentanyl and selective serotonin reuptake inhibitor interactions.

Serotonin syndrome is a rare but potentially fatal adverse drug reaction associated with increased serotonergic activity in the central nervous system. It is characterized by a triad of symptoms, which include altered mental status, neuromuscular hyperactivity, and autonomic instability or hyperactivity. Due to the potential of rapid onset, it is important for clinicians to recognize the signs and symptoms of serotonin syndrome. Serotonin syndrome symptoms may resemble other conditions. Although this article focuses on serotonin syndrome as a result of an adverse interaction of selective serotonin reuptake inhibitors (SSRI) and fentanyl, it is important for not only anesthesia professionals, but all clinicians--such as those in emergency medicine and critical care--to be aware of this syndrome and its management. This article discusses the clinical manifestations of the serotonin syndrome and highlights reported cases of serotonin syndrome specifically related to an interaction between SSRIs and fentanyl, a commonly used opioid in anesthesia practice.

The revised scope of nurse anesthesia practice embodies the broad continuum of nurse anesthesia services.

The AANA determines the scope of nurse anesthesia practice. It is important for all members to understand the scope of practice that governs their work to better practice their profession and mentorship. In January 2013, the AANA Board of Directors charged the Practice Committee to revise the Scope of Nurse Anesthesia Practice. A systematic review of literature, focus groups, and a survey were conducted. Major focus group themes were identified, and survey results were analyzed to identify relationships between variables. The literature search resulted in 8,739 abstracts. Forty-six articles were reviewed. Full scope of advanced practice registered nurse (APRN) practice was a recurrent theme across the literature. Focus group themes include: (1) elements of nurse anesthesia practice; (2) future practice opportunities; (3) interprofessional collaboration; (4) full scope of practice; (5) autonomous practice; and (6) barriers to practice and recommendations. Of the 4,200 CRNA survey respondents, 44.6% are not permitted to practice to their full scope of practice. The revised Scope of Nurse Anesthesia Practice embodies the comprehensive span of nurse anesthesia practice.