Analysis of noteworthy indicators on the anesthesia record: a prospective, multiregional study.

A national sample of anesthesia records were studied prospectively for the presence or absence of predetermined, noteworthy record indicators judged important in documenting a basic core of information describing the monitoring and care provided in a generic clinical setting. Only records involving the administration of a volatile anesthetic for the purpose of achieving general anesthesia, prepared by providers with at least 6 months of experience in anesthesia care were examined. No identifying patient, provider, or institutional data were recorded. Indicators were scored in a "present/absent" format. All data were pooled; the goal was to describe the overall phenomena in terms of frequency of compliance. A total of 4,989 anesthesia records were evaluated in terms of 13 record indicators. Those missed ranged from 0.0% (patient identification) to 28.6% (notation regarding emergence). Ten were omitted on less than 6% of the records: 3 (surgery and/or anesthesia start time, notation regarding emergence, surgical positioning noted) were omitted on more han 13.0% of the records. Given he observed inconsistencies, perhaps the anesthesia record needs redesign or the rationale behind documentation requires increased emphasis in educational and equally assurance programs.

Latex allergy: are you at risk?

The prevalence of latex allergies in healthcare workers has significantly increased over the past 2 decades. Increases in exposure to latex products in healthcare environments are related primarily to the use of gloves for barrier protection. In the early 1980s, with the implementation of universal precautions and appropriate healthcare worker protection, latex glove use dramatically rose in many countries. Manufacturing techniques and additional factories for latex gloves were developed to meet the tremendous demand. As a result of new "fast-track" production processes, some of the latex gloves had variant amounts of powder and allergen content. Synthetic materials, such as polyvinyl, polyurethanes, nitrile, and neoprene, are being used to manufacture medical gloves. Some hospitals and clinics have adopted the use of these alternatives to provide a "latex-free" healthcare environment. Risk reduction and prevention strategies are being implemented in many countries. Latex sensitivity and allergy can present as variable clinical reactions including contact dermatitis, rhinoconjuctivitis, asthma, and anaphylaxis. Some healthcare providers who have coexisting risk factors, such as atopy and food allergies (chestnuts, bananas, avocados, passion fruit, celery, potatoes, and peaches), are at an even greater risk for severe allergic reactions following repeated latex exposure. This journal course will provide an overview of the information available related to latex allergy in healthcare workers.

The effect of flumazenil on patient recovery and discharge following ambulatory surgery.

Midazolam is a short-acting agent used for preoperative and conscious sedation. Despite a relatively short half-life, midazolam sedation contributes to postoperative sedation, delays in discharge, and increased costs. Administration of flumazenil, a benzodiazepine antagonist, can reverse the centrally mediated effects of midazolam and facilitate patient recovery and discharge, thereby reducing costs. The purpose of this multicenter study was to determine whether flumazenil antagonism of midazolam decreased the length of postoperative stay following intravenous sedation during local and selected regional procedures. A prospective, double-blinded, and randomized convenience sample of 110 adult patients who underwent procedures lasting 90 minutes or less was used. After receiving institutional review board approval and informed consent, patients received up to 150 micrograms of fentanyl and unlimited midazolam titrated intravenously to effect. Flumazenil or a placebo was administered at the conclusion of the surgical procedure. Cognitive scores were assessed by using the Digital Symbol Substitution Test and picture recall, while sedation scores were assessed by using the Observer's Assessment of Alertness/Sedation Scale. The time between the end of the surgical procedure until the patient met discharge criteria in phases I and II was recorded. Statistical analyses revealed no significant difference in age, height, weight, sex, ASA physical status, amount of midazolam and fentanyl received, time for each group to achieve phase I and phase II discharge criteria, or postoperative congnitive scores. The flumazenil group exhibited less amnesia and sedation than the placebo group on initial arrival in the postanesthesia care unit. Discharge times between the groups were not significantly different. Factors such as staffing and institutional discharge policies were identified as determinants of discharge times.

A comparative analysis of latex allergy in the healthy versus high-risk pediatric population.

Allergic or hypersensitivity reactions to natural latex have been reported with increasing frequency. Many specific populations have been identified as high risk for latex sensitivity. This research focused on the pediatric surgical population. Previous research had identified children with spina bifida, children requiring bowel or bladder programs, children with a history of atopy, and children with multiple surgical exposures as high risk. The purposes of this study were to identify the prevalence of latex sensitivity in the healthy pediatric population, to compare the incidence with that of an identified high-risk population, and to determine if a survey of known risk factors for latex sensitivity was predictive of positive serum latex antibody. This was a prospective, descriptive correlational study utilizing a convenience sample size of 400 pediatric patients aged 1 to 18 years, conducted at Henry Ford Hospital and Children's Hospital of Michigan. Children were identified as high or low risk from the survey results, and all had AlaSTAT latex allergy testing (Diagnostic Products Corporation, Los Angeles, Calif). The survey was not predictive for the positive serum latex antibody. The incidence of latex sensitivity was found to be greater in the high-risk group (17.3%) than in the general pediatric population (8.6%) using the chi 2 test (P = .01). Latex-reduced environments for children likely to have repeated latex exposure may decrease the risk of reaction and more importantly decrease sensitization for them. From an anesthetic standpoint, a fairly standard preoperative question is, "What are the number and types of surgeries a patient has undergone in the past?" This information can alert the healthcare worker to how much exposure the child has had and whether a latex-reduced environment might be required to avert a latex reaction.

A report on the Council on Certification 1996 Professional Practice Analysis.

The purpose of this article is to provide an overview of the Council on Certification of Nurse Anesthetists 1996 Professional Practice Analysis. This analysis was used to update the previous content validation studies. Surveys were mailed to a select group and a practitioner group of 2,859 Certified Registered Nurse Anesthetists with a response rate of 63.7%. Respondents were asked survey questions related to demographics, practice settings, education, and fundamental knowledge related to nurse anesthesia practice. Respondents were asked for the frequency and level of expertise related to patient conditions, procedures, anesthesia agents and techniques, equipment, instrumentation, and technology of anesthesia practice. The results for both groups were consistent with the previous studies. The Rasch rating scale model was used to transform the results from ordinal data onto a linear, equal-interval scale. Members of the Council on Certification of Nurse Anesthetists carefully reviewed all of the Professional Practice Analysis results and voted to maintain the current test blueprint and percentage of test items in each area.

A Council on Certification of Nurse Anesthetists report on the candidate satisfaction survey for the national certification examination.

Since the implementation of computerized adaptive testing for the national certification examination in April 1996 through June 30, 1998, over 2,400 candidates have been tested. Ongoing monitoring and evaluation of candidate satisfaction on the national certification examination has been an essential component of the Council on Certification of Nurse Anesthetists' testing procedures. During the year period of July 1, 1997 through June 30, 1998, 988 first-time candidates took the national certification examination. Of the 988 candidates, 932 were administered the same eight-statement satisfaction survey. This article reports on candidate satisfaction for this group of first-time takers. Overall response rate to the survey was 96%. Completion of the eight-statement survey is voluntary after the examination has been completed. The majority of candidates are very satisfied with the computerized adaptive test process and procedures.

The transition of the national certification examination from paper and pencil to computer adaptive testing.

The Council on Certification of Nurse Anesthetists (CCNA) has been exploring computerized adaptive testing (CAT) for the national certification examination (NCE) over the past several years. CCNA representatives have consulted with experts in testing and with individuals from professional associations who use CAT for certification or licensure testing. This article will provide an overview of CAT and discuss how the CCNA plans to implement CAT for the NCE beginning April 8, 1996. A future article that explains the theoretical concepts of CAT will be published in the April 1996 AANA Journal. It is important to note that the NCE will not be a new test, the current content outline and item bank will remain the same. It is only the method of test administration that is changed--from paper and pencil to CAT. Each candidate will answer questions and take a test that is individualized to his or her ability or competence level and meets the specifications of the test outline. All candidates must achieve the same passing score. The implementation of CAT for the NCE will be advantageous for the candidates and provide a more efficient competency assessment. The last paper and pencil examination was administered on December 9, 1995. The transition is a significant event in nurse anesthesia history, just as nurse anesthesia was the first advanced practice nursing specialty to implement the certification credential, the CCNA will be the first to introduce CAT.

Council on Certification Professional Practice Analysis.

The CCNA has completed a PPA and will begin implementing its recommendations with the December 1993 certification examination. The results of the PPA provide content validation for the CCNA certification examination. The certification examination is reflective of the knowledge and skill required for entry-level practice. Assessment of this knowledge is accomplished through the use of questions that are based on the areas represented in the content outline. Analysis of the PPA has resulted in changes in the examination content outline and percentages of questions in each area to reflect current entry-level nurse anesthesia practice. The new outline is based on the major domains of knowledge required for nurse anesthesia practice. These changes are justified by the consistency in the responses of the practitioners surveyed. There was overall agreement as to the knowledge and skills related to patient conditions, procedures, agents, techniques, and equipment that an entry-level CRNA must have to practice. Members of the CCNA and Examination Committee will use the revised outline to develop questions for the certification examination. The questions will be focused on the areas identified as requiring high levels of expertise and those that appeared higher in frequency. The PPA survey will be used as a basis for subsequent content validation studies. It will be revised to reflect new knowledge, technology, and techniques related to nurse anesthesia practice. The CCNA has demonstrated its commitment to the certification process through completion of the PPA and implementation of changes in the structure of the examination.

Factors which predict performance on the National Certification Examination for Nurse Anesthetists.

Predicting the performance of registered nurse anesthesia students (RNAS) on the national certification examination (NCE) is an area of interest to educators, students, and employers. Following graduation from an accredited nurse anesthesia educational program, RNAS must pass the NCE to practice. The purpose of this study was to investigate 13 academic, demographic, and preadmission factors which predict RNAS' performance on the NCE. This retrospective analysis included 1,690 RNAS who took the five NCEs administered from December 1987 through December 1989. Results of multiple regression analyses revealed that seven of the 13 academic, demographic, and preadmission variables were predictive of performance on the NCE. These variables included science and overall grade point average (GPA), highest degree attained before entry, gender, number of cases, age, and years of nursing experience. The GPA in science accounted for 24% of the variance in the overall certification examination score, and the remaining six variables contributed an additional 3% to the variance. Variables which were not predictive of performance on the NCE included type of nursing preparation, clinical background, type of nurse anesthesia program, case hours, number of science hours, and length of the nurse anesthesia program. Additional research findings from the one-way analysis of variance of the categorical variables indicate that level of education before entry into a nurse anesthesia educational program is predictive of performance on the NCE. RNAS with bachelor's or master's degrees achieve higher mean certification examination scores than RNAS with diplomas or associate degrees. Similar results were found for the type of nurse anesthesia program.(ABSTRACT TRUNCATED AT 250 WORDS)