President’s Message……..

November 1, 2012

Special points of interest:

Take the Plunge ASPAN High-lights IPAB Lariat Procedure Social Media Financial Assis-tance Workshops Recognition

Air Exchange

Volume 28, Issue 2, Summer 2013

Take the Plunge

My role as president of the RMPANA component is coming to an end, and  I  can  say  it  has  been  quite  a  year.    I  am  glad  I  “took  the  plunge”  to  run  for  RMPANA  president.    Whenever  we  are  seeking  new  leaders  to  join  our  board  of  directors  we  encourage  them  to  “take  the  plunge”  by  saying  “you  have  so  much  to  offer,”  “you  will  learn  so  much,”  and  “you  will  meet  some  wonderful  people  along  the  way.”    I  wasn’t  sure  about  what  I  had  to  offer  but  I  feel  I  have  done  a  good job this year keeping us on track.

One thing I know for sure is as a component we have a lot to offer. Although we are not the largest, we are near the top as we were only a few points from being component of the year (Gold Leaf). That means we are doing things very well and we are growing (currently at 490 members, aiming for 500). Our educational offerings are evidence base. We utilize social media through our website and newsletter to invite interest in our component. We offer scholarship grants to our mem-bers and are in the process of extending this effort. All this activities involve many committed mem-bers  that  have  “taken  the  plunge”,  so  as  a  group  we  can  provide  these  benefits  to  our  members.  

Many  members  have  also  “taken  the  plunge”  to  be  involved  in  our  national  organization,  ASPAN. About 42 members (nine percent) are involved in ASPAN committees or strategic work teams.  To  top  it  off,  55  percent  of  our  members  have  “taken  the  plunge”  to  get  certified.  This  is  such  an awesome number with seven percent of those having dual certifications. These numbers provided us with our first Shining Star Award from ABPANC. Congratulations to all who have been certified, those newly certified and those thinking about certifying. All of these numbers and percentages put us way ahead of a lot of the components in ASPAN. We are a strong organization.

Did  I  mention  the  incredible  people  along  the  way?  Over  25  years  ago  many  “recovery  room”  nurses  gathered  together  and  following  in  the  footsteps  of  a  couple  of  other  states  and  the  newly  formed  national  organization  decided  to  “take  the  plunge”  and  form  our  own  Rocky  Mountain  PeriAnesthesia Nurse Association. Many of these nurses are still very active and involved in RMPA-NA and have been helpful mentors to me. I want to especially thank Barb Godden, Lois Schick, Nan-cy  O’Malley,  and  Lynda  Marks.  They  encouraged  me  to  “take  the  plunge”  and  have  always  been  avail-­able for any kind of assistance. It is because of them and many other leaders along the way that have made RMPANA a strong component. It has also been an honor to be able to get to know our national leadership on a first name basis, connect through e-mails and know I can ask them any question. They have been so supportive and always ready to help me out. Our component has the extra bless-ing of getting the current ASPAN president to come to our Retreat in the Rockies every year for many years. These relationships are the backbone to a strong organization and will also keep me involved as a resource for those that will follow in our footsteps.

Do  you  think  it  is  time  for  you  to  “Take  the  Plunge”?

Sincerely,

Valerie Watkins BSN RN CAPA RMPANA President 2012-2013 Valerie@rrwatkins.com

A Newsletter of the Rocky Mountain Perianesthesia Nurses Association

MISSION: The mission of Rocky Mountain PeriAnesthesia Nurses Association is to unite registered nurses in all phases of perianesthesia/peri-procedural care through education, research, and standards of practice in order to promote quality care for patients, families, and the community.

2012-2013 RMPANA Board of Directors

Officers and Committee Chairs President Valerie Watkins RN, BSN, CAPA VP/President Elect/Strategic Planning Regina Hoefner-Notz RN, BSN, CPAN, CPN Past President/Nominating Olyn Carlson RN, BSN, CAPA Secretary Dorothy “Dot” Kieber RN, CAPA Treasurer/Fundraising JoEtte Krissel RN, BSN, CAPA Historian Nancy O’‛ Malley RN, MA, CPAN, CAPA Education Barbara Krumbach RN, MSN, CCRN, CPAN Bylaws Policies and Procedures Sharon Sample RN, CPAN, CAPA Communication/Membership Nicole Babu RN, BSN, CPAN Newsletter Editor/Governmental Affairs Mary “Rachel” Romero RN, MSN, CPAN, CAPA Website Coordinator Donna Gaul Bobo RN, CPAN, CAPA www.rmpana.org Research Diane McCue RN, BSN, CAPA Parliamentarian Lynda Marks RN, CAPA

District Representative District I- Phyllis MacDonald RN, BSN, CPAN District II- inactive District III- Janice Strong RN, CPAN, CAPA District IV- Gail Stout RN, BSN, CPAN District V– Sana Zamarripa RN, BSN District VI– Marcia Keiser, RN, CPAN

Honarary BOD Lois Schick RN,MN,MBA,CPAN, CAPA

Barbara Godden RN, MHS, CPAN, CAPA Myrna Mamaril RN, MS, CPAN, CAPA, FAAN

PAGE 2 AIR EXCHANGE

Message from ASPAN President

Today, I invite you to be a part of the next year with my new

ASPAN journey —a time of change and challenges in life and

work for all of us. This will truly be an exceptional journey. It

was  Kelly  Morgan  who  said,  “Changes  are  inevitable  and  not  

always controllable. What can be controlled is how you man-

age,  react  to  and  work  through  the  change  process.”1

My theme for the upcoming year is “Dealing  with  Challenges:  Winning  with  Power  •  

Practice  •  Purpose.”  The  word  “challenges”  is  defined  by  Wikipedia  as  “referring  to  

things that have a sense of difficulty and victory, that which encourages someone to

do something they otherwise would not—a  difficult  task.”2 It is the dedication of

ASPAN’s  grassroots  members,  its  committees  and  strategic  work  teams  that  make  

ASPAN the premier resource for perianesthesia nurses. ASPAN leadership, by way

of strategic planning, constantly charts the course of the organization. ASPAN must

maintain vigilance in recognizing the constantly evolving changes in healthcare.

ASPAN must continue to be the premier professional perianesthesia nursing organi-

zation that embraces challenges, and through education, research and strategic deci-

sion-making processes, consistently improves the practice of all perianesthesia nurs-

es.

Power

There  is  powerful  strength  in  ASPAN’s  numbers.  Its  voices  and  strategic  decision-

making processes are built on evidence-based information. We, the members and

leaders, are liaisons to various organizations such as the American Society of Anes-

thesiologists’  Patient  Safety  Foundation,  the  Council  on  Surgical  and  Perioperative  

Safety, the Society of Anesthesia and Sleep Medicine, the Nursing Community Fo-

rum and the American Association of Critical Care Nurses, to name a few. We have

collaborated with these organizations and have brought powerful voices to the table

through our partnerships, which ultimately have enhanced our goal of excellence in

our perianesthesia nursing practice.

These  powerful  words  were  written  by  author  and  speaker  Steve  Maroboli:  “Do  not  

dilute the truth of your potential. We often convince ourselves that we cannot change,

that we cannot overcome the circumstances of our lives. That is simply not true. You

have been blessed with immeasurable power to make positive changes in your life.

But  you  can’t  just  wish  it,  you  can’t  just  hope  it,  you  can’t  just  want  it…..you  have  to  

live  it,  be  it,  do  it.”3

ASPAN can meet the challenges through its power, purpose and practice

to fulfill its compelling vision.

(Con’t  page  3)

Practice

Excellence  in  perianesthesia  nursing  is  ASPAN’s  strength.  We,  the  members,  have  the  knowledge  and  passion  to  provide  the  best possible care to our

patients and their families. The Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements are the foundation of

knowledge  for  daily  clinical  practice.  ASPAN’s  Clinical  Practice  Committee  provides  answers  to  both  ASPAN  members  and  non-members alike. The

committee goes above and beyond to ensure that sound evidence-based practice resources are provided in the answers. With these responses, they

encourage the member and non-member to achieve their full potential. Many times, the answers include attachments, examples, internet links and

other valuable information. Our nursing practice provides ASPAN with a broad base of knowledge and experience that enables its members to practice

in varied settings, in a variety of roles, caring for a diverse group of patients ranging from the pediatric to the geriatric, with the goal of excellence in our

daily delivery of perianesthesia nursing care.

Purpose

With 15,000 members and growing, ASPAN has strength in numbers. United, we support the concept that the perianesthesia nurse is the first line of

defense for the safety of patients. In the landmark case, Laidlaw versus Lions Gate Hospital, the court referred to the Phase I PACU  as  ”the  most  im-­

portant  room  in  the  hospital  because  it  poses  the  greatest  potential  dangers  to  the  patient.”4 ASPAN’s  reason  for  existence  is  exemplified  in  its  core  

purpose  “to  advance  the  unique  specialty  of  perianesthesia  nursing.”5

Next year, we will be in Las Vegas for National Conference. To many, this city is an oasis in the middle of the desert. What started as barren land is

now full of lights, hope and dreams for those that think they may win a fortune, or for those that want to escape to nonstop fun and adventure. Whatev-

er the purpose, it is a beacon of light in the horizon of hope and power of what might be. ASPAN can meet the challenges through its power, purpose

and  practice  to  fulfill  its  compelling  vision.  ASPAN  will  also  remain  true  to  its  core  values:  “building  integrity,  modeling  respect, honoring diversity, pro-

moting stewardship, providing mentorship, cultivating passion, supporting community, vigilance to safety and standards and upholding  excellence.”5

The following is an excerpt from the book, The Power of One,  by  Steve  Maroboli:  “When  a  new  day  begins,  dare  to  smile  gratefully.  When  there  is  

darkness, dare to be the first to shine a light. When there is injustice, dare to be the first to condemn it. When something seems difficult, dare to do it

anyway.  When  life  seems  to  beat  you  down,  dare  to  fight  back.  When  there  seems  to  be  no  hope,  dare  to  find  some.  When  you’re  feeling tired, dare to

keep going. When times are tough, dare to be tougher. When love hurts you, dare to love again. When someone is hurting, dare to help them heal.

When another is lost, dare to help them find the way. When a friend falls, dare to be the first to extend a hand. When you cross paths with another,

dare to make them smile. When you feel great, dare to help someone else feel great. When the day has ended, dare to feel as you’ve done your best.

Dare to be the best you can-at  all  times,  dare  to  be!”6

I  look  forward  to  the  coming  year  as  a  time  when  together,  we  move  forward  with  ASPAN’s  power  in  numbers,  its  specialty  practice and its purpose to

be the best it can be. ASPAN is now. ASPAN is here to stay. As your ASPAN leader, I will strive to fulfill my presidency by embracing changes and

meeting the challenges through all of you---the members.

Con’t……………...Message  from  ASPAN  President

JoEtte Krissel RN, BSN, CAPA Treasurer

We recently purchased purple “TEAM RMPANA” t-shirts and visors for the National conference component night. The t-shirts now belong to those that attended the conference and paid for them. The visors will be used by the board at the Retreat in the Rockies to distinguish the board. We had four members request scholarships for National Conference for a potential payout of $900.00. Remember the RMPANA board sets aside scholarship monies every year for its members. Look at the policy on rmpana.org for how and when to submit. You also have an opportunity to submit a scholarship applica-tion for the Retreat in the Rockies this fall.

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District Report

Phyllis Mcdonald RN, BSN, CPAN District I Hello from District One!

We have a lot of news to share and are looking forward to another great year. We have a new Board of Directors this year and I will send out a roster so everyone will know who to contact if they have questions or concerns as soon and the roster is completed. Please take a moment to meet your board at the meetings this year and com-municate with us when you have a need.

Parker Hospital has 3 newly certified nurses

Sarah Holstein, CAPA Niko Ferguson, CPAN Mary Griffith, CPAN

This makes 48% of the Nurses at Parker Adventist are certified at this time and there are more planning to take the next tests so they are going to top the 50% mark soon. Great Job!!!

University Hospital has 5 newly Certified Nurses

Roberta Harner, CAPA Jackie Tolson, CAPA Katie Conyers, CAPA Tricia Curley, CPAP Marta Hoffman, CPAN

This is such an outstanding effort!!!

Our very own Mary Rachel Romero, MSN, RN, CPAN, CAPA won the 2013 Nightingale Luminary Award for Advocacy. Way to go Ra-chel!!!

Barbara Godden was one of 38 Nightingale finalists and is also one of our District 1 members. She was a finalist for Leadership cate-gory. Great work!!!!

Our District I secretary, Carolyn Dietrich was the recipient of the 2013 ASPAN Excellence in Clinical Practice Award. Congratulations!

I was nominated for the Outstanding achievement award from district 1 this year and I received it. Two of my co-workers nominated me for my certification review classes and this goes to show that all you need is for someone to care enough to recognize you for these awards. There are so many of you out there doing so many different things to advance perianesthesia nursing practice. If you want to nominate a coworker, send an email to me and I will share it with the rest of the Board. Keep those nominations coming! Nominate each other! Recognize someone you think is putting forth a little extra effort in the job.

Parker Adventist, Littleton hospital and Porter hospital are teaming up with the Quease-ease company to do a research project in the next year.

We are currently in the planning stages for the next year of meetings and educational opportunities for District 1. Our meeting sched-ule for the upcoming year is a work in progress. However, I would like to share some of the dates that have been set so you can plan your schedules and support our district.

Sept. 5th -University of Colorado Oct 4th to the 6th-Retreat at the Rockies-Winter Park Nov. 7th at PSL Hospital.

January 2nd, March 6th and April 3rd are to be determined. If your department is interested in hosting, please contact Court-ney McClellan at mcclellancourt@gmail.com.

Feb 6th at  St.  Anthony’s   May 8th The Medical Center of Aurora

We will be offering a winter workshop and would love to have some input from the membership on what topics they would like to see so send Courtney all of your suggestions.

We are also looking for some volunteers at this time. We need 3-4 volunteers for the historical committee to help with a project about the history of district 1 if you have a few hours and feel like going though the boxes of pictures and things that we have accumulated email me at pjmac142@gmail.com and we will work on setting up a day and time to do this. We are also looking to set up a few visits to Project Cure to help organize medical supplies and we are considering doing this instead of one of our meetings. If you are interested in volunteering for this event, send me an email. We are considering either 2 hours on a weekday evening or 3 hours on a weekend. We will decide once we have a good number of volunteers. If you have other ideas, let us know.

Thanks for all that you all do every day, you are the best.

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VO L UME 28, ISSUE 2, SUMMER PAGE 5

Janice Strong, RN District III, President On May 16th District III had a successful educational offering at St. Mary's Hospital in Grand Junction. It was our largest turnout so far. We had 49 people who attended the workshop. We had at least one representation from all the local

hospitals and free-standing surgical centers in the Grand Junction area. Nurses from Greeley, Cortez, Vail, and Glenwood Springs attended the workshops as well as those from Fruita and Grand Junction. Last May, a group of nurses reviewed and updated our by-laws to reflect RMPANA’s strategic initiatives and to help strengthen our district. The RMPANA traveling road show provided the next educational offering last June 15th in Cortez. RMPANA nurses from the Denver area were the speakers. Contact hours were awarded. Don't miss this opportunity next year to see a beautiful part of the state and hear dynamic speakers! Congratulations to Joan Dorrance from First Choice in Grand Junction who passed the CAPA test. Janice Strong was recognized by ASPAN President Susan Carter at ASPAN's 32nd National Conference in Chicago, Illinois for being one of the top ten individuals who were nominated for an ASPAN Above and Beyond Service Recognition Award. From Deanna Yeomans…………………………………………. District III has been very busy this spring. We had two conferences: "Wake up: It's Spring", offered in March, was a huge success. We had five very knowledgeable physicians from Grand Junction as guest lecturers. We gave two $250.00 scholarships to attend the RMPANA conference which was won by a non-member and a member of ASPAN. The other conference was held last June15th, RMPANA Summer Perianestheisa Review, in Cortez. The presenters were Nancy 0'Malley, Mary Seitenback, and Barbara Krumbach. Turnout for this event was spectacular with attendees coming from Grand Junction and Littleton, CO At these conferences, we gave two $250.00 scholarships to attend the RMPANA conference which was won by a non-member and a member of ASPAN. One of District III goals is to try and provide annual scholarship to RMPANA conference and encouraging non-members to join. Our meetings are held through teleconferencing and so far it has been working well. Thank you and I hope to see you in OCT.

Gail Stout, RN, District VI, President gailstoutrn@gmail.com We have had a very busy beginning to the new year! We started with District 1 and District 4 com-bined offering of the Spring Perianesthesia Review

held in March at Medical Center of the Rockies on a blizzardy Satur-day! I applaud and thank all that braved this storm from long distanc-es; we had a great turnout with approximately 100 attending the conference to hear our beloved Lois Schick, Nancy O'Malley and Barb Krumbach speak on ETCO2, PACU implications of OR positioning, and EKG changes in the PACU setting.

At the beginning of April, we held our community service project at Barb Anto-nucci's house in Longmont. We completed some pillow case dresses for Joette's African mission project and got a good start on our Quilt of Valor. At the end of April, I attended national conference with many of our board members and District 4 members. Chicago was filled with many memories, fun, commaradery, and a boun- ty of knowledge for all of us that attended to bring back to our districts.

According to Barb Comstock at NCMC we have five newly certified CPAN/CAPAs!

We will be presenting them with Aspen leaf pendant and earrings which we as a dis-trict have started to do with all of our newly certified nurses! So far we have had a very positive response to our gift in recognition for their dedication to the profes-sion they serve.

As president of District 4, our hospital system has gone through some major changes which have occupied my ability to focus on my duty as president, and my obligation with my job. I hope to get some certification classes going after our hospital computer conversion is complete, and be able to offer a "Women's Health Issues with Third World Countries" with Kim Thompson CRNA, and Leann Cohen, CRNA. Please stay tuned to the RMPANA website for all upcoming events!

Sana Zamarripa, RN, BSN, CPAN District V, President sanazam@comcast.net District V met June 4th. We approved a set of bylaws for District V which are adapted from the RMPANA by-

laws. We also voted to send 1 or 2 people to Retreat in the Rockies, preferably nurses who have not attended before to increase involvement in our professional organisation. If anyone would like to be considered for this, please submit your name to me via email, and we will draw from the interested people before the conference. We enjoyed a presentation by Dr JoAnn Crownover on MaskEd. She is a professor at CSU Pueblo who brought this educational technique to the United States. All nursing students are taught with simulations of patients- dummies, actors, simulation labs. The newest technique involves the educator dressing in Hollywood created masks and body costumes to interact with the stu-dents. Unlike a paid actor who must stick to a script, the educator can adapt to the student's nursing interventions . As this presen-tation involved perianesthesisa and perioperative staff, she role played a patient scheduled for surgery with a list of questions and concerns about her upcoming surgery. It  was  interesting  to  see  our  “patient”  had  a  number  of  concerns  regarding  her  meds,  her  red bum-pressure ulcer, and a possible lump in her breast.

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PAGE 7

Committee Report AIR EXCHANGE

JoEtte Krissel, RN, BSN, CAPA Fundraiser

Please come up with ideas to support our fundraising efforts for our annual Retreat in the Rockies. This year the event will be in Winter

Park, Colorado. Last year, we generated a great amount from the fleece jackets and candles. We are hoping to have these items sold again this year but would prefer if we have newer and more interesting offerings. Please email me at dkris-sel@comcast.net.

Sharon Sample, RN, CPAN, CAPA Bylaws, Policy & Procedure

Financial Assistance Available To Members And Student Nurses

These are always positive words to hear, especially in our turbulent economic  times!      RMPANA’s  goals  are  not  only  to  promote  member  and  stu-­dent nursing scholarships, but to utilize 100% of the monies allocated in each year’s  budget  for  these  activities.    Every  member  can  apply  for  up  to  $250.00  yearly for attendance at educational offerings or for CPAN/CAPA certifica-tion/recertification. An applicant must be a RMPANA member for the entire year for which the application is being made. The amount awarded will not exceed the cost of the educational offering or duplicate financial aid from another source. The amount of money awarded is based on points accrued, with 10 points being the minimum. All points must be accrued in one year and points not used that year will ex-pire. Each year RMPANA offers two $500.00 scholarships to entry level students and one $1000.00 schol-arship to a RMPANA member in an advanced degree program. Encourage those you know pursuing a career in nursing or a RMPANA member working toward an advanced degree to apply. The application dead-line for nursing scholarships is June 30th. RMPANA Scholarship applications can be obtained online (Action/Forms) and submitted to the Treasurer along with documentation of attendance/certification and fees paid. Nursing scholarship applica-tions are also accessible online at www.rmpana.org/education and submitted to the Education Chairperson. If questions arise, contact any RMPANA officer or committee chairperson as listed on the website.

Olyn Carlson RN, BSN, CAPA Nominating Chair

Vice President / President Elect & Secretary

RMPANA would like to conduct an online Officer Election for 2013 -2014 Vice President / President Elect and Secretary. First, of all we need candidates. We currently have one person interested in Vice President / President Elect, but no one has stepped up for Secretary. The job descriptions can be found on the RMPANA website under Actions / Job Descriptions / Vice-President or Secretary. It is expected that interested parties submit a Biographical Data Sheet for the consideration of the voting members that is also found on the website under Actions / Forms / Biographical Data. we are prepared to have the election via Survey Monkey before the end of the month.

We are always on the lookout for nurses who would like to pursue a leadership role in a great organization such as RMPANA. If you would like to take on the role of president next year or the year after, please send an email to me at docenterprises1@optimum.net or Valerie Watkins at valerie@rrwatkins.com . The president position is a three year commitment to help support the elected president. Election process is facilitate through Survey Monkey. The position for RMPANA secretary is also currently open. Please spread the word to anyone interested in be-ing involved with RMPANA.

PAGE 8

Diane McCue RN BSN CAPA Research

Attending  ASPAN’s  32nd National Conference in Chicago was, for me, a time to be in-spired by my peers. It was both stimulation and rejuvenating. We, as nurses, were

recognized for our knowledge base , our contributions to patient health and safety, and it was espe-cially exciting to see the number of nurses attending for the first time. In the arena of research there were a plethora of posters and presentations. It is easy for anyone to access the information from these CSP (Celebrate Successful Practices) Abstracts and I encourage each of you to do so. Go to www.aspan.org/ClinicalPractice/CSPAbstracts. In 2013 the number of abstracts in each of the categories are in parentheses here. Click on any of the titles for a brief abstract to learn what your colleagues are questioning, researching and presenting. The categories are Patient Care (34), Staff Education (23), Nursing Leadership (14), Preadmit/Preop (18), Patient Flow(9), Handoff Communi-cation/Documentation(8) and Unit/Environment (8). Over the next several months check back into this website under the Research heading to follow along  with  the  process  one  of  our  own  RMPANA  members  goes  through  to  ‘do  a  research  project’.

Poster Presentations at ASPAN National Conference

PAGE 9

Mary Rachel Romero, RN, MSN, CPAN, CAPA Governmental Affairs FAQs on Independent Advisory Board Panel (IPAB)

No, this is not a typo. My article is not about the Apple IPAD but on the advisory panel that was established by our current admin-istration, when the Affordable Care Act (ACA) was signed into law last March 2010. Along with the passage of the Healthcare Reform 2010 was the creation of a panel that will look into ways on how to rein in Medicare cost. As Perianesthesia nurses, we are in the frontline when patients undergo procedures. We see many patients that are too frail and sometimes question ourselves if it is really necessary for them to undergo extensive surgeries that may offer a 50-50 chance to attain better health. In the United States, we encourage patients to have autonomy when it comes to their health. However, our current healthcare  payment  structure  is  flailing  and  may  not  be  sufficient  to  cover  everyone  in  the  system.      IPAB  to  the  rescue…...Will having an IPAB, who seeks to monitor Medicare expense, alleviate our hemorrhaging healthcare system? Let us find out what this panel is about…….. What is the Independent Payment Advisory Board? IPAB is a new, independent, unelected body of individuals with unprecedented power to set payment rates and make other Medicare policy decisions. The Board is responsible for submitting annual proposals to Congress (starting in January 2014) that would reduce Medicare spending by targeted amounts set in legislation. Who are the members of the panel? There are 15 voting members of IPAB appointed by the President and confirmed by the Sen-ate for six-year terms, only a minority of them can be health care providers. The president is required to get suggestions from leaders of both parties in Congress in nominating 12 of the 15 appointees. For the other three, he doesn't have to consult Congress. The members have to be confirmed by the Senate. Obama hasn't nominated anyone yet, but has promised to fill the slots with "doctors, nurses, medical experts and consumers." Board members, who will serve six-year terms, are to be paid the salary of senior executives in the federal government -- $165,300 this year -- and cannot hold any other jobs. How will patients be affected?

IPAB is limited to reducing reimbursement rates for providers and plans, which could very likely  limit  patients’  access  to  care  and  interfere  with  physicians’  choices  in  treating  their  patients.  This  change  comes  at  a  time  when  Medicare’s  formula-driven payment system is already poised to make large cuts to physician payment. Will patients have a voice in the Board decision-making process? Currently,  there  is  no  mandated  role  for  patients  in  the  Board  membership.  The  ACA  establishes  a  “consumer  advisory  council”  to advise the Board on the impact of payment policies on consumers; however, the council is purely advisory and can be ignored by IPAB. Moreover, patient views and con-sumer views do not always match. There is no requirement that patient views are represented in the consumer advisory council. Are there any checks and balances on the Board? The IPAB is given an unprecedented amount of power for a body comprised solely of unelected officials. Its recommendations carry the force of law, even when they override laws passed by Congress. It can adopt entirely new policies never even considered by Congress. The only check on the Board is that Congress can pass an alternative proposal - but that proposal must meet the same spending reduction target - or block the resolution by a three-fifths majority in the Senate. Even if the Board is unable to agree on recommendations to cut Medicare, the Secretary of Health and Human Services in Washington, DC must step in and propose cuts meeting the spending reduction targets that carry the same force of law. Just as important, individuals - including physicians - will  have  no  way  to  appeal  IPAB’s  decisions  because  these  decisions  when  implemented  cannot  be  challenged, even in court. IPAB cannot propose any recommendation to "ration" care; raise revenues; increase beneficiary premiums or cost sharing; restrict benefits; or alter rules for Medicare eligibility. The law directs the panel to give priority to measures that extend the solvency of the program, improve beneficiaries' access to care, and improve the health delivery system and health outcomes, among others IPAB cannot propose any recommendation to "ration" care; raise revenues; increase beneficiary premiums or cost sharing; restrict benefits; or alter rules for Medicare eligibility. The law directs the panel to give priority to measures that extend the solvency of the program, improve beneficiaries' access to care, and improve the health delivery system and health outcomes, among others. IPAB cannot propose any recommendation to "ration" care; raise revenues; increase beneficiary premiums or cost sharing; restrict benefits; or alter rules for Medicare eligibility. The law directs the panel to give priority to measures that extend the solvency of the program, improve beneficiaries' access to care, and improve the health delivery system and health outcomes, among others References:

The IPAB: The Center Of A Political Clash Over How To Change Medicare. Retrieved from http://www.kaiserhealthnews.org/stories/2011/may/09/ipab-faq.aspx

IPAB FAQs. Retrieved from http://www.weworkforhealth.org/state/texas/lab/independent-payment-advisory-board-ipab/faq

IPAD. Retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=59

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Barbara Krumbach RN, MSN, CCRN, CPAN Education The RMPANA education committee joined with District IV to present the spring perianesthesia review on March 23, 2013 in Loveland, Colorado. Well maybe not spring as Mother Nature pre-sented us with a snow storm. However about 80 nurses bared the weather and attended the

workshop. Lois Schick, Barb Krumbach and Nancy O’Malley presented topics on the 12 lead EKG, potential post-op complications from surgical positioning, ETCO2 monitoring and how to keep out of a jam in the PACU. District III hosted the summer perianesthesia review on Jun 15, 2015 in Cortez, Colorado. Eighteen nurses joined three members of the education committee ( Nancy O’Malley, Barb Krumbach and Mary Seitenbach) as they heard presentations on peripheral nerve blocks in the perianesthesia setting, post op complications related to positioning, sleep apnea and sleep related disorders and strokes in the perianesthesia arena. Congratulations to the leaders and members of these two districts for hosting the workshops. SAVE THE DATES of October 4-6, 2013 for the15th annual Retreat in the Rockies. This will be held at Snow Mountain Ranch in Winter Park Colora-do. The education committee is busy planning the retreat. Fliers will be out soon. Early bird registration will be before August 3rd. Topics will include information on: Perianesthesia hot topics, thyroid problems, social media for perianesthesia nurses, impact of marijuana, spine surgery, pain man-agement, and health information technology. Twilla Shrout, ASPAN’s president, will be joining us. So mark you calendars and plan on attending.

Donna Gaul Bobo RN, CAPA, CPAN Website Manager rmpana.org Please check our Facebook page, Rocky Mountain Perianesthesia Association, for photos at

ASPAN National Conference 2013 in Chicago, Illinois. I fyou are interested in knowing more about our ou-ganization and would like to participation in becoming a board member please check our website www.rmpana.org. To submit photos, content or suggestions, email Donna @ dnr1797@gmail.com. Websites: www.rmpana.org AND facebook.com/RockyMountainPeriAnesthesiaNurses

Nicole Babu RN, BSN, CPAN Membership

We would like to welcome new RMPANA members who joined us in March and April…...

Barger Kelly

Benson Michael Bloom Gayle

Glowacki Michelle

Lauri Joni Raver Marilyn

Rowe Elizabeth

Salser Karen

Starkey Joanne

Welchert Sarah

Corrigan Shannon

Craig Angela

Hendrix Rita

Johnson Jessica

Kirsch Marc

Kleiner Amber

Locker Jennifer

Lucey Christine

Matthews Annette

Mckew Adam

Sammons Jackie

Seaton Brenda

Thorpe Lisa

Warren Leslie

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Cutting Edge

AIR EXCHANGE

Lariat Procedure to Reduce Stroke Risk in Patients with

Atrial Fibrillation Submitted by Elizabeth Carrier RN, BSN

Atrial fibrillation is the most common type of

heart arrhythmia. It is caused by disorganized electri-cal signals which makes the two atria of the heart con-tract  rapidly  and  irregularly,  or  “fibrillate”.    Atrial  fi-­brillation does not allow blood to properly pump out of the heart, and often pools in the atria. The stagna-tion of blood in the atria forms into clots that can dis-lodge and travel to various areas in the body, such as the brain, resulting in strokes.

Strokes are the third leading cause of death in patients with atrial fibrillation, with 90% of the clots originating from the left atrial appendage, a pouch off the left atria, in the heart. There are multiple existing surgeries that exclude the left atrial appendage, howev-er the LARIAT suture delivery system is one of the newer developments. The minimally invasive LARIAT procedure uses a percutaneous approach that ligates this appendage, thus for reducing the risk of thrombo-embolism in patients with atrial fibrillation while also decreasing the use of immediate postoperative antico-agulant therapies that are usually used in other LAA exclusion procedures.

This procedure is performed under anesthesia, using two magnet tipped guidewire catheters carrying a pretied LARIAT Suture Delivery Device to the left atrial appendage. Using both epicardial and transseptal access allow for stabilization inside and outside the heart while preparing to deploy the suture. Once arrived, the device is placed and tightened around the base of the appendage, permanently sealing it from the left atria. Risk

Though the LARIAT is an alternative to open heart surgery and postoperative anticoagulation therapy is not required post procedure, other risks are directly associated. The risk of pericarditis is inevitable due to the nature of the procedure. Other possible risks to the LARIAT included atrial perforation, pericardial effu-sion and cardiac tamponade. Nursing Implications

Post procedure, nurses should frequently monitor vital signs with an emphasis on blood pressure or ECG changes, assess for chest pain, and frequently check puncture sites for increased bleeding.

Resources:

Ganjehei, L., Massumi, A., Razavi, M., & Rasekh, A. (2011). Stroke prevention in nonvalvular atrial fibrillation. Texas Heart Institute

Journal, 38(4). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147190/

http://www.henryfordhospital.com/body.cfm?id=57694

http://www.nhlbi.nih.gov/health/health-topics/topics/af/

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ASPAN National Conference 2013-Chicago

ASPAN National Conference 2013– Chicago

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Save the Date!

RMPANA 15th Annual Retreat in the Rockies, October 4-6, 2013, Winter Park, CO

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Workshops/Conferences/Webcast PAGE 15

VO L UME 28, ISSUE 2, SUMMER

Nurses and Social Media By Mary Rachel Romero

Technology and social media has definitely changed how we express ourselves and what we think. Long before Facebook, Twitter and emails, we had dis-cussion groups, meetings, open forums in small scale. We often ponder if an organization is reliable if it does not have a website or Facebook account. As healthcare providers, social media has been useful in connecting us with colleagues and has helped in supporting our profession. However, the rules of using social media especially in healthcare is not clearly defined. We all know about HIPAA privacy act but probably may not be aware on how this regulation influences the use of social media. We have heard of stories where healthcare staff lost their jobs because of posting pictures of patients in their Facebook page. There were others who received suspension due to unre-markable postings or blogs about their employers. The board of nursing may not have regulations to explicitly describe the ethical and legal consideration related to social media however, certain actions can still be placed under the following context of our nurse practice act:

Breach of privacy or confidentiality Failure to report breach in privacy Lateral violence against colleague Boundary violation Communication against employees

Here are some tips/advice for using social media responsibly in the nurses professional environment: 1. Maintain patient privacy and confidentiality at all times. 2. Do not transmit any patient photos or images that are not approved for use by patients 3. Do not post any information about patient information unless there is a patient related need for such action 4. Avoid posting discriminatory remarks related to patient care. 5. Know your hospital policy in relation to work related postings 6. Avoid misuse of computer access to social media at your workplace. 7. The internet is not your therapist. Avoid posting vicious or threatening remarks of your employer. 8. Report incidences that are a breach of patient confidentiality. Reference: Spector, N., and Kappel, D. (2012). Guidelines for Using Electronic and Social Media: The Regulatory Perspective, Online Journal Issues Nursing, 17 (3)

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Perianesthesia Trends

Certification

A toast to our newly minted CPAN and CAPA certified nurses!

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CAPA Emily Arroyo Catherine Brewer Katie Conyers Barbara Cook Patricia Curley Joan Dorrance Stephanie Eckles Sheryl Greenbury Roberta Harner Debra Hebbel Sarah Holsteen Jane Hutson Connie Kreider Patrick Mahoney Carol Mullins Pia Niewoonder Hillary Payne Amy Rahe Sara Theobald Jacqueline Tolson

CPAN Marta Hoffman Amy Dickerson Mary Griffith Kelly Talbot Misty Russell Angela Craig Niko Ferguson Janet Laird Lisa Thorpe Stefanie Ungstad Jessica Johnson Leslie Warren Jacqueline Baldwin Julie Lange

Carolyn Dietrich was awarded ASPAN Excellence in Clinical Practice 2013. She is a Clinical Nurse IV RN at the University of Colorado Hospital. Ms. Dietrich is recognized for her contribution to nursing through her research project on Comparing Temperature results from Infrared Thermometry. She also developed a perioperative survey on customer satisfaction. She served as the Secretary for RMPANA District I for 5 years. At the University of Colorado, she is active with hospital wide commit-tees such as Magnet and Safety.

Recognition Barbara Godden was the Denver Metro Regional Nightingale Awardee for Leadership Non-traditional Role. Event was held March 16th and sponsored by Cental Colorado AHEC. She was nominated for her numerous contribution to perianesthesia nursing. Her role as ASPAN Director for Clinical Practice strengthened the specialty practice by addressing issues and con-cerns by clinicians. Barbara Godden is currently the editor of ASPAN newsletter, Breathline. She also serves as a member of ASPAN SWT Standards and Guidelines and National Conference Pri-mer. She is the clinical coordinator of Perianesthesia Services at Sky Ridge Medical Center.

Mary Rachel Romero was awarded the 2013 Colorado Nightingale Luminary Award for Advocacy. She was nominated for her numerous projects to improve patient care. She has authored guide-lines such as Prevention of Pressure Ulcers in PACU and Managing Corneal Abrasion. Ms. Romero worked on an evidence based project on how to reduce noise levels in the PACU setting. This pro-ject showcased her concerns on how noise affected not only the patient’s recovery, but also how disruptive noise can be to healthcare providers. Mary Rachel is a Team leader for ASPAN Clinical Practice Committee, a member of ASPAN SWT EMR Implementation and SWT Governmental Af-fairs. She is currently the editor of Air Exchange, RMPANA component newsletter and chair of Governmental Affairs.

Bedside Story

Chronicles of a PACU New Grad

(three of four series) By Kristen Kriegshauser RN , BSN

I am on my own. Well, I am a nurse without a preceptor but in the PACU you are never truly on your own. A PACU nurse has several nurses around him or her to bounce questions off of and use for support and advice. Nevertheless, I am official-ly on my own and taking care of my own patients. For most PACU nurses this is nothing new, but for a new grad in the PACU this is a completely new and nerve racking experience. The first couple weeks I constantly asked myself if I was missing something. I was extremely wor-

ried I was going to get a complicated patient that I never had before and I would not know what to do. I would constantly question myself if I was giving my patient enough pain medication or too much. Should I start with fentanyl or go straight to Dilaudid? Will a doctor want to know about drain bleeding or do they expect it? Am I bothering a doctor with a phone call that seasoned nurses would not call about, or am I doing the right thing? Will the patient ask me a question I do not know, and how will I deal with it? All these questions and concerns started to slowly dissipate overtime as I continued to get more and more experience on my own. The pain medication situ-ations became very easy for me to start navigating. I think I was so scared I was going to give someone too much pain medication and they would need Narcan, but in reality I know what signs and symptoms to look for in patients who have re-ceived too much medication or patients who have not received enough. As for deciding when to call a doctor and when not too, that will always be a learning experience. At University of Colorado there is the option to text page resi-dents and doctors. I have found this to be the best way to get a hold of a doctor and let them know about something or get an order placed. The more serious and

pressing issues I always call, but things that I just want to inform the service about I have learned that text paging is a quick and easy system to use. Finally, the most important thing I have learned is that I will never know everything and I will al-ways be learning. If I do not know the specific answer to a question I am honest and say I do not know but I will go find out. Nursing is a career where learning will never stop and to be the best nurse you can be a person should really have the goal to continue to learn. Things are constantly changing in the health care field and reading up on literature, participating and following evidence based studies and attending continuing education courses are things that extremely im-portant for all RNs to do, no matter their years of experience. As a new graduate, it has been a hard, challenging, and sometimes stressful to take my first job in the PACU, however I would not change my decision. I have learned so much, seen so much, and encountered a large diverse patient population that I am very fortunate and glad to have experienced. I cannot wait to see how I will feel in the next couple months and years as my practice continues and I learn and grow.

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Grand Valley Surgical Center

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Hospital Views PAGE 19 AIR EXC HAN GE

Grand Valley Surgical Center is a licensed and accredited freestanding ambulatory surgical center jointly owned by surgeons and St.  Mary’s  Hos-­‐pital and Medical Center. Together the owners have designated a governing board that has oversight and accountability for all facility operations.

The board has made has made every effort to insure the center pro-vides high quality care in a safe environment, with state –of-the-art equipment and an experienced staff. GVSC was established in 2000. The GVSC specialties include ENT, orthopedic, ophthalmology, general surgery, plastics, neurology, vascular, urology, gynecology and a chronic pain clinic. There are five surgical suites and one procedure room. On most days we utilize 4 or 5 of the suites/procedure room. GVSC averages around 400 cases a month.  We  are  licensed  for  “2359”  and  have  begun  investigating  procedures that could include overnight stays. Our regular business

hours are 7:30 am – 5:00 pm Monday through Friday. GVSC has 6 preoperative rooms and 12 postoperative rooms surrounding one of the operating suites and the procedure room and the pre and post nursing stations. 2 of the larger glass-fronted postoperative

rooms serve as peripheral block rooms during the morning and overnight rooms later in the day. There are four other glass-fronted rooms to accommodate pediatric cases in the morning and larger cases in the afternoon. The other 6 are curtained bays for shorter stay procedures. There are two conference rooms for physicians/family consultations. GVSC provides care across a broad spectrum of ages. Pediatric specialist in orthopedics, ophthalmol-ogy, general surgery, as well as our ENT surgeons provide procedures for infants and children. The Ophthalmologists, of course, bring us a significant geriatric population. Our most frequent cases involve T&T, T&A, sinus, knee arthroscopy, ACL reconstruction, shoulder procedures, cataracts with LRI and ECP, eye muscles, breast biopsies, hernias, laparoscopic cholecystectomies, various plastic procedures and the chronic pain injections. Our original clinical staff included very experi-enced nurses. Our average years of experi-

ence for clinical nursing staff, PACU and OR, when we started was 22 years. That experi-ence allowed us to get a solid start. We have steadily grown for the past 13 years. Change and adaptation being the name of the game in healthcare, we have just hired and are training our first new grad nurse in the perianesthesia staff. 6 of the staff have been with us less than 6 months, and 2 others are in their first year. So there are 7 nurses mentoring the others. As of January 1st this year Surgical Management Professionals was hired to handle our administration, at the retirement of our longtime administrator. The transition has been professional and smooth. We have 3 RMPANA members, one CAPA RN and 8 who have attend a RMPANA activities. There seems to be considerable interest in RMPA-NA from our newer staff. GVSC currently has 4 full time RNs, 8 part-time RNs, 3 casual RNs, 1 CNA/Rad Tech/Ward Clerk and a full-time Ward Clerk in its perianesthesia mix. We rotate on a weekly basis between preadmission assessment, preoperative and postopera-tive duties, and often participate in all three areas in the same day. We practice a form of shared governance with everyone responsible for a role in daily operation of the perianesthesia area in addition to our patient care. It is a real team effort Our physicians and clinical staff have been active in mission trips in Africa and South America. As evidenced by this young man from Cusco, Peru.

Healthstyles-Summer Recipes PAGE 20

Grant Family Farms Italian Kale Salad Submitted by JoEtte Krissel

1 head Kale, stems removed ( hold base of stalk and strip by running your fingers up the stalk 1 Red Bell Pepper, diced 1 clove garlic, crushed 1 cup Pine Nuts or Sunflower Seeds ½ cup Grape Tomatoes, halved 1 tsp Sea or Kosher salt ½ cup Cauliflower, sliced thin Marinade 3 Tbsp Lemon Juice 2 Tbsp Agave Nectar or juice of one orange 1 ½ tsp sea or kosher salt 1 tsp Italian seasoning 1 tsp dried Oregano powder 1 tsp Cayenne Pepper (optional) 1 tsp Cumin powder 1 tsp black pepper Method Stack 3 – 4 Kale leaves, fold in half lengthwise and roll up tightly. Chiffonade the kale by slicing crosswise into thin ribbon strips, repeat with all the kale. Combine marinade ingredients in a separate bowl. Pour over cut kale. Add the crushed garlic and slat. Use your hands to mas-sage the marinade into the kale. The kale will wilt and become soft and take on a cooked appearance. Taste the kale and if there is still bitterness, add additional slat and or lemon juice to balance the flavors. Gently toss with the rest of the vegetables. (Mine turned out too spicy hot the first time with the called for cayenne pepper, and the second time with the called for salt, so be careful and taste accordingly.)

Watermelon Mint Smoothie

Ingredients: 1 to 2 cups seedless watermelon chunks 1 tablespoons honey 1 tablespoon fresh mint leaves, or to taste 1 cup lemon yogurt Dash cinnamon

Directions: Puree watermelon, honey, and mint in a blender or food processor quickly–do not over blend. Pulse in the yogurt and cinnamon just until smooth.

Pear Mimosas

Ingredients: 2 bottles Champagne or Ginger Ale, chilled 4 cups pear nectar 1 lime cut into 8 wedges Directions: For each serv-ing, pour 3/4 cup of Cham-pagne (or ginger ale) into a flute or wineglass and top with 1/2 cup of pear nec-tar. Squeeze and drop in 1 wedge of lime.

PAGE 21 AIR EXCHANGE

What’s Buzzing Around……………...………………………………………………………………………………………….

Poudre Valley and Medical Center of the Rockies are switching to EPIC system. Their “Go Live” date is July 13th. Perianesthesia and perioperative staff just completed their intense training last May and June 2013. We wish them the best as they transition into “infinity and beyond”.

Editor’s Note Hello dear readers! I attended the Developmental Luncheon at the 2013 ASPAN National Conference-Chicago. The speaker during this session was Ms. Maureen Iaconno who, like Lois Schick and Myrna Mamaril, has been an inspiration to me ever since I started my perian-esthesia nursing career in 1991. Ms.Iaconno talked about our journey as nurses and how we all have stories to tell regarding our relation-ships with our patients and colleagues. She believes that we should write of our experiences because through this story telling, we can learn from each other. Writing our bedside stories can also be cathartic. It has been noted that reflective journaling has profound effects in purifying the soul. In this connection, I would like everyone to submit your bedside stories so we can all share common ex-periences. If you prefer to submit other articles, these are our categories. However, we accept all kinds of write-up so feel free to send on what you are interested in.

Cutting Edge-innovations in surgery or medicine Little Voices-news related to pediatrics Perianesthesia Trends-New changes in nursing practice Bedside Story-Clinical narratives from the bedside, patient advocacy Community Service-Mission trips, fundraising, food drives Others: Events related to Perianesthesia nursing Heath and Wellness Tips

This is your chance to showcase your skills! My email address is maryrachel.romero@yahoo.com Looking forward to your articles! Mary “Rachel” Romero