By Debra Wood, RN, contributor Sep 04, 2018
Many people across the United
States rely on certified registered nurse anesthetists (CRNAs) for pain
management, and the anesthesia and analgesic specialists are moving to a
multimodal approach to address pain issues and the country’s opioid crisis.
“Patient
safety is our priority, and we care for patients across the continuum of life,
whether it’s a neonate addicted to cocaine or opioids at birth clear through
taking care of patients in surgery or the emergency room to resuscitate,” said Lynn Reede, DNP, MBA, CRNA, FNAP, chief clinical officer at
the American Association of Nurse Anesthetists (AANA), outlining
the organization’s interest in addressing the opioid crisis.
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The
role of nurse anesthetists in pain management
CRNA jobs may include placing
epidurals or regional nerve blocks with ultrasound guidance. Military CRNAs
place blocks in wounded soldiers before they are transported to a tertiary hospital
for definitive care.
Bruce Schoneboom, PhD, CRNA,
FAAN, chief learning officer of the AANA, is the organization’s appointee to
the U.S. Health and Human Services Pain Management Best Practices Inter-Agency
Task Force, which will identify gaps in pain management protocols and make
recommendations to address those gaps, propose best practices, and develop a
strategy for sharing that information with the public and federal agencies.
Schoneboom is the only nurse
appointed to the task force. He has explained the role CRNAs play in pain
management and access to care. He indicated that AANA “believes that moving
from a unimodal approach of using opioid drugs to manage chronic and acute pain
to a more patient-centered, multidisciplinary, multimodal opioid-sparing
treatment approach optimizes patient engagement in their own pain care.” That
will reduce the risk of substance use disorder.
Reede explained that engaging
the patient prior to surgery and educating the patient that he or she will have
some pain but the patient will be able to manage it helps with reducing opioid
use.
“If we can prevent pain
sensations from getting to the brain, the [patient] can be more comfortable,”
Reede said. Without opioids, which only work in the brain, the patient will be
less sleepy, and not suffer other side effects associated with opioids.
“The real management is the
partnership between the provider and the patient,” Reede said.
Managing
pain with and without opioids
Every year, millions of
Americans experience acute or chronic pain, according to the American Academy
of Pain Medicine. An estimated 100 million suffer with chronic pain. There are
no easy solutions.
Many patients rely on certified
registered nurse anesthetists as their primary pain specialist.
An estimated 6 to 12 percent of
patients treated with opioids develop addiction, said Michael D. McGee, MD, chief
medical officer at The Haven at Pismo in Grover Beach, California, and author
of The Joy of Recovery: The New 12-Step
Guide to Recovery from Addiction.
Therefore, he said, it is “important to
avoid opioids if at all possible and use multimodal interventions for pain
management.”
The Centers for Disease Control and
Prevention has issued guidelines for managing chronic pain. It recommends non-pharmacologic
therapy for chronic pain and use of opioids only with other methods of
relieving pain. Patients receiving opioids must be monitored.
McGee advised in treating chronic pain that clinicians work
to improve functioning, reduce pain and reduce psychological suffering.
“Integrate the treatment of pain and other comorbidities,
including addictions and other psychiatric illnesses,” McGee said. “Combine nonopioid
pharmacological and nonpharmacological therapies, collaborating as part of a
team with other caregivers.”
Removing
barriers to CRNA practice
Despite CRNAs administering more
than 43 million anesthetics to patients annually, artificial barriers and restrictions
exist, limiting access to care.
CRNA jobs are plentiful, and the U.S. Bureau
of Labor Statistics predicts job growth will far exceed the average of other
occupations from 2016 to 2026.
Recruiters at Staff Care report
that nurse practitioner and CRNA jobs are the most in-demand advanced practice
specialties for locum tenens assignments.
Seventeen states do not require
physician supervision for Medicare A reimbursement. Maryland recently
eliminated the requirement that CRNAs have a written collaborative agreement
with a physician.
The marketplace is driving
change to supervision, because one-on-one supervision is not cost effective,
Reede said.
“Employers are looking to
provide optimal anesthesia and pain-management services at a reasonable cost,”
Reede added. “When a CRNA salary is a half or sometimes a third of the cost of
an anesthesiologist, and we are expected to deliver the same care, which we do,
it is expensive model when you have an anesthesiologist staffing a CRNA."
AANA continues to push to remove
barriers to practice.
“The goal is for all healthcare
professionals, in particular the advanced practice providers, to practice to
the full scope of education and licensure,” Reede said.
Related:
CRNA
Scope of Practice: Advancing Anesthesia Safety
Nurse
Practitioner and CRNA Scope of Practice: 2018 Updates
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