John Nance, JD

Keynote speaker John Nance, JD, presented a compelling “flight plan” for hospitals to change the culture of medicine and reduce errors. According to Nance, lessons learned from aviation can help reduce errors to zero.

Nance is a pioneer of Crew Resource Management, which revolutionized aviation safety, and a founding member of the National Patient Safety Foundation. Best known for his work as aviation analyst for ABC World News and Good Morning America, Nance is also a decorated Air Force officer and pilot, a lawyer, and the author of 19 books, including Why Hospitals Should Fly, which won the prestigious “Book of the Year” award for 2009 by the American College of Healthcare Executives. Nance also writes best-selling fiction, riveting thrillers set in the world of aviation. His latest novel, Orbit, is currently in development as a major motion picture.

Evolution in Healthcare

To describe the “revolutionary evolution” in healthcare today, Nance began by quoting the opening lines of Charles Dickens’ A Tale of Two Cities: “It was the best of times, it was the worst of times.” He stressed the need for a change in the culture of medicine, a move from physician-centric to patient-centric care. “We have to change the way we do business,” he said, “we have to make it a unified system that says everything is subordinate to the best interests of the patient—everything. That’s patient-centric. We’re just not there.”

The shift needs to happen, according to Nance, because doctors are trained to operate autonomously. This system worked 100 years ago, but it does not work in today’s complex healthcare environment. Also of concern is the expectation in healthcare of perfection, which Nance describes as “a fraud.” He spoke of “the inertia of perfectionism,” suggesting that admitting we’re human and understanding that the potential for mistakes is always there can lead to a different philosophy that can reduce error rates.

Getting to Zero Errors

Getting to zero errors is achievable, according to Nance, and involves intelligence and three important steps: 1.) learning how humans fail, 2.) fostering relationships, and 3.) ending the age of autonomous scientists and creating teamwork.

Nance described three ways that human beings fail; errors of perception, assumptions, and miscommunication. He encouraged the crowd to remember the 12.5% Rule: 12.5% of the time, “people who speak the same language, same dialect, and same level of education do not understand each other.”

Fostering relationships is crucial to creating good communication. Nance asked the crowd if they could think of an error that did not involve at least one element of communications failure. No hands were raised, and Nance said that none of the 15,000 people who have attended his speeches have raised a hand.

The revolution in aviation safety stressed the need for camaraderie in the cockpit, an atmosphere in which “Everybody on that team has respect for everybody else and there is no barrier to communication. If anyone sees, hears, feels, or even intuits without any logical foundation whatsoever that something is wrong, they share that instantaneously,” said Nance. With this kind of open communication and collegiality, along with appropriate checklists and the minimization of variables, the team can make the split-second decisions necessary in the cockpit and the operating room.

Three Pedestals of Patient Safety

Nance described three pedestals of patient safety: 1.) Patient-centric care, 2.) Best practices, and 3.) Collegial, interactive teams. “You are in charge of all three,” he said.

“This is a revolution. This is the best of times, not the worst of times,” said Nance, “We’ve got the ability to make something grander, and do it right. And do it with zero patient impact, and do it in a way that’s going to require a certain amount of courage.” He sees nurse anesthetists as an important part of the revolution. “You are all in a position of great authority and responsibility, and you can’t stay silent.”

Nance believes that applying these principles of aviation safety to healthcare can make a difference in the rate of medical errors. With these pedestals of patient safety in place, he said, “We can almost guarantee perfection because any mistake that any of us make, any latent mistake in the system, we’re going to be ready to catch. That is tremendously powerful.”

Evelyn McKnight, AuD

Audiologist Evelyn McKnight, AuD, began her presentation to the Monday General Session audience by telling them a story about her family. The story began in 2000, when she was diagnosed with breast cancer. Her doctors assured her it was only “a bump in the road,” and she underwent chemotherapy. That “bump in the road,” she related to the audience, would “lead our lives in an entirely different direction.”

When McKnight‘s cancer recurred, she decided to undergo the arduous stem cell rescue procedure to improve her chances of survival. It was when she checked in for the procedure after “screwing up my courage and packing my hats and wigs and reading material,” that tests revealed that she had contracted Hepatitis C. McKnight and her husband, Tom McKnight, MD, a family practitioner from Fremont, Neb., were “shell shocked.” Adding to their anguish was the fact that there was no explanation of how or why she contracted the disease. Her only risk factor was that she had “accessed healthcare.”

McKnight ultimately underwent the stem cell rescue procedure, and fortunately, has not experienced a recurrence of her cancer.

McKnight’s story, “one of many,” is the story of the worst outbreak of Hepatitis C in U.S. history. Traced to unsafe injection practices in the Fremont, Neb., oncology clinic where McKnight received treatment for her cancer, the outbreak encompassed 99 patients.

Six of the 99 patients died of Hepatitis C instead of cancer. Thirty-three of the 99 patients underwent grueling antiviral therapy for Hepatitis C, with 28 achieving sustained virological response (SVR). Eleven of the 99 patients died of cancer. Poignantly, McKnight noted that two of those patients had achieved SVR, having undergone the difficult antiviral treatment at the same time they were fighting cancer, and ultimately losing their battle.

The outbreak is the subject of McKnight’s book A Never Event, coauthored with attorney Travis T. Bennington. The book is available through the AANA bookstore and provides a riveting look at the tragedy as it unfolded from a medical, legal, and patient perspective.

McKnight notes that unfortunately, her story is one of many. Outbreaks continue to happen, including one reported last week in Mississippi. The results of these continued outbreaks are untold human suffering, patient distrust in the healthcare system, the spread of blood borne viruses and other inflections, and disciplinary actions and malpractice suits against providers—a medical, financial, emotional, and social disaster.

As a result of her experience, and with the desire to do “something good” with her lawsuit settlement, McKnight and her husband founded the HONOReform Foundation, an organization dedicated to preventing tragedies such as the outbreak in Nebraska.

As a result of her work, McKnight hears from patients with Hepatitis C from around the country. She told the audience about Ron, the safety director of radiation center in a large hospital in Boston. Ron had been treated for throat cancer and never found out how he contracted Hepatitis C. Like McKnight, his only risk factor was that he had accessed healthcare. “He was buried on Saturday,” McKnight told the hushed audience.  She dedicated her Monday General Session speech to Ron and other patients across the country who don’t know how or why they contracted Hepatitis C. She told the audience, “It’s hard to come to a place of peace when you don’t have those answers.”

McKnight provided an overview of the One and Only Campaign (http://www.oneandonlycampaign.org/), a public health campaign led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise awareness among patients and healthcare providers about safe injection practices. The campaign aims to eradicate outbreaks resulting from unsafe injection practices. She asked members of the audience to repeat the campaign pledge aloud: One Needle, One, syringe, Only one time.

McKnight ended her speech by thanking the audience and the AANA for their commitment to safe injection practices, and told them how she valued them and the nursing profession.  She said that as a patient, “I can see the care in your eyes over your surgical mask and feel the warmth of your touch through the latex gloves.”

Amy Young, RN (l) and Emma Batchelder, RN

A full crowd of student registered nurse anesthetists attended the Annual Student Luncheon on Monday. Amy Young, RN, BSN, outgoing student representative to the Education Committee, served as emcee, welcoming the students and introducing guests. She thanked the members of the Education Committee and fellow students for the opportunity to serve the AANA.

Young acknowledged that student registered nurse anesthetists come from many different backgrounds and have a variety of challenges, but “the one thing we have in common is we chose this path.” She expressed that she feels “fortunate to be an anesthesia student.” Young said, “Anesthesia school is not fun, but it is awesome,” giving examples of the many exciting experiences that are a part of being a student of anesthesia.

The program included remarks from AANA President Paul Santoro, CRNA, MS, NBCRNA President Mary Anne Krough, CRNA, PhD, and AANA Foundation Chair Louise Hershkowitz, CRNA, MSHA. A slideshow depicted the winners of the various AANA Foundation scholarships that were awarded, and Hershkowitz encouraged students to give back to the profession by supporting the Foundation. Krough urged students to “embrace the student experience” reminding them that “situations that challenge us contribute to our growth.”

James Walker, CRNA, DNP, past president and chair of the Education Committee, announced the winner of the Student Writing Contest, Amanda C. Rossman, RN, BSN, from the York College of Pennsylvania/Wellspan Health Nurse Anesthetist Program in York, Pennsylvania. Her article is titled “The Physiology of the Nicotinic Acetylcholine Receptor and its Importance in the Administration of Anesthesia.”

Eight student manuscripts were submitted for blinded peer review and judged by the AANA Journal Committee on quality of writing and organization; critical analysis, use of the literature, and novel thoughts and ideas; and contribution to the profession. Walker thanked students for submitting their work to the Student Writing Contest.

John Preston, CRNA, DNSc, AANA senior director, Education and Professional Development, awarded the Student Excellence in Education Award to Matrina Whitley, RN,  from Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences in Detroit, Mich. The Student Excellence in Education Award was developed to recognize student achievement in promoting the profession of nurse anesthesia. Whitley’s entry, according to Preston, was the clear winner of nine submitted.

Whitley invited 20 students in Detroit who excel in school and have an interest in the health sciences to learn about being a nurse anesthetist. Students were shown the University’s simulation laboratory and an operating room, and told what they need to do now if they want to choose nurse anesthesia as a career path.

At the end of the luncheon, Young announced the 2012 student representative to the Education Committee, Emma Batchelder, RN, from Wake Forest Baptist Health Nurse Anesthesia Program in Winston-Salem, N.C.

Congratulations to all participants. Here are the top finishers:

Top three men

1) Mark Blazey at 19.57 minutes

2) David Dirito at 19.59 minutes

3) Greg Escaria at 21.05 minutes

Top three women

1) Megan Fritchman at 21.33 minutes

2) Jen Ulicmi at 21.54 minutes

3) Emily Herzig at 23.31 minutes

Wellness Booth Pushup and Situp Contests

The AANA Wellness Program offered CRNA and student registered nurse anesthetists two more opportunities to demonstrate their athletic prowess: the Pushup Contest on Sunday and the Situp Contest on Monday!

Congratulations to all participants!

Sunday Pushup Contest Winners

• Men less than 30 years old: Joe Rodriguez, 84
• Women less than 30 years old: Maureen Devlin, 60
• Men age 30-39: Tom Sampson, 140, making him the overall winner
• Women age 30-39: Cara Vonhof, 51
• Men age 40-49: Mark Haffey, 100
• Women age 40-49: Karla Moore, 62
• Men age 50-59: Scott Allen, 63
• Women age 50-59: Denise Mitchelan, 45
• Participants over 60: Paul Odom, 30

Monday Situp Contest Winners

• Men less than 30 years old: Brian Tabor, 40
• Women less than 30 years old: Sarah Billings, 85
• Men age 30-39: Carlos Wild, 135
• Women age 30-39: Sarah Howard 135
• Women age 40-49: Paula Randazzo, 62
• Men age 50-59: Terry Wicks, 60
• Participants over 60: Diana Quinlan, 25

So, hurry and stop by the Bookstore, located on the third floor of the Hynes Convention Center—they’ll be there “in person” on Tuesday from  7 a.m. to 2 p.m., and Wednesday, from 7 a.m. to 1 p.m.

Prices have been slashed to move a variety of merchandise, and signed copies of Gene Blumenreich’s book Let the Record Show are still available for purchase at $29.95.

On the topic of pharmacology, Vesna Jevtovich-Todorovich, MD, PhD, MBA, offers her views on whether anesthesia of any kind is safe during pregnancy or lactation. Developments in vasopressor pharmacology are analyzed, and the relevance of old drugs is re-examined. Later, Myron H. Arnaud, CRNA, MS, discusses propofol infusion syndrome.

A concurrent session presents a potpourri of general-topic lectures. Mary K. O’Brien, CRNA, MSN, EJD, will present her lecture, “Anatomy of a Lawsuit” — important information for all healthcare providers. Patients with obstructive sleep apnea syndrome and their suitability for ambulatory surgery, codes in the postanesthesia care unit (PACU), and fires in the operating room are some issues affecting the practice of medicine that are explored in the remaining potpourri lectures.

Pediatric patients can present special challenges for CRNAs. Therefore, an entire concurrent session is devoted to issues involving the pediatric patient. Andrew L. Pitt, CRNA, and Stanley M. Hall, MD, PhD, debate the concerns of perioperative management in children, discuss pediatric pain management, impart pearls for pediatric anesthesia providers, and offer advice for dealing with a pediatric patient with congenital heart disease who undergoes noncardiac surgery.

Cardiothoracic concerns are also addressed in this final morning session. Attendees can improve their ability to interpret perioperative ECG changes and further their understanding of the pulmonary function test. Strategies presented for handling cardiac arrest in the obstetric patient and acute cardiac ischemic events in the operating room will help CRNAs grow more confident in their decision-making skills.

Myron Arnaud, CRNA, MS, and Mary Golinski, CRNA, PhD, will discuss some of the current conundrums in pharmacology at the afternoon pharmacology session. Arnaud will review current evidence on intraoperative glycemic control, and Golinski will discuss current SCIP protocols vs. evidence of increased mortality with beta blockade therapy.

The Wednesday afternoon pediatrics session gives attendees a chance to learn about the latest evidence-based management of airway emergencies. Thomas Miller, CRNA, MSN, will discuss practical approaches for the management of the difficult pediatric airway. Kim Reiser, CRNA, CPNP, will then present, The (Un)common Pediatric Patient – Not so Routine? The talk will review anesthetic implications regarding pediatric patients undergoing surgical procedures with complicating comorbidities.

This year’s Educators session tackles the topic of generational differences and their effects on the educational process. Lisa Mileto, CRNA, MS, will describe cross-generational conflict and its impact on nurse anesthesia education, analyze how healthcare education is changing, and identify methods to effectively teach and evaluate students of various generations. The AANA Education Committee will then offer strategies for managing generational differences in the nurse anesthesia program.

The Wednesday 1 p.m. to 3 p.m. timeslot provides attendees plenty of learning opportunities. Be sure to check out any of the afternoon educational sessions that may be of interest before bidding adieu to the beautiful city of Boston.