Volume 35 Issue 2 FALL/WINTER

Transcription

1 ASPAN 2013 COMPONENT NEWSLETTER OF THE YEAR Inside MEMBER SPOTLIGHTS & AWARDS Page 3-4 CPAN/CAPA CERTIFICATION NEWS Page 5 SUGAMMADEX Page 6-7 NAPAN FINANCIAL SUMMARY Page 7 NAPAN State Conference Page 8-9 NAPAN Membership Meeting Minutes Page 10 GOVERNMENT AFFAIRS Page 11 CALENDAR Page 12 RESEARCH ARTICLE Page PRESIDENT S MESSAGE NAPPIN News Volume 35 Issue 2 FALL/WINTER The Official Newsletter of NAPAN. All rights reserved If you hear a voice within you say you cannot paint, then by all means paint and that voice will be silenced Vincent Van Gogh As I begin my term as NAPAN President (a job that I am very humbled and excited to have) I would like to take this opportunity to say hello and to affirm my commitment to you, our members and all perianesthesia nurses. My Nursing career began in 1976 after graduating from Methodist Hospital School of Nursing in Omaha, Nebraska. I worked at St. Anthony s Hospital in O Neill, Nebraska. O Neill is located in Northwest Nebraska and is a town of about O Neill is known far and wide for its St. Patrick s Day Celebrations and Irish Traditions. You may have heard of it or even had a green beer there. The hospital had 27 beds. The nurses were required to have ACLS, PALS, NALS, and Trauma Certifications. In working in a small community hospital you covered ER, OB, Nursery, Medical-Surgical, Pre-op and Post-op, and cared for critical patients on ventilators. I was also cross-trained to work in OR and worked one day a week in chemotherapy. It was truly a colorful mixture of everything. This broad base of nursing experience where we had to do everything gave me the opportunity to do anything when I moved to Omaha 8 years ago. I have worked at CHI Lakeside Hospital Procedure Center for 7 ½ years. I truly love and am passionate about perianesthesia nursing and continue to learn new things every day. I have been an ASPAN/NAPAN member for many years and I received my CAPA certification while working in O Neill and my CPAN certification in May of After moving to Omaha I became Member at Large and was on Finance Committee. Over the years I also served as secretary and the last 2 years as Vice President. EDITOR S EDGE Page 20 NAPAN BOARD Page 21 I would like to thank Pat Stevens for her commitment and leadership these past 2 years as president of NAPAN. She has been a mentor to me and I will continue to rely on her experience and insights. I would also like to thank and acknowledge the NAPAN Board and Committee chairs and members for their solid record in leadership in providing this organization with outstanding educational programs, for maintaining membership recruitment and retention and for promoting certification, governance and fiscal

2 2 responsibility. I would also thank them for their community involvement and volunteering of time and talents. I invite each of you to become more involved with this vibrant organization ASPAN/NAPAN. We want to listen to your ideas and concerns and we look forward to connecting with you at educational programs, through newsletters, web page, s & Facebook. Consider writing an article for our newsletter. Apply for scholarship funding. Join a committee. Think about your professional goals. Celebrate PANAW week Feb 6-12 th Send pictures to webpage or Facebook. Volunteer in your community. This year we are supporting Vets with Angel Tree at Christmas. We will be donating personal or clothing items and will also do a hands on event. There will be more on our web page. With health care changes and challenges, we must adjust and work together keeping our patients, families and community s safety and care at the forefront. Please feel free to contact me, Carolyn Carr RN, CAPA, CPAN, NAPAN President (carolynacarr@yhoo.com) NAPAN MISSION STATEMENT NAPAN exists as a component of ASPAN to advance nursing practice through education, research and standards Do you want to contribute? To contribute information or articles for publication in the Nappin News, please note the following publication schedule. Articles will be accepted at any time for publication at a future date. Correspondence should include author s full name, credentials and references as needed. All material will be subject to editing prior to publication. Please send all material for inclusion in Nappin News via to Judy judymink40@gmail.com For Publication in: Send info by: Spring Issue May 1 Fall Issue November 1

3 NAPAN AWARDS & MEMBER SPOTLIGHTS It is my privilege and honor to present the Outstanding Service Award to Phyliss Bolton. Phyliss is a long time member of ASPAN and NAPAN. Throughout the years she has served on many committees and has served as President of NAPAN. She is immediate past editor of our Nappin News newsletter. The Newsletter won the ASPAN newsletter award in At the national level Phyliss has served on the ASPAN Clinical Practice Team. Phyliss has been instrumental in bringing ASPAN leaders to present at our State Conferences. She has hosted meetings at Methodist Jenni Edmundson Hospital and always made the event special. Phyliss is married to Ken and has one daughter and 3 grandchildren. She lives in Council Bluffs, Iowa and has worked at Methodist Jenni Edmundson Hospital for 37 years. Phyliss is Charge PACU nurse at Methodist Jenni Edmundson Hospital in Council Bluffs. Her leadership and dedication has impacted Perianesthesia nursing at her place of employment, her community and at the state and national levels. NAPAN thanks you Phyliss, for your commitment and service to Perianesthesia Nursing. NEBRASKA ASSOCIATION OF PERIANESTHESIA NURSES Carolyn Carr RN, CAPA, CPAN, NAPAN President Carolyn Carr, NAPAN President and Pat Stevens, NAPAN President presenting the Outstanding Service Award to Phyliss Bolton. Phyliss Bolton RN CPAN 2016 Outstanding Service Award Winner

4 4 The 2016 journalism awards were presented at the 33rd annual NAPAN state conference. Bernie Larsen received the General Interest Article award for her article Measles which was published the the spring 2015 issue of NAPPIN News. Diana Eggerss was awarded the Clinical Practice award for her article Capnography Can Prevent Respiratory Events which was published in the fall 2015 issue of NAPPIN News. Bernie Larsen RN, CAPA receiving the 2016 General Interest journalism award for her article Measles from Pat Stevens BSN, RN, CPAN Diana Eggerss BSN, RN, CPAN Winner of the 2016 Clinical Practice award for Capnography Can Prevent Respiratory Events

5 5 CPAN / CAPA CERTIFICATION NEWS ASPAN/NAPAN members receive a $110 discount. Register early to get the testing date you want and have time to study. Learn more about CPAN and CAPA Certification at CPAN / CAPA Study Tools ABPANC has a whole section of their website dedicated to providing study tools to help you prepare for the exam. Free resources include: Certification Candidate Handbook Test Blueprints Study Reference List 12-week Study Plan Study Question of the Week Study Tips Test Taking Strategies Webinar Conquering Test Anxiety Webinar Mind Mapping Study Guide Certification Coach Practice Exams Buy One Get One Free 100 questions for $50. Earn 3.67 contact hours.

6 6 Sugammadex: The New Kid on the Neuromuscular Block By Kristy Iwansky, MSN RN CPAN CAPA According to Anesthesia Essays and Researchers (2013), Sugammadex is described as a revolutionary and unique drug in neuromuscular pharmacology! Though previously used in other countries, Sugammadex was not approved by the FDA for use in the USA until December of Sugammadex, also known as Bridion, is the first of a new class of selective binding agents, known as cyclodextrins, which can be used to reverse the neuromuscular blockade of the nondepolarizing neuromuscular blocking agents (NMBA s) rocuronium and vecuronium. Authors Nag et al (2013) claim that Sugammadex is close to being the ideal reversal agent due to its fast onset of complete reversal. It also comes with fewer side effects (e.g. bradycardia and nausea) when compared to other popular reversal agents used. According to MERCK (2015), Sugammadex works differently than other reversal agents. For example, while neostigmine is used to reverse the effects of muscle relaxants by blocking acetylcholinesterase, allowing an increase in acetylcholine at the neuromuscular junction and return of movement, Sugammadex actually encapsulates the NMBA thereby completely removing these agents from the neuromuscular junction and facilitating the return of normal muscle function. This encapsulation eliminates the occurrence of postoperative residual NMB. This drug is almost completely excreted by the urine and its half-life can be prolonged in patients with renal disease. Adverse effects reported include dysgeusia (metal or bitter taste), nausea and vomiting, and bradycardia. The few adverse effects reported have also been associated with higher dosages of Sugammadex, which are not used as often as the lower doses. Noted drug interactions with use of Sugammadex include a delay of recovery in patients using toremifene. And, any patient using hormonal contraceptives must be advised they will need to use an additional, non-hormonal method of contraception for the next 7 days following Sugammadex administration.

7 7 Sugammadex can be used as a rescue agent in patients experiencing residual curarisation. This new drug comes with a high price tag. The cost of reversal of NMBAs with Suggamadex is approximately $63 (2mg/kg) for a 70kg patient compared to the cost of reversal with Neostigmine at approximately $5 (5mg dose) for a 70kg patient. Undoubtedly, Sugammadex is a milestone and could likely become the favorite new kid on the neuromuscular block. References Nag, K., Singh, D., Shetti, A. et al. (2013). Anesthesia essays and researches. accessed 10/28/16. MERCK (2015). If sugammadex is the answer what is the question? accessed 10/28/16. Jolley, D. (2012). Gasexchange. accessed 10/28/16. NAPAN Financial Summary Ending Balance Checking account- October 26, 2016 $ 8,300 Scholarships outstanding- October 26, 2016 $ 586 CD balance as of October 26, 2016 $ 5,818 Money market account balance as of October 26, 2016 $ 5,218 Kountz Food Pantry Donation $ 25 Petty Cash as of October 26, 2016 $ 20 Respectfully Submitted by Cindy Stehno BSN, RN, CPAN NAPAN Treasurer

8 8 NAPAN 33rd Annual State Conference The 2016 NAPAN Annual State Conference was held on Saturday, October 8, 2016 at CHI Alegent Creighton Immanuel Medical Center in Omaha, Nebraska. A full day was planned starting with registration and breakfast. President Patricia Stevens opened the conference and introduced Kristy Iwansky MSN RN CPAN CAPA as the opening speaker. Kristy presented A Review of ASPAN Standards. She began with the evolution of perianesthesia nursing and went on to cover the seven parts of the Perianesthesia Nursing Standards Practice Recommendation & Interpretive Statements. Erick L. Hill, PhD took the floor addressing Incivility in an Otherwise Civil Workplace: Tempering the Effects of Bullying in the Workplace while Improving the Resiliency of the Individual Worker. This presentation was helpful in providing skills to handle conflict and promote teamwork in stressful environments. Erick L. Hill PhD Kristy Iwansky, MSN, RN, CPAN, CAPA Brittany Kauffman BSN RN CPAN then presented Revisiting the Orientation of the Perianesthesia Nurse. Brittany shared the Surgical Support Nurse Novice to Expert Path pyramid with the movement from novice to expert. Orientation checklists, RN surgical service competency tool and RN Pre Op PACU unit based competency tool were shared with the audience and specific methods to get the novice nurse to the expert level in a timely manner. Brittany Kauffmann, BSN, RN, CPAN Lunch was served and the annual state membership meeting was held with elections and awards presented. Rose Leavitt, MSN, RN, PhD then presented the hot topic of Harnessing the Strength of a Multigenerational Work Force. Dr. Leavitt identified the different generations and the traits specific to each and then identified misconceptions/misperceptions that commonly arise due to the multiple generations. She touched on the negative effects due to misunderstandings that can affect patient care and identified the strength of a multigenerational workforce. Rose Leavitt, MSN, RN, PhD

9 9 Kristy Iwansky finished up with her presentation of Prioritization of Perianesthesia Cares: ABCD s. She shared the A is for Airway, B is for Breathing, C is for Circulation and D is for Drugs & Perianesthesia. As she identified each section, she explained the risks inherent in surgical procedures and how a preoperative nurse plays a critical role in preventing complications through early recognition and management of both potential and impending adverse outcomes. The day was filled with useful information, door prizes, great conversation and important networking and exchanging of ideas with nurses from other institutions. Carolyn Carr, RN, CPAN, CAPA NAPAN President NAPAN T-Shirts for sale!!! NAPAN audience enjoying Kristy Iwansky s presentation Photos courtesy of Cindy Stehno

10 10 Called to Order by President Pat Stevens MINUTES FOR NAPAN BUSINESS MEETING NAPAN State Conference October 8, 2018 CHI Alegent Creighton Immanuel Medical Center Minutes of Fall Conference Meeting 2015 Approved by Cindy Stehno, 2nd by Linda Lenser NAPAN Committee Reports: copies all placed in handouts for members Treasurer Report: Cindy Stehno: Please review handout. Shows expenses for year and budget Nominating Committee Report: Bernie Larsen: Need to find members to run for board. No nominees. No ballets to be handed out. Lisa DeVries nominated for Member-at-Large Membership. Lisa accepted the position. Member-at-Large Governmental Affairs to be continued by Gayle Kiviniemi. Secretary to be continued by Bernie Larsen. We will need to find a Vice President elect for the upcoming year. Members were encouraged to consider running. We need articles for the newsletter. Information on website on how to share your knowledge with everyone. Journalism Awards: General Interest Article goes to Bernie Larsen for her article Measles Clinical Practice Award to Diane Eggerss for her article, Capnography Can Prevent Respiratory Events Outstanding Service Award presented to Phyliss Bolton by Carolyn Carr. Phyliss was not present. Welcomed New President Carolyn Carr to her position. Thank you to Pat Stevens for her past service as President. No Old Business No New Business Donations for auction: Thanksgiving Center Piece Table and Chairs 3 piece Chocolates Redi Relief Reference Book NAPAN donations: $50 Bill $105 to be used for future Continuing Education ABPANC donated bracelet Drawings: 6 gift cards along with NAPAN T-Shirts Meeting adjourned by Pat Stevens, 2nd by Bernie Larsen Respectfully submitted by Bernie Larsen, NAPAN Secretary

11 11 Governmental Affairs This committee has been following two bills in the Nebraska Legislature during the year LB Protection for Individuals Who Report Others Who Are Working Outside Their Scope of Practice and LB 721 Surgical First Assistance Licensing. To access more information regarding these bills, log on to Several members of NAPAN attended Nurses' Day at the Unicameral sponsored by the Nebraska Nurses Association on February 11 th, The agenda was a combination of lecture, discussion and networking. If you are interested in attending in 2017, watch for the announcement in the Nebraska Nurse publication. Well worth the trip to Lincoln! Submitted by Gayle Kiviniemi, RN, CAPA Member-at-Large Governmental Affairs Chair COMMUNITY SERVICE It is the goal of NAPAN to reach out and serve our local community. Each educational offering includes a freewill offering to a local charity. The Kountz Food Pantry was the charity chosen for the 33 rd Annual NAPAN State Conference.

12 12 MARK YOUR CALENDAR!!! 2016 SUMMER/FALL ASPAN webcasts and seminars aspan.org for Live Seminars, Full-Day Live Webcasts and Half-Day Live Webcasts Facebook: Nebraska NAPAN for 2017 Winter/Spring Seminars 36 TH Annual ASPAN National Conference April 30-May 4, 2017 Indianapolis, Indiana

13 13 Implementation of a New Post Anesthesia Scoring System to Include Discharge Criteria for The Hospital Based Post Anesthesia Care Unit Team Members: M. Divine, RN, BSN, CPAN, N. Gondringer, CRNA, Surgical Services Director, L. Woerth, MD Anesthesia Chairman, J. Mangers RHIT, Director of Health Information Management. Trial Nurses: M. Divine, RN, K. Johnson, RN, J. Sharp, RN, T. Buffum, LPN-C, PACU/Preop Practice Council Members, J. Sharp, RN Education Author: Margaret Divine, RN, BSN, CPAN The Purpose of Implementing a new post anesthesia scoring system for the Post Anesthesia Care Unit (PACU) was to replace an older outdated recovery scoring system with our own anesthesia approved discharge scoring system, update changes and add information to the current PACU patient documentation record and secondly to have a consistent discharge criterion that would be included in the PACU record for Post Anesthesia Patients. After meeting with the Director of Surgical Services and the Chairman of the Anesthesia Department it was decided that a literature search would be done and that we would develop our own Post Anesthesia Scoring System and at the same time we would include a numeric way to document patient s pain and sedation prior to dismissal from the PACU. It is, at all times, and up to the Anesthesia provider to oversee any concerns should the patient not meet the discharge criteria score. Nine areas of concern were included in the scoring system for any post anesthesia patient. A descriptive scale was developed by Dr. Woerth MD, M. Divine, RN and approved by N. Gondringer CRNA, Surgical Services Director and by the Anesthesia Department. The descriptive scale is a follows: Post Anesthesia Recovery Score: PARS (Discharge Criteria) Notify Anesthesia Provider if patient does not meet criteria or any other concerns. Assessment: Score: Airway/Ventilation: Requires assistance with Respirations or apneic 0 Respirations spontaneous but unable to deep breath/breathing is weak 1 Respirations spontaneous, able to cough and deep breath, Respiratory Status is satisfactory 2

14 14 Activity/Strength: Unable to move extremities 0 Is able to move extremities but is weak (exceptions are patients with Peripheral nerve blocks, spinal or epidural) 1 Able to move all extremities on command or voluntarily 2 Hemodynamic Status, (BP, Heart rate and circulation) BP is 50% + below or above preoperative baseline BP 0 BP is 25-50% + preoperative baseline BP 1 2 BP s readings + 20% of preoperative baseline 15 minutes apart, HR is within 10% of preoperative HR. 2 Consciousness/ Mental Status: Patient is not responding to voice or stimuli 0 Responds to commands, pain, arousable 1 Response is unchanged from preoperative status, responds Appropriately to questions 2 Oxygenation: SaO2 is < 92% with supplemental O2 0 SaO2 is > 92% with supplemental O2 1 SaO2 is > 92% on room air without supplemental O2 2 Normothermia: Patient is experiencing hypothermia requiring warming 0 Patient is experiencing hypothermia, no intervention required 1 Patients temperature is 96.8 F or 36 C or above 2 Postoperative Nausea and Vomiting: Nausea and/or vomiting present, requires intervention 0 Nausea and/or vomiting is subsiding after intervention 1 Patient has relief of PONV, or none present 2 Pain management/assess/reassess: Pain is present and unacceptable to patient or the patient is not cognizant, 0 (Use a visual analog scale as the patient becomes cognizant, i.e.0-10 scale) Pain is still present but improved after intervention 1 Level of pain is acceptable to patient and > 30minutes has passed Since the last IV narcotic was given 2 Acceptable score range Total 14-16

15 15 The Pasero Opioid-induced Sedation Score (POSS) was chosen to be used to document patient sedation level prior to leaving the PACU. Permission from the author was obtained by the Agency to be used in the general care areas of the hospital prior to using it in the PACU. Pasero Opioid-Induced Sedation Scale (POSS) If the patient has received narcotics in the PACU document a POSS score on Patient s readiness for dismissal from PACU, score must be no higher than 2 (See Table 2 reference below, ref. 6) Discharge criteria is as follows: Dismissal from PACU The length of stay in PACU for a postoperative patient is based on discharge criteria established and approved by the anesthesiology department. The nurse s assessment/judgment of the patient s stability postoperatively is also considered before ending the PACU time. Patients may be dismissed from the PACU either by: 1. Direct order from a physician. 2. Relevant discharge criteria, approved by the CHI Health St. Elizabeth Anesthesiology Department and executive committee, is utilized and applied for each patient prior to discharge from the unit by the PACU staff. 3. Anesthesia provider will be notified at any time if the patient does not meet discharge criteria or any other concerns.

16 16 Criteria for discharge: 1. The St. Elizabeth Post Anesthesia Recovery Score, (PARS), is used for discharge criteria from the PACU. Evaluation is done on admission to PACU, every 30 minutes and on dismissal from PACU. A score of is required for discharge, except on orders from the anesthesiologist or CRNA, or discharge to the BTU or CCU areas. 2. The patient s temperature must be at least 96.8 F or 36 degrees Celsius prior to discharge from PACU. 3. Patients with spinal anesthetics should not be dismissed before 30 minutes after admission to PACU. 4. Pain level is again assessed prior to discharge using the Pasero Opioid Sedation Scale (POSS). Patient s vital signs and respiratory status will be assessed for a minimum of 30 minutes after the last dose of IV narcotics before dismissal from the PACU. The POSS score should be 2 or less otherwise the patient remains in PACU until a score of 2 or less can be assessed. Preparing the scoring system and implementing: Meetings were held by the author, the practice council members and the director of health information management, during the preparation of, and creation of the new PACU record to include the new scoring system. After approval by Dr. Woerth MD the Anesthesia Chairman, and Nancy Gondringer CRNA, Surgical Services Director, education of staff nurses for PACU was begun. In this facility patients can be recovered in the Burn Trauma Unit, the Critical Care Unit and the Labor and Delivery Recovery room when needed. These nurses were also educated along with the PACU Staff. Education: Education was done for the PACU nurses by reviewing the new policy and scoring system in writing and by a mandatory self -learning power point lesson which was assigned to PACU nurses. Opportunities for questions and clarification was offered by the author of the scoring system and by a team of 4 staff nurses who trialed the record for one week. Any corrections were addressed and clarified before the new record was approved for use. After the trial and education for the staff the new Record and Scoring System was implemented. Evaluation: To evaluate how the PACU nurse and the Anesthesia providers were doing using the new scoring system after 5 months of use a survey was done and completed by the PACU nurses and some of the Anesthesia Providers.

17 17 Questions were asked and staff were allowed to comment on each questions. Out of 15 possible respondents, 12 PACU nurses responded to the survey and 5 Anesthesia Providers responded. I would like to share some of the comments from the questions. #1. After using the new Recovery Scoring System, I feel confident in dismissing my patient s per our anesthesia discharge criteria from PACU. All 12 nurses said yes to this question and I have included some comments here. I think this form has brought out other ways more finite ways to assess patients PACU performance-old way was more nebulous, and another comment was, I feel it covers all the important aspects of waking from anesthesia. #2. Patients pain management and my ability to assess my patient s pain and responses to interventions, has improved since using the new recovery scoring system. 8 answered yes, 3 answered no and one was unsure as yet. Comments were: I feel it has improved and I think it is just a better way to document what you see clinically and another I already used many of the techniques and tools. This allows me to chart and visualize the information. And one more, It is easier to validate. #3. Utilization of the Pasero Opioid Sedation Scale (POSS), has helped me in assessment of my patient s sedation level and administer narcotics safely. 11-yes 1- no. Comments: Like the POSS, Yes! and I have seen her (Pasero) in person. She has an excellent background, this scale helps the nurse adjust the medication dose so it can be given without untoward events, (keeping in mind the MD s order) and another, Yes it is a guide and easy addition that allows us to assess patient s readiness for narcotics. #4. Please rate the PACU nurse s confidence in administering opioid medications, in meeting the patient s pain needs and avoiding over sedation, after utilizing the PARS and the POSS, on a 1-10 scale. 11 of the 12 respondents rated this confidence as neutral to highly confident. #5. My preparation for use of the new Recovery Scoring System and the POSS was adequate. 11-yes, 1-no. Comment: yes, good job on the new scoring, -I felt it was easy to transition to. Anesthesia Providers were asked two questions. #1. I am aware of the new Recovery Scoring System. 4-yes, 1-no. #2. I have received an increase in consultation calls from the PACU nurses for a dismissal order for my patients. 5-no.

18 18 Discussion: Pain assessment documentation was a quality improvement item that this PACU was working to improve. After implementing the new scoring system, chart audits revealed on 2 separate audits, a 100% documentation for pain assessment and reassessment, in the PACU. According to RRT audits for the general floors, Rapid Response calls have decreased since the implementation of the POSS. Further information on these audits revealed that the use of Narcan on the general floors has also decreased. Some of the PACU nurses already felt confidence in their assessments but do feel that now there is a numeric and clear documentation on our PACU record for pain and sedation. References: Post Anesthesia Discharge Score 1. Standards for Postanesthesia Care, ASA (American Society of Anesthesiologists), (Approved by the ASA House of Delegates on October 27, 2004 and amended on October21, 2009) ASA web site. 2. Moline, B, MS, RN-BC, ACNS-BC, Roberts, M, MS, APRN, CNNS, CCRN, Houser, J, PhD, RN Validity and Interrater Reliability of the Moline-Roberts Pharmacology Scale, Clinical Nurse Specialist, Copyright 2012, May-June, pg Drain s Perianesthesia Nursing: A Critical Care Approach / (edited by) Jan Odem- Forren. 6 th Edition, copyright 2013 and 2009, revision of Perianesthesia Nursing/ (edited by) Cecil B Drain, Jan Odem-Forren, c 2009, by Saunders, and imprint of Elsevier Inc. 4. Brown, I, DO, Jellish, W. Scott, PhD et al Department of Anesthesiology, Loyola University Medical Center, Maywood, Ill. Use of postanesthesia discharge criteria to reduce discharge delays for inpatients in the postanesthesia care unit. Journal of Clinical Anesthesia, (2008), 20, Pasero, Chris, MS, RN-BC, FAAN, The Perianesthesia Nurse s Role in the Prevention of Opioid Related Sentinel Events, Journal of Perianesthsia Nursing, Vol. 28, No. 1, (February), 2013: Pp Pasero, Chris, MS, RN-BC, FAAN, Safe IV Opioid Titration in Patients with Severe Acute Pain Journal of Perianesthesia Nursing, Vol. 25, no 5 (October), 2010: pp

19 19 7. Nisbet AT, Mooney-cotter F., Inova Fairfax Hospital, Falls Church, VA 22042, USA, Pain Manag Nurs. 2009, Sep; 10(3): Doi: /j.pmn Comparison of Selected Sedation Scales for Reporting Opioid-induced Sedation Assessment. 8. Discharge criteria: Does a Revised Discharge scoring Tool accurately reflect patient readiness for discharge form phase I PACU? Poster Presentation/abstract, DeWitt MSN, RN, CPAN, CAPA et all, Cleveland Clinic, Cleveland, Oh ASPAN National Conference. 9. Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements, American Society of Perianesthesia Nurses, American Society of Perianesthesia Nurses (ASPAN), , Perianesthesia nursing standards: Practice recommendations and interpretive statements Margaret Divine, RN, BSN, CPAN

20 20 Editor s Edge I am pleased to announce that NAPAN has created a Facebook page with the help of our former Member-at- Large Membership, Audrey Person. Thank you Audrey! The address is: Nebraska We think that this page will be helpful in communicating news and updates that occur between editions of our newsletter. This autumn of 2016 brings to completion the 33 rd annual NAPAN state conference which was held in Omaha, Nebraska. It was a successful conference with four excellent speakers covering interesting and pertinent material. NAPAN is always looking for people who are interested in serving on the board and who are willing to sit on various committees. We are happy to welcome Lisa Bensen-DeVries as our new Member-at-Large Membership and hope you will consider joining us as well. The NAPAN Willingness to Participate form is on our website and the ASPAN Willingness to Participate form is found on the ASPAN website. Please take a look and find a committee that can use your particular skills and interests. The ASPAN committees are chaired by an experienced member of ASPAN and all business is conducted via correspondence. As always, I hope you will consider studying for and taking the CPAN/CAPA exam to earn your certification. Certification in your field of expertise is a valuable asset. Please consider submitting your articles and items to be published to me: judymink40@gmail.com Sincerely, Judy Mink RN BSN CPAN NAPAN is looking for candidates for the Vice Presidency. It is a three-year commitment: Vice President, President and then Past President. The first year includes supporting and learning the roles of the President which will prepare you to take on the presidency the following year. The role of the Past President is simply supporting the new president and sharing your wisdom with the NAPAN board. Please check out these websites for more information: Facebook: NAPAN Nebraska

21 NAPAN Executive Board Carolyn Carr, RN, CPAN, CAPA Diana Eggerss, BSN, RN, CPAN President Member-at-Large Finance Patricia Stevens, BSN, RN, CPAN Lisa Benson-DeVries, BSN, RN, CPAN Past President Member-at-Large Membership Bernie Larsen, RN, CAPA Secretary Gayle Kiviniemi, RN, CAPA Member-at-Large Governmental Affairs Cindy Stehno, BSN, RN, CPAN Treasurer