PPT 1 Flashcards
First reported use of ether and year
Dr. Crawford Long - 1842
Discovery of N2O
Priestly, 1773
First public use of ether
1846 by Dr. William Morton in ether dome, Mass General
First true anesthesiologist
Dr. Snow
First to utilize anesthesia generally
Dentists
Landmark case
Frank v. South
Ruling of frank v south
Margaret Hatfield not engaged in practice of medicine
1921
ANA rejected nurse anesthetists, Agatha Hodgins
Earliest administration of anesthesia
Ether and chloroform
First nurse to administer anesthesia
Catherine Lawrence
First year nurses gave anesthesia
1861
By nuns
First “nurse anesthetist”
Sister Mary Bernard; 1878
First CRNA school
Charity Hospital in New Orleans
Early physicians to support CRNAs
Mayo Broothers
Nurse who took over anesthesia at Mayo
Alice Magaw
Who is “mother of anesthesia”
Alice Magaw
Reason for name “mother of anesthesia”
First to document (3000 cases), taught dr.s and nurses sent from everywhere
Founded NANA
Agatha Hodgins
Magaws successor
Florence Henderson
First faculty position in medical school
Alice Hunt
One of first to use O2N2O
Agatha Hodgins
Spent life denouncing nurse anesthetist
Dr. Francis McMechan
1936
ASA founded (American society of anesthesiologists)
Meaning of “ology”
Expert
Frank v South
Significant court case - 1917; anesthesia NOT solely practice of medicine
1921
ANA denied nurse anesthetists
Hodgins
Margaret Hatfield
Found not guilty in frank v south (not engaged in practice of medicine)
World War I
Agatha taught European/British Drs how to give N2O/O2
Outcome of Frank v. South
Hatfield was not engaged in the practice of medicine
Agatha Hodgins first organization
NANA - National association of Nurse Anesthetists
First meeting of NANA
June 17, 1931 know this
Agatha Hodgins
Founder of first association of nurse anesthetists
Who started local group of CRNAs in Jewish Hospital in Philadelphia?
Hilda Solomon
Hilda Solomon
Began frontier of education committee for CRNAs
Dagmar Nelson
Lawsuit stating Dagmar Nelson (CRNA) performed as physician without medical license
Outcome of Dagmar Nelson Case
Established legality of nurse anesthetist — Dagmar found not guilty (CRNA under direction of surgeon)
What factor has played a major role in attracting physicians into anesthesia?
Economic factors
Who addressed the first national convention of the National association of nurse anesthetists?
Gertrude Fife
Standards of Care for CRNAs began when by who?
1933 - still used to this day. Gertrude Fife and NANA Board of Trustees
Who began AANA Education Committee?
Helen Lamb
First CRNA to serve as Chief of the Army Nurse Corps
Mildred Clark
Worked with Alfred Blalock at Johns Hopkins working on “Blue Babies” - tetralogy of Fallot
Olive Berger
Anti-Adriani Bylaw
ASA developed bylaw stating anesthesiologist were unethical if participating in training/education of CRNAs
Outcome of Anti-Adriani Bylaw
Rescinded 1964
First AANA qualifying (certification) exam
1945
First executive director of AANA
Florence McQuillen
AANA began accrediting schools
1952
1940s
First male; African American class in AANA
Virginia Thatcher
Wrote history of Nurse Anesthesia practice
1957
AANA officially credentialed “Certified Registered Nurse Anesthetist” CRNA
When was certification exam implemented?
1957
Significant issue in 1980s
U.S. Congress passed legislation which created disincentives for utilization for CRNAS. Hospitals terminated CRNAs.
OBRA
1986 - direct reimbursement under Medicare for CRNAs. OBRA - Omnibus Budget Reconciliation Act
TEFRA
Tax Equity and financial responsibility act
TEFRA does what?
Defines reimbursement for Medicare Parts A and B - 1982. PASSED 1986
TEFRA regulations
7 regulations. MDA present for: preop eval, induction, maintenance, emergence, critical points of case, postop and release from PACU. Cannot supervise more than 4 CRNAs at once
TEFRA is under which part?
Medicare part B
Bhan v. NME Hospitals, Inc.
Anti competitive arrangements designed to exclude CRNAs from practice may be challenged under the antitrust laws
Significant event in 2001
Opt-Out Rule
Opt-Out Rule
CRNAs do not have to collaborate or be supervised by any physician
First CRNA inducted in FAAN
Ira Gunn
First male president of AANA
John Garde
Gale Pollock
Major General - appointed as acting Deputy Surgeon General of US Army from oct 2006-march 2007; also chief of army nurse corps
COA
Council for accreditation - determines school eligibility, etc.
Barriers to successful surgery 1800s
Infection, sterilization, lack of surgical knowledge, anesthesia
NANA changed to current name
1939 - AANA, headquarters moved to Chicago
What is the medical direction model?
MDA involved in or supervising up to 4 concurrent cases. Fulfills TEFRA regulations
1 MD supervising 5 CRNAs
Medical supervision - not medical direction model
TEFRA regulations
7 regulations for MDA in order to get paid, not commit fraud
Can CRNAs in all states bill non-medically directed?
Yes
How CRNAs bill if not medically directed
QZ Modifier
QX
CRNA modifier, under medical direction
QZ
CRNA modifier with NO MD direction
QK
MD modifier, directing 2-4 concurrent cases
QY
MD modifier, directing 1 CRNA
What is the most cost effective anesthesia practice model in anesthesia care?
Nonmedical direction billing, CRNA only
Components of billing
Base unit + time units x conversion fee
Significant event in 2001
Opt out rule passed
Components to pass Opt Out
State governor must send letter of attestation to CMS, meets with BON, BOM
TEFRA regulations
PIMECPR — preop eval, induction, maintenance, emergence, critical points, post op, release from PACU. Must be immediately available.