Pennsylvania Extends COVID-19 Waivers

Pennsylvania Association of Nurse Anesthetists

FOR IMMEDIATE RELEASE

CONTACT: Kurt Knaus, P: 717-724-2866

E: kurt@ceislermedia.com

Among the waivers is a provision that temporarily suspends physician supervision of CRNAs in a hospital setting

HARRISBURG (April 1, 2022) --- Pennsylvania lawmakers once again have voted to extend several regulatory waivers put into place at the start of the pandemic to help health-care providers respond to COVID-19. Without action, the waivers would have expired March 31. Gov. Tom Wolf signed the legislation March 30, keeping the waivers in place through June.

Among the waivers is a provision that suspends the physician supervision requirement of a certified registered nurse anesthetist in a hospital setting, giving health-care facilities the flexibility to continue tapping into the unique skillset of CRNAs to fulfill critical roles inside and outside the operating room as the state continues its pandemic recovery.

The governor announced the original temporary blanket waiver for advanced practice nurses and CRNAs on May 6, 2020, as part of an executive order to enhance the state’s response to the emerging health-care crisis.

After the passage of two constitutional amendments dealing with executive power, the General Assembly ended the governor’s emergency order in June 2021 but allowed the waivers to remain in place until September 2021. Before they expired, lawmakers voted then to keep the waivers in place until March 2022. The latest legislative action keeps the waivers in effect for three more months.

The Pennsylvania Association of Nurse Anesthetists (PANA) represents more than 4,000 CRNAs and students across the commonwealth.

Removing the supervision requirement and allowing CRNAs to practice to the fullest extent of their education and training avails more physicians to provide hands-on care, expands the capacity of both CRNA and physician providers, and augments the state’s health-care system to continue to meet the demands of this pandemic.

For more information, visit www.PANAforQualityCare.com or follow along on social media via Twitter at @PANACRNA, Facebook at www.facebook.com/PANACRNA, or Instagram at @PANACRNA.

###

A training program is making surgery easier on veterans and safer for health care staff

One day at his job at the VA Pittsburgh Healthcare System (VA), nurse anesthetist William Pileggi (NURS ’97G) was with a patient who was coming out of anesthesia after surgery. The patient woke abruptly, reached through the side rails of his stretcher and shoved Pileggi to the ground as he shouted, “Get down! You’re gonna get shot!”

The patient had woken up in a disoriented state, unaware of where he was, in an episode of emergence delirium (ED). ED occurs when patients emerge from general anesthesia agitated, confused or — in some cases — aggressive. This patient also was a combat veteran with a history of post-traumatic stress disorder (PTSD), which research shows put him at a high risk for emergence delirium. The incidence of ED in adult combat veterans has been reported to be as high as 27%, compared to only 5% within the general population.

Pileggi, a veteran himself, has seen patients thrash on the bed, remove their IV line, self-extubate and even injure hospital staff without realizing what’s happening.

“They go to sleep in Pittsburgh but wake up in Iraq,” he says.

The problem has slowly been gaining attention. In the 2010s, two nurses at the VA started a program called Project Golden Eagle that helped to identify patients with PTSD. Those patients were placed in quiet rooms and given a gold surgical cap, instead of the usual blue, so that staff would be aware of the heightened risk of ED.

Still, when Pileggi joined the VA in 2016, he and his colleagues would encounter ED an average of twice a week. It was distressing to the staff, who feared for their own safety, as well as to the patients, who were thrust back into a state of fear and trauma from past experiences. He knew something more needed to be done.

So, in 2017, he teamed up with behavioral health and education specialists David Julian and Michael Boland, as well as fellow nurse anesthetist Amanda Beckstead (NURS ’15, ’20G) to research more, strategize improved practices and create a training program for better assessment and screening for patients with PTSD. Their group — the PTSD/Emergence Delirium Training and Response Team — discovered that certain anesthesia drugs affect the neurocircuitry of the brain in PTSD patients more than others.

In people who have experienced trauma, the amygdala (which is responsible for the “fight or flight” response) often is perpetually hyperactive, and the hippocampus — which controls emotional memory — does not function optimally. Commonly used anesthetics like benzodiazepines and volatile inhalants are particularly dangerous for trauma patients, due to the way they blunt reactions in the amygdala and hippocampus and wear off quickly. Thus, the team’s plan emphasized using alternative anesthetics and tailoring the dosage and timing of particular drugs to each individual’s risk factors.

They also created preassessment questions to identify patients with a history of PTSD (even if undocumented), what triggers might activate a bad response and how to help those patients wake up with ease.

Finally, they compiled the research into a training program that was required for all perioperative hospital staff, complete with recorded demonstrations and hands-on practice.

The effects were almost immediate: The incidence rate of ED plummeted to 2.7% in high-risk PTSD patients, and in 2019 and 2020, there were no cases of staff injuries, lost airways or lost IVs. Pileggi saw patients cry with gratitude that their worst fears about waking up didn’t happen.

In recognition of their impact, the team won a 2020 Gears of Government Award from the U.S. Department of Veterans Affairs and a 2021 I Am Patient Safety Achievement Award from Pennsylvania’s Patient Safety Authority. Veterans Affairs hospitals around the country are now requesting the training program. Pileggi also was recognized as a 2020 Excellence in Education awardee by the National APRN Council.

In the end, it’s about patient care. “Our home run is making that wake up better,” says Pileggi.

This story appears in the latest Pitt Nurse magazine, which will be hitting mailboxes soon. Photos courtesy of William Pileggi and the VA Pittsburgh Healthcare System

The Association of Veterans Affairs Nurse Anesthetists (AVANA) Announces Inaugural VA CRNA Week

AVANA is excited to announce 'National VA CRNA Week' will be held November 15 - 19th, 2021. PANA joins our friends at AVANA to honor, recognize, and show appreciation for all the VA CRNAs that provide exceptional care to veterans each and every day.