AANA Presents Daniel D. Vigness Federal Political Director Award to PANA

The American Association of Nurse Anesthesiology (AANA) honored Lt. Col. Laura Wiggins, DNP, CRNA, with the Daniel D. Vigness Federal Political Director Award at its Mid-Year Assembly, held in Washington, D.C. on April 2-6. Wiggins, a Certified Registered Nurse Anesthetist (CRNA), is staff CRNA with the University of Pittsburgh Medical Center in Pittsburgh and chief nurse for the critical care transport team in the U.S. Air Force Reserve.

“It is an honor to receive the Federal Political Director Award. Promoting and safeguarding the profession and helping to work towards regulations and legislation that allow CRNAs to practice at their full scope has been both an honor and a privilege,” Wiggins said. “However, all my work could not be accomplished without the support of the Pennsylvania Association of Nurse Anesthetists and my employers. I thank them for providing me with the resources and time to build the relationships that have allowed me to be a successful advocate for all CRNAs.”

Wiggins has been the Federal Political Director (FPD) for the Pennsylvania Association of Nurse Anesthetists (PANA) for the past two years and serves on its Board of Trustees. In 2019 she helped lead more than 180 CRNAs and students enrolled in nurse anesthesiology programs to lobby in Harrisburg on behalf of the profession. She is the former Chief Nurse for the 911th Aeromedical Staging Squadron and former Critical Care Air Transport Team member and has been deployed to support numerous international situations throughout her career.

According to her nominator, Wiggins is a natural leader with a passion for nurse anesthesia. “Whether leading a medical team as the anesthesia director for military operations in Kyrgyzstan, or providing obstetric anesthesia in Pittsburgh, Laura carries herself with a sense of dignity and skill that reflects the best of our profession.”

In addition, she was lauded for her hands-on leadership early in the COVID-19 pandemic. According to her nomination, weeks before Pennsylvania Gov. Tom Wolf even issued a formal stay-at-home order for the commonwealth, the PANA board began researching options to provide personal protective equipment (PPE) to its members. Wiggins relied on her military expertise to review mask options and determine the best fit for PANA to provide to members to keep them safe.

“Laura knew early on how important it was for PANA to not disrupt the supply chain already working on PPE for local hospitals and other facilities around Pennsylvania,” cited her nomination. “Therefore, she spearheaded a discussion with a small 3D printing company in southwestern Pennsylvania. Wiggins began to work with the co-owner of the company to design a 3D-printed mask that would keep our members safe. Laura Wiggins oversaw all of the details, even recruiting a biochemist and an engineer from Stanley Black & Decker to support the cause. After numerous back-and-forth phone calls, texts, virtual calls, and prototype designs, the mask was ready to offer to members as a complimentary benefit. In the initial two hours of sending the e-mail to alert members about the free product offering, PANA received over 400 requests. When completed, PANA shipped over 1,200 PPE masks around the state within four weeks, and this was largely due to the work of Lt. Col Laura Wiggins.”

She is a clinical instructor at the University of Pittsburgh Nurse Anesthesia Program for various courses, including Difficult Airway Course; Regional Anesthesia; and Obstetrics Anesthesia. As a critical care nurse in the Air Force Reserves, Wiggins directly supervises more than 60 medical military personnel while managing all nursing services and flight member activities. In addition, she is an independent contractor with Anesthesiology Services Network, providing anesthesia services for a Level One Trauma Center with 24 operating rooms and diverse areas, including neurosurgery, vascular, thoracic, orthopedics, general, gynecology, pediatrics, trauma, and obstetrics.

Wiggins received her bachelor’s degree in nursing from Pennsylvania State University in State College, and a master’s degree in nursing with a specialization in nurse anesthesia area from Uniformed Services University in Bethesda, Maryland. She earned a Doctor of Nurse Practice degree from the University of Pittsburgh.

As advanced practice nurses, CRNAs are members of one of the most trusted professions according to Gallup. CRNAs provide anesthesia care across all settings and in all patient populations and are the primary anesthesia providers in rural and underserved areas and on the battlefield in forward surgical teams.

During the COVID-19 pandemic, nurse anesthetists across the country have been essential in addressing the deadliest part of the disease in addition to providing top-of-the-line anesthesia care. They have served as experts in airway management, hemodynamic monitoring, management of patients on ventilators, and overall management of critically ill patients.

About the Daniel D. Vigness Federal Political Director Award

The Federal Political Director of the Year Award, established in 2001, was renamed the Daniel D. Vigness Federal Political Director Award in 2013 in tribute and memory of its first winner. It is presented annually to an individual who has made a significant contribution to the advancement of the national healthcare agenda of CRNAs by coordinating grassroots CRNA involvement at the state level or through special contributions to the federal political process.

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