Pittsburgh Magazine Honors Hometown Heroes with 2021 Excellence in Nursing Awards

A Salute to Nurses By RACHEL WEAVER LABAR | Photos by LAURA PETRILLA

The pandemic has killed more than 700,000 Americans, a disproportionate number of whom were people of color or the underserved. This crisis has taken a heavy toll on the nursing community — especially those who served on the front lines, supporting patients and helping families communicate with their very ill loved ones.

But as harrowing as this has been, I’ve often felt inspired and hopeful.

Why? Because COVID-19 has shown the world the important role nurses play in health care — not because they have no fear but because they approach their work and care for patients despite their fear with the utmost compassion.

On behalf of the Pittsburgh community, I would like to extend our collective thanks, gratitude and appreciation to all of the nurses and nursing students who responded to those in need. Join me in congratulating the 2021 Excellence in Nursing Award recipients who are recognized in this issue. They have demonstrated extraordinary dedication and courage.

– Mary Ellen Glasgow Dean and Professor, Duquesne University School of Nursing; Chair, Pittsburgh Magazine Excellence in Nursing Selection Committee

View the nominees!

Excellence In Nursing – Pandemic Response Hero: Pauline Hutsler Excellence in Nursing – Leader: Maribeth McLaughlin Excellence In Nursing – Emerging Leader: Jeffrey Bomba Excellence In Nursing – Advanced Practitioner: Maj. William Pileggi Excellence In Nursing – Clinician: Shenoa Jamieson Excellence in Nursing – Community: Alexis Myers Excellence In Nursing – Academic: Ruth Madden Foreman Excellence In Nursing – Researcher: Alison Colbert

HONORABLE MENTION

Pandemic Response Hero

Mark Cashioli, Infusion Nurse, Chartwell Specialty Pharmacy Jonna L. Morris, Assistant Professor, University of Pittsburgh School of Nursing Judith A. Shovel, Improvement Specialist, Clinical Improvement Department, Wolff Center at UPMC

Leadership Krista Bragg, Chief Operating Officer, Allegheny Health Network Christin M. Durham, Associate Chief Nurse, Primary Care, VA Pittsburgh Healthcare System Nancy Gross, RN Director, Butler Health System Geralyn Lee, Clinical Director, UPMC Home Healthcare

Emerging Leader Ashleigh Anderson, Senior Professional Staff Nurse, UPMC Children’s Hospital of Pittsburgh Tammy Barker-Fleming, Unit Director Neuro/Trauma, UPMC Presbyterian Hospital Leanne Feil, ER Case Management Access Nurse, Butler Health System Amber Kolesar, Instructor and Director, Second-Degree BSN Program, Duquesne University School of Nursing Tara Stickley, Unit Director, Womancare Birth Center, UPMC Magee-Womens Hospital

Advanced Practitioner Erin Q. Dieter, Palliative Medicine, Excela Health Medical Group Joyce Knestrick, Associate Professor, George Washington University School of Nursing (Visiting Professor; Family Nurse Practitioner from Washington, Pa.) Charles Warner, Nurse Practitioner, Critical Care Medicine, UPMC Magee-Womens Hospital

Clinician Mandy Emmick, Registered Nurse/Case Manager, UPMC Home Healthcare Christopher Hornberger, Registered Nurse, 7T Telemetry, Butler Memorial Hospital Catherine “Caty” Thomas, Clinical Education Specialist, UPMC Magee-Womens Hospital

Community Mary Jo Bellush and Deborah Schotting, Infection Preventionists, Excela Health Westmoreland Hospital Elizabeth DiLembo, Project Manager, COVID Vaccine Clinic, Quality, Clinical Documentation Specialist, Excela Health

Academic Janet Barber, Standardized Patient Manager, Robert Morris University Richard Henker, Professor, Department of Nurse Anesthesia, University of Pittsburgh School of Nursing Rebecca Kronk, Associate Professor, Associate Dean for Academic Affairs, Duquesne University

Researcher Susan W. Wesmiller, Associate Professor, University of Pittsburgh School of Nursing

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