Nationally Accredited Joint Program 4/Oro Valley Hospital...- Incentive Spirometer 10x/hr. while...

Nationally Accredited Joint Program

• Hallmark of Excellence

• Performance Improvement

• Development of Comprehensive Program ‒ Tracking quality indicators

‒ Patient Education

‒ Reducing variation in patient care

‒ Providing program structure

‒ Creating a loyal and cohesive team

Role of Joint Program Coordinator

• Complete Pre-op Education

• Make daily rounds

• Address patient concerns

Objectives For Today- Topics

• Preparing your home

• Understanding your

procedure

• What to expect during

your hospital stay

• Role of Physical &

Occupational therapy

• Pain management

strategies

• How to care for

yourself at home

• Role of the caregiver

• Discharge planning

The Guidebook

• FAQs

• Pre-op Checklist

• Pre-op Exercises

• Hospital Stay

Preparing For Surgery

• Family member or friend

• Provides comfort, motivation

• Observe therapy sessions

• Gain confidence for discharge

home

Coaches are recommended

• Caring for Yourself at Home

• Role of the Caregiver

• Discharge Instructions

• Resuming Activities

Bring the Guidebook with you to the hospital

and all doctor appointments.

The Guidebook

• Chair with arm rests

• Recliner chairs okay

• Special bed not necessary

• Remove throw rugs

• Prepare frozen meals

• Arrange for someone to care for pets

Preparing Your Home

• Total Joint Replacement (hip or knee)

• Unicondylar Knee Replacement

• Hip Replacement

• Hip Resurfacing

The goal of surgery is to lessen pain

and restore function.

Understanding the Procedure

Total Hip Replacement

• Removal of damaged bone

and cartilage from your

thighbone and hip bone with

insertion of an artificial joint

(prosthesis)

Procedures

Posterior Hip Precautions

• No bending hip past 90 deg

• No crossing legs

• No internal rotation

Procedures

Total Knee Replacement

• Removal of damaged bone

and cartilage from your

thighbone, shinbone and

kneecap with insertion of an

artificial joint (prosthesis)

Procedures

Unicondylar Knee

Replacement

• Replaces only half of the

knee joint with a prosthesis

Procedures

Hip Resurfacing

• Total – ball is resurfaced and a

plastic or metal cup is inserted

into hip

• Hemi – ball is resurfaced only

Procedures

• Pre-Admit Testing

– Lab work

– EKG

– Chest X-ray

• Appointments (See page 8 of Guidebook)

– With your primary care doctor

– Cardiologist

– Dentist?

• Instructions to Stop or Change Any

Medications

Medical Clearance

• Picture ID

• Loose fitting clothes

• Supportive shoes – slip on preferred

• Glasses and glass case

• Hearing aide

• Denture case

• Cell phone and charger

What To Pack In Your Bag

• List of medications (See page 9 of Guidebook)

• C-Pap machine

• List of medication allergies

• List of food allergies

• Copy of Advance Directives,

Living Will

• Walker (if you have one) and put

your name on it

Also Bring…

Leave your valuables, such as jewelry or

watches at home

Valuables

• The day before surgery, call scheduling at

(520) 901-3678 after 2 p.m.

• That evening shower with ½ bottle of the CHG

• Do not shave your legs

• Do not use lotion

• Nothing to eat or drink after midnight

Day Before Surgery

• Shower with the other half of the CHG

• Dress in loose fitting clothing

• No perfume, deodorant or lotion

• Take your medications as directed

with a sip of water

Day of Surgery

• Before you leave home the day of surgery,

what are some of the things you should/

should not do?

• When is the last time you can have

anything to eat or drink (other than a sip of

water to take any medications as directed

by you physician the day of surgery)?

Questions

Surgery Entrance To Hospital

North Side in Back of Hospital

Reception Area

• Report to Surgery waiting room

• Check in at the desk

• Family members and coaches, wait here

until called back to pre-op

Day of Surgery

Pre-operative Area

• Anesthesia assessment

• Meet with surgeon and

operating room staff

• Place IV

• Nerve block placed

• Answer any last minute

questions you may have

1. Preventing Infection

2. Preventing Blood clots

3. Post Op nausea and vomiting

4. Pulmonary/pneumonia

Preventing Post-op Complications

Preventing Infection

2% CHG Cloths

• Applied in Pre-op with help

• Use all six cloths in the packages

• Skin should completely dry before applying

• Avoid contact with eyes, ears and mouth; avoid open

wounds

• Allow area to air dry for one minute; do not rinse

• It is normal for the skin to have a temporary “tacky” feel

for several minutes after the antiseptic solution is applied

• Do not apply lotions, perfumes or any other typical items

to skin after application

Preventing Infection 3MTH Skin and Nasal Antiseptic

Why We Do It

• 30% of people carry a bacteria called Staph aureus in their

noses

• Carriers are at greater risk of developing an inflation

• Reduces bacteria in the nose

• Effective as soon as one hour

• Persistent for up to 12 hours

• Easy to apply

Applying the Product

• Oro Valley Hospital staff will assist you in Pre-op

• Do not blow your nose or wipe the inside after the application

• Easily applied with soft cotton swabs

• Let us know if you have iodine sensitivity

Physicians & Hospital staff will:

• Take frequent vital signs including your

temperature

• Inspect incision for excess drainage

• Administer antibiotics

• Monitor your white blood cell count

• Frequent hand washing – patient and staff

Preventing Infection

• Nausea and Vomiting Medications protocol

• Constipation Post-op – Pain meds are constipating- take softeners and laxatives as

directed by physicians and nurses

– Decreased motility from reduced mobility

******** Early Ambulation is best medicine !!!!*******

Preventing Post-op Complications

• Blood Clots/Pulmonary Embolus – SCDs- pump calves when in bed

– TEDS- compression stockings

– Anticoagulants per physician based on individual needs(Coumadin, Heparin, Lovenox, Xarelto, Fragmin or aspirin)

– Up in the chair the evening of surgery

• Pneumonia

- Incentive Spirometer 10x/hr. while awake, Cough and - Deep

Breathing, Early Ambulation – up in the chair the evening of

surgery

******Early Ambulation is best Medicine!!! *****

Preventing Post-op Complications

What are the four things done to help prevent

surgical site infections?

How many times and how often do you use your

Incentive Spirometer?

Name four things to help prevent blood clots?

Questions

• Review Health and Medication History

• Discuss Nausea/Pain Management Concerns

• General Anesthesia

- IV Sedation

- Mild Sore Throat

• Regional Anesthesia

- Local nerve Block

Meet Anesthesiologist and Surgeon

• Operating room table

• Placement on hospital bed

• Surgery 1 to 1.5 hours

Operating Room/PACU

Recovery Area

• You will be in the recovery

area for approximately 1-2

hours

• To protect our patients’

privacy, no visitors are

allowed in this area

• Stabilize Vital Signs

• Neuromuscular Assessment

• Comfort Measures

– IV pain medication

– Nausea medication

– Bladder scan and possible catheterize

Recovery Room/PACU

• 30 Bed Unit on 3rd floor, 3 West and 3 North • All private rooms and bathrooms

• Wireless is available

Medical/Surgical Unit

• Staff who care for you

• Registered Nurse (RN) will manage you care with the

assistance of Patient Care Technicians

• Case managers will assist you with your discharge planning

• Physical and Occupational Therapists will work with you

daily

• An internal medicine physician known as a Hospitalist may

also care for you during your stay

Medical/Surgical Unit

You may have after surgery:

• Post operative dressing/wrap to your surgical site

• IV for fluids and medications

• You may require oxygen (O2 cannula)

• You will have elastic stockings (TED hose) and

compression sleeves (SCDs) on your legs to help

prevent blood clots

Medical/Surgical Equipment….

• To ensure you stay safe and comfortable as possible, you will be

asked about the 4 Ps: PAIN, POTTY, POSITION and PERSONAL

ITEMS

• Each room is equipped with a communication board updated by

staff members during hourly rounding. Information about your pain

medication and activity level are including on the board

• You may also have a member of hospital leadership round on you

while you are here

Hourly Rounding

Communication Board

Pain Scale- Handouts

• Standard Rating scale to communicate objective pain

• Allows for improved pain management strategies.

• Cold therapy

– No more then 20-30

min of every hour

while awake.

– Cold packs, ice bags,

Additional Comfort Measures

Types of Discomfort

Incision Site • Soreness, pressure

• Treat with pain medication

Swelling/Bruising • Tightness around the incision/joint

• Treat with compression and elevation

• Hospital staff will check on you at least every

hour to make sure all your needs are met

• Safety come first…do not get out of bed or chair

without assistance of a staff member

REMEMBER CALL, DON’T FALL!

Staying Safe

• Elective surgery – you are not sick

• Participate in group therapy

• Wear your own clothing

• Participate in daily care

• We can’t make the pain go completely away

• We aim to manage the discomfort so you can

eat, sleep and move around

• Be proactive in your pain management

Remember…

• What can you do to help prevent falls?

• Name the 4 Ps

Questions

Early Mobilization is key to outcome!

• Evaluate patients day of surgery

• Assist with guiding pain

management strategies

Physical Therapy

Evaluation at the bedside may start

the day of surgery

Getting in/out of bed

Getting in/out of a chair

Walking distances

Stairs

Car transfers

Physical Therapy

• You will be going to group therapy twice

a day for exercises starting on Post-op

Day 1

• Your coach is encouraged to come

Group Therapy

• Bathing

• Dressing

• Hygiene

Assistive Devices

• Reacher

• Sock Aide

Occupational Therapy

• To have most effective oral pain medication

regimen in place prior to local nerve block wearing off

• Maximize effective oral pain medication regimen while minimizing risk of any adverse side effects prior to going home

Primary Pain Management Goals

• Intercept the pain. Ask for medication when the pain starts to escalate – do not wait.

• Take your pain medication frequently so you will

not need to take as much. • Tell the nurse if the medication is not effective

or giving you adverse side affects. • Ask questions. Be sure you understand the

pain management efforts that are in place.

Pain Management Goal

• We don’t want the pain to go completely

away- it provides protection.

• We aim to manage discomfort so you can eat,

sleep and move around.

• We will work with you to ensure your comfort

and safety.

Did You Forget?

• What are your goals for pain

management?

• When should you report your pain level to

your nurse?

• How often should ice be used during your

hospital stay?

Questions

• Assist with mobility

• Dressing changes

• TED stockings

• Observe patient

Role of the Caregiver

Daily Newsletters

• The gold standard is for patients to go home! – Decreased infection risk

– Improved comfort

– More opportunity for self-initiated mobility

Transition To Home

Making the Discharge Plan

• Patient and Family Interview

• Program Coordinator

• Surgeon

• Physical Therapist

• Case Manager

Transition To Home

Case Management

• Case Manager will meet with you on your first post-op day

• Your Care Manager will coordinate post acute services per

physician orders

• If you have questions that cannot wait until your visit with

the Case Manager here in the hospital, call 901-3627 and

leave a message. A Case Manager will call you back within

one business day.

• Durable medical equipment (DME) including a walker or

cane will be arranged for you if you don’t have one. We will

use your insurance company’s preferred partner.

Discharge Planning Options

• Home with Outpatient Services

• Home with Home Health PT

• Sub-acute Rehab

• Insurance Plans and Authorizations

Transition To Home

• Pain is under control with oral pain med regimen

• Eating and drinking

• Met short term therapy goals

• Urinating

• Passing gas or had a bowel movement

Going Home

• Going Home the morning of your second day

• Your surgeon will write discharge orders

• After breakfast you will dress and go to

morning group therapy

• Your physical therapist and nurse will review

your discharge instructions

• Any questions you have will be answered at

this time

• You will be given a discharge survey prior to

discharge

Day of Discharge

• Clean technique

• Change daily

• Notify doctor of fever, incisional

redness, drainage, odor or

increased pain

Dressing Change Procedure

• Change positions often

• Follow your joint precautions

• Walk daily and steadily; increase your

distance

• Limit stair use to two times a day for the

first week at home

Caring For Yourself At Home

• Take pain medication regularly exactly

as prescribed

• Speak to your surgeon about when to

decrease or discontinue pain meds

• Take stool softeners

• Resume pre-op medications

Medications

• Pick one day each week to measure progress • Do your exercises regularly • Eat healthy • DO NOT SMOKE

Pearls of Recovery

• Ride in the front seat

• Stop along the way if your

ride is more than two hours or

you become uncomfortable

Discharge To Home

• Posterior Approach

– Do not bend past 90°

– Do not twist

– Do not cross legs

Hip Precautions

Physical Therapy After Discharge

• Two to three times per week after you

go home

• Length of time varies

• Outpatient, home health or rehab facility

based on your personal need after

discharge

• After your stay, you may receive a phone call from the

hospital for a patient satisfaction survey…thank you for

taking the time to answer the questions!

• You will also be receiving a survey in the mail; please

complete it and mailed it back

• You will be invited to a reunion luncheon about eight

weeks after discharge

• If you have any additional questions prior to your surgery,

please contact Pre-Admission Testing at 901-3676 and

press option #2

• Joint Program Coordinator number is 901-6273

Stay In Touch

Oro Valley Hospital’s dedicated staff is committed to

providing excellent customer service. Our team is

ready to help you transition to pain-free

independence and take the first steps toward

reclaiming your active lifestyle.

We look forward to serving you!