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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!