The Health Central Joint Replacement Center received the Disease Specific
Care Certification for Total Knee Replacement and Total Hip Replacement
from The Joint Commission during the fall of 2015. The program focuses on
improving the quality of lives of the patients and the families that participate
in the program. The program focuses on a multidisciplinary approach
to provide care to patients undergoing an elective total knee or total hip
joint replacement. The program counts with a Multidisciplinary Committee
that includes board certified orthopaedic surgeons, orthopaedic certified
nurses, physical and occupational therapists, nurse techs, case managers,
Clinical Informatics, Pharmacy, Nurse Educators, the perioperative team
and anesthesiology, and a clinical program coordinator. Dr. W Kevin Cox
is the Physician Leader for the program. He has been a pivotal participant
in the development, implementation, and maintenance of the program by
providing his support and expertise in total joint replacements. Matthew D.
Hurbanis, as well as other orthopaedic surgeons, is an active participant of
the program offering his expertise and innovative ideas.
The program is geared toward individualizing the patient care to meet the
patients’ needs. The Total Joint Replacement patient care is initiated at the
physician’s office where they are offered a total knee or total hip replacement
surgery specific pamphlet that describes the process before, during,
and after the surgery. The patients attend a pre-operative joint replacement
class that is offered once a week; a Spanish version of the class is offered
once a month. The objective of the class is to prepare the patient and his
or her family to understand the Total Joint Replacement process. The class
follows the same approach as the pamphlet. During the class the patients
have an opportunity to ask questions and to learn about what happens
before, during, and after surgery.
Pain management is an important aspect of the care for our patients. The
team developed a multi-modal pain management regimen that combines
non-narcotic medications and interventions to promote pain management
and decrease or eliminate undesirable side effects such as sedation,
nausea, vomiting, constipation, and respiratory depression that are common
side effects with the use of narcotics alone. The program includes the use of
a local nerve blockade to improve pain management. Other pain management
interventions include cold therapy and early mobilization. The nursing
and rehabilitation team constantly communicate to promote adequate pain
management for our patients.
Complications such as blood clots, pneumonia, and infection are a major
focus of the multidisciplinary committee. The Infection Control team implemented
a preoperative skin-prep shower protocol that reduces the possibility
of developing an infection. During 2015, the Total Knee Replacement and
the Total Hip Replacement programs had 0 Surgical Site Infections.
The Rehabilitation team’s goal is to restore the patient’s function as soon
as possible. This is accomplished by providing rehabilitation services
beginning the day of surgery. This approach helps prevent complications
such as blood clots, pneumonia, and joint stiffness. The team promotes
patient safety by teaching the patient exercises to strengthen the muscles
and safety tips to protect the new joint. The rehabilitation team teaches the
patient to modify activities of daily living such as standing, walking, sitting,
getting in the shower, doing stairs, and getting in and out of the car. Early
mobilization and safety promotes healing and an earlier return to normal
The patients are encouraged to identify a coach that will help the patient
through his or her joint replacement journey. The coach is encouraged to
stay with the patient in the hospital overnight as each patient is in a private
room. The program promotes the coach’s participation in rehabilitation
sessions, activities or daily living, and discharge needs. The coach is
encouraged to assist with cold therapy application. The patients are encouraged
to use their own clothes and participate of physical therapy at the
dedicated Orthopaedic Gymnasium located on the Ortho-Spine Unit.
The nursing and rehabilitation team receives orthopaedic-related education
throughout the year. Seminars, conferences, independent studies, and
hospital developed educational opportunities are available to the team. The
program counts with Orthopaedic Certified nurses and promotes preparation
for nurses to qualify for the certification.
Accomplishments during 2015 included:
• Disease Specific Care designation by The Joint Commission for the Total
Knee Replacement and Total Hip Replacement programs.
• Zero surgical site infections.
• The implementation of a saphenous nerve block for Total Knee Replacement
that provides pain relief and promotes safer walking patterns. After
surgery, the patients are able to safely walk longer distances in a shorter
periods of time.
• Increase in the number of patients that are ready to be discharged to
• Reduction in blood transfusion rates for both patient populations
(Knee & Hip).
• Increase of patient attendance to the Pre-op Joint Replacement Class.
The main goal of the orthopaedic surgeons, rehabilitation team, nursing
team, and all of the Health Central Joint Replacement Committee is to
provide compassionate, evidence-based care to our patients that promote
improvement of the quality of life of the patients and family members that
participate of the program.