Jewett Orthopaedic Clinic

Jewett Physicians & Health Central Hospital Team Earns Disease Specific Care Certification

By: | Tags: , | Comments: 0 | April 3rd, 2014

Jewett Physicians & Health Central Hospital Team Earns Disease Specific Care Certification for Total Knee Replacement and Total Hip Replacement from The Joint Commission

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

activities.

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

home.

• 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.