HIP REPLACEMENT CARE PATHWAY

Transcription

1 HIP RPLACMT CAR PATHWAY Right Primary Left Revision PATIT ITIFICATIO ISCHARG CHCKLIST / GOALS ISCHARG PLA as per pre-admission: (specify) Anticipated discharge date: YYYY / MM / ate cleared for discharge: YYYY / MM / Reason (s) for delay (specify): PAI COTROL & MICATIOS Pain control adequate Patient s own medications returned at discharge ischarge medications reviewed with patient Prescription for medications provided PHYSICAL FUCTIO & SAFTY Satisfactory mobility to meet home requirements Ambulation + gait aids (specify): Stairs: Understanding of any restrictions/precautions Specify: Able to perform home AL independently or has assistance arranged APPROPRIAT RFRRALS COMPLT CCAC: nursing / PT / OT / PSW / home safety assessment Out-patient physiotherapy Rehabilitation Hospital Application submitted on YYYY / MM / Transfer date: YYYY / MM / Time: (h) confi rmed : specify TRAVL PLAS Method of transportation Transportation booked and confi rmed Time: (h) ate: YYYY / MM / uration of trip: Strategies to manage trip home discussed including pain management strategy Specify: ISCHARG ISTRUCTIOS Holland Centre Guide discharge instructions completed, reviewed with patient APPOITMT CAR(s) Cards completed and given to patient Print ame Signature esignation Initial ate YYYY/MM/ Sunnybrook Health Sciences Centre, operating as the Holland Orthopaedic & Arthritic Centre. Page 1 of 16

2 Patient ame: HF #: PR-AMISSIO YYYY/MM/ ITRVTIOS OUTCOMS Patient/Family Perspective iscuss patient/family perspective, needs & concerns Patient / family perspective; needs and concerns documented in interdisciplinary progress notes Identify patient s coach Patient s coach identifi ed; coach s involvement discussed Systems Assessments/ Treatments Assessment Intervention valuation. Teaching occurs with each patient contact during hospital stay Complete / update interdisciplinary assessment form Complete Braden skin risk assessment record Complete pre-admission medication list Complete in-patient allergy record Antibiotic Resistant Organisms (ARO). Admission screen Consultations: Medical internist Anaesthesiologist Assessment completed o S&S of pressure ulcers / open lesions Medications documented Allergies & sensitivities identifi ed/ documented ARO screen completed Consultations completed Social Work Physiotherapy Complete education/tests Measure height & weight Height cm Weight kg Screen / explain / recruit for clinical trials Research consultation Patient has received A guide for patients having hip or knee replacement and V Understanding verbalized by patient / family Patient instructed to review and sign partnership agreement Patient understands need to review & sign partnership agreement Complete admission information section of the patient education guide Patient verbalizes understanding emonstration and review of: Patient able to demonstrate -deep breathing & coughing exercises -foot & ankle pumping exercises Fluid/utrition/ limination Pre-operative PO routine Understanding verbalized Medications Medications to take the morning of surgery reviewed and documented in admission information section of patient ed. guide Understanding verbalized Medications to be discontinued before surgery reviewed and documented in admission information section of patient ed. guide Understanding verbalized Activity Assess Rehab functional measures *see Assessment Centre documents ischarge Initiate discharge planning ischarge Plan: Home independent Home with out-patient physio Home with CCAC FIT xternal rehab Page 2 of 16

3 Patient ame: HF #: YYYY/MM/ Patient/ Family Perspective SAM AY AMISSIO - AY 0 BLOCK / OR / PACU - AY 0 ITRVTIOS OUTCOMS ITRVTIOS OUTCOMS iscuss patient/family perspective, needs and concerns Identify patient s coach Patient/family perspective; needs and concerns documented in interdisciplinary progress notes Patient s coach identifi ed; coach s involvement discussed iscuss patient perspective, needs and concerns Patient / family perspective; needs and concerns documented in interdisciplinary progress notes Systems Complete pre-operative checklist Assessments/ Treatments Perform skin assessment: complete Braden skin risk assessment record Pre-op routine completed o S&S of pressure ulcers ocument interventions on: Block area record; anaesthetic record; intraoperative electronic patient record; recovery room record Surgical intervention uneventful; operative extremity warm with no reddened / broken skin when tourniquet removed Assess baseline vital signs/ SpO 2 /pain Assessment fi ndings normal for patient BP (mmhg) HR (bpm) Temperature (ºC) SpO 2 (%) Pain Score (0-10) ocument neurovascular baseline status on neurovascular assessment form emonstration & review of deep breathing / coughing & foot/ankle pumping exercises Review post-op pain management strategies Glucose point of care testing (POCT) Satisfactory neurovascular status Patient able to demonstrate Understanding verbalized by patient / family Blood glucose within acceptable range for patient Fluid/ utrition/ limination Insert IV catheter/saline lock as per physician order Provide oral fl uids as ordered Type: Amount: ml Glucose POCT result (mmol/l) Insertion well tolerated by patient; no diffi culty inserting Catheter type: Size: Location: o solid foods consumed Assess patient s bowel routine ate of last (BM) Usual BM pattern YYYY/MM/ Medications Update medications Pharmacy care Verify patient s own medications Pharmacy care provided Administer anaesthesia and medications: General anaesthesia Spinal anaesthesia o negative effects pidural analgesia Administer pre-operative medications as ordered; document on pre-printed order form o negative effects Administer prophylactic antibiotic(s) Antibiotic (s) administered on time; no negative effects Print ame Signature esignation Initial Print ame Signature esignation Initial Surgeon Page 3 of 16

4 Patient ame: HF #: POST-OP AY 0 YYYY/MM/ Patient/Family Perspective ITRVTIOS iscuss patient / family perspective, needs and concerns OUTCOMS Patient / family perspective; needs and concerns documented in interdisciplinary progress notes Identify patient s coach Patient s coach identifi ed; coach s involvement discussed Systems Assessment/ Treatment Assess vital signs, pain score and pain location as per policy; document on clinical fl ow sheet Assess respiratory system; monitor SpO 2 / administer 0 2 as ordered; document on clinical fl ow sheet BP and HR within acceptable limits for patient; Respiratory rate > 10, < 24 per min; Temperature < 38.0 C; pain score 3/10 or mild o adventitious breath sounds; no S & S of respiratory distress / respiratory depression; Sp0 2 > 92% maintained ncourage patient to perform hourly deep breathing and coughing Patient performs deep breathing and coughing as instructed eurological assessment o S & S of delirium / confusion; pt easy to rouse; no dizziness / drowsiness Perform spinal dermatome testing; document on pain fl ow sheet Level of spinal anaesthesia decreasing as expected eurovascular assessment; document on neurovascular assessment form ncourage hourly foot and ankle exercises Satisfactory neurovascular status Patient performs regular foot and ankle exercises Monitor dressing; assess for S & S of bleeding o excessive drainage / bleeding; no need to reinforce Assess for S & S of VT o S & S of VT Provide hygiene & skin care; complete Braden skin risk assessment record o S & S of pressure ulcers; skin integrity maintained Help patient to turn in bed q2h q4h Reinforce hip precautions iscuss use of side rails with patient Patient turned at least q4h; pillow (s) between legs Patient agrees with plan; understanding verbalized Perform glucose point of care testing; document results on clinical fl ow sheet Review lab results; enter blood work as ordered Blood glucose within acceptable range for patient o critical lab results Fluid/utrition/ limination Administer IV fl uids as ordered; monitor IV insertion site; document on clinical fl ow sheet Administer blood; document on clinical flow sheet Monitor total fl uid input and output; complete end of shift fl uid balance; document on clinical fl ow sheet Assess abdomen Ordered amount absorbed; IV infusing well; no S & S of complications at insertion site o S & S of transfusion reaction o S & S of hypovolemia/volume overload; clear odourless urine > 300mL over 12 hours o S & S of ileus; no S & S of urinary retention Insert urinary catheter if indicated Urinary catheter inserted; no concerns Monitor BM Time of BM: (h) o abdominal discomfort / distension; no diarrhea Amount: small medium large Consistency: hard formed loose liquid Assess food intake; increase diet as tolerated ; assess nausea and vomiting; diet as per physician order Light diet tolerated; minimized nausea and vomiting Page 4 of 16

5 Patient ame: HF #: POST-OP AY 0 YYYY/MM/ ITRVTIOS OUTCOMS Medications Administer medications; document on MAR All ordered medications given / taken Pharmacy care Verify patient s own medications Pharmacy care provided Monitor patient controlled analgesia (PCA); document on pain fl ow sheet Patient understands use of PCA o negative effect Patient satisfi ed with pain management Monitor epidural analgesia; document on pain fl ow sheet Perform MAR check against physician orders; initial last page of MAR in upper right corner Perform 24-hour chart check; draw red line and initial / date after last order o negative effect; patient satisfi ed with pain management All orders transcribed; MAR correct; yellow copies sent to pharmacy Activity For specific components check Hip Surgical Module Activity restrictions restrictions Specify: Assist sitting at edge of bed Sat with assistance x /supervision Assist sitting to standing Stood with assistance x /supervision WB as tolerated Partial WB Touch WB on WB Print ame Signature esignation Initial Print ame Signature esignation Initial Page 5 of 16

6 Patient ame: HF #: YYYY/MM/ Patient/Family Perspective ITRVTIOS iscuss patient / family perspective, needs and concerns POST-OP AY 1 OUTCOMS Patient / family perspective; needs and concerns documented in interdisciplinary progress notes Identify patient s coach Patient s coach identifi ed; coach s involvement discussed Systems Assessment/ Treatment Assess vital signs, pain score and pain location as per policy; document on clinical flow sheet BP and HR within acceptable limits for pt.; respiratory rate > 10, < 24 per min; Temp. < 38.0 C; pain score 3/10 or mild Assess respiratory system; monitor SpO 2 / administer 0 2 as ordered; document on clinical fl ow sheet o adventitious breath sounds; no S & S of respiratory distress Sp0 2 > 92% maintained ncourage patient to perform hourly deep breathing and coughing while awake Patient performs deep breathing and coughing as instructed eurological assessment eurovascular assessment; document on neurovascular assessment form o S & S of delirium / confusion; patient easy to rouse; no dizziness / drowsiness Satisfactory neurovascular status ncourage hourly foot and ankle exercises while awake Patient performs regular foot and ankle exercises Check dressing every shift; assess for S & S of bleeding Apply ice pack as needed for swelling and pain Provide hygiene & skin care; complete Braden skin risk assessment record Help patient to turn in bed q2h q4h Reinforce hip precautions iscuss use of side rails with patient ressing clean and intact; no excessive drainage/ bleeding, no need to reinforce Patient understands strategies to reduce swelling and pain o S & S of pressure ulcers; skin integrity maintained Patient turned at least q4h; pillow (s) between legs Patient agrees with plan; understanding verbalized Perform glucose point of care testing as ordered Review lab results; enter blood work as ordered Blood glucose within acceptable range for patient o critical lab results Hourly night checks o concerns identified Fluid/utrition/ limination Administer IV fl uids as ordered; monitor IV insertion site; document on clinical fl ow sheet Insert new peripheral IV catheter if indicated Ordered amount absorbed; IV infusing well; no S & S of complications at insertion site IV catheter inserted; no concerns Administer blood; document on clinical fl ow sheet Monitor total fl uid input and output; complete end of shift fl uid balance; document on clinical fl ow sheet Assess abdomen o signs and symptoms of transfusion reaction o S & S of hypovolemia / volume overload; clear odourless urine > 300mL over 12 hours o S & S of ileus; no S & S of urinary retention Insert urinary catheter if indicated Urinary catheter inserted; no concerns Monitor BM Time of BM: (h) o S & S of constipation; no diarrhea Amount: small medium large Consistency: hard formed loose liquid Assess food and fluid intake; diet as ordered; assess nausea and vomiting Light diet tolerated; minimized nausea and vomiting Page 6 of 16

7 Patient ame: HF #: POST-OP AY 1 YYYY/MM/ Medications ITRVTIOS Administer medications; document on MAR All ordered medications given / taken OUTCOMS Pharmacy care Verify patient s own medications Pharmacy care provided Monitor patient controlled analgesia; document on pain fl ow sheet Monitor epidural analgesia; document on pain fl ow sheet Anticoagulation Perform MAR to MAR check; initial last page of MAR in upper right corner Perform 24-hour chart check; draw red line and initial/date after last order Patient understands use of PCA; no negative effect; patient satisfi ed with pain management o negative effect; patient satisfi ed with pain management Anticoagulant received; no S & S of excessive bleeding; no S & S of VT All orders transcribed; MAR correct; yellow copies sent to pharmacy Activity For specific components check Hip Surgical Module Informed consent for Physiotherapy assessment and treatment Consent for treatment by Physiotherapy Assistant ducation: Safe positioning and hip precautions Informed consent obtained Consent obtained Knowledge of safe positioning verbalized ducation: xercise (s) as per exercise book xercise book provided xercise (s) demo as per list ducation: transfer techniques. Assist sitting at edge of bed. Assist sitting to standing Transferred with assistance x Hip precations reinforced / maintained. Transferred with assistance x /Supervision / Indep /Supervision / Indep. Amb with assistance Amb with assistance with Amb distance meters WB as tolerated Partial WB Touch WB on WB Initiate OT acitivities of daily living (AL) assessment (AL) assessment initiated Assess Functional Measure (s) ischarge Reassess progress and confi rm discharge plan ischarge as per POP plan Indep. exercises xpected discharge / transfer day other specify reasons for delay Home FIT xternal Rehab Out-patient physiotherapy CCAC Referral completed, yes / no (Please circle) PT / OT / PSW / home safety asessment / referral initiated / completed FIT orders completed Application initiated / completed Specify: Print ame Signature esignation Initial Print ame Signature esignation Initial Page 7 of 16

8 Patient ame: HF #: YYYY/MM/ Patient/Family Perspective ITRVTIOS iscuss patient / family perspective, needs and concerns POST-OP AY 2 OUTCOMS Patient / family perspective; needs and concerns documented in interdisciplinary progress notes Identify patient s coach Patient s coach identifi ed; coach s involvement discussed Systems Assessment/ Treatment Assess vital signs, pain score and pain location as per policy; document on clinical flow sheet BP and HR within acceptable limits for pt.; respiratory rate > 10, < 24 per min; Temp. < 38.0 C; pain score 3/10 or mild Assess respiratory system; monitor SpO 2 / administer 0 2 as ordered; document on clinical fl ow sheet o adventitious breath sounds; no S & S of respiratory distress; Sp0 2 > 92% maintained ncourage patient to perform hourly deep breathing and coughing while awake Patient performs deep breathing and coughing as instructed eurological assessment o S & S of delirium/confusion; patient easy to rouse; no dizziness / drowsiness eurovascular assessment; document on neurovascular assessment form Satisfactory neurovascular status ncourage hourly foot/ankle exercises while awake Patient performs regular foot and ankle exercises Perform dressing change using maximum barrier technique Incision edges approximated / no open gaps; minimal amount of sanguineous or serous exudate; no purulent drainage Check dressing every shift ressing clean and intact Apply ice pack as needed for swelling and pain Patient understands strategies to reduce swelling and pain Provide hygiene & skin care; complete Braden skin risk assessment record o S & S of pressure ulcers; skin integrity maintained Help patient to turn in bed q2h q4h Reinforce hip precautions Patient turned at least q4h; pillow (s) between legs iscuss use of side rails with patient Patient agrees with plan; understanding verbalized Perform glucose point of care testing as ordered Blood glucose within acceptable range for patient Review lab results; enter blood work as ordered o critical lab results Hourly night checks o concerns identifi ed Fluid/utrition/ limination iscontinue IV fl uids; document on clinical fl ow sheet Patient is drinking suffi cient amount / not vomiting iscontinue peripheral IV access Removed catheter intact, site satisfactory Saline lock left in situ; document on patient care plan Saline lock flushed q8h Administer blood; document on clinical fl ow sheet o S & S of transfusion reaction Monitor total fl uid input & output; complete end of shift fl uid balance until IV fl uids discontinued; document on clinical fl ow sheet Assess abdomen Monitor BM o S & S of hypovolemia / volume overload; clear odourless urine > 300mL over 12 hours o S & S of ileus; no S & S of urinary retention o S & S of constipation; no diarrhea Time of BM: (h) Amount: small medium large Consistency: hard formed loose liquid Provide education on stool softener Assess food intake; diet as ordered; assess nausea & vomiting Patient understands the need for stool softener 50% of meal consumed; no nausea and vomiting Page 8 of 16

9 Patient ame: HF #: POST-OP AY 2 YYYY/MM/ Medications ITRVTIOS Administer medications; document on MAR All ordered medications given / taken OUTCOMS Pharmacy care Verify patient s own medications Pharmacy care provided Monitor patient controlled analgesia; document on pain fl ow sheet Patient understands use of PCA; no negative effect; patient satisfi ed with pain management Activity iscontinue patient controlled analgesia; document on pain flow sheet Monitor epidural analgesia; document on pain fl ow sheet Remove epidural catheter Anticoagulation Perform MAR to MAR check; initial last page of MAR in upper right corner Perform 24-hour chart check; draw red line and initial/date after last order Reinforce safe positioning and hip precautions ducation: exercise (s) as per exercise book Patient agrees to switch to oral pain management o negative effect; patient satisfi ed with pain management Removed catheter intact; no signs and symptoms of site infection / bleeding Anticoagulant received; no S & S of excessive bleeding; no S & S of VT All orders transcribed; MAR correct; yellow copies sent to pharmacy Correct positioning and knowledge of precautions verbalized/ demonstrated xercise (s) reviewed / demo added as per list Reinforce transfer techniques; sitting at edge of bed Sitting to standing Transferred with assistance x Transferred with assistance x /Supervision / Indep. /Supervision / Indep. ncourage sitting as tolerated Sat in chair 45 min per sitting ducation: ambulation OT assessment Amb with assistance / supervision / independent with Amb distance meters WB as tolerated Partial WB Touch WB on WB Refer to OT AL Assessment Form AL training and education: re equipment needs ressing Toilet transfers ischarge Reassess progress and confi rm discharge plan ischarge as per POP plan Indep. exercises xpected discharge / transfer day other specify reasons for delay Home FIT xternal Rehab Out-patient physiotherapy CCAC Referral completed, yes / no (Please circle) PT / OT / PSW / home safety asessment / referral initiated / completed FIT orders completed Application initiated / completed Specify: Print ame Signature esignation Initial Print ame Signature esignation Initial Page 9 of 16

10 Patient ame: HF #: POST-OP AY 3 YYYY/MM/ Patient/Family Perspective ITRVTIOS iscuss patient / family perspective, needs and concerns OUTCOMS Patient / family perspective; needs and concerns documented in interdisciplinary progress notes Identify patient s coach Patient s coach identifi ed; coach s involvement discussed Systems Assessment/ Treatment Assess vital signs, pain score and pain location; document on clinical flow sheet BP and HR within acceptable limits for pt.; respiratory rate > 10, < 24 per min; Temp. < 38.0 C; pain score 3/10 or mild Assess respiratory system; monitor SpO 2 ; document on clinical flow sheet o adventitious breath sounds; no S & S of respiratory distress; Sp0 2 > 92% maintained Patient to continue deep breathing and coughing eurological assessment o S & S of delirium / confusion; patient easy to rouse; no dizziness / drowsiness eurovascular assessment; document on neurovascular assessment form Satisfactory neurovascular status Patient to continue foot and ankle exercises Check surgical incision; reapply new dressing if incision not healed or if requested by patient Incision edges approximated/no gaps; no drainage / bleeding Apply ice pack as needed for swelling and pain Patient understands strategies to reduce swelling and pain Assist patient with hygiene & skin care; complete Braden skin risk assessment record o S & S of pressure ulcers; skin integrity maintained Perform glucose point of care testing as ordered Blood glucose within acceptable range for patient Review lab results; enter blood work as ordered o critical lab results Regular night checks o concerns identified Fluid/utrition/ limination iscontinue saline lock; document on patient care plan Patient is drinking suffi cient amount / not vomiting; removed catheter intact; site satisfactory Insert new peripheral IV catheter if IV fl uids/ medications continued; document on patient care plan IV catheter inserted, no concerns Administer blood; document on clinical flow sheet o signs and symptoms of anaemia Assess abdomen o S & S of ileus Monitor BM o S & S of urinary retention. Adequate amount clear odourless urine voided Time of BM: (h) o S & S of constipation; no diarrhea Amount: small medium large Consistency: hard formed loose liquid Provide education on stool softener Provide laxative if no BM Give suppositories if no BM; document on MAR Assess food intake; diet as ordered; assess nausea and vomiting BM as per usual pattern; patient understands the need for stool softener Patient accepts initiation of additional bowel routine strategies 50% of meal consumed; no nausea and vomiting Page 10 of 16

11 Patient ame: HF #: POST-OP AY 3 YYYY/MM/ ITRVTIOS OUTCOMS Medications Administer medications All ordered medications given / taken Pharmacy care Pharmacy care provided Activity Monitor effectiveness of oral analgesics and adverse effects: document on clinical fl ow sheet / progress notes Anticoagulation Perform MAR to MAR check; initial last page of MAR in upper right corner Perform 24-hour chart check; draw red line and initial / date after last order Reinforce safe positioning and hip precautions ducation: exercise (s) as per exercise book Patient satisfi ed with pain management Anticoagulant received; no S & S of excessive bleeding; no S & S of VT All orders transcribed; MAR correct; yellow copies sent to pharmacy Correct positioning and knowledge of precautions verbalized/ demonstrated xercise (s) reviewed / demo added as per list Reinforce transfer techniques. Transferred with supervision / Indep. ncourage sitting as tolerated Sitting up in chair 45 min per sitting ducation: ambulation Amb with supervision / independent with If home education: stair technique Amb distance meters WB as tolerated Partial WB Touch WB on WB Stairs managed assist / supervision / indep. OT assessment AL training and education: re equipment needs Refer to OT AL Assessment Form ressing Toilet transfers Assess Functional Measure (s) ischarge Reassess progress and confi rm discharge plan xpected discharge / transfer day 3 ischarge as per POP plan other specify reasons for delay 4 5 Indep. exercises Home Out-patient physiotherapy Referral completed, yes / no CCAC (Please circle) PT / OT / PSW / home safety asessment / referral initiated / completed FIT xternal Rehab FIT orders completed Application initiated / completed Specify: Print ame Signature esignation Initial Print ame Signature esignation Initial Page 11 of 16

12 Patient ame: HF #: POST-OP AY 4 YYYY/MM/ ITRVTIOS OUTCOMS Patient/Family Perspective iscuss patient / family perspective, needs and concerns Patient / family perspective; needs and concerns documented in interdisciplinary progress notes Identify patient s coach Patient s coach identifi ed; coach s involvement discussed Systems Assessment/ Treatment Assess vital signs; pain score and pain location, as per policy, document on clinical fl ow sheet Assess respiratory system; monitor SpO 2 ; document on clinical flow sheet; patient to continue deep breathing and coughing eurovascular assessment; document on neurovascular assessment form; patient to continue foot / ankle exercises BP and HR within acceptable limits for pt.; respiratory rate > 10, < 24 per min; temp. < 38.0 C; pain score 3/10 or mild o adventitious breath sounds; no S & S of respiratory distress Sp0 2 > 92% maintained Satisfactory neurovascular status Check surgical incision; reapply new dressing if incision not healed or if requested by patient Incision edges approximated/no gaps; no drainage / bleeding Apply ice pack as needed for swelling and pain Patient understands strategies to reduce swelling and pain Assist patient with hygiene & skin care; complete Braden skin risk assessment record Perform glucose point of care testing as ordered o signs and symptoms of pressure ulcers; skin integrity maintained Blood glucose within acceptable range for patient Review lab results; enter blood work as ordered o critical lab results Regular night checks o concerns identified Fluid/utrition/ limination Administer blood; document on clinical fl ow sheet Assess abdomen o signs and symptoms of anaemia o S & S of ileus o S & S of urinary retention; adequate amount clear odourless urine voided Monitor BM Time of BM: (h) o S & S of constipation; no diarrhea; BM as per usual pattern Amount: small medium large Consistency: hard formed loose liquid Provide laxative if no BM Patient accepts initiation of additional bowel routine strategies Give suppositories/enema if no BM; document on MAR Medications Assess food intake; diet as ordered; assess nausea and vomiting Administer medications 50% of meal consumed; no nausea and vomiting All ordered medications given/taken Pharmacy care Pharmacy care provided Monitor effectiveness of oral analgesics and adverse effects: document on clinical fl ow sheet Anticoagulation Perform MAR to MAR check; initial last page of MAR in upper right corner Perform 24-hour chart check; draw red line and initial/date after last order Patient satisfied with pain management Anticoagulant received; no S & S of excessive bleeding; no S & S of VT All orders transcribed; MAR correct; yellow copies sent to pharmacy Page 12 of 16

13 Patient ame: HF #: POST-OP AY 4 YYYY/MM/ ITRVTIOS OUTCOMS Activity Reinforce safe positioning and hip precautions ducation: exercise (s) as per exercise book Correct positioning and knowledge of precautions verbalized/ demonstrated xercise (s) reviewed / demo added as per list. Performing previously taught exercises correctly Reinforce transfer techniques. Transfered independently ncourage sitting as tolerated Progress amb pattern, distance and gait aid as able Amb independent with Amb distance meters WB as tolerated Partial WB Touch WB on WB Assess gait aid needs for /C Gait aid needs addressed ducation: stair technique Stairs managed assist / supervision / indep. AL training and education: re equipment needs ressing Toilet transfers Safe vehicle transfer Safe vehicle transfer demonstrated Assess Functional Measure (s) ischarge Reassess progress and confi rm discharge plan xpected discharge / transfer day 4 5 ischarge as per POP plan other specify reasons for delay Home Indep. exercises Out-patient physiotherapy CCAC Referral completed, yes / no (Please circle) PT / OT / PSW / home safety asessment / referral initiated / completed FIT xternal Rehab FIT orders completed Application initiated / completed Specify: Print ame Signature esignation Initial Print ame Signature esignation Initial Page 13 of 16

14 Patient ame: HF #: YYYY/MM/ Patient/Family Perspective ITRVTIOS iscuss patient / family perspective, needs and concerns POST-OP AY 5 OUTCOMS Patient / family perspective; needs and concerns documented in interdisciplinary progress notes Identify patient s coach Patient s coach identifi ed; coach s involvement discussed Systems Assessment/ Treatment Assess vital signs, pain score and pain location as per policy; document on clinical fl ow sheet BP and HR within acceptable limits for pt.; respiratory rate > 10, < 24 per min; temp. < 38.0 C; pain score 3/10 or mild Assess respiratory system; monitor SpO 2 ; document on clinical flow sheet; patient to continue deep breathing and coughing o adventitious breath sounds; no S & S of respiratory distress; Sp0 2 > 92% maintained Check surgical incision; reapply new dressing if incision not healed or if requested by patient; provide discharge education Incision edges approximated / no gaps; no drainage / bleeding Apply ice pack as needed for swelling and pain Patient understands strategies to reduce swelling and pain Assist patient with hygiene & skin care; complete Braden skin risk assessment record o S & S of pressure ulcers; skin integrity maintained Perform glucose point of care testing as ordered Blood glucose within acceptable range for patient Review lab results; enter blood work as ordered o critical lab results Regular night checks o concerns identified Fluid/utrition/ limination Assess abdomen o S & S of ileus; no S & S of urinary retention; adequate amount clear odourless urine voided Monitor BM Time of BM: (h) o S & S of constipation; no diarrhea; BM as per usual pattern Amount: small medium large Consistency: hard formed loose liquid Provide laxative if no BM; provide education: regarding constipation and management technique Patient / familiy s questions / concerns addressed Medications Administer medications All ordered medications given/taken Pharmacy care Pharmacy care provided Monitor effectiveness of oral analgesics and adverse effects: document on clinical fl ow sheet / progress notes Patient satisfi ed with pain management Anticoagulation Provide discharge teaching Anticoagulant received; no S & S of excessive bleeding; no S & S of VT Patient / family s questions / concerns addressed Return patients own medication Patient s medication returned Page 14 of 16

15 Patient ame: HF #: POST-OP AY 5 YYYY/MM/ ITRVTIOS OUTCOMS Activity Reinforce safe positioning and hip precautions Correct positioning demonstrated. Hip precautions being followed. ducation: exercise (s) as per exercise book xercise (s) reviewed / demo added as per list. Performing previously taught exercises correctly, indep for home If home, discuss indep exercise program and function at home. Progress amb pattern, distance and aid as able Amb independent with Amb distance meters WB as tolerated Partial WB Touch WB on WB Assess gait aid needs for discharge Gait aid needs addressed If home, ducation stair technique Stairs managed assist / supervision / indep. Safe vehicle transfer Safe vehicle transfer demonstrated Assess Functional Measure (s) ischarge Reassess progress and confi rm discharge plan xpected discharge / transfer day 5 ischarge as per POP plan other specify reasons for delay Home FIT xternal Rehab Indep. exercises Out-patient physiotherapy CCAC Referral completed, yes / no (Please circle) PT / OT / PSW / home safety asessment / referral initiated / completed FIT orders completed Application initiated / completed Specify: Print ame Signature esignation Initial Print ame Signature esignation Initial Surgeon Page 15 of 16

16 LG a active a/a active assisted AL activities of daily living amb ambulation/ambulate Block a room to initiate regional anesthesia BM bowel movement BPM beats per minute CCAC Community Care Access Centre day demo demonstrates /C discharge V digital video display evening FIT Functional Independence Training HWW high-wheeled walker Indep Independence MAR Medication Administration Record max maximum min minimum mod moderate m/s meters per second night /A not applicable PO nothing per mouth OR operating room OT occupational therapy/occupational therapist p passive PACU post anesthetic care unit POP Patient Orientation Program pt patient PT physiotherapy/physiotherapist PTA physiotherapy assistant PSW personal support worker ROM range of motion s seconds SPW self-paced walk S & S signs and symptoms sup supervision TUG timed up and go VT venous thromboembolism WB weight bearing & and > greater than < less than less than or equal to x times Page 16 of 16