Nationally Accredited Joint Program

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2 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

3 Role of Joint Program Coordinator Complete Pre-op Education Make daily rounds Address patient concerns

4 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

5 Preparing For Surgery The Guidebook FAQs Pre-op Checklist Pre-op Exercises Hospital Stay

6 Coaches are recommended Family member or friend Provides comfort, motivation Observe therapy sessions Gain confidence for discharge home

7 The Guidebook 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.

8 Preparing Your Home Chair with arm rests Recliner chairs okay Special bed not necessary Remove throw rugs Prepare frozen meals Arrange for someone to care for pets

9 Understanding the Procedure Total Joint Replacement (hip or knee) Unicondylar Knee Replacement Hip Replacement Hip Resurfacing The goal of surgery is to lessen pain and restore function.

10 Procedures Total Hip Replacement Removal of damaged bone and cartilage from your thighbone and hip bone with insertion of an artificial joint (prosthesis)

11 Procedures Posterior Hip Precautions No bending hip past 90 deg No crossing legs No internal rotation

12 Procedures Total Knee Replacement Removal of damaged bone and cartilage from your thighbone, shinbone and kneecap with insertion of an artificial joint (prosthesis)

13 Procedures Unicondylar Knee Replacement Replaces only half of the knee joint with a prosthesis

14 Procedures Hip Resurfacing Total ball is resurfaced and a plastic or metal cup is inserted into hip Hemi ball is resurfaced only

15 Medical Clearance 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

16 What To Pack In Your Bag Picture ID Loose fitting clothes Supportive shoes slip on preferred Glasses and glass case Hearing aide Denture case Cell phone and charger

17 Also Bring 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

18 Valuables Leave your valuables, such as jewelry or watches at home

19 Day Before Surgery The day before surgery, call scheduling at (520) 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

20 Day of 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

21 Questions 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)?

22 Surgery Entrance To Hospital North Side in Back of Hospital

23 Reception Area

24 Report to Surgery waiting room Check in at the desk Day of Surgery Family members and coaches, wait here until called back to pre-op

25 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

26 Preventing Post-op Complications 1. Preventing Infection 2. Preventing Blood clots 3. Post Op nausea and vomiting 4. Pulmonary/pneumonia

27 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

28 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

29 Preventing Infection 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

30 Preventing Post-op Complications 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!!!!*******

31 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!!! *****

32 Questions 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?

33 Meet Anesthesiologist and Surgeon Review Health and Medication History Discuss Nausea/Pain Management Concerns General Anesthesia - IV Sedation - Mild Sore Throat Regional Anesthesia - Local nerve Block

34 Operating Room/PACU Operating room table Placement on hospital bed Surgery 1 to 1.5 hours

35 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

36 Recovery Room/PACU Stabilize Vital Signs Neuromuscular Assessment Comfort Measures IV pain medication Nausea medication Bladder scan and possible catheterize

37 Medical/Surgical Unit 30 Bed Unit on 3 rd floor, 3 West and 3 North All private rooms and bathrooms Wireless is available

38 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

39 Medical/Surgical Equipment. 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

40 Hourly Rounding 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

41 Communication Board

42 Pain Scale- Handouts Standard Rating scale to communicate objective pain Allows for improved pain management strategies.

43 Additional Comfort Measures Cold therapy No more then min of every hour while awake. Cold packs, ice bags,

44 Types of Discomfort Incision Site Soreness, pressure Treat with pain medication Swelling/Bruising Tightness around the incision/joint Treat with compression and elevation

45 Staying Safe 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!

46 Remember 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

47 Questions What can you do to help prevent falls? Name the 4 Ps

48 Physical Therapy Early Mobilization is key to outcome! Evaluate patients day of surgery Assist with guiding pain management strategies

49 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

50 Group 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

51 Occupational Therapy Bathing Dressing Hygiene Assistive Devices Reacher Sock Aide

52 Primary Pain Management Goals 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

53 Pain Management Goal 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.

54 Did You Forget? 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.

55 Questions 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?

56 Role of the Caregiver Assist with mobility Dressing changes TED stockings Observe patient

57 Daily Newsletters

58 Transition To Home The gold standard is for patients to go home! Decreased infection risk Improved comfort More opportunity for self-initiated mobility

59 Transition To Home Making the Discharge Plan Patient and Family Interview Program Coordinator Surgeon Physical Therapist Case Manager

60 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 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.

61 Transition To Home Discharge Planning Options Home with Outpatient Services Home with Home Health PT Sub-acute Rehab Insurance Plans and Authorizations

62 Going 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

63 Day of Discharge 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

64 Dressing Change Procedure Clean technique Change daily Notify doctor of fever, incisional redness, drainage, odor or increased pain

65 Caring For Yourself At Home 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

66 Take pain medication regularly exactly as prescribed Speak to your surgeon about when to decrease or discontinue pain meds Take stool softeners Medications Resume pre-op medications

67 Pearls of Recovery Pick one day each week to measure progress Do your exercises regularly Eat healthy DO NOT SMOKE

68 Discharge To Home Ride in the front seat Stop along the way if your ride is more than two hours or you become uncomfortable

69 Hip Precautions Posterior Approach Do not bend past 90 Do not twist Do not cross legs

70 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

71 Stay In Touch 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 and press option #2 Joint Program Coordinator number is

72 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!