Orthopedics Center for Excellence

Specialties Orthopaedic

Published

Specializes in Orthopaedics.

i work on a 32 bed orthopedic unit in a 600 bed hospital in new jersey shore. we are implementing a new program called "orthopedic center for excellence." right now our total joint pt are being discharged to a sub-acute rehab on 3rd day post op. they have p.t. once a day in their room and by time of dicharge the ultimate goal is to walk 300ft with the use of a walker with the therapist. tkr's are at 45degrees flexion. the new program is totally different. we knocked down a wall in between 2 rooms and are making it a kind of "day room" for pt. 6 rooms that are now two patient rooms,are now converting to single patient rooms. these rooms in addition to the 4 other private rooms will be dedicated to the total joint replacement patient. (we will go from 32 beds to 21) every total joint pt will have a coach (kind of like a birthing coach who will be a family member or close friend). they will have a pull out bed if they want to spend the night and their job will be to push and encourage the pt to work harder and help partake in the pt's care. am care will be done at 6am. and the pt will be encouraged to do their own am care. the pt's will have physical therapy 3times a day. for lunch they will all have lunch in the day room and then have p.t. again, all together in that room. they will have a total of 3 p.t. sessions a day. the rationale behind this is humans are competitive by nature (like if suzie sees rose doing 20 steps she will want to "beat" her and do 25 steps.) the ultimate goal is to avoid rehab and go home and possibly have outpatient p.t. at time of discharge from the hospital they should be able to walk 1500ft (instead of the 300ft they walk now) on post-op day 3(then go home). of course it won't apply to everyone (there always are exceptions). apparently several hospitals have adopted this joint replacement program. oh another thing is most pt will be getting femoral nerve blocks and constant pain management control. we had a group of pt/ot, some nurses, and some directors of our hospital went on a field trip to a hospital in maryland to observe first hand this program in use. so we know it does work. my question to all is do any of the other nurses on this site have this program and/or has anyone heard of it? i want to hear other ortho nurse's feedback on this. keep in mind the "baby-boomer generation" will all be in need of total joints soon. please respond and let me know what u think or if anyone has had experience with it. we plan on launching this program in the beginning of september. and trust me i'll let you all know how it works :nurse: :yeah:

Hey Lauren its Mike I am curious to see how Thursday is going to go. I wonder if they will staff us decently or try and get blood from a stone. Maybe I will see you there Thursday see ya.:banghead:

Sorry I realize this post was a while ago, but our unit is going to something similiar. We are also a 32 bed floor and we are changing to 30 bed and a new approach. To treat our new joints as healthy patients. We are doing away with pain pumps and once a day rehab. Now we are doing scheduled oral pain meds with TID rehab. Everyone is up and dressed for breakfast in a central dining room. We started this with one doc and will be doing this with all total joints in Jan. We are also getting new rooms, etc. So how is this working for you? I am initially very excited about this. I think that it will improve the outcomes for pts. What have you found? Thanks.

Specializes in Ortho, Case Management, blabla.

The unit I work on is called "joint works" and what you described is pretty much our unit in a nutshell. The PT room/headquarters is in the same hallway as the majority of our patients. The only difference is we do not have "group" sessions. We do utilize coaches (although they are not allowed to spend the night). We do the 6am rise and shine too. We do 90 degrees flexion as a goal before discharge and also "walking the steps" is another. Otherwise the patient goes to inpatient rehab on day 4.

I do not think making it a competitive thing is a very good idea. "if suzie sees rose doing 20 steps she will want to "beat" her and do 25 steps." seems like it may actually make suzie feel like she is doing really bad (some people are pessimistic). I think if someone not doing as well as another may feel like they are doing worse if they see a much younger patient doing more than they are. Does that make sense? I think recovery should be a lot more personalized than they are making it sound.

I do like the idea of 3 PT sessions per day though. I think that's awesome! I also like the idea of the femoral blocks for every patient. A lot of the orthopods where I work are pretty oldschool though so I don't know how well they'd take to change. I expect a post from you in the future letting us know how this works out for your unit. :D

Check out Plaza Medical Center in Fort Worth TX. We have recently received the JCAHO certification for joint centers!

I would like to know more about your designation as a center of excellence

Specializes in LTC, Float Pool, Ortho, Telemetry.

Hi, our Joint Replacement program recently became certified as a Joint Replacement Center of Excellence by JCAHO! It was a lot of hard work and we had to meet many standards of care on a consistent basis for months before they came to certify us. We have a wonderful group of Orthopods who specialize in all areas of Orthopedics, but we only have 3 who do Joint Replacement. Each week we recieve 8-15 joints a week. Our main Joint Replacement doctor has a very regimented order set that is standard for all of his patients with very minor changes when needed. Everyone starts on Coumadin 5mg the first night of surgery and it is then regulated via sliding scale to reach INR of 2.0-2.5. Every patient must stand at the bedside first night of surgery, 3 doses of antibiotics within 24 hours of surgery, ted hose and foot pumps for everyone, PCA pain pumps of Morphine or Dilaudid, percocet ot Lortab for btp, routine orders for stool softeners, GI prophylaxis, itching, indigestion, and nausea. Goal is discharge to home on Post-op day 3. Each day PT BID and they must learn steps before discharge. We also so blood reinfusion for the knee replacements on the night of surgery in which they recieve their own blood back that is draining into a closed, sterile system known as a Constavac drain. Each pt has a femeoral nerve block that they keep until day of discharge. IVF's and PCA pumps are DC'd on post-op day 2 unless pt is having bad side effects and then adjustments will be made to pain control. We treat our patients as if they are healthy and nit sick so they can have the best attitude possible for recovery. We encourage them to do their own ADL's and dress in their own clothes. Each patient must attend a Joint Replacement class 2 weeks before surgery so they will know what to expect. Education is carried out on admission and throughout their stay. On 3rd post-op day they are discharged to home with Home Health who will provide PT at home for a couple of weeks and then they graduate to OP PT. Nurses come into their home and draw blood for their Coumadin therapy which they continue for 6 weeks post-op. Our program is very successful and we have many repeaters who come back and have a second Joint Replacement on the opposite knee. We have an extremely low infection rate and high pt satisfaction scores. There are some more elderly patients who do need to go to Rehab for a week or so depending on their progress during their 3 day stay. In the 13 yrs I have been working on this unit, we have grown and have patients coming from other states to have their Joint Replacement. The other 2 Orthopods follow this same basic routine with some minor changes. I hope this helps anyone who is interested in this subject.

Thanks, orthorn:nurse:

Hi, our Joint Replacement program recently became certified as a Joint Replacement Center of Excellence by JCAHO! It was a lot of hard work and we had to meet many standards of care on a consistent basis for months before they came to certify us. We have a wonderful group of Orthopods who specialize in all areas of Orthopedics, but we only have 3 who do Joint Replacement. Each week we recieve 8-15 joints a week. Our main Joint Replacement doctor has a very regimented order set that is standard for all of his patients with very minor changes when needed. Everyone starts on Coumadin 5mg the first night of surgery and it is then regulated via sliding scale to reach INR of 2.0-2.5. Every patient must stand at the bedside first night of surgery, 3 doses of antibiotics within 24 hours of surgery, ted hose and foot pumps for everyone, PCA pain pumps of Morphine or Dilaudid, percocet ot Lortab for btp, routine orders for stool softeners, GI prophylaxis, itching, indigestion, and nausea. Goal is discharge to home on Post-op day 3. Each day PT BID and they must learn steps before discharge. We also so blood reinfusion for the knee replacements on the night of surgery in which they recieve their own blood back that is draining into a closed, sterile system known as a Constavac drain. Each pt has a femeoral nerve block that they keep until day of discharge. IVF's and PCA pumps are DC'd on post-op day 2 unless pt is having bad side effects and then adjustments will be made to pain control. We treat our patients as if they are healthy and nit sick so they can have the best attitude possible for recovery. We encourage them to do their own ADL's and dress in their own clothes. Each patient must attend a Joint Replacement class 2 weeks before surgery so they will know what to expect. Education is carried out on admission and throughout their stay. On 3rd post-op day they are discharged to home with Home Health who will provide PT at home for a couple of weeks and then they graduate to OP PT. Nurses come into their home and draw blood for their Coumadin therapy which they continue for 6 weeks post-op. Our program is very successful and we have many repeaters who come back and have a second Joint Replacement on the opposite knee. We have an extremely low infection rate and high pt satisfaction scores. There are some more elderly patients who do need to go to Rehab for a week or so depending on their progress during their 3 day stay. In the 13 yrs I have been working on this unit, we have grown and have patients coming from other states to have their Joint Replacement. The other 2 Orthopods follow this same basic routine with some minor changes. I hope this helps anyone who is interested in this subject.

Thanks, orthorn:nurse:

We use almost the same program at my facility. The only exceptions are PCA's are stopped the morning of POD1, and we still use CPM's on some patients but we are starting to get away from them. Some of the surgeons are resistant to that change. Our patients are very successful and we also have out-of-state and repeat patients.

Specializes in Ortho, OB/GYN, long-term care.

Our ortho unit implemented this about a year ago but being a regional hospital in a rural area we were not able to utilize it the way it was intended. Just Joints is the name of ours but it has ended up being larger "suite" type rooms as we have to share the therapists with the rest of the hospital. It is an awesome idea and would work well for the elective patients that can prepare to be in the hospital and participate in the rehab. We do still have once a week "pre-op" meetings with patient and coach for instructions and what to expect. I wish you all well with your joint centers. :o

Specializes in Orthopedics.

Our program is very close to yours. We do 40-60 total joints/week and have a 27 bed unit with an overflow unit. The goal is to do up to 100 total joints every week. (We will need more beds obviously.) We are working hard on getting certified by JCAHO. In fact, they are at our hospital this week! :eek: For anticoagulation, our total knees have lovenox bid and the total hips have lovenox daily. Some providers also still use coumadin which the medical md will manage. Our pt also have P.T. BID and then nursing walks them on the pm shift. They also must learn the stairs, car transfer, and do coumadin/lovenox teaching with pharmacy before they are discharged. We also have orthopedic routine care protocols we have implemented so RNs can write orders based on needs. For example, for severe post-op pain we give a one-time dose of Toradol (for qualifying pts), for indigestion we order maalox (if no renal impairment), we discontinue the PCA on POD 2, there is a whole long list the ortho docs have approved that we can write per protocol using our nursing judgment. (For example, I wouldn't order Toradol for a steriod-induced asthma patient since it is contraindicated) This really helps for the night shifts. We also do blood reinfusion if ordered for up to 6 hours post-op. Our patients must also attend a pre-op total joint class. We also do have some patient with perineural infusions (continuous fem nerve blocks) but we discontinue those on POD 2 d/t the knees tending to buckle with the infusions. Almost all of our patients have Spinal Anesthesia unless refused by the patient. We also have a surgeon who does Total Hip using an anterior approach and they don't have to be on Total hip precautions. They have had great results with this and there has been less blood loss and less pain. These patients also do much better with therapy. I wish more of the orthopods would learn this approach!

Hi, our Joint Replacement program recently became certified as a Joint Replacement Center of Excellence by JCAHO! It was a lot of hard work and we had to meet many standards of care on a consistent basis for months before they came to certify us. We have a wonderful group of Orthopods who specialize in all areas of Orthopedics, but we only have 3 who do Joint Replacement. Each week we recieve 8-15 joints a week. Our main Joint Replacement doctor has a very regimented order set that is standard for all of his patients with very minor changes when needed. Everyone starts on Coumadin 5mg the first night of surgery and it is then regulated via sliding scale to reach INR of 2.0-2.5. Every patient must stand at the bedside first night of surgery, 3 doses of antibiotics within 24 hours of surgery, ted hose and foot pumps for everyone, PCA pain pumps of Morphine or Dilaudid, percocet ot Lortab for btp, routine orders for stool softeners, GI prophylaxis, itching, indigestion, and nausea. Goal is discharge to home on Post-op day 3. Each day PT BID and they must learn steps before discharge. We also so blood reinfusion for the knee replacements on the night of surgery in which they recieve their own blood back that is draining into a closed, sterile system known as a Constavac drain. Each pt has a femeoral nerve block that they keep until day of discharge. IVF's and PCA pumps are DC'd on post-op day 2 unless pt is having bad side effects and then adjustments will be made to pain control. We treat our patients as if they are healthy and nit sick so they can have the best attitude possible for recovery. We encourage them to do their own ADL's and dress in their own clothes. Each patient must attend a Joint Replacement class 2 weeks before surgery so they will know what to expect. Education is carried out on admission and throughout their stay. On 3rd post-op day they are discharged to home with Home Health who will provide PT at home for a couple of weeks and then they graduate to OP PT. Nurses come into their home and draw blood for their Coumadin therapy which they continue for 6 weeks post-op. Our program is very successful and we have many repeaters who come back and have a second Joint Replacement on the opposite knee. We have an extremely low infection rate and high pt satisfaction scores. There are some more elderly patients who do need to go to Rehab for a week or so depending on their progress during their 3 day stay. In the 13 yrs I have been working on this unit, we have grown and have patients coming from other states to have their Joint Replacement. The other 2 Orthopods follow this same basic routine with some minor changes. I hope this helps anyone who is interested in this subject.

Thanks, orthorn:nurse:

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