PATIENT EDUCATION MATERIALS
ANDREWS INSTITUTE
H I P & K N E E R E P L AC ACEMENT GUIDEBOOK
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TABLE OF CONTENTS Your Care Team...............................................................................................................3 Your Pathway to Success............................................................................................ 4 Before Surgery................................................................................................................5 Home Safety Check List.............................................................................6-7 Nutrition..............................................................................................................8 Durable Medical Equipment (DME).......................................................... 9 Day of Surgery..............................................................................................................10 After Surgery.................................................................................................................. 11 Post-Operative Safety...........................................................................................12-13 Returning Home...........................................................................................................14 Rehabilitation Clinic Locations (Map).................................................................... 15 Healthy Habits Tracker..........................................................................................16-17 Joint Replacement Outcome Data......................................................................... 18
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YOUR CARE TEAM Thank you for choosing Andrews Institute. Throughout the course of your surgery and recovery you will have many health care professionals helping you along the way. You can use this section to record who participated in your care.
The team listed below participated in your care: ______________________________________ Physician ______________________________________ Physician Assistant (PA) ______________________________________Joint Navigator ______________________________________Hospital Physical Therapist ______________________________________Outpatient Physical Therapist If you have any questions, concerns, or would like to share details of your experience with us, please contact us using the information below.
Baptist Hospital Ally Wade, MPH 850.469.2476
Gulf Breeze Hospital Sherry Weed, BSN, RN, CNOR 850.934.2154
Andrews Institute Ambulatory Surgery Center (ASC) Alyson Hughes 850.916.8526 By listening to our patients, we are able to provide the best care possible. We want you to be completely satisfied with the service you received today, and we invite your feedback. Following your visit with us, you may receive a survey by email or text message from an independent surveyor, Press Ganey, asking about your experience.
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YOUR PATHWAY TO TOTAL JOINT REPLACEMENT SUCCESS Congratulations on taking your first step to better mobility and quality of life. Our team is here to guide you along your joint replacement journey and provide you the tools to impact your success. Patients who become active partners in their own care achieve better outcomes. By participating in this prescribed pathway, patients typically experience shorter hospital stays, lower infection rates and shorter recovery with return to normal activity. Below is a general overview of your surgical care pathway. The following pages of this booklet will provide important information and tools to help you succeed.
Your total joint journey will be described in the following four phases of care:
Before Surgery Day of Surgery After Surgery Returning Home
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BEFORE SURGERY PRE-SURGICAL OPTIMIZATION CLINIC At this appointment you will receive a medical work-up and education to help you prepare for surgery. Your appointment will be scheduled for a few weeks prior to your surgery. This visit may take up to three hours.
WHAT TO EXPECT 1. Prior to the appointment, a pre-surgery nurse will conduct a phone interview to review your medications and medical/surgical history. Instructions for your surgery will be provided. *Please bring all medications you take (prescription medication, over the counter medication and herbal products) in their pharmacy bottles. 2. You will receive testing, which includes non-fasting labs (patient may eat prior to appointment), a nasal swab, urinalysis, EKG and chest X-ray. In preparation for your EKG, please do not wear any lotions or perfumes. If female, please do wear a sports bra. 3. Dr. William Willis, M.D., will complete your physical exam. 4. You will be contacted separately by one of our total joint navigators to review the total joint booklet, clarify instructions for the day of surgery and answer any questions you may have.
PRESURGICAL EXERCISE Initiating an exercise program prior to surgery can greatly improve your recovery. If your surgeon prescribed physical therapy or gave you a home exercise program, be sure to complete your exercises regularly in the weeks leading up to surgery.
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HOME SAFETY CHECK LIST Before your surgery, use our home safety checklist to prepare your home when you return home after your surgery.
STAIRS & STEPS (INDOOR & OUTDOOR) Are there papers, shoes, books, or other objects on the stairs?
o Always keep objects off the stairs. Are some of the steps broken or uneven?
o Fix loose or uneven steps. Is there a light available at the top and bottom of the stairs?
o Consider placing a night light at top and bottom of stairs, or having a flashlight available. Has a stairway bulb burned out?
o Have a friend or family member change the light bulb. Is the carpet on the steps loose or torn?
o Make sure the carpet is firmly attached to every step or remove the carpet and attach non-slip rubber treads to the stairs.
Are the handrails loose or broken? Is there a handrail on only one side of the stairs?
o Fix loose handrails, or put in new ones. Make sure handrails are as long as the stairs. FLOORS When you walk through a room, do you have to walk around furniture?
o Ask someone to move the furniture so your path is clear and direct. Do you have throw rugs on the floor?
o Remove the rugs, or use double-sided tape or a non-slip backing so the rugs will not slip. Are there papers, shoes, books, or other objects on the floor?
o Pick up things on the floor. Always keep objects off the floor. Do you have to walk over or around wires or cords (like lamp, telephone, or extension cords)?
o Coil or tape cords and wires next to the wall to avoid tripping.
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KITCHEN Are the things you use often on high shelves?
o Keep things you use often at counter top level. Is your step stool sturdy?
o If you must use a step stool, get one with a bar to hold on to. Never use a chair as a step stool. BEDROOMS Is the light near the bed hard to reach?
o Place a lamp close to the bed where it is easy to reach. Is the path from your bed to the bathroom dark?
o Put in a night light so you can see where you are walking. Some night lights go on by themselves after dark.
BATHROOMS Is the tub or shower floor slippery?
o Put a non-slip rubber mat or self-stick strips on the floor of the tub or shower. Do you need some support when you get in and out of the tub, or up from the toilet?
o Install grab bars next to and inside the tub, and next to the toilet. MISCELLANEOUS Do you have a cat or dog? Any other pet loose in your home?
o Have a friend or family member secure your pet prior to you entering the room. After you are seated, your pet may be released.
o _____________________________________________
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NUTRITION Eating a healthy, well-balanced diet is one of the keys to success on your total joint journey. A healthy diet before and after your surgery will give you the energy to help fuel your recovery and provide your body with the right nutrients and oxygen to heal. Make sure you are consuming enough fruits, vegetables, lean proteins, and whole grains every day, while minimizing saturated fats (e.g., butter, cheese, cream). If you are diabetic, it is very important to check your glucose (sugar) levels regularly and follow the diet recommended by your physician. Iron-rich foods reduce the risk of pre- and post-operative anemia: • Beans and peas, such as lima, black, red, and kidney beans, split and chickpeas. • Enriched breads, pastas and whole grains such as whole wheat bread, pasta, oats and quinoa. • Fruits (e.g., strawberries, watermelon, figs, prunes and prune juice, dried raisins and apricots). • Dark leafy greens such as spinach, kale and swiss chard, iron-fortified cereals like oats and wheat and whole grain cereals. • Red meat, pork and poultry. • Seafood (e.g., haddock, shrimp, oysters and tuna). To prevent constipation, be sure to maintain a high-fiber diet. Eat foods that are naturally grown and picked, like vegetables and fruits. Avoid foods that are manufactured, boxed or bagged. Make sure you drink plenty of fluids to keep your body well-hydrated. Water is your best choice!
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DURABLE MEDICAL EQUIPMENT (DME) You will need to obtain your walker before surgery.* Be sure you get the correct walker. You will need a two front wheeled (not four wheeled) rolling walker at time of surgery and for several weeks after. Post-operatively, walkers and canes are necessary to ensure safety and optimal outcomes. Here is a list of local resources to obtain this vital equipment: • Local pharmacies. • Durable medical equipment companies. • Online purchase. • Consignment stores. • Greater Little Rock Baptist Church has a DME closet in partnership with Baptist Health Care’s Faith Health Network. For more information: Faithhealthnetworkinfo@bhcpns.org. *Used or donated walkers cannot be guaranteed for safety; user assumes liability.
PHYSICAL THERAPY PRIOR TO SURGERY Your surgeon may order physical therapy prior to surgery, sometimes known as “prehab.” This is a physical therapy appointment scheduled in the weeks leading to surgery. It gives you the chance to meet with a therapist and learn exercises you can do prior to surgery to improve your range of motion and strength, leading to greater success after surgery. 9
DAY OF SURGERY REGISTRATION You will arrive at surgery registration at a specific time that is given to you. This time may be given to you as late as the evening before your surgery.
PREOPERATIVE AREA In the preoperative area a nurse will verify your identity and confirm your surgery. You will also see the anesthesiologist at this time and discuss the type of anesthesia you will receive.
SURGERY Your surgeon and the operating room team will work together to complete your surgery. Each surgery is unique to address the specific need of each patient. Total joint replacement surgery can take anywhere from one to two hours.
RECOVERY AREA •
If you are staying overnight in the hospital: After surgery you will be taken to the recovery area, where you will awake from anesthesia. Your family will be notified when you arrive in the recovery area. When you are fully awake, the clinical team will ensure that you are alert, feeling well and comfortable (this usually takes one to two hours). Once you’re fully recovered, you will be transferred from the recovery area to your hospital room where you will be cared for by the orthopedic specialty team.
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If you are going home after surgery: After surgery you will be taken to the recovery area, where you will awake from anesthesia. When you are fully awake and recovered, the clinical team will ensure that you are alert, comfortable and safe to be discharged to your home (this usually takes one to two hours). A physical therapist will evaluate you to determine that you are safe to walk with a walker and can care for yourself with the help of your support person. The nursing team will review your discharge instructions and answer any questions you may have.
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AFTER SURGERY HOSPITAL STAY Your time spent in the hospital will be determined by your surgeon and care team. Please remember when you go home you will need someone to stay with you for the first 24 hours, but we encourage having someone to help you for at least 2-4 days.
PAIN After surgery, you can expect to have some pain. The goal is to manage your pain so you are able to complete your exercises over the course of your recovery. Please discuss your pain management options with the hospital care team throughout your stay.
FALL RISK – CALL DON’T FALL While in the hospital, you will learn how to move safely with your new total joint. Please keep in mind that you will be using a walker and will be in a new environment. Extra caution is needed to ensure you do not suffer a fall in the days immediately following surgery. Certain medications, especially pain medications, may make you dizzy or drowsy. These side effects can make it more likely for you to fall. Be sure to tell your nurse if a medication makes you feel dizzy or drowsy so that extra caution can be taken, or medications can be adjusted to reduce your risk of falling.
PHYSICAL THERAPY If you are staying overnight in the hospital, once you are on the orthopedic unit, you will begin a rehabilitation program to help strengthen your muscles and regain your range of motion. Within hours of your arrival to the orthopedic unit, your physical therapist and/or a nurse will help you start walking a few steps at a time. Before you are discharged from the hospital, a therapist will show you how to perform daily tasks at home after surgery. Physical therapy and occupational therapy after your joint replacement surgery are critical parts of your recovery. The exercises will help you regain range of motion and strength so you can get back to doing the things you love. In addition to using your prescribed medications, use of ice and elevation after your exercises will help you reach your rehab goals.
DISCHARGE GOALS The following goals are to be met with the guidance and supervision of a therapist or nurse: 1. Get out of bed by yourself. 2. Walk 100 feet with the use of a walker or crutches.
CALL DON'T FALL
3. Walk to the bathroom with assistance. 4. Climb and descend stairs (if necessary). 5. Bathe and dress yourself with minimal help. 6. Control any pain with oral medication. 7. Recite and use your hip precautions (total hips only). 8. Make arrangements to return home.
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POST-OPERATIVE SAFETY PAIN MANAGEMENT It is normal to have pain following your total joint surgery. This pain should gradually decrease as you heal, and there are steps you can take to ease the pain during recovery. • Your doctor may prescribe pain medications, and it is important to take these as prescribed. Pain medication can help you engage fully in exercise or therapy, especially if taken before participating. • Swelling can be a cause of pain in the healing joint. Elevate your leg, including your foot, by propping it up on pillows or blankets. Be sure to raise your leg above your heart to help reduce swelling. • Applying an ice pack to your new knee or hip for 10-20 minutes, every hour or two, as needed, can also ease pain. Be sure to place a towel or pillowcase between your skin and the ice pack to protect your skin. Although you may be excited to use your new joint, you need to take breaks in the beginning as you heal. If you increase your walking or other activities, give yourself an extra break to let your body recover.
ASSISTIVE DEVICES Use your walker or assistive device as instructed by your healthcare provider. You may also be instructed to use an assistive device for dressing (such as a reacher) or toileting (such as an adjustable commode seat).
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WOUND CARE & INFECTION PREVENTION You will have stitches, staples, or glue in the skin around your incision for up to 14 days after surgery. It is important to keep a clean, dry dressing on your incision until your physician or healthcare provider allows it to be removed. If your wound is draining (leaking) and your dressings are soaked, let your surgeon know. There should be no new drainage from the incision starting 3-4 days after surgery. Check with your surgeon about bathing or showering after your surgery. Your incision may take 6-8 weeks to fully heal. Always clean your hands, or be sure your caregiver cleans their hands, with warm soapy water, before touching the wound or wound dressings.
CONTACT YOUR HEALTHCARE PROVIDER IF YOU EXPERIENCE: • Redness, pain, swelling, or tenderness. • Green or yellow drainage, redness around the incision or joint. • Excessive blood soaking through your dressing. • Pain worsens over time or does not go away with pain medicine. • Your temperature is over 101 degrees Fahrenheit.
GO TO THE EMERGENCY ROOM IF YOU EXPERIENCE: • Chest pain, uncontrolled coughing, or shortness of breath • Severe pain which prevents you from putting any weight on your operated leg (after you previously have been able to do so)
RED FLAGS Help your recovery by alerting your healthcare provider about any concerns. You will be given special medication to lower the risk of a blood clot, so be sure you understand and take your medications as instructed. If you notice increased redness or swelling in your calf, sharp pain in your calf, or develop shortness of breath, contact your medical provider immediately. Some people may react to medications, so be sure to let your healthcare provider know if you are experiencing excessive bleeding from your incision, dizziness, redness or swelling in your calf, constipation, excessive fatigue, nausea or vomiting, or any new symptoms that may be related to your medication use.
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RETURNING HOME EXERCISE It is important you take part in your prescribed therapy or home exercise program to maximize your ability to regain your full mobility and strength. Patients who commit to their exercise program will recover more quickly than patients who do not complete their prescribed exercise program. Based on your surgical procedure and physician orders, you may be referred for outpatient therapy upon discharge from the hospital. If you receive a physical therapy prescription from your surgeon, please take it with you to your first physical therapy appointment.
PHYSICIAN FOLLOW UP VISITS You will have a follow up with your physician in 2-4 weeks after surgery. Please refer to your discharge instructions regarding how to schedule this appointment.
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ANDREWS INSTITUTE REHABILITATION LOCATIONS JAY HOSPITAL JAY
29 10
BAPTIST MEDICAL PARK – PACE BAPTIST MEDICAL PARK – NINE MILE
90
10
29
PACE
90
10
BEAR LEVIN STUDER FAMILY YMCA
BAPTIST SPEECH CLINIC PENSACOLA
98
98 GULF BREEZE
WESTSIDE
90
BAPTIST MEDICAL PARK – NAVARRE
NAVARRE
ANDREWS INSTITUTE
Andrews Institute for Orthopaedics & Sports Medicine
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Bear Levin Studer Family YMCA
1040 Gulf Breeze Parkway, Suite 101, Gulf Breeze, FL 32561 850.916.8600 • Fax 850.934.4181 Disciplines: PT, OT, SP
165 E. Intendencia St., Suite 200, Pensacola, FL 32502 850.469.7555 • Fax 850.469.7585 Disciplines: PT, OT
Baptist Medical Park – Navarre
Jay Hospital
8880 Navarre Parkway, Suite 202, Navarre, FL 32566 850.939.1017 • Fax 850.908.3079 Disciplines: PT, OT
14114 Alabama St., Jay, FL 32565 850.675.8040 • Fax 850.675.8016 Disciplines: PT, OT
Baptist Medical Park – Nine Mile
Westside
9400 University Parkway, Suite 104, Pensacola, FL 32514 850.208.6120 • Fax 850.208.6129 Disciplines: PT, OT, SP
12601 Sorrento Road, Suite A, Pensacola, FL 32507 850.453.8549 • Fax 850.455.0938 Disciplines: PT
Baptist Medical Park – Pace
To make an appointment call 850.908.1555, option “0” or email: airaccess@bhcpns.org
3876 Highway 90, Pace, FL 32571 850.908.1701 • Fax 850.994.9794 Disciplines: PT, OT
Baptist Speech Clinic Baptist Tower 3, Suite 236 1717 North E St., Pensacola, FL 32501 850.434.4957 • Fax 850.469.7490 Disciplines: SP
Indicates Disciplines Available: PT - Physical Therapy OT - Occupational Therapy SP - Speech Therapy
Outpatient Departments of Baptist Hospital, Gulf Breeze Hospital and Jay Hospital
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HEALTHY HABITS TRACKER Committing to a healthy lifestyle and developing habits will greatly increase your success after a total hip or knee replacement. Use the chart below to keep track of your progress.
Date Day
1
2
Exercise Ice Elevate Drink 64oz of Water Eat Nutritious Meal
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3
4
5
6
7
8
9
10
11
12
13
12
13
14
15
16
17
18
19
20
21
22
23
17
24
25
26
27
28
29
30
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JOINT REPLACEMENT OUTCOME DATA As an affiliate of Baptist Health Care (BHC), Andrews Institute for Orthopaedics & Sports Medicine is dedicated to providing value based care for patients that require hip and knee arthroplasty. Our top priority is to provide high quality care for a patient from surgery through recovery. As participants in the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Care for Joint Replacement (CJR) model, BHC has received the highest rating available among ALL area hospitals by improving outcomes for patients while reducing costs billed to Medicare.
Here’s the impact on OUR Patients* SHORTER HOSPITAL STAY
REDUCED READMISSIONS DUE TO COMPLICATIONS
2.54 Days
2.5 2.0 1.5 1.0 0.5
3%
1.88 Days
2%
1.69%
1%
Days
Baptist/ Andrews
National Average
Baptist/ Andrews
GOING HOME AFTER HOSPITAL STAY
10
20
30
40
50
60
70
80
National Average
Our preoptimization program helps patients manage their risk factors prior to elective surgery to decrease the risk of complications during a total joint procedure.
More than 95% of our patients go home after hospital stay. 0
2.53%
90 100
22.3% of those patients utilize home health services
Our goal is to decrease the utilization of post-acute care (including skilled nursing facilities) by developing discharge plans that most appropriately fit the need of the patient.
*Data specific to Baptist Hospital and participating CJR hospitals.
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NOTES
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0821/RES/AI
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