PATIENT EDUCATION MATERIALS
ANDREWS INSTITUTE HIP & KNEE REPLACEMENT GUIDEBOOK
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
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 four and a half hours. You are encouraged to bring a snack or a light lunch and a light jacket. AT YOUR VISIT, YOU WILL: 1. Meet with a pre-surgery nurse to review your medications and medical/surgical history. Instructions for your surgery will also be provided.
*Please bring all medications you take (prescription medication, over the counter medication and herbal products) in their pharmacy bottles.
2. Receive testing, which includes non-fasting labs (patient may eat prior to appointment), a nasal swab, urinalysis, EKG and chest x-ray. 3. See a nurse practitioner who will complete a physical exam on you. 4. Attend a one-hour joint replacement class led by your Joint Replacement Navigator. 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.
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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 ROOM Immediatley after surgery you will be taken to the recovery room, where you will awake from anesthesia. Your family will be notified when you arrive in the recovery room. You will remain in the recovery room until your vital signs are stable and your pain is well controlled. This usually takes one to two hours. You will then be transferred from the recovery room to your hospital room or stepdown area.
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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. 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 Before discharged, you will need to be able to complete the following tasks (under the supervision of your PT or nurse): 1. Get out of bed by yourself. 2. Walk 100 feet with the use of a walker or crutches. 3. Get to the bathroom with little or no help. 4. Climb and descend stairs (if necessary). 5. Bathe and dress yourself with minimal help. 6. Pain is controlled 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 NORTH OKALOOSA MEDICAL CENTER
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CRESTVIEW
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BAPTIST MEDICAL PARK – PACE BAPTIST MEDICAL PARK – NINE MILE
90
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29
PACE
90
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BEAR LEVIN STUDER FAMILY YMCA
BAPTIST SPEECH CLINIC PENSACOLA WESTSIDE
90
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98 GULF BREEZE
NAVARRE
BAPTIST MEDICAL PARK – NAVARRE
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ANDREWS INSTITUTE
Andrews Institute for Orthopaedics & Sports Medicine 1040 Gulf Breeze Pkwy., Suite 101, Gulf Breeze, Fla. 32561 850.916.8600 • Fax 850.934.4181 Disciplines: PT, OT, SP
Bear Levin Studer Family YMCA 165 E. Intendencia St., Suite 200, Pensacola, Fla. 32502 850.469.7555 • Fax 850.469.7585 Disciplines: PT, OT
Baptist Medical Park - Navarre 8880 Navarre Pkwy., Suite 202, Navarre, Fla. 32566 850.939.1017 • Fax 850.908.3079 Disciplines: PT, OT
Jay Hospital 14114 Alabama St., Jay, Fla. 32565 850.675.8040 • Fax 850.675.8016 Disciplines: PT, OT, SP
Baptist Medical Park - Nine Mile 9400 University Pkwy., Suite 104, Pensacola, Fla. 32514 850.208.6120 • Fax 850.208.6129 Disciplines: PT, OT, SP
North Okaloosa Medical Center 550 West Redstone Ave., Suite 100, Crestview, Fla. 32536 850.683.5906 • Fax 850.683.5917 Disciplines: PT, OT, SP
Baptist Medical Park - Pace 3876 Highway 90, Pace, Fla. 32571 850.994.6318 • Fax 850.994.9794 Disciplines: PT, OT
Westside 12601 Sorrento Rd., Suite A, Pensacola, Fla. 32507 850.453.8549 • Fax 850.455.0938 Disciplines: PT
Baptist Speech Clinic Baptist Tower 3, Suite 236 1717 North “E” St., Pensacola, Fla. 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.
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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*
*Data specific to Baptist Hospital and participating CJR hospitals.
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