Implementation of a Nurse Navigator Protocol to Decrease Postoperative Complications Jillian Knudsen RN, MSN, CNL, CMSRN, ONC and Heather Schulte RN, BSN, ONC PLAN
According to AAOS, total hip and knee replacement volumes are on the rise with volumes expected to more than double by 2030. Even with the elective nature of these surgeries, postoperative complications continue to raise attention across many organizations.
DO
Reviewed best practices Adopted clinical practice guidelines Development of a nurse navigator protocol addressing: Elevated BMI Uncontrolled diabetes Cardiovascular history Unmanaged OSA Respiratory health Substance dependence Post discharge readiness
STUDY
ACT
Since the implementation of the protocol, North Kansas City Hospital has seen over a two percent decrease in its Medicare complication rates. Use of a standardized protocol to optimize patients before total hip and knee replacement can decrease complication rates and improve overall surgical outcomes.
Sustainability
• Gradual increase in volumes of patients sent for optimization • Started with CJR population • Added all payer > 65 • Extended to high risk only • Goal of 90% use
Lessons Learned
AIM
North Kansas City Hospital’s total joint program set out to identify the highest risk patients for postoperative complications and develop a program and protocol to lower those risks by optimizing patients preoperatively.
• Complications is multifactorial • patient, staff, environment • Not all are preventable by optimization • patient compliance, unforeseen events (i.e. trauma, illness, etc.) • Consider adding hard stops and additional criteria • Tobacco testing, albumin, anemia clinics • Documentation of compliance • Incentive Spirometer use