The Total Joint Program atOro Valley Hospital

Nationally Accredited JointProgram

Nationally Accredited JointProgram

✤ 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

Welcome to Oro Valley Hospital’sTotal Joint Class

The Total Joint class is designed to walk you,our patient, through the process of what willhappen before, during and after your jointreplacement surgery

Preparing for Surgery

✤ Pre-Admit Testing

✤ Lab work

✤ ECG

✤ Chest x-ray

✤ Appointments

✤ Primary care doctor

✤ Cardiologist

✤ Dentist

✤ Create a list of your medications includingsupplements, vitamins, herbs and over-the-counter medications

Be Ready to Go Home

✤ Prepare meals

✤ Accident-proof your home

✤ If you live alone, arrange for someone tocheck in on you several times a day

✤ Special needs will be addressed with yourstaff in regard to special equipment, such as awalker, needed upon discharge

✤ Set up a ride home at the time of discharge

Case Management

✤ The Case Manager will meet with you on your first post-op day

✤ Your Case Manager will coordinate home health services,skilled nursing facility or acute rehab unit per physicianorders

✤ If you have questions that cannot wait until your visitwith the case manager here in the hospital, call the CaseManagement department at 901-3627 and leave amessage. A case manager will call you back within onebusiness day.

✤ Durable medical equipment (DME) including a walker orcane will be arranged for you if you do not have one. Wewill use your insurance company’s preferred provider.

What to Pack in Your Bag

✤ Picture ID

✤ Consider labeling personal items likeyour clothing

✤ Pack loose fitting clothes

✤ Pack supportive shoes--slip on preferred

✤ Bring glasses and cases

✤ Hearing aide

✤ Denture case

Also Bring...

✤ Walker (if you have one) and put your nameon it

✤ List of medications, including supplements,vitamins, herbs and over-the-countermedications

✤ C-Pap machine

✤ List of food allergies

✤ List of medication allergies

✤ Copy of Advance Directives, Living Will

Valuables

✤ Please leave valuables such asjewelry or watches, at home

Surgery Day--Before You LeaveHome

✤ Shower

✤ Brush teeth

✤ Take medications as directed

✤ Dress in loose fitting clothing

✤ No perfume, deodorant or lotion

✤ Do not eat or drink after midnight

✤ Do not shave legs

Surgery Day--Before You LeaveHome

Questions

✤ What can you do to help prepare your home prior to having surgery?

✤ Before you leave home the day of surgery, what are some things youshould/should not do?

✤ When is the last time you can have anything to eat or drink (other than a sipof water to take any medication as directed by your physician the day ofsurgery)?

Our Focus

✤ Providing a comfortable and therapeuticenvironment for your recovery

✤ Managing your pain, so you can get back onyour feet and back to your life

✤ Respecting your privacy. We do not shareyour medical information with anyone withoutyour permission

✤ Customizing your care. Our comprehensiveand collaborative efforts focus on you, as anindividual, to cover all aspects of your post-operative care.

Surgery Entrance to Hospital (Northside in back of hospital)

Reception Area

Pre-Operative Area

✤ Anesthesia assessment

✤ Meet with surgeon and operating room staff

✤ Place IV

✤ Nerve block if indicated

✤ Answer any last minute questions you mayhave

Preventing Infection

✤ Patient and provider hand hygiene

✤ Antibiotics

✤ Monitor incision

✤ Monitor white blood cell count

✤ Monitor temperature

Preventing Infection—2% CHGCloths

✤ Applied in Preop

✤ 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 topical items to skin after application

Preventing Infection: 3M™ Skinand Nasal Antiseptic

Why We Do It

✤ 30% of people carry a bacteriacalled Staph aureus in their noses

✤ Carriers are at greater risk ofdeveloping an infection

✤ Reduces bacteria in the nose

✤ Effective as soon as 1 hour

✤ Persistent for up to 12 hours

✤ Easy to apply

Applying the Product

✤ Oro Valley Hospital staff will assistyou in PreOp

✤ Do not blow your nose or wipe theinside after the application

✤ Easily applied with soft cottonswabs

✤ Let us know if you have iodinesensitivity

Question

✤ What are four things done to help prevent surgical site infections?

Recovery Area

✤ You will be in the recovery areafor approximately 1-2 hours

✤ To protect our patients’privacy, no visitors are allowedinto this area

Expectations and Goals

✤ Elective surgery—remember, you are not sick

✤ Participate in physical therapy

✤ Participate in daily care/proactive in daily care

✤ Be proactive in pain management

Medical/Surgical Unit

✤ 30-bed unit on the 3rd floor with all private rooms andbathrooms. Wireless access is available

✤ Staff who will care for you:

✤ Registered Nurses (RN) will manage your care with theassistance of Patient Care Technicians

✤ Case Managers will assist with your discharge planning

✤ Physical and Occupational Therapists will work withyou daily

✤ An internal medicine physician known as a Hospitalistmay also care for you during your stay

Medical Equipment You May HaveAfter Surgery

✤ You will have a dressing/wrap to your surgical site

✤ You will have an IV for fluids and medication

✤ You may require oxygen (nasal cannula)

✤ You may have a tube in your bladder (Foley catheter)to drain urine

✤ You will have elastic stockings (TED hose) andcompression sleeves (SCDs) on your legs to helpprevent blood clots at bedside

More Equipment/Supplies

✤ You may have a surgical drain to collect bloodfrom your surgical site

✤ Depending on your surgeon, knee replacementpatients may be put on a Continuous PassiveMotion machine (CPM)

✤ You may have a polar ice care machine to decreasepain and inflammation

Hourly Rounding

✤ At Oro Valley Hospital, we are committed to providing excellent care andcustomer service. A staff member will round on you about every hour whileyou are in your room.

✤ To ensure you stay as safe and comfortable as possible, you will be askedabout the “4 Ps”: Pain, Potty, Position and Personal Items.

✤ Each room is equipped with a communication board updated by staffmembers at the beginning of each shift (during bedside report) and duringhourly rounding. Information about your pain medication and activity levelare included on the board.

✤ You may also have a member of hospital leadership round on you while youare here.

Communication Board

Staying Safe!

✤ We will “round” on you approximatelyevery hour to make sure all your needsare met!

✤ Safety comes first. Do not get out ofbed without the assistance of a staffmember. “Call, don’t fall.”

Questions

✤ What can you do to help prevent falls?

✤ Name the 4 “Ps”

Knee Precautions

✤ No pillow under surgical knee

✤ Knee will be locked in straightposition while in bed

✤ No weight bearing until nerve blockis worn off

Physical Therapy

✤ May start day of surgery

✤ Up to twice a day while you are here

✤ Walker-correct use and fit

✤ Gait training

✤ Transfers—getting in and out of bed, chair, car, etc.

✤ Range of motion exercises

Occupational Therapy

✤ May start day of surgery

✤ Activities of daily living

✤ How to use assistive equipment

✤ Hip kits are available in the hospital gift shop

Vital Signs are Vital

We will be checking your blood pressure, heart rate, temperature, oxygensaturation and respirations every 4-6 hours during your stay. When you firstget to your room, vitals will be completed more frequently for a short time.

Pain Control

✤ Patient-Controlled Analgesia (PCA)

✤ Intermittent IV medication

✤ Pain pills

✤ Ice

Pain Rating Scales

✤ Our nursing staff will discusssetting a “pain goal” with thepatient during the patient’shospital stay

✤ Pain goal: a realistic numeric goalrelated to the pain scale thatallows you to participate withphysical therapy/occupationaltherapy and allows rest

Pain Scales

Questions

✤ What are the goals for pain management?

✤ How should you report your pain level to your nurse?

✤ How often should ice be used during your hospital stay?

Preventing Blood Clots

✤ Your surgeon will prescribe medications (Coumadin, Heparin, Lovenox,Xarelto, Fragmin or aspirin) that will help prevent blood clots

✤ Early ambulation

✤ TED hose

✤ Sequential Compression Device (SCD) machine

Question

✤ Name four things to help prevent blood clots

Maintaining Fluid Balance

✤ Monitor for bleeding

✤ IV fluids as ordered

✤ Oral intake as ordered

✤ Measure fluid intake

✤ Measure urinary output

Preventing PulmonaryComplications

✤ Using an incentive spirometer (IS) 10 times every hour while awake to assistwith lung inflation which will help decrease the risk of pneumonia

✤ Early ambulation

✤ Supplemental oxygen as needed

Question

✤ How many times and how often should you use the incentive spirometer?

Going Home...Day of Discharge

✤ Your surgeon will write discharge orders

✤ After breakfast we will assist you to get dressed andready

✤ You may have one final physical therapy session andpossibly a second session in the afternoon

✤ Your nurse will review your discharge instructions andyour medication list with you

✤ Any questions you have will be answered at this time

✤ A nurse will provide you a discharge survey to be givenback to the nurse prior to discharge

Going Home

✤ Pain is under control

✤ Eating and drinking

✤ Met short-term therapy goals

✤ Urinating

✤ Passing gas or had a bowel movement

Question

✤ What are the criteria (goals) for discharge?

Going Home...Organizing YourRide

Please coordinate with your nurse andthe person providing your ride on thetime for pick-up

Going Home...Staying Safe

It is very important you continue yourphysical therapy after you aredischarged. Case management willassist you in coordinating care per yourphysician’s recommendation.

You will need to follow activityrestrictions based on your surgery.These restrictions will be explained indetail during your recovery.

Physical Therapy After Discharge

✤ 2-3 times per week after you go home

✤ Length of time varies

✤ Outpatient, home health or rehab facility,based on your personal need after discharge

Question

✤ How long could you potentially use your walker and wear TED hose aftergoing home?

✤ How long could you potentially continue hip precautions after going home(if applicable)?

Good Luck and Stay in Touch

✤ We would love to hear from you after you feelbetter!

✤ After your stay, you may receive a phone call for apatient satisfaction survey. Thank you for takingthe time to answer the questions.

✤ If you have any additional questions prior to yoursurgery please contact:

✤ Pre-Admission Testing at 901-3676 and pressoption #2, or

✤ A Total Joint Coordinator at 901-3565

Oro Valley Hospital’s dedicated staff is committed to providingexcellent customer service. Our team is ready to help you

transition to pain-free independence and take the first steps towardreclaiming your active lifestyle.We look forward to serving you.