From left, Anna DeLuca, RN, nurse manager, and Chris Apkarian, RN, clinical coordinator, demonstrate how Chilton patients practice getting in and out of a car after hip or knee replacements.
In March, Chilton Hospitals Total Joint Center earned The Joint Commissions Gold Seal of Approval for demonstrating compliance with national standards for healthcare quality and safety in hip and knee replacements.
Only one year ago, the Pompton Plains, N.J., facility officially opened the 24-private-room center for patients undergoing total joint replacement.
“When we initially created the service line in March 2010, we knew that we had work ahead of us with a total restructure and redesign, and our journey has been one that we would characterize as collaborative, educational and rewarding as we embarked on building a center of excellence,” said Anna DeLuca, RN, BSN, nurse manager, the Total Joint Center. “The entire team, which consists of nurses, physicians, physical therapists, social service, case managers and ancillary staff, were an integral part to our success.”
The unit serves patients with other orthopedic problems, such as fractures, laminectomies and total shoulder replacements.
Nurse-driven protocol change
After months of observing and treating patients postop reactions to epidurals, DeLuca and Chris Apkarian, RN-BC, BSN, clinical coordinator, Total Joint Center, presented their observations and literature review results to the orthopedics medical staff. “We were seeing patients who experienced decreased mobility as well as numbness, hypotension, dizziness, nausea and vomiting, and based on our research of evidence-based practice, we learned that the continuous femoral block could offer our patients a safer pain management option,” Apkarian said.
In the six months since the data was presented, patients who receive the femoral block are in less pain, experience increased mobility and a significant decrease in epidural-associated symptoms, and those who experience knee buckling on the first postop day wear a knee immobilizer, according to Apkarian.
Patient surveys support the nurses research, showing that patients pain is being managed more effectively, the preop class is preparing patients for surgery and patients are recommending Chilton for total hip and knee replacement surgery to their friends and families.Photo by Josh Speert
Standing in front of the Total Joint Center are, from left, Chris Apkarian, RN, clinical coordinator; Anna DeLuca, RN, nurse manager; and Luisita Yalung, RN, staff nurse.
Built for success
The first to develop standardized order sets in the facility, DeLuca initially worked with the chief of orthopedics to develop them for both hip and knee replacement surgeries, and the they also created clinical pathways from preadmission testing through discharge, a collaborative effort with physical therapy, dietary, social services, OR, preadmission services and respiratory therapy.
Nursing staff established specific patient education guidelines with the approval of the National Association of Orthopaedic Nurses, and it wasnt long before DeLuca, along with the physical therapy department, created a comprehensive patient education brochure that covers preop and postop care, pain, exercises, complications and discharge education.
Every patient attends a preop patient education class, and after a multidisciplinary presentation that includes hands-on experience with an abductor pillow, spirometer, hip and knee models, replacement parts and the continuous passive motion machine, patients return home with the brochure and other educational materials.
While the center was being completely renovated, every staff nurse was taking a NAON-approved core class on care of patients after total knee and hip replacements, and RNs and PCTs were being trained in customer service and proper techniques in mobility and transport. “We wanted to deliver the quality, personalized care we said we were going to deliver, which meant everyone needed to receive the appropriate nursing education; everyone, not just our physical therapists, needed to know how to get our patients out of bed and walking; and everyone needed to understand what our patients are experiencing while they are in our care,” DeLuca said.
This year, the facility was recognized by Health Grades among the best in New Jersey for overall orthopedic services and joint replacement.
“Our nursing staff, along with our physical therapists, social workers and case management staff, are dedicated to ensuring our patients achieve the best possible outcomes through the care, education and support they provide,” said Joanne Reich, RN, MA, NE-A, BC, vice president and CNO.
Janice Petrella Lynch, RN, MSN, is a regional nurse executive.