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Today’s Webinar will begin at 1:00pm PST
5/24/13
Welcome from Barb DeBaun, RN, MSN, CIC
Introduction
Please do not put your phone on hold; use the mute function or *6
Please type questions or comments into text box
If time permits, we will open up the phone lines at the conclusion of the presentation
Evaluation and CE credit
Evaluation of session
1 CE credit
Pre-registration with license required
Learning Objectives
Describe 2 approaches to eliminating barriers associated with pre-operative chlorhexidine bathing
Identify an approach that creates incentives for surgical patients to participate in a physical rehab program
Describe a simple and cost effective approach to reducing blood transfusions in orthopedic surgery patients
Karen Tanner, RN
MERCY JOINT REPLACEMENT
CENTER Providing a comprehensive quality approach to
Joint Replacement
MRSA On The Rise
Identified Best Practice – site visits, research
Joined with IHI on Project Joints
Standardized Orders and Patient Education
Interdisciplinary Group Involvement
Process Map for Patient Flow and Care
Program Coordinator to ensure compliance
Ongoing Education – Patients and Staff
Our Journey Begins….
The Steps Taken….
Proposal to Admin Team – research indicating patient safety and decreased infection rates
Participated in IHI’s Project Joints Cohort 1
Determined providing CHG soap to patient would directly impact compliance
Education of physicians and coworkers
Pre-Operative Screening
• Began Rapid MRSA screening in 2011 and providing results to MD office to decolonize
• Switched to standardized order for decolonization to be facilitated by PAT nurse if MRSA was positive
• Did a trial of MSSA screening in 2012 did not see any MSSA positive that were not MRSA positive
• Nutrition labs – Transferritin, Total Protein, Albumin, Pre-albumin
• Will begin MSSA screening on all joint replacement patients in June
Our Screening Protocol
Timeline of Progress
SSI decreased in CVOR patients
with CHG showers
Proposal to Admin Team to
Begin CHG showers and provide soap
DEC 2010
Initiated 1 Pre-op CHG Shower
for Joint Replacement
Patients
JUNE 2011
3 showers with CHG soap per
recommendation from IHI
How We Made It Happen
Determining benefit of Active Screening – Ongoing education for physicians and staff
Working closely with IHI and Project Joints on streamlining pre-op screening
Monitoring Compliance with decolonization - Have tried various methods - currently trusting report of patient
Availability of CHG – Determined that this will be provided by hospital at PAT
Standardized post-op dressings
Don’t Forget Education With The OR Staff
Education regarding the difference of the Alcohol based preps is imperative
Assisting physicians with Order Sets in Electronic Health Record secured the use of alcohol based preps
Electronic Health Record also helped with documentation of prep
We Can’t Forget Hand Washing… Monitor co-workers with their hand washing
practice
We use the phrase ‘Foam in…Foam out’
This is monitored by Administration like ‘secret shoppers’
Reducing Blood Transfusions
Ferrous Sulfate 325 mg po daily 1-4 weeks prior to surgery.
Stopped standard drain use
Began using Tranexamic Acid (pre-operatively and intra-operatively) on May 21, 2013
Pre-Operative Class
This class is mandatory for all patients having a total joint replacement
General overview of what to expect and what we will expect from them during their stay
A brief description and overview of a total joint replacement – actual implants for them to examine
Discuss pain expectations and review the pain scale – teach pain medications with handouts provided
Review showering with the CHG and it’s importance
Explain daily schedule during hospitalization and again expectations
What they must complete before being discharged
Patient Education
Total Knee or Total Hip Replacement books ◦ Given to the patient in the clinic when surgery is
scheduled
Medication teaching sheets ◦ Given and reviewed in the pre-op class
Pre-operative class ◦ Mandatory
Having Fun in Therapy
Group therapy - Request coaches attend
Patient’s wearing regular clothes
Encouragement between patients and coaches
Putt Putt Golf – LPGA
Baseball – Arkansas Naturals
‘Dancing with The Scars’ – Walton Art Center
Difference We Have Seen
Patient satisfaction up to 90% and above
Orthopaedic surgeons and co-workers satisfaction have drastically improved
Improved patient outcomes
Reduced LOS from 4.5 to 2.5 for THA and 4.8 to 2.8 on TKA
Reduction in blood transfusions from 2-3/wk to 0-1/mo
Questions?
www.cynosurehealth.org
Thanks for joining us today For additional information, please contact Karen Tanner at [email protected]