PAT
How are the Anesthesiologist involved in PAT?
Reviews all charts after the NP consult and answers any questions the PAT nurse may have. The PAT nurse can contact the Anaesthesiologist on call if needed to come and see the patient during the PAT appointment.
Type of surgery, Type of anesthesia, medical history, vital signs, restrictions, orders, special needs (platform walker, weight bearing status)
Patient engaged bedside report, individualizing plan of care, setting pain goals, utilizing the white boards, and including the significant other/support person in their care
Who is responsible for explaining the risk/benefits of surgery, ensuring "informed consent?"
The surgeon
On the intranet; under Orthopedic Resources
What pathway do you follow that includes carb loading?
ERAS
How soon do you evaluate your patient post operatively?
If the patient is a same day discharge, we wait to hear from the POD staff for when the patients are alert enough to participate and if their pain is under control.
If the patient is an overnight stay, the first visit is early that afternoon
What education is provided to the patients at discharge?
Signs and symptoms of VTE; infection; instructions on wound care/dressing; medications including the last dose of medication given and when the next dose can be taken; follow up appointments; when to contact the provider; PT plan
Why is it important to verify allergies to Iodine pre-op?
All surgical patients receive Profend in the pre-op area
What role do you play in preparing the patients for their joint replacement?
Speak at the joint replacement class
How is your department involved in in the program's performance measures?
Our department completes the HOOS/KOOS questionnaire if not completed at the total joint class.
How is your department involved with the programs performance measures?
Discussion at our monthly joint team meetings
How often do you complete vital signs for your patient?
Vitals are done every 4 hours, then every 8 hours for 24 hours, then every 12 hours afterwards
What is the process for verifying the surgical procedure with the patient?
verify the correct procedure, correct patient, on the correct site and laterality. The patient needs to be involved in the verification process
If patients need to go to a SNF what should be provided and documented in the patients chart?
A list of all available SNF's unless the patient has a specific request in mind
Ideally, BMI is below 40. What number is a hard stop for A1C?
7.7
Do patients receive assistive devices that help with their ADL's and safety?
Walker - contract program
Raised toilet seats are available
Long handled equipment (shoe horn, reacher, sock aid, bath sponge)
How often do you complete the neurovascular assessment on your patient?
every 4 hours, then every 8 hours for 24 hours, then every 12 hours afterwards
What focused assessment needs to be performed on all joint replacement patients?
Neurovascular assessment
Neurological assessment
include plantar /dori flexion
What resources can you use for patients who need an interpreter?
MARTTI
Hospital Interpreter program
Pain management
Skin prep instructions and/or verify if they have received their Hibiclens
Instructions for the day of surgery - including what medications to stop and when; what medications to take the morning of surgery
Gatorade
what education do you provide to patients and do you include their support person?
Hip precautions; stair training; mobility aids; bathing and toileting equipment, dressing equipment; safety and independence for home; energy conservation techniques; therapy options post discharge.
The support person is included and encouraged to be at the hospital to observe the morning PT/OT session prior to discharge
How do you manage your patients pain?
How often do you assess pain?
We use multimodal pain management-pharmacologicial and non-pharmacological interventions. Patients may have scheduled and PRN medications. Nursing interventions include: cooling packs, elevation of extremity, distraction, change in position, ambulation, dimming the lights.
Pain should be assessed every 4 hours every 24 hours then every 8 hours for 24 hours, then every 12 hours afterwards per policy
How do you determine when a patient meets discharge criteria?
Parameters that are followed for vital signs, pain, nausea, spinal progression; aldrete scoring system is also used
How many patient identifiers should you use?
Use at least 2 ways to identify patients
Patients name and date of birth