N.J. Surgery Center RNs Care for Joint Replacement Patients
Monday June 15, 2009
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Greater numbers of younger patients are turning to joint replacements, or arthroplasty, to ease their pain.
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“It’s done on younger, healthier patients, more selective patients motivated to go home,” says Jeanette Gerst, RN, director of nursing at SurgiCare. “This is not for grandma, who fell and broke her hip.”
Greater numbers of younger patients are turning to joint replacements, or arthroplasty, to ease their pain. Steven M. Kurtz, PhD, corporate vice president and office director at Exponent in Philadelphia, presented results of a study at the 2009 annual Meeting of the American Academy of Orthopedic Surgeons that showed demand for hip and knee arthroplasty among patients younger than 65 was projected to exceed 50% of all total hip and knee joints replaced by 2011 and 2016, respectfully. Demand for knee replacements from patients aged 45 to 54 years was expected to grow the fastest. The number of procedures performed in this age group is projected to grow from 59,077 in 2006 to 994,104 by 2030 — a 17-fold increase.
The center, which has three operating rooms, handles from one to five joint replacements per day, operating each Monday. Patients have driven from as far as Massachusetts to take advantage of the same-day surgery service.
“We were the first in a wide area to do this,” says Christine Villopoto RN, BS, head recovery room nurse at SurgiCare of Carlstadt. “It’s exciting.”
During a two-month period, SurgiCare nurses learned how to reinfuse blood from a drain at the surgical site into the patient’s intravenous line. The nurses also take out the drain before discharge. The center had to stock different medications because before the operation nurses administer pain medications, anti-inflammatory drugs, and antibiotics. SurgiCare ordered new instruments and converted a conference room into a sterilization center. “We went from sterilizing one tray for one procedure to sterilizing for one day up to 150 instrument trays,” Gerst says.
The center had to obtain a blood bank license that would allow for autologous transfusions, arrange for a courier service to pick up the blood, and establish a place to store it. Patients receive spinal analgesia and a sedative. The arthroplasty procedures last from one to 1.5 hours.
The nurses solved the food issue with frozen dinners and a microwave. Families also are allowed to bring in takeout meals from nearby restaurants or grocery stores.
SurgiCare arranged for physical therapists to come to the center to get the joint replacement patients up and ambulating with walkers. The therapists accompany the patient to a radiology center on a lower level in the building for an X-ray of the joint. After the X-ray, the team starts the patient on crutch walking.
Considerable teaching must take place. SurgiCare nurses begin educating patients the week before the surgery is scheduled. They discuss the need for a raised toilet seat, proper wound care, and body movement.
Nurses reinforce the teaching post-op with the patient and a family member. They also provide written instructions and show a family member how to inject low-molecular weight heparin, ordered prophylactically to prevent deep vein thrombosis. Home health nurses follow up with nurses’ instructions.
“You use a lot of your advanced nursing skills,” Villopoto says. “It’s really cool. You get to do a lot of teaching and interacting.”
The joint replacement patients stay so long, the center cannot schedule many other procedures that day. The seven-bed recovery area quickly fills up and remains that way. The center hired a couple of per diem nurses and staggered shifts to ensure proper coverage. Admitting nurses start at 6 a.m. and work until 2:30 p.m. Other nurses arrive at 2 p.m. and stay until all of the patients return home. Patients remain in the recovery area until discharge but come off the monitor and one-on-one nursing after a few hours, provided they are stable.
SurgiCare’s decision to let orthopedic specialists perform joint replacement cases at the center has offered its nurses an opportunity to provide safe, quality care to a population traditionally cared for in a hospital setting. “It’s great, not everyone gets that opportunity,” Gerst says. “We’re happy to be doing it.”
Debra Anscombe Wood, RN, is a freelance writer. To comment, e-mail editorNJ@nursingspectrum.com.
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