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Team approach helps Saint Clare’s achieve joint replacement certification


In late December, Saint Clare’s Hospital, Denville, N.J., received the Gold Seal of Approval and Disease-Specific Certification from The Joint Commission for Hip and Knee Replacement.

The joint replacement program met all 28 standards set by The Joint Commission, and the achievement was the work of dozens of nurses and healthcare professionals.

“This is a momentous accomplishment for the hospital, and now incoming patients can confidently know that they will be receiving the best care when getting their hip or knee replaced,” said Katie Pierson, RN-BC, MSN, ONC, who works as an orthopedic nurse navigator.

Among the numerous aspects of the successful program is a preop education class taught by Leslie Brushaber, RN, BSN, ONC. The class was moved from the Dover, N.J., campus to Denville so patients could attend at the facility where they would have surgery.

“I wish every patient would come to the class,” Brushaber said. “It makes it so much easier when they get to the hospital [that]they already know what to expect.”

By moving the location of the class, and with encouragement from orthopedic surgeons, the attendance rate is now at 85% and rising, Pierson said.

Recognizing that patient education was an important aspect of the program, Pierson helped create new patient guidebooks with input from departments such as nursing, physical therapy, anesthesia and case management. The guidebook is distributed to patients in a surgeon’s office once they plan their surgery.

Assembling a multidisciplinary joint replacement team also has been important to the program’s success. Initially, the team met to discuss several orthopedic issues, and there wasn’t a full representation from all the key players, according to Pierson.

“The meeting focus was changed to hip and knee replacement, and everyone involved in the care of that patient population was invited to attend,” she said. “We now have had great collaboration between departments, and the meeting is now well attended by the majority of our physicians.” The Saint Clare’s program also addresses pain management, a key concern for hip and knee replacement patients. Pierson credited pain management physicians and anesthesiologists for their efforts.

“Our patients are visited on a daily basis by a pain management specialist to ensure that adequate pain relief measures are being implemented,” Pierson said. “They are always looking to provide the most effective current methods in pain management. This has led to the use of peripheral nerve blocks in our total hip replacement patients [in addition to the knee replacement patients]and most currently, use of IV acetaminophen to provide adequate pain relief and allow for the patient to ambulate quicker and be discharged sooner.”

Hip and knee replacement surgery is rapidly becoming a procedure in which patients are discharged within 1-2 days, according to Pierson.

“The length of stay for this population has gone from four days to 2.9 days within the past year and a half, and the patients discharged home went from 20% to 60%, with the remaining patients going to a sub-acute or acute rehab facility,” she said.

As part of Saint Clare’s commitment to care, Pierson said patients are now contacted by a discharge planner a week before surgery to begin the discharge process before they even come to the hospital.

Katie Pierson, RN-BC, contributed to this story.


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