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 Karen.Tanner@Mercy.net