Nurse Led Collaboration and Innovation: Creating Standardized Care for Same Day Joint Arthroplasty Patients

Abstract

<h3>Background Information</h3> As a Magnet designated hospital, BWFH strives to achieve excellent patient outcomes. Our dedication to provide innovative, high-quality care for patients in a busy 171-bed community teaching hospital in Boston, MA has led to the development of a successful same day joint (SDJ) program. <h3>Objectives of Project</h3> To implement strategies that facilitate the safe discharge of patients undergoing SDJ replacement surgery. <h3>Process of Implementation</h3> After successfully launching a SDJ replacement program, it was identified that nurses needed education and resources to support safe discharge home for this patient population. Identification and education of dedicated resource nurses •Development of SDJ Resource binder that includes tip sheets and checklists opre-discharge medications, hydration and nourishment guidelines, spinal anesthesia recovery protocols, pre-discharge required consultations (PT and Care Continuum Management), and home discharge instructions. <h3>Statement of Successful Practice</h3> Since April 2019, >600 patients have been discharged home the same day as their joint replacement surgery resulting in a reduced hospital length of stay compared with traditional practice. With the identification of dedicated resource nurses and the implementation of a SDJ resource binder, nurses have been able to provide high quality, standardized care. In addition, nurses have been able to identify deviations from the SDJ care pathway that might impede a successful discharge home. Nurses have reported a decrease in anxiety when caring for this population since the addition of these resources. Providers from the orthopedic teams have reported receiving fewer phone calls to clarify post-op orders and instructions. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Perianesthesia nurses are collaborative and innovative in designing systems that allow for a successful SDJ program. Standardizing post-op care and having resources such as informational binders and PACU nurse champions play an important role in the safe care and discharge of SDJ patients.