Same-Day Total Joint Discharges: A Collaborative Effort for Patient Safety

Abstract

<h3>Background Information</h3> Previously, both knee and hip replacement patients had been admitted to the hospital for several days on average. Our orthopedic surgeons began booking them as same day discharges. In navigating this new plan of care, we identified a lack of knowledge of the PACU RN regarding discharge instructions for these patients. The required home discharge information included: antibiotics, anticoagulation therapy, home visits with nursing, and physical therapy. Coordinating these therapies, same day, was identified as a new process for the PACU RN. <h3>Objective of Project</h3> The objective and goal of this project was to ensure our patients have a safe discharge on post-op day zero with adequate preparation for medication management and the necessary services at home. <h3>Process of Implementation</h3> Our team identified the key stakeholders to accomplish our objective. These stakeholders included: Orthopedic surgery, Orthopedic Nurse Practitioner, Case Management, Physical Therapy, PACU management, and PACU staff members. Multiple meetings occurred between these multidisciplinary team members to discuss each member's expectations for a safe discharge, potential roadblocks, and solutions. Issues identified were Case Management coverage for PACU, proper lovenox teaching, and physical therapy evaluation equipment needed in the PACU. These issues were addressed and resolved. To assure that the complex criteria for discharge was met, the PACU RN's created a tool to assist with this process. This tool listed all the activities to be completed prior to discharge. <h3>Statement of Successful Practice</h3> The identification of proper discharge requirements and the creation of the "Orthopedic Same-Day Surgery Tip Sheet" streamlined the discharge process. This tip sheet provided guidance to RN's to ensure each patient was being sent home with the correct teaching and tools for a safe same-day discharge. During the post-operative phone call the patients confirmed that the discharge instructions were complete and the home visits were scheduled. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The identification of a knowledge deficit led to a multidisciplinary group collaborating on best practices. The creation of a PACU "Tip Sheet" gave the RN's the necessary tool and knowledge to care for the same day discharged total joint patient. Our patients are going home with proper education and resources needed for a successful and safe recovery at home.