Improving patient outcomes by preoperative education among Orthopedic patients- A Patient and Family centered approach

Purpose:
Many times patients undergoing joint replacement surgery are not prepared before surgery. This leads to poor self care at home after discharge. Based on the 2006 NNIS, our SSI rate was above the 50th percentile and the goal was to reduce SSI's to less than the 50th percentile on the NNIS scale.

Significance:
Healthcare-associated infections (HAI) account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections: 22% percent are surgical site infections(SSI)(Centers for Disease Control and Prevention, 2008).OrthopedicSSI can lead to greater physical disabilities.

Strategy and Implementation:
Orthopedic nurses, surgeons and infection control department worked together as a team to reduce the surgical site infection rate after Joint replacement surgery. Developed weekly preoperative educational program in 2007 for patients opting to undergo elective joint replacement surgery and their families. Surgeons required their patients to attend the class before surgery. Nasal MRSA screening process implemented during the class.MRSA Decolonization protocol implemented with the help of pharmacy & lab. Experienced orthopedic staff nurses were prepared as patient educators for the class. Patients are encouraged to attend class with a family member who will be their coach/trainer at home after discharge. Education included chlorhexidine skin prep the night before & day of surgery. Patients & families receive a tour of the unit, meet the staff, an hour long power point presentation about pre/post op care, and wound care at home. Opportunity to clarify any aspect of care at the end.

Evaluation:
Orthopedic patients are better prepared for the Joint replacement surgery.Patients and their families understand their role in prevention of SSI after joint replacement surgery and there has been a reduction in SSIs since 2007. Success has been measured by the decrease in the hip & knee SSI's.

Implications for Practice:
This has helped reduce the number of surgical site infections. Patients and their families are better prepared to go home. Reduction of SSIs reduces length of stay and reduces physical diabilities after joint replacement surgery. Financial implications relate to decrease in repeat surgeries.