Newsome Home Health Care Joint Replacement Protocol

Newsome’s In-Home Health Care Adheres to Joint Replacement Protocols to Help Minimize the Impact of the Patient’s Condition

Newsome Home Health Joint Replacement Protocol Goals of Care (includes total knee and total hip)

Patient will be independent in:

• All transfers (bed to stand, sit to stand to sit, shower, commode, car)
• Dressing, bathing, and personal care. May use assistive device or aid
• Community ambulation with appropriate assistive device
• Stair mobility with assistive device if needed in the home, or for accessing the community

Patient/Caregiver verbalizes, demonstrates understanding, and is independent in:

• Performance of written home exercise programs, active range of motion, stretching, strengthening, and balance/proprioceptive activities to improve body awareness and safety during activities
• Use of pain management techniques including pharmacological and non-pharmacological methods
• Incision management including signs and symptoms of infection
• Edema management including icing and positioning
• Use of anticoagulant medication prescribed
• Signs and symptoms of DVT, PE, and increased bleeding risk while on anticoagulants
• Bowel management
• Maintains prescribed hip precautions with all positioning and mobility (hip only)

Patient has:

• All needed assistive/adaptive equipment
• Scheduled follow-up appointments with orthopedic MD as indicated by discharge plan, or by 3 weeks post-op
• Scheduled outpatient therapy services if indicated. (Patient should be referred to outpatient services approximately 3 weeks post-op or sooner if goals are met)

Nursing visits will include, but are not limited to the following assessment points:

• Comprehensive clinical, psychosocial, and environmental assessment
• Medication reconciliation and education performed including high alert/high risk medication, and prevention of constipation with pain meds
• Conduct home safety checklist and fall prevention education
• Determine plan for staple/suture removal if applicable
• Order supplies as needed (staple/suture remover, incision care supplies)
• Confirm follow-up appointments with orthopedic and other doctors are scheduled
• Assessing optimal diet for bowel management, incision healing, anticoagulation management, and other health concerns
• Assess patient has all needed assistive/adaptive equipment.

Physical therapy visits will include, but are not limited to the following:

• Complete physical therapy assessment including vital signs, range of motion and strength of involved and uninvolved limbs, functional mobility, balance, home safety, and other indicated assessments using objective measures.
• Edema management including icing and positioning
• Use of pain management techniques including pharmacological and non-pharmacological methods
• Maintains prescribed hip precautions with all positioning and mobility (hip only)
• Transfers (bed to stand, sit to stand to sit, shower, car, commode)
• Home ambulation with appropriate assistive device, household distances, and stairs if needed to access bathroom and bedroom
• Written home exercise program/activity program
• How to schedule appointment for outpatient therapy
• Use of continuous passive motion if ordered (knee only)
• Assess patient has all needed assistive/adaptive equipment.

Occupational therapy visits will include, but are not limited to the following:

• Complete occupational therapy assessment including vital signs, range of motion and strength of involved and uninvolved limbs, functional mobility, balance, home safety, and other indicated assessments using objective measures.
• Patient / caregiver given written home exercise/activity program, if appropriate, for upper extremity active range of motion, stretching, and strengthening
• Education on:
  – Maintaining prescribed hip precautions with all positioning and mobility (hip only)
  – All bathroom transfers (shower, commode)
  – Dressing, bathing, and personal care. May use assistive device or aid
• Assessment of pain management techniques including pharmacological and non-pharmacological methods
• Assess patient has all needed assistive/adaptive equipment.