Final Care Coordination Plan Discussion Essay Paper

Total hip and knee replacements are among the most prevalent operations done today, with over one million of them done annually in the United States, and the need for these services is expected to keep rising. Pain reduction, improved functioning, and correction of deformities are all intended to enhance the patient’s overall quality of life via these procedures (Okafor & Chen, 2019). Total hip and knee arthroplasties are performed in the case of hip joint impairment caused by illnesses like rheumatoid arthritis, osteoarthritis, and avascular necrosis. Performing activities of daily life such as walking, sleeping, and getting dressed might be made harder by these illnesses. A favorable prognosis for such individuals is significantly improved with post-operative care. This paper presents an overview of post-operative care, including related best practices, health goals, and community resources that may be used for a healthy outcome after an operation Final Care Coordination Plan Discussion Essay Paper.

Analysis

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During the post-operative period of a hip or knee replacement, a patient will experience a variety of hurdles. Infections, thrombosis, and physical inability are the possible challenges. The patient’s and family members’ understanding of such problems and incidents post-operatively is critical to a positive outcome.

Preoperative education helps to establish an atmosphere of confidence for proactive involvement, which should begin as early as possible in the perioperative period. The information offered should cover issues such as enhancing pre-operative physical state, assessing post-operative complications, explaining the operation, providing perioperative care, and preparing for discharge from the facility (Okafor & Chen, 2019).

 Associated Best Practices for Health Improvement

According to Okafor and Chen (2019), the management of individuals who have had hip or knee replacements has advanced as a result of the implementation of enhanced rehabilitation programs (ERPs). Through the implementation of such programs, the preoperative, postoperative, and rehabilitative experiences of all patients have all been significantly enhanced. ERPs are evidence-based procedures that are used to enhance self-reliance, stress relief, and the elimination of unpleasant post-operative side effects, including vomiting, nausea, and discomfort. ERPs are intended to provide perioperative teaching in the form of videos, handbooks, or courses, as well as sensitization on the day of surgical intervention (Arkin et al., 2019). On the other hand, post-operative day one requires the assistance of either a nurse or a physiotherapist in order to gain knowledge about exercises and movement measures in order to ensure a smooth return to home.

Managing postoperative pain is a serious issue for people who have had hip or knee replacements. There is evidence to suggest that the severe pain manifests itself 48 hours following the procedure. Increased pain has a detrimental impact on participants in postoperative mobilization, forcing them to miss out on physiotherapy, raise the number of problems after the surgery, and extend their duration of stay in the hospital. Researchers discovered that increasing patient awareness of pain self-management may significantly lower post-operative pain levels while also increasing adherence to post-operative therapy. Patients also become more comfortable with preoperative nerve blocks and targeted pain medicine during postoperative wound healing (Özdemir et al., 2021)Final Care Coordination Plan Discussion Essay Paper.

Prompt mobilization, the use of compression garments, and the prescription of anticoagulants are all examples of best practice in the treatment of blood clots. Starting mobilization as early as the day after the operation is highly recommended. While undergoing a surgical procedure and for a period of time thereafter, compression stockings will be worn on the lower legs to assist in stopping blood from accumulating in the leg veins. Thus, the likelihood of thrombus development will be reduced. Depending on the client’s risk variables for thrombosis and level of physical activity, an anticoagulant can be administered as an injection or orally for many weeks after a surgical procedure (Marsh & Newman, 2021).

Health Goals for Care Coordination Plan

Following a hip or knee replacement, most of the overall costs of healthcare is incurred in post-operative rehabilitation. Approximately 20-50 percent of total expenses are spent on outpatient and inpatient rehabilitative health care services. Except for the growth in the occurrence of hip and knee replacements, it is critical to make every effort to lower these expenses while still maintaining a good quality of healthcare (Adelani et al., 2018). The goals of hip and knee replacement must therefore be centered on preoperative teaching, with priority given to goals for rehabilitation and physiotherapy, as well as pain control after surgery in order to ensure adherence to prompt mobilization recommendations.

Community Resources

Because of the critical relevance of prompt and sustained mobilization of hip and knee replacement patients, it is essential to have local resources more accessible at all stages of treatment. Such resources must comprise pre-operative teaching by an orthopedic clinician on the procedure and the healing process, as well as pre-operative and post-operative teaching by a physiotherapist on exceptions to movement and strength workouts. When determining whether a patient requires home care services, hospitalization, or outpatient care, case management participation will be critical (Okafor & Chen, 2019).

 Healthcare Issues and Available Community Resources

 Risk of injury due to reduced mobility

Starting on day one after surgery, the patient will begin mobility exercises and engage in physiotherapy to acquire optimal body movements and strength-building activities to help him or her recover. Medical supplies for home use might be obtained if necessary. Patients with little help at home will have their meals delivered to them at their convenience.

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  • Ongoing occupational and physical therapy, residential care, and outpatient treatment facilities
  • Medical supplies, such as a crutch, elevated toilet seats, and compression socks
  • Home meal delivery services, such as Meals on Wheels, and shopping delivery services, such as Shipt.

Pain control related to post-operative pain

Pain control information will be provided to the patient, which will comprise reading material on post-operative pain control and potential dependence, drugs, and non-pharmacological pain control techniques.

  • Pain control and drug education materials: community pharmacy to provide information on the uses of individual drugs as well as any potential adverse effects.
  • Narcotics Anonymous support groups in the community will be concerned about potential dependency.
  • There are people in the community who can help you learn about psychological techniques like cognitive-behavioral therapy (CBT), meditation, and mindfulness interventions Final Care Coordination Plan Discussion Essay Paper.

Risk for surgical site infection

Surgical site infection is a possibility for a patient who has undergone hip or knee replacement. Appropriate care of the wound and changing of the dressings are essential for good recovery, as is a healthy diet that promotes healing of the wound.

  • For dressing changes and wound care, as well as regular examinations of the wound, home healthcare services will be arranged.
  • A medical supply firm will offer appropriate dressing change supplies.
  • It will be the role of the dietitian to provide information on healthy eating habits in order to aid in wound healing.

Ethical Implications and Health Policy Implications

When nurse practitioners are caring for patients, they may encounter ethical issues that conflict with the ethical code or with the nurse’s personal ideals and values. Beneficence, non-maleficence, justice, and autonomy are the four basic ethical principles (Ingham-Broomfield, 2017).

The term “autonomy” pertains to a person’s liberty to make their own medical decisions based on their own personal values and convictions. For example, the use of medication for pain treatment may conflict with one’s personal views when used as part of their treatment regimen. Patients may be reluctant to utilize pain drugs on a regular basis for fear of becoming addicted to them (Ingham-Broomfield, 2017).

Justice is the manner in which an individual is handled when his or her beliefs or ideals conflict with those of other people. The freedom to receive fair and equitable care is guaranteed to each and every patient. Individuals who do not have equal access to medical care or who lack medical insurance are sometimes portrayed as victims of injustice (Ingham-Broomfield, 2017)Final Care Coordination Plan Discussion Essay Paper. Access to home care services, whether because of health coverage or physical region, is one of the elements in the patient’s treatment regimen that might jeopardize fair treatment. The choice to undergo an optional operation like a total hip replacement may also have an impact on the equitable care of the patient.

When it comes to health care, the Patient Protection and Affordable Care Act has made significant strides in a number of areas, including decreasing the cost of healthcare, improving the quality of services, and improving accessibility. The Bundled Payments for Care Improvement (BPCI) program was established as part of the Affordable Care Act policy recommendations. This resulted in a reimbursement of a flat amount of charges for treatment that occurred just once, like knee or hip replacements. The use of BPCI reimbursements has transformed these procedures into a blueprint for patient-centered, collaborative, and quality care, while also empowering patients to make enlightened decisions about their own health (Hardin et al., 2017).

Evaluation of Patient Satisfaction with Care Coordination Plan

When evaluating a treatment plan, the nurse should begin by taking the patient’s best interests into consideration. Following total hip or knee replacement, a patient’s self-esteem in his or her capacity to adapt is assessed (Olsson et al., 2018). Improved health outcomes or rehabilitation became achievable when a treatment plan was developed based on evidence-based standards, professional expertise, and the patient’s individual interests. Using this technique, the healthcare practitioners and the patient were able to work collaboratively. When the patient expressed fears and anxieties about recovery, the medical team was ready to handle those issues and ensure that the patient followed through on their adherence to the treatment plan.

The Healthy People 2030 goal of health-related life quality and well-being matches this care coordination strategy. In order to achieve this goal, the pleasant aspects of a patient’s life, like feelings and emotional fulfillment, must be evaluated, as well as the aspect of optimizing an individual’s daily life in the physical, psychological, and interpersonal functional domains (Healthy People 2030, n.d).

Conclusion

Total hip and knee replacements yield the best outcomes when patients are well informed about the complications and their impact before surgery. It is possible to fulfill the aims of a safe hip or knee arthroplasty while also increasing one’s life quality and decreasing related expenses via the use of enhanced rehabilitation programs and community resources.

References

Adelani, M. A., Nunley, R. M., Clohisy, J. C., & Barrack, R. L. (2018). Patient perceptions of home health care services after total joint replacement. Orthopedics, 41(5), e713–e717. Retrieved April 1, 2021, from https://doi.org/10.3928/01477447-20180828-01

Arkin, L. C., Reising, E., Penoyer, D., & Talbert, S. (2019). Impact of bundled care on outcomes following elective primary total hip or total knee arthroplasty. Orthopaedic Nursing, 38(4), 262–269. Retrieved April 1, 2021, from https://doi.org/10.1097/nor.0000000000000573

Hardin, L., Kilian, A., & Murphy, E. (2017). Bundled payments for care improvement. JONA: The Journal of Nursing Administration, 47(6), 313-319. https://doi.org/10.1097/nna.0000000000000492

Healthy People.gov. (n.d.). Healthy people 2030 framework. https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework

Ingham-Broomfield, R. (2017). A nurses’ guide to ethical considerations and the process for ethical approval of nursing research. Australian Journal of Advanced Nursing, The, 35(1), 40-47. https://doi. org/10.3316/ielapa.509772218688556

Okafor, L., & Chen, A. F. (2019). Patient satisfaction and total hip arthroplasty: A review. Arthroplasty, 1(1). https://doi.org/10.1186/s42836-019-0007-3

Olsson, L.-E., Hansson, E., & Ekman, I. (2018). Evaluation of person-centred care after hip replacement-a controlled before and after study on the effects of fear of movement and self-efficacy compared to standard care. BMC Nursing, 15(1)Final Care Coordination Plan Discussion Essay Paper. https://doi.org/10.1186/s12912-016-0173-3

Marsh, M., & Newman, S. (2021). Trends and developments in hip and knee arthroplasty technology. Journal of Rehabilitation and Assistive Technologies Engineering, 8, 205566832095204. https://doi.org/10.1177/2055668320952043

Özdemir, C., Karazeybek, E., & Söyüncü, Y. (2021). Relationship between quality of care and patient care outcomes for postoperative pain in major orthopedic surgery: Analytical and cross-sectional study. Clinical Nursing Research, 105477382110599. https://doi.org/10.1177/10547738211059960

Preliminary Care Coordination Plan (Orthopedic Concerns Hip Replacement or Knee Replacement)

Analysis of the Health Concerns and Recommended Best Practices

The selected health concern under analysis is care coordination planning in hip or knee replacement surgery. Ditton et al. (2020) noted that care coordination in hip or knee replacement surgery is essential by the orthopedic surgeons and other involved healthcare professionals. Coordination is critical to reduce the high levels of postoperative pain experienced by patients, fast-track the return to normal functioning, boost the rehabilitation process, reduce the length of hospital stay, ensure cost-effective health services. Adopting appropriate best practices to support care coordination and active management of an orthopedic surgery service is integral to achieving comprehensive care for hip or knee replacement.

Adopting evidence-based best practices is essential to improving outcomes for hip or knee replacement patients, involving healthcare providers, payers, and the community. Ditton et al. (2020) established that the use of multimodal regimens that combines both anesthetic and analgesic agents could assist in the optimal outcomes in the knee or hip replacement procedures. Aimed at achieving a standard of care, strong emphasis in this new practice focuses on constant communication and coordination across the care continuum. Engagement of all clinical care team members: anesthesiologist, surgeon, physical therapist, pharmacist, and nursing staff (National Association of Orthopaedic Nurses, 2018). In another study, Dossett and Chesser (2017) asserted the provision of individualized treatment in line with the patient need and type of procedure is integral in ensuring the personalized implantation of the knee and hip components. As a best practice, the personalized hip and knee joint replacement model is associated with proper positioning of known and hip components to suit individual anatomy, attain high prosthetic performance, ensure enhanced surgical reproducibility and lead to a decline in complications.

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The study by Fedonnikov et al. (2020) recommended prioritizing the postoperative rehabilitation process and its management as a best practice that can immensely contribute to enhanced outcomes in patients undergoing hip or knee replacement. Focus in the postoperative rehabilitative process is essential, ensuring constant communication with key parties, including local health authorities, patients and their caregivers, regular local orthopedic follow-up, monitoring of patients. Varacallo et al. (2022) added that the pursuit of medical consultation, physical therapy, and timely follow-up by the orthopedic surgeon and other key staff personnel is essential in identifying and responding to other medical comorbidities experienced by the hip or knee joint replacement patient, reducing the risk of complications and readmissions.

 

 

Specific Goals aimed at addressing the Selected Health Care Problem

  1. Preoperative Care

A key objective is to adopt evidence-based interventions to achieve preoperative patient optimization by identifying and responding to medical issues and complications that could undermine the procedure’s success. Some critical interventions in preoperative care include nutrition assessment,  prophylaxis risk assessment for venous thromboembolism, anesthesia consultation, patient education, and case management consultation. (National Association of Orthopaedic Nurses, 2018). Varacallo et al. (2022) highlighted that the adoption of enhanced recovery programs for hip or knee replacements aims to contribute to positive improvements in patient outcomes and reduce the risk of complications following a hip or total knee replacement.

  1. Adoption of Total Knee Arthroplasty

Varacallo et al. (2022) described total knee arthroplasty (TKA) as a widely adopted elective surgical treatment for end-stage degenerative osteoarthritis of the hip or knee. The fundamental motivation behind adopting this cost-effective and consistently successful procedure in orthopedics is to contribute to enhanced quality of life, restore normal functioning, and alleviate pain associated with hip or knee replacement procedures. In addition, Fedonnikov et al. (2020) illustrated that care coordination is highly crucial based on how inter-professional teams must be actively and continuously involved in the care and support of hip or knee joint replacement patients.

  1. Non-operative Treatment modalities

Barrington et al. (2014) revealed that adopting non-operative treatment modalities (e.g., physical activity, weight loss, tramadol, and physical therapy programs) to treat and manage symptomatic knee or hip osteoarthritis can be realistic treatment options in the care continuum Final Care Coordination Plan Discussion Essay Paper.

Available Community Resources

The growing availability of rehabilitation programs has helped to improve preoperative education, group therapy, patient selection, preoperative optimization, and fast-track changes in rehab therapy needs. Other community resources include the existence of integrated practice units (IPUs) tasked with providing holistic, high quality, evidence-based, and patient-centered treatment and support to patients and their respective families (National Association of Orthopaedic Nurses, 2018). The community’s educational programs and counseling sessions could prove highly instrumental in encouraging and supporting strict adherence to the prescribed treatment regime, supporting required behavioral transformations, compliance with prevention protocol, and maximizing the patient’s outcomes and satisfaction with the available treatment interventions (Ditton et al., 2020)Final Care Coordination Plan Discussion Essay Paper.

References

Barrington, J.W., Sinatra, R., & Halaszynski, T.M. (2014).Perioperative pain management in hip and knee replacement surgery. American Journal of Orthopedics, 43(4), S1-S16. https://pubmed.ncbi.nlm.nih.gov/24911869/

Ditton, E., Johnson, S., Hodyl, N., Flynn, T., Pollack, M., Ribbons, K., Walker, F. R., & Nilsson, M. (2020). Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors. Frontiers In Psychology, 11, 1061. https://doi.org/10.3389/fpsyg.2020.01061

Dossett, H. G., & Chesser, M. S. (2017). Improving Care and Reducing Length of Stay in Patients Undergoing Total Knee Replacement. Federal practitioner: for the health care professionals of the V.A., DoD, and PHS, 34(10), 38–41.

Fedonnikov, A.S., Andriyanova, A.E., Kiselev, A.R., & Norkin, A.I. (2020).Rehabilitation Process Issues and Functional Performance after Total Hip and Knee Replacement. Healthcare, 9, 1126. https://doi.org/10.3390/healthcare9091126

National Association of Orthopaedic Nurses, (2018).Best Practice Guideline Total Knee Replacement (Arthroplasty). https://www.lifespan.org/sites/default/files/lifespan-files/images/centers/total-joint-center/best-practice-guideline-for-total-knee-replacement-final-naon.pdf

Varacallo M., Luo T.D., Johanson N.A. (2022). Total Knee Arthroplasty Techniques. Treasure Island (F.L.): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499896/

Final Care Coordination Plan Discussion Essay Paper