Orthopaedics (Bones and Joints)

Joint replacement clinic (Basingstoke)

Arthroplasty Nurse Specialist

Jo Burke
Modern Matron Nikki Potter
Contact 01256 313580 / 01256 313459

 


joint review 1Our Clinic began in 2000 as a clinical governance project prompted by an increasing number of enquiries from GPs and patients following discharge after total hip replacement. It was also found that our physiotherapy department had an increasing number of referrals from follow up clinics requesting treatment for poor gait and muscle weakness to summarise there was an inconsistency in follow up care.” A missing link”. The clinic now sees all hip and knee replacements.

A search began and work done by the University of York highlighted the need for a multidisciplinary follow up clinic at six weeks. Our team then set about designing the clinic.

We needed to find out how our patients were coping with everyday activities at home and to assess and measure physical recovery and assess muscle strength and walking pattern and refer as appropriate for further treatment, to advise our patients on how to progress and above all to give our patients time. This would not be a rushed, pressurised experience; we were determined to allow plenty of opportunity for questions and discussion.

The clinic is held on the orthopaedic floor and run by senior nurses, senior physiotherapists and a senior occupational therapist with a registrar available if needed.

On arrival each patient fills in a questionnaire to give a clear picture of progress since surgery. A full assessment is made of range of movement, muscle strength and walking is assessed, allowing many patients to leave their crutches behind! The occupational therapist offers the opportunity to practice everyday activities without the aid and equipment used over the last six weeks. One particular request is to try getting down into the bath. The clinic has greatly improved the rate of return of equipment as the patient has newfound confidence to manage without it. Throughout questions are answered (sometimes the list is very long!) and a full range of advice given about every aspect of coping with the future. Feedback has been very positive the main gain for our patients being information and confidence giving the ability to extend their horizons.

 

Hip School

joint review 2Following feedback from patient focus groups and hip clinic it was noted that patients expressed how nervous they were prior to hip surgery. Anecdotally it was noted that patients who had had a previous hip replacement were more confident and progressed much quicker after subsequent surgery.

Therefore we decided to start a “Hip School”

At the hip school patients are taught how to walk and transfer using appropriate walking aids, practice their post-operative exercises and stairs. They are advised how to get their house ready for discharge and shown the equipment available to aid independence on their return home.

It has been noted that patients who attend the hip school progress more quickly being able to mobilize on day one with crutches practice stairs on day two, they are more compliant with their exercises and seem to progress with more confidence.

Orthopaedic pre-assessment unit

All patients who wish to undergo elective orthopaedic surgery are given an appointment for pre-op assessment clinic, to take place two to four weeks before their operation. The purposes of the clinic are:

  • To educate patients about their admission, operation and after care.
  • To ensure we have accurate, up-to-date personal and social information.
  • To enable staff, patients, and their families and carers to plan and prepare for a specific discharge date.
  • To carry out basic clinical assessments (e.g. blood pressure and chemistry, ECG, urine testing etc.) and a medical history taking and examination. These can identify medical problems that might otherwise delay surgery. In many cases, such problems can be rectified in time for the operation to go ahead on the planned date.
  • To facilitate participation in research and development, through initiatives such as the National Joint Register.
  • To allow patients who may benefit from such input, to meet with occupational therapists, and discuss appliances and adaptations they may need after surgery. Sometimes, this is followed by a home visit, to confirm arrangements.
  • To enable total hip replacement patients, if they are willing, to be screened for suitability for bone donation.
  • For each patient to see their surgeon, to discuss, and give their written consent for, their surgery. Sometimes, the specific surgery anticipated is no longer appropriate, because of changes in the patients’ condition. Also at this point, any need for special equipment, instrumentation or prostheses is identified, so they can be ordered in time for theatre.

After each clinic, the patients’ notes are kept until all the test results can be reviewed, according to established protocols, and any action taken that may be deemed necessary. In most cases, it is also possible for the anaesthetist who will be involved to review the completed assessment as well.

MRSA Screening in Pre-Op Assessment

At this appointment, all patients are screened for MRSA, by taking a nasal swab, and swabbing any open wounds or catheters. This is an excellent opportunity to provide education about avoiding cross infection, and gives them a chance to express the concerns that many feel about hospital-acquired infection. After the assessment, the notes are kept in the clinic and the patient cannot be passed as fit for admission until they are proved negative for MRSA.

If a patient’s swab is positive, a nurse will contact both them, and their GP. This is obviously an anxious time, so we are as reassuring as possible. The patient is told to visit their doctor, who has been asked to prescribe treatment according to the Foundation Trust protocol. This specifies five days use of a nasal ointment, and hair and body wash. Two days after completing treatment, the patient is more extensively screened, by re-swabbing nose, any wounds or catheters, plus axillae and groins. If the results are now negative, the patient can be admitted to a side room. If time permits, a second and third screen is carried out at weekly intervals. If they continue negative the patient can be nursed on the open ward. Very rarely, this unfortunately means that surgery must be deferred by a week or so.

For further information: www.hipandknee.tv

 

 

 

 

 

 

 


updated 10 October 2017

 

Equality Service Profile January to March 2013

This report provides a profile of the patients who access this service from an Equality perspective.  If you have any questions regarding this report, please do not hesitate to contact either the services Operational Services Manager or Clinical Services Manager.

Orthopaedics service report

Orthopaedic pre-assessment unit

Unit Sister
Satina Edwards

01256 313570

Modern Matron
Anna Slater

01256 486740

W3C AAA