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Best Practice Guideline Total Knee Replacement (Arthroplasty)

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Best Practice Guideline Total Knee Replacement (Arthroplasty) ® National Association of Orthopaedic Nurses Qaon Advancing the Art and Science of Orthopaedic Care Best Practice Guideline Total Knee Replacement (Arthroplasty) Editor Rebekah Filson, MS, RN, ANP-BC, ACNS-BC Authors Candy Mori, MSN, RN, ACNS-BC, ONC Victoria Ribsam, MSN, RN, ONC Reviewer Lisa Holtz, MSN, RN, ONC Additional Contributors Janine Bodden, MSN, NP-C, RN, ONP-C, RNFA Carrie Coppola, MSN, RN-BC, ONC Kari Erickson, RN, BAN, ONC Tandy Gabbert, MSN, RN, ONC Copyright 2018 National Association of Orthopaedic Nurses All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system without the written permission of the National Association of Orthopaedic Nurses. Published for NAON by: SmithBucklin 330 N. Wabash Ave. Suite 2000 Chicago, IL 60611-4267 Toll Free: 800.289.NAON (6266) Fax: 312.673.6941 [email protected] Disclaimer This Best Practice Guideline (BPG) was developed by experts in clinical practice who work in Joint Commission Disease Specific Certified environments. The BPG was guided by the NAON Executive Board with oversight from NAON’s Director of Education. It is provided as an educational tool based on an assessment of current scientific and clinical research information, as well as quantifiable best practices. The tool is not intended to replace a clinician’s independent judgment and critical thinking, but to enhance the clinician’s knowledge regarding the care and the needs of the total joint patient throughout the continuum of care. Levels of Evidence The evidence within this best practice guideline is rated to differentiate evidence of varying strengths and quality. “The underlying assumption is that recommendations from strong evidence of high quality would be more likely to represent best practices than evidence of lower strength and less quality” (Newhouse, 2007, p. 90). Refer to the Appendix for an explanation of the levels of evidence contained within this guideline. NAON Best Practice Guideline: Total Knee Replacement Page 2 of 39 Table of Contents Introduction ................................................................................................................................................ 5 Purpose ....................................................................................................................................................... 5 Rationale for Guideline ................................................................................................................................ 5 Goal of Best Practice Guideline .................................................................................................................... 5 Description .................................................................................................................................................. 5 Definition of the Problem ............................................................................................................................. 6 Pathophysiology .......................................................................................................................................... 6 Continuum of Care ....................................................................................................................................... 6 Preoperative Care .................................................................................................................................... 6 Preoperative Patient Optimization ............................................................................................................................................... 6 Nutrition Screening ....................................................................................................................................................................... 9 Joint Coach (Care Partner) Selection .......................................................................................................................................... 10 Planning for Postoperative Destination ...................................................................................................................................... 10 Mandatory Preoperative Education ........................................................................................................................................... 10 Blood Transfusions Prevention ................................................................................................................................................... 12 "PreHab" ..................................................................................................................................................................................... 12 Pain Management Plan before Surgery ...................................................................................................................................... 13 VTE Prophylaxis Plan ................................................................................................................................................................... 14 Preoperative Surgical Skin and Nares Preparation ..................................................................................................................... 15 Skin Antisepsis ............................................................................................................................................................................ 16 Intraoperative Care ................................................................................................................................ 16 Skin Antisepsis ............................................................................................................................................................................ 16 Anesthesia .................................................................................................................................................................................. 16 Antibiotic Prophylaxis ................................................................................................................................................................. 18 SCD and/or Compression Stockings ............................................................................................................................................ 18 Traffic Patterns ........................................................................................................................................................................... 19 Maintain Normothermia to Avoid Hypothermia ........................................................................................................................ 19 Postoperative Care ................................................................................................................................. 19 Multimodal Pain Management Plan ........................................................................................................................................... 19 Postoperative Incisional Care ..................................................................................................................................................... 22 Rapid Recovery and Early Mobility ............................................................................................................................................. 22 Urinary Catheter and Hemovac Removal ................................................................................................................................... 23 Drain Removal............................................................................................................................................................................. 24 Constipation Prevention ............................................................................................................................................................. 24 Prevention of Readmissions ....................................................................................................................................................... 24 Utilization of Clinical Quality Indicators ..................................................................................................... 26 What Does the Future Hold for Total Hip/Knee Replacements? ........................................................... 26 Becoming Joint Commission Disease Specific Certified ................................................................................ 27 NAON Best Practice Guideline: Total Knee Replacement Page 3 of 39 Web Sites .................................................................................................................................................. 27 Professionals: ......................................................................................................................................... 27 Patient and Family: ................................................................................................................................ 27 References ................................................................................................................................................. 29 Appendix: System for Rating the Strength of Evidence.................................................................................... 39 System for Rating the Strength of Evidence ...........................................................................................
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