The Influence of Health Equity on Patient Outcomes in Orthopaedics.

Health equity has become both a national and international health priority when addressing health disparities that influence health outcomes across all patient populations. Orthopaedic nurses play a critical role in advancing health equity among orthopaedic patients when it comes to ensuring orthopaedic patients have fair and just opportunities to achieve their best state of musculoskeletal health. For health equity to be realized by the specialty of orthopaedics and the orthopaedic patient populations being served, it is important for the orthopaedic nurse to be involved in community-based partnerships, research opportunities, and health policy initiatives that focus on the advancement of health equity for all populations.

Total Knee Arthroplasty in the Ambulatory Surgery Center Setting: Best Practices for Cost Containment and Clinical Care Delivery.

As the current population continues to increase in age, so does the degeneration of the musculoskeletal system and the development of knee osteoarthritis. Total knee arthroplasty (TKA) will be the treatment of choice when it comes to improving physical function and decreasing pain associated with osteoarthritis of the knee. The global push for more cost-effective healthcare services has led to new models of care and payment delivery methods such as performing TKA in the ambulatory surgery center (ASC) setting. With deeply invasive surgical procedures such as TKA being done in the ASC setting, orthopaedic nurses must be mindful of best practices that will promote quality and safety while considering the importance of using current evidence to guide nursing practice when promoting appropriate patient selection and effective patient education of self-management of postoperative care pertaining to TKA being performed in the ASC setting. This is critical to consider during a time when financial profits in the ASC setting may take a front seat to the delivery of high-quality and safe patient care.

Tobacco Use, Tobacco Cessation, and Musculoskeletal Health.

It is widely known that the physiological impacts of nicotine from cigarette smoking are harmful to almost every organ of the body, cause various diseases, and negatively impact the overall health of individuals. When it comes to musculoskeletal health and the specialty of orthopaedics, cigarette smoking has a significant influence on negative outcomes. This article discusses the impact of cigarette smoking and nicotine on the musculoskeletal system and the role of the orthopaedic nurse in educating patients on the importance of smoking cessation to improve musculoskeletal health and meet quality measures that serve to improve patient outcomes and lower healthcare costs.

MACRA and the Quality Payment Program: How Does It Relate to Orthopaedic Nursing?

The introduction of 2017 also brought with it the beginning of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation related to the Quality Payment Program (QPP), in addition to alternative payment models and the merit-based incentive payment system. The successful implementation of the QPP within the specialty of orthopaedics will rely heavily on the active involvement of orthopaedic nurses when it comes to improving quality, lowering costs, and incorporating value. It is important for orthopaedic nurses to understand the QPP and the role it plays in determining value-based payment of orthopaedic care delivery, in addition to how the structure of the QPP correlates with nursing diagnoses and respective plans of care delivery.

The ethics/advocacy connection.

What are the ethical leadership qualities of nurses, and how do these traits contribute to competent, safe patient care?

Orthopaedic Snafus: When Adverse Events Happen in Orthopaedics.

The potential for adverse events exists when treating and managing orthopaedic patients in the intraoperative or postoperative environments, especially when it comes to falls, surgical site infections, venous thromboembolism, and injuries to nerves and blood vessels. Orthopaedic nurses play a vital role in the promotion and use of evidence-based interventions to decrease the incidence of these adverse events, improve quality of care, and minimize the financial burden related to these adverse events.

The Role of Shared Decision Making in Patient-Centered Care and Orthopaedics.

Shared decision making (SDM) is gaining momentum within the delivery of patient-centered care. Shared decision making takes into account the findings from current evidence-based practice, in addition to the patient's values, desires, and preferences. This article reviews the phases of SDM: patient engagement, discussion, and decision, in addition to the role SDM plays in the specialty of orthopaedics.

Universal Postoperative Hip Instruction Protocol for Rehabilitation in Rural Skilled Nursing Facilities.

PURPOSE/OBJECTIVES: Hip fractures among the elderly increase the incidence of mortality and other health-related complications, lead to poor quality of life, and create major economic challenges. Elderly individuals often reside in rural skilled nursing facilities (SNFs) for rehabilitation after undergoing surgical fixation for a hip fracture. Orthopedic providers (OPs) can develop protocols that will encourage continuity of postoperative orthopedic follow-up care, guiding and educating SNF staff in best practices, and encouraging regular communication between SNF staff and OPs. The purpose of this article is to describe how an orthopedic practice developed a universal postoperative hip instruction protocol (UP-HIP) to promote a streamlined approach to postoperative follow-up assessment and rehabilitation for the elderly residing in rural SNFs. The overall goal of the UP-HIP is to provide the OP with assessment findings remotely and avoid putting frail elderly patients at risk by physically transporting them to and from follow-up appointments with the OP. PRIMARY PRACTICE SETTING(S): Orthopedic clinic setting and rural SNFs. FINDINGS/CONCLUSIONS: Comprehensive postoperative protocols focused on elderly patients with hip fracture in rural SNFs serve to improve remote communication during the rehabilitation phase and guide SNF in a coordinated approach to postoperative follow-up care. Future recommendations include the addition of telehealth technology to allow for remote real-time visual assessments by the OP while the elderly patient with hip fracture remains in the SNF environment. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The UP-HIP allows the OP and case manager to ensure continuity of postoperative care by conducting remote follow-up postoperative visits with elderly patients with hip fracture while they remain in the rural SNF setting. Comprehensive evidence-based protocols assist OPs and case managers with remotely monitoring rehabilitation progress in the rural SNF setting more efficiently and consistently. Telehealth technology added to evidence-based protocols enables the OP and case manager to conduct real-time visual assessments of the patient without the patient having to leave the rural SNF setting.

Anterior cruciate ligament tears: reconstruction and rehabilitation.

Tears of the anterior cruciate ligament (ACL) are common knee injuries experienced by athletes and people with active lifestyles. It is important for members of the healthcare team to take an evidence-based approach to the diagnosis, surgical management, and postoperative rehabilitation of patients with an ACL-deficient knee. Mechanism of ACL injury and diagnostic testing is consistent throughout the literature. Patients frequently opt for ACL reconstruction, and many surgical techniques for ACL reconstruction are available with no clear consensus regarding superiority. Surgeon preference dictates the type of reconstruction and graft choice utilized. No standardized pre- and postoperative rehabilitation protocol exists. However, rehabilitation plays an important role in functional outcomes. A comprehensive rehabilitation program is needed pre- and postoperatively to produce positive patient outcomes.

Introduction: NAON Surgical Site Infection Prevention Clinical Practice Guideline.

According to the , "Clinical practice guidelines are statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." Nursing clinical practice guidelines provide defined best practice modalities that assist nurses in the diagnosis, management, or prevention of specific healthcare conditions, while including recommendations that are derived from the highest levels of evidence. These levels of evidence include high-quality systematic reviews of current literature, meta-analyses, or well-designed clinical trials.

The American Joint Replacement Registry.

The cost of healthcare procedures is continuously rising and more emphasis is being placed on increasing the quality and effectiveness of healthcare services. A combined total of 711,000 hip and knee arthroplasties are performed yearly. This figure is expected to increase to 4 million by the year 2030. The American Joint Replacement Registry has been developed to monitor the performance of devices, determine the cost-effectiveness of procedures, and increase patient safety for individuals in need of hip and knee replacement procedures.

Clinical quality indicators: infection prophylaxis for total knee arthroplasty.

Clinical quality indicators have a strong influence on reducing the overall financial impact, improving the outcomes, and minimizing the adverse events among patients undergoing elective total knee arthroplasty. In today's era of healthcare reform and increasing healthcare costs, it is important for orthopaedic nurses to be aware of the vital role clinical quality indicators play in the perioperative and postoperative settings.

Emerging techniques in orthopaedics: platelet-rich plasma.

Platelet-rich plasma (PRP), a portion of autologous blood containing concentrated platelets above baseline values, has gained recent popularity in the field of orthopaedics. Many orthopaedic surgeons feel that PRP plays an influential role in enhancing the healing process following soft-issue injuries in patients who have failed conservative management or in patients requiring surgical intervention. Platelet-rich plasma is currently being used to treat acute and chronic tendinopathies in the clinical and surgical settings. For clinicians to fully understand the role of PRP, it is imperative that they have a general understanding of the body's healing process. Clinicians should also be aware of the various commercial systems available that may be utilized to produce PRP and the basis behind the performance of these systems. The presence of PRP provides additional treatment options when managing and treating soft-tissue injuries. However, clinicians must realize that little clinical evidence exists supporting the efficacy of PRP and more well-designed, controlled, clinical trials are needed.

Informatics. Detecting risks in elderly patients taking NSAIDs.

Nonsteroidal anti-inflammatory drugs are strongly associated with gastrointestinal bleeding among the elderly population. NPs may find the utilization of healthcare informatics beneficial when addressing adverse events such as this. The innovative healthcare information technology products available today assist with increasing the quality, safety, and efficiency of healthcare delivery.

Rotator cuff tears: an overview.

Rotator cuff tears are a common contributing factor of shoulder pain and occupational disability. Tears of the rotator cuff are becoming increasingly prevalent in today's musculoskeletal population. Accurate recognition and successful treatment of patients with rotator cuff tears require thorough comprehension of the normal and pathologic anatomy of the rotator cuff. This article will provide an overview of the rotator cuff that consists of normal anatomy, pathology, physical assessment, diagnostic imaging, and recommended treatment. This article also discusses the importance of providing adequate and straightforward patient education and the role it plays in positive outcomes of rotator cuff tear rehabilitation.