Archive September 2017 XVIII, No. 9

Pain Control: When Total Joint Patients Want to Kick Up Their Heels

At Houston Physicians' Hospital, a multifaceted initiative has dramatically improved pain scores and recoveries.

Jim Burger

Jim Burger, Senior Editor


2017 OR Excellence Award: Pain Control
everybody contributes GROUP EFFORT From pre-admission to discharge, just about everybody contributes to pain control at Houston Physicians' Hospital.

The total knee patients at Houston Physicians' Hospital tend to feel surprisingly good after surgery. At times, they've felt a little too good. "Patients were flexing their knees so much on the first post-op day that we had to tell them to back off a little bit," says Patricia Ford, MSN, RN, the chief nursing officer. "We were getting feedback from surgeons that some incisions weren't healing well because patients were flexing too much."

How did it come about that this year's OR Excellence Award winner for pain control actually had to rein patients in to keep them from bolting out of the gate? Credit the hospital's multifaceted initiative to implement and standardize best practices that educate patients, minimize opioids, employ multimodal pain protocols, and help total-joint patients heal as quickly and comfortably as possible.

"We're really proud of what we've done in the last year," says Ms. Ford. The hospital, she says, had been doing joint replacements for 12 years, "but last year we decided to take a closer look at some best practices and try to standardize what we were doing. All of our surgeons were doing things a little differently, so we decided to set up some meetings and compare notes."

The result was a program in which patients set their own expectations, begin physical therapy on the day of surgery and circle back for "reunion lunches," to provide a continuous feedback loop for the care and handling of future patients.

It all hinges on careful collection of data, says Ms. Ford. "Because that's what tells the story about the effectiveness of our care." Shortly after implementing the program, the hospital was able to document that patients were getting up sooner, walking farther, decreasing their lengths of stay, and, yes, improving their flexion. "We attribute it all to better pain control," she says.

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