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Joint Replacement

Home Health Joint Replacement Protocol Goals of Care (includes total knee and total hip)

Patient will be independent in:

  • All transfers (bed to stand, sit to stand to sit, shower, commode, car)
  • Dressing, bathing, and personal care. May use assistive device or aid
  • Community ambulation with appropriate assistive device
  • Stair mobility with assistive device if needed in the home, or for accessing the community

Patient/Caregiver verbalizes, demonstrates understanding, and is independent in:

  • Performance of written home exercise programs, active range of motion, stretching, strengthening, and balance/proprioceptive activities
  • Use of pain management techniques including pharmacological and non-pharmacological methods
  • Incision management including signs and symptoms of infection
  • Edema management including icing and positioning
  • Use of anticoagulant medication prescribed
  • Signs and symptoms of DVT, PE, and increased bleeding risk while on anticoagulants
  • Bowel management
  • Maintains prescribed hip putions with all positirecaoning and mobility (hip only)

Patient has:

  • All needed assistive/adaptive equipment
  • Scheduled follow-up appointments with orthopedic MD as indicated by discharge plan, or by 3 weeks post-op
  • Scheduled outpatient therapy services if indicated. Patient should be referred to outpatient services approximately 3 weeks post-op or sooner (if goals are met)

Nursing visits will include, but are not limited to the following assessment points:

  • Comprehensive clinical, psychosocial, and environmental assessment
  • Medication reconciliation and education performed including high alert/high risk medication, and prevention of constipation with pain meds
  • Conduct home safety checklist and fall prevention education
  • Determine plan for staple/suture removal if applicable
  • Order supplies as needed (staple/suture remover, incision care supplies)
  • Confirm follow-up appointments with orthopedic and other doctors are scheduled
  • Assessing optimal diet for bowel management, incision healing, anticoagulation management, and other health concerns
  • Assess patient has all needed assistive/adaptive equipment.

Physical therapy visits will include, but are not limited to the following:

  • Complete physical therapy assessment including vital signs, range of motion and strength of involved and uninvolved limbs, functional mobility, balance, home safety, and other indicated assessments using objective measures.
  • Edema management including icing and positioning
  • Use of pain management techniques including pharmacological and non-pharmacological methods
  • Maintains prescribed hip precautions with all positioning and mobility (hip only)
  • Transfers (bed to stand, sit to stand to sit, shower, car, commode)
  • Home ambulation with appropriate assistive device, household distances, and stairs if needed to access bathroom and bedroom
  • Written home exercise program/activity program
  • How to schedule appointment for outpatient therapy
  • Use of continuous passive motion if ordered (knee only)
  • Assess patient has all needed assistive/adaptive equipment.

Occupational therapy visits will include, but are not limited to the following:

  • Complete occupational therapy assessment including vital signs, range of motion and strength of involved and uninvolved limbs, functional mobility, balance, home safety, and other indicated assessments using objective measures
  • Patient / caregiver given written home exercise/activity program, if appropriate, for upper extremity active range of motion, stretching, and strengthening
  • Education on:
    • Maintaining prescribed hip precautions with all positioning and mobility (hip only)
    • All bathroom transfers (shower, commode)
    • Dressing, bathing, and personal care. May use assistive device or aid
  • Assessment of pain management techniques including pharmacological and non-pharmacological methods
  • Assess patient has all needed assistive/adaptive equipment