AESCULAP_Sample Guide Pages

Facility LogoPATIENT GUIDEThe Superior Joint Replacement Journey POWERED BY

Facility LogoSAMPLE The Superior Joint Replacement Journey POWERED BYShort, customized welcome message from the facility goes here.

Patient Name: ______________________________________________________ Daytime Contact Phone #: _____________________________________________ Or, if found, please contact \"Your Practice\" at \"Phone Number\". Facility Logo SWIFTPATH METHOD®TABLE OF CONTENTSIntroduction .............................................................................................................................................................................. 2Your SwiftPath ......................................................................................................................................................................... 3Decision for Surgery SwiftPath® Non-Surgical Conservative Measures Review ...................................................................................... 4 SwiftPath® Decision for Surgery Review ........................................................................................................................ 5 SwiftPath® Preoperative Patient Education Review ................................................................................................ 6 SwiftPath® Multimodal Pain Management Review .............................................................................................. 7-8 SwiftPath JointCamp, Quiz, DME, and Pre-op Physical Therapy ......................................................... PowerPoint Slide Presentation for Patients ............................................................................................................9-20ESwiftPath Quiz ................................................................................................................................................................ 21-22 DME Equipment Prescription for Joint Replacement .............................................................................................23LPre-op Physical Therapy Referral ...................................................................................................................................24PLast Minute Checklist ................................................................................................................................................. 25-26Day of Surgery ......................................................................................................................................................................27Home Care and Postoperative Care MHome Care Instruction Summary ......................................................................................................................... 28-29 Wound Care and Dressing Change Instructions .......................................................................................................30APostoperative Day #1 .........................................................................................................................................................31SPostoperative Day #2 ........................................................................................................................................................32 Postoperative Day #3-5 .....................................................................................................................................................33 Discharge Orders for Total Knee Replacement ..........................................................................................................34 Discharge Orders for Total Hip Replacement ............................................................................................................35 Discharge Criteria for Outpatient Joint Replacement ...........................................................................................36Glossary ....................................................................................................................................................................................37Notes ...........................................................................................................................................................................................38 The Superior Joint Replacement Journey POWERED BY

YOUR 1. Initial evaluation.... 2. Speak with...SURGERY 3. Attend JointCamp...E4. Preoperative physical therapy visit... 5. Decision for Surgery...L6. Obtain...P7. Testing... 8. Review... 9. Check-in...M10. Obtain check-in time...11. SURGERYA12. Discharge...S13. RecoveryJOINT CAMP DECISION CONSULTATIONIf you experience any urgent issues following surgery, call 911. Otherwise, if you need assistanceduring office hours, please call......... If after hours, please call........ There is a physician on call 24/7. The Superior Joint Replacement Journey POWERED BY

Facility Logo PRE-OP PATIENT LETTERDear: Date:Here is the information regarding your upcoming surgery with_________________Please review the following information and call us with any questions or concerns.Schedule dates for Surgery: SwiftPath® JointCamp Date: _____________________________ SwiftPath® Decision For Surgery Date: _____________________________EThings to do Before Surgery:ScheduleL____ Schedule ...for SurgerySURGERY DATE: _____________________________ 1st Post-op appointment, day 5-7: _____________________________ 2nd Post-op appointment, day 10-14: _____________________________P____ Get labs ....____ Other Surgical Clearance: ...S A M____ Pre-op Physical Therapy Consult....____ Purchase incentive spirometer.....____ Pharmacy Information and Preoperative Medications...____ Pick up ________________________ for nausea prevention.____ Take __________________________ the night of surgery. The Superior Joint Replacement Journey POWERED BY

Facility LogoDME EQUIPMENT PRESCRIPTION FOR JOINT REPLACEMENTI certify that the below prescribed equipment is medically indicated and, in my opinion, is reasonable andcustomary with reference to the accepted standards of medical practice and treatment of this patient’s medicalcondition.Patient Name: ___________________ ICD 9/10: ___________________ Surgery Date: ___________________ Diagnosis: ___________________ Type of Surgery: Total Knee L / R Total Hip L / RI request that the patient be provided the following durable medical equipment (DME):DME Equipment Required Recommended OptionalIncentive spirometerIce packs/cooling deviceFront wheeled walker (FWW)Shower chairCaneRaised toilet seatCompression socksFoam pillow for leg elevationBedside commodeBathtub transfer benchCrutchesFoot/leg lifterCPM for kneeHome SCDSock aide/dressing stickReacherIsland Dressing (for hips)4X4 Gauze (for knees)Alcohol pads(for Lovenox injections)Prognosis: Good Fair Poor Unknown Other ____________Physician’s Signature: ____________________________ NPI#: __________________Physician’s Name (print): __________________________ Date: __________________

Facility Logo PRE-OP PHYSICAL THERAPY REFERRALPatient Name: _________________________________ Date: ___________________Diagnosis/Condition: Arthritis Total Hip L / RCondition Remarks/Precautions:Type of Surgery: Total Knee L / REvaluate and treat at therapist’s discretion including the use of modalities: YesRehabilitation Program: Conservative Arthritis ManagementProtocols • • • • • • • Physical Therapist’s EvaluationPlease complete the following: • After training was the patient able to do the following using a walker (using walker is defined as performing the assigned task without putting full weight on operated limb)? Rise out of bed Pass Fail Ascend/descend stairs Pass Fail Ambulate 100 feet Pass Fail Toilet Pass Fail• Patient’s current range of motion: _______________________________________________• Patient’s current quads function as a percent of normal: _____________________________• Does the patient need to use stairs to enter/exit or move about their house? ____ Yes ____ NoPhysical Therapist’s Recommendation _____________________________ (Physical Therapist signature) # of visits ______ , or # times/week _____ for _____ weeks Recheck Date: __________________ _____________________________ Electronic Provider Signature: (Physical Therapist printed name)

Facility LogoLAST MINUTE CHECKLISTCall Hospital to Verify Final Surgical Information• Arrival time: _______________________________• Person you spoke with: _______________________________ For hospital: Call..... For ASC: Call....... You have... Arrange.... EPrepare....S A M P LBring......The Superior Joint Replacement JourneyPOWERED BY

Facility Logo DAY OF SURGERY• Wear..... SURGERY• Take...... DAY• Do NOT......• Bring ........In the pre-op area:• Your.....E• ........• Bring..... • .........L• .........PIn the recovery area: • ......... • .........M• .........S A• .........The Superior Joint Replacement JourneyPOWERED BY

The SwiftPath ®S AJoMMinettPChaomLd pE“Connectingtherightpatient,withtherightsurgeon,andtherightpathway” The Superior Joint Replacement Journey POWERED BY

S 1 PURPOSE of Joint Camp/ Reminder to Always Carry SwiftPath Patient Guide- • Indication you are planning to have a hip or knee replacement • Purpose of the camp- 1. to help you make a good decision about having surgery 2. highlight the risks and benefits of surgery 3. help ensure that you have a successful surgery and rapid recovery • Write down details and questions to be discussed at your “Decision for Surgery Visit”. • Your SwiftPath Patient Guide - designed to help you improve pain management, decrease risks of surgery, reduce your length of stay, and improve your recovery. It contains information that you need to know as A M P L Ewell as information that all your caregivers will need throughout the entire episode of care. 2 This is an overview of the topics that will be covered in your JointCamp. 3 Like other highly technical, well planned procedures, joint replacement has known predictors of success. JointCamp will prepare you for your upcoming “Decision for Surgery” visit and will help you to understand what you can do to help ensure a successful surgery.

4 • Your next appointment will be called the “Decision for Surgery Visit”. • Goal - confirm your diagnosis and that joint replacement surgery is right for you. • Review of clinical information, images, and the diagnosis - confirm your symptoms are debilitating enough to warrant the risks of surgery All appropriate, non-surgical/conservative measures have been considered. Has your Decision for Surgery Visit been scheduled? _____ (initial) Date: _____________________S A M P L E5 Take a moment and check off which of these have been tried in the care of your arthritic joint. All appropriate, non-surgical/conservative measures have been considered. ____ Anti-inflammatories (Advil, Aleve, prescription) ____ Physical therapy/exercise ____ Lifestyle modifications ____ Injections ____ Assistive devices for walking (cane, walker) ____ Braces (unloader, neoprene sleeve) ____ Weight loss 6 Prescription for the pre-op physical therapy (PT) appointment is in this guide. At the pre-op physical therapy (PT) consult, the physical therapist will go over instructions for: 1. using assistive devices 2. how to get up and down stairs 3. in and out of cars 4. proper body mechanics 5. preventing problems like dislocation, fainting and blood clots Has your pre-op physical therapy visit been scheduled? _____ (initial) Date: ___________________

7 Risks of Surgery Please take a minute to review this page. Initial those that may apply to you. ____ Age>70 ____ BMI (body mass index) >30 ____ Diabetes ____ Psoriasis, eczema, rashes, itching/scratching, slow healing ulcers, etc. ____ History of heart disease, strokes, clots, embolism ____ Smoking ____ Kidney problems ____ Liver disease ____ Bleeding problems ____GI problems ____ Previous infection ____Narcotic use ____ Previous surgeries ____High blood pressure ____ Other________________________________________S A M P L E8 FamilyCareProvider Your “Family Care Provider” (spouse, friend, significant other, relative) plays a very important role in the success of your joint replacement. Be sure they have the same understanding of all the information related to surgery and post-surgery care that you do. They will help to make sure you manage your pain using multimodal pain management strategies. They will stay in contact with you, your surgeon and his surgical team, and communicate with them, as needed.They need to make sure you are following instructions related to activity. 9 Required DME for Total Hip or Total Knee Replacement: Incentive spirometer Ice packs/cooling device Front wheeled walker (FWW) Recommended DME: Optional DME include: Shower chair Bedside commode Cane Bathtub transfer bench Raised toilet seat Crutches Compression socks Foot/leg lifter Foam pillow for leg elevation CPM for knee Home SCD Sock aide/dressing stick Reacher

10 Patient Education and Rehab The SwiftPath Method® decreases the pain associated with joint replacement. Proven rapid rehab methods + state-of- the-art patient education + multimodal pain management = a program that allows for outpatient joint replacement, for properly selected patients, and an improved surgical experience for all patients. Complications can be identified and interventions can help prevent readmissions by evaluating: _____ Personal or family history of blood clots _____ Previous problems of nausea and vomiting related to medicines/surgery, motion sickness _____ Urinary retention, frequent urination, etc. _____ Previous wound infections in you or your family _____ History of bleeding disorders _____ OtherS A M P L E11 MutimodalPainManagement Pain Management is both Pain Prevention and Pain Treatment. What medicines and non-narcotic methods will you use to help prevent pain? _____ Acetaminophen ... _____ Ibuprofen... _____ Naprosyn (Aleve) .... _____ Cryotherapy (watch out for frostbite) What narcotic will be your first one to use in the case of “breakthrough pain”? Be sure to watch out for overdose! _____ Oxycodone .... _____ Hydromorphone ... _____ Hydrocodone/acetaminophen...- 12 Please dispose of narcotics properly! Authorized Collectors for Unused Prescription Drugs: __________________________________________________ ________________________________________ You can also visit the Drug Enforcement Administration’s (DEA) website for more information about: proper disposal of unused medications (https://goo.gl/ rbf939) to locate a DEA-authorized collector of unused narcotics in your area (https://goo.gl/ZRFXPs) National Prescription Drug Take-Back Day Events (https:// goo.gl/L2jkni)  

Facility Logo SWIFTPATH QUIZThe purpose of this quiz is to make sure you have read and understand the information provided inyour SwiftPath Patient Guide. Please make note of any items where you don’t know the answer, or havequestions, so you can discuss them with your surgical team.Mark the correct answer for each item.1. Which of the following can be used to manage your pain? A. B. C. ED.L2. What is the dose of Tylenol/acetaminophen you will use after your surgery? A. PB. C. D.M3. How can you avoid frostbite from cryotherapy/ice after your surgery? AA. SB. C. D.4. What medicine is missing from the proposed treatment strategy below? A. B. C. D.5. What is the definition of “elevation” in multimodal pain management? A. B. C. D.

Facility Logo DISCHARGE ORDERS FOR TOTAL KNEE REPLACEMENTPatient follow-up appointment: _____________________ (date)Resume medications on: _____________________ (date)If you experience any urgent issues following surgery, call 911. Otherwise, if you need assistance duringoffice hours, please call 425.216.7060 and ask to speak with Emily Estabrook or Dr. Fuchs. If after hours,please call 425.823.4000. There is a physician on call 24/7.ActivityYour activity level after surgery should be limited until your first postoperative appointment. A goodrule of thumb is to get up for 10-15 minutes every hour that you are awake to move around your roomand to and from the bathroom. We suggest that you: • • • E• LPainP• • M• • S A• Wound Care • • • • • • • • Physician ________________________________ RN __________________________________Care Taker _______________________________ Date _________________________________

Facility Logo You have made it through your surgery and starting the recovery process. If you experience any urgent issues, call 911. If you need assistance, during office hours, please call ................. After hours, call ..............for a physician on call. POSTOPERATIVE DAY #1 1. Continue multimodal pain therapy..... 2. ELEVATE ..... 3. Take medications...... 4. Use your..... 5. All patients should ..... L EPOSTOPERATIVE DAY #2P1. Continue multimodal pain therapy..... 2. ELEVATE .....M3. Take medications......A4. Use your.....S5. All patients should .....--5 POSTOPERATIVE DAY #3-5 1. Continue multimodal pain therapy..... 2. ELEVATE ..... 3. Take medications...... 4. Use your..... 5. All patients should .....

FLaociglioty HOME CAREMultimodal Pain Management (Pain Prevention and Pain Treatment)• Cryotherapy/Ice/Cooling Device • Tylenol/Acetaminophen HOME........................................................................... ........ CARE............................................................................ ................................................................................... .................................................................................... • Narcotic Pain Medication• Anti-inflammatory ........ ........ ........ ........ ........ WOUND CARE AND DRESSING CHANGE INSTRUCTIONSEAfter knee surgery, your wound will be covered by an Aquacel adhesive dressing. This dressing has a specialLgauze that is sealed inside a water resistant, elastic cover. The dressing keeps the wound dry and releasesionic silver into the wound. It can be left in place for 5-7 days and is shown to reduce wound infections.PPostoperative Wound Care Instructions:5. MKnees 1. 2. A3. S4. Hips1.2.3. The Superior Joint Replacement Journey POWERED BY

Facility Logo GLOSSARYBMI: Pathway Selection Algorithm: Body Mass Index Brief set of questions for the patient toCryotherapy: answer to help determine surgical pathway, Cold or ice therapy i.e. outpatient, overnight stay or shortened hospital stay.JointCamp: SCD Machine: Patient and caregiver attend an educational A Sequential Compression Device (SCD) helps class prior to surgery to confirm joint to circulate blood in the legs of immobile replacement surgery is right for the patient. patients. The JointCamp also provides what the patient needs to know to help ensure a good result Shared Decision Making: from surgery. • Educating patients and caregivers on non- surgical conservative measuresELanding Page:LCustomized location on the SwiftPath website • Determining that all conservative measures have failed and other key decisions about with details and credentials about your surgeryPsurgeon and the tools to help you participate SwiftPath Program: A combination of patient and caregiver in your care. education and engagement, surgical methods, implants, medications, anesthesia, jointMMultimodal Pain Management: injections, etc. that when combined allow for a Combines multiple non-narcotic medications more successful joint replacement. and techniques to relieve pain and reduce theS Aneed for narcotics.NSAIDs:Nonsteroidal anti-inflammatory drugs. Classof drugs that provides pain killing and feverreducing effects, i.e. aspirin, ibuprofen,naproxen. The Superior Joint Replacement Journey POWERED BY

The Superior Joint Replacement JourneyPOWERED BY 1st Edition, April 2018