A Planning Guide for Your Childs Orthopedic Surgery

1
A Planning Guide for Your Childs Orthopedic
Surgery
2
Objectives

• Decision making process, development of
  information, evaluation
• A clinical algorithm related to the process
• An interactive workbook to help families through
  the pre, and post operative periods

3
Why

• History of following clients and families prior
  to surgery, being involved in surgical decision
  making, working with our colleagues in the acute
  care setting and following the children post
  surgically at home, at school and as outpatients.
• Loss of SHSSP contract in 2003 made the home and
  school component fiscally and organizationally
  unrealistic

4
Best Practice
Research Evidence Clinical Expertise Values
Fiscal Realities Policy Issues
5
Evidence, Clinical Expertise, Values

• Family centred care
• Communication
• Interdisciplinary services
• Continuity of care
• Pain management
• Muscle and bone physiology
• Surgical and adult literature
• Learning preferences

6
Fiscal Realities and Policy Issues

• Funding insufficient to cover post operative in
  home therapy without CCAC contract
• Need to delineate responsibilities
• CTC Policy
• College guidelines

7
Process

• CTC meeting with CCAC to delineate
  responsibilities
• Development of clinical pathway
• Collaboration among the CTC therapists, acute
  care clinicians and families to develop an
  information package for families
• Meeting with CTC, acute care and CCAC therapists
  to disseminate information
• Evaluation

8
Clinical Practice GuidelinesPre Operative
CCAC Contracted Service Providers   1. Arranges
joint visit with CDRP therapists if indicated 2.
Arranges and assesses clients needs in home
environment 3. Faxes summary of visit and
anticipated equipment needs to PAS CM
CDRP Therapists   1. Team collaboration re
surgical decision 2. Pre operative
assessment and treatment 3. Family Education 4.
Consents 5. Notify MUMC 6 Call or fax referral
to CCAC
IR Centre Reps/CM   1. Gathers referral info
from CDRP staff 2. Obtains consents 3. Client
information logged in CMIS 4. Referral forwarded
to PAS team
9
Pre Operative
CCAC Contracted Service Providers   1. Arranges
joint visit with CDRP therapists if indicated 2.
Arranges and assesses clients needs in home
environment 3. Faxes summary of visit and
anticipated equipment needs to PAS CM
PAS CM/CMA   1. Processes on hold
notification 2. Faxes therapy report and
equipment needs to CCAC office at MUMC
CCAC MUMC office   1. Places on hold
information on clients hospital chart
10
Post Operative

• CCAC MUMC OFFICE
• (WEEKEND CCAC
• MAIN OFFICE)
• Off hold (services reports)
• Order equipment
• Inform PAS team of off hold
• Voice Mail to CCAC therapists re discharge from
  hospital

• PAS CM
• Home visit post hospital
• Reassess services equipment as needed

• MUMC Therapist
• Plan client discharge
• Complete discharge referral/update to CCAC
• Transportation
• Notify CDRP

11
Post Operative

• COMMUNITY THERAPISTS
• Treat client at home
• Plan for transition back to school
• Plan return to LTC-CDRP
• Discharge summary to CCAC with consent to CDRP

PAS CM Discharge service equipment from CCAC

• CDRP
• Ongoing follow-up treatment and consultation.

12
A planning guide for your childs orthopedic
surgery
Your childs health care team will help you and
your child prepare for surgery by giving you
information         to help you make decisions
about surgery         about what to do before
the surgery         about what will happen in
the hospital         about how to care for your
child at home after surgery   Use the folder to
keep all your information together. Bring it with
you to all your appointments and when you come
to the hospital for surgery. We hope this
information and our support will make this time a
little easier for you and your family.    
If you have any
questions or concerns, please talk with any
member of the health care team.    
 
13
Making decisions about surgery
For some families, the decision about surgery
can be a difficult one and may involve
people. Your child may need some assessments to
decide whether surgery is recommended or to
determine the type of operation needed.  
Assessments may include         Motion
Laboratory testing         videotaping
a thorough evaluation of muscle strength and
flexibility         a trial of Botox
Before you decide whether your child will have
surgery, consider - the types of surgery
- the alternatives to surgery - the
risks and benefits of the surgery and the
alternatives - the implications for you and
your family on accessibility, equipment,
transportation and employment - the
need for therapy after surgery B
14
Making decisions about surgery
If the surgery is planned (elective), you may be
able to choose when to have the surgery. Choose a
time that is best for your child and family, when
supports will be available.  Here are some things
to consider         You may want to avoid busy
or stressful times such as holidays.         You
may want to avoid certain seasons. For example,
if your child has surgery in the summer, he or
she will be very uncomfortable being in a cast if
you do not have air conditioning in your
home.         If your child is in school, you
may want to avoid having surgery at the start of
the school year or at a time of change, such as
the start of high school.         Think about
the time of year when your child will be having
their surgery and the rehabilitation after. You
may have to take time off work to care for your
child during this time.
15
Learning about your childs surgery
  The name of your childs operation
is ______________________________________________
_________________     The goals of surgery and
rehabilitation are ______________________________
_________________________________________________
_______________________________________________ __
__________________________________________________
___________     Your childs pre-operative
appointment _____________________________________
__________________________ _______________________
________________________________________     Date
of your childs surgery is ______________________
_________________________________________
16
Frequently asked questions
  How long will my child be in the hospital?
_____________________________   Can I stay with
my child in the hospital? ________________________
______   Will my child be in casts? What type?
________________________________   _______________
________________________________________________  
How will the pain be managed? ___________________
__________________   _____________________________
__________________________________   How long
will it take to reach our goals?
______________________________  
17
Your childs health care team
Y Your childs care will be provided by teams
from         McMaster Childrens
Hospital         Childrens Developmental
Rehabilitation Program (CDRP) at the Chedoke
site         Acute care at the McMaster
site         Community Care Access Centre
(CCAC)   Use this chart to help you
remember your childs caregivers.
18
What to do before surgery
? Tell your CDRP therapists, CCAC case manager,
and CCAC therapists when your child will be
having surgery.   ? The therapists from the
McMaster Childrens Hospital (CDRP and hospital)
and CCAC will work together to plan your childs
care. If you are not currently involved with the
CCAC, but will require services in the home, a
referral will be made before your childs
hospital admission or while your child is in the
hospital.   ? Plan for the equipment your child
may need. The CCAC therapists will organize the
equipment for in-home use. The CCAC will fund 2
items for 1 month. If your child needs the
equipment longer, the CCAC may extend the
coverage or you, your health insurance plan or
Ontario Works may cover some equipment costs.
19
o    Hospital bed ? tray ? frame
________________________ o    Seating
__________________________________________(type) o
    Wheelchair or adaptations to the wheelchair
your child already has, to be used while your
child has casts or after the casts come off.
__________________________________________________
(type) o    Mobility aids ______________________
________________ (type) o    Toilet and bath
equipment ________________________________________
__________ (type) o    Transfer or lifting
equipment ________________________________________
__________(type) o    Braces (orthotics). Your
childs braces may be adjusted or new orthotics
may be needed after surgery.
Type and plan
___________________________________________
__________________________________________________
_____ o    If back surgery is planned your child
may need a brace or changes to their seating.
Type and plan ___________________________________
___________________ o    Ramps___________________
______________________________ o    Positioning
equipment (e.g. gaiters) ________________________
__
20
Caring for your child after surgery
? Your childs breathing o    Breathing
exercises _____________________________________ o 
   Changing position for ventilation
___________________________   ? Turning or
lifting your child o    turning or changing
positions ______________________________ o   
lifting techniques _______________________________
_________ o    using equipment ___________________
______________________   ? Positioning to
maintain muscle length ___________________________
___   ? Managing your childs pain and
spasticity o    medication _______________________
______________________ o    positioning
_____________________________________________ o   
comfort measures ________________________________
_______
21
Caring for your child after surgery
? Managing your childs bladder and bowels o   
diapering ________________________________________
______ o    using the toilet or toilet equipment
(bedpan, urinal, commode)   ? Feeding ____________
______________________________________________ ___
__________________________________________________
_____ ____________________________________________
______________   ? Caring for your childs
skin o    Skin care ______________________________
_________________ o    Bathing or showering
______________________________________  
22
Caring for your child after surgery

• Safety issues
• o    Mobility ____________________________________
  ____________
• o    Car seat or seat belt _______________________
  _______________
•  
• ? Plans for care after surgery
• o    Therapy _____________________________________
  __________
• o    Follow-up appointments ______________________
  ____________
• o    Transportation ______________________________
  ____________
• o    Entertainment and activities
  ________________________________
• o    Return to day care or school
• __________________________________________________
  ________

23
Caring for your child after surgery what you
need to know
You will be given more information about your
childs recovery and care at home. These
information sheets are also available        
Relieving your childs pain        
Constipation         Caring for your childs
cast         Transportation         Muscle
Length and Strength   Your childs health care
team will work together with you to make sure you
are comfortable with all aspects of caring for
your child, including         your childs
mobility         feeding your child        
breathing exercises         your childs
personal care   The Community Care Access Centre
(CCAC) case manager at the hospital is your link
between the hospital and the CCAC services at
home, which may include  
24
Before you leave the hospital
Before you and your child leave the hospital make
sure you         can move your child safely and
that they can fit through the doorways of your
home         know if they are allowed to bear
weight and when _______________ __________________
_____________________________________        
have safe transportation home and for follow-up
appointments         have a follow-up
appointment with the surgeon         know the
warning signs of complications and who to call
for help         know how to relieve or control
your childs pain (make sure you receive a
prescription for pain medication) and spasticity
as needed         have a referral for CCAC
services at home, if needed   The hospital staff
will notify the CCAC when your child will be
discharged from the hospital.  
25
What to do at home
Your childs daily care needs may be somewhat
different at home. You can use the information
you were given in the hospital as a place to
start. Review any new and changing needs with
your CCAC health care team. It may help to use
the What you need to know list on page 6 and
7.   The health care team will work together with
you to design a rehabilitation program for your
child. Your childs progress will depend on many
factors such as the type of surgery and how he or
she responds. The goals for your childs
rehabilitation will change over time and this
process can take up to a year.   When your child
is able to travel easily and comfortably, he or
she will come to CDRP for out patient
rehabilitation services.
26
Goals for rehabilitation while casts are on
1Your child moves comfortably within the limits
for weight bearing and activity as ordered by the
surgeon.         Your child will have some pain
and muscle spasm. The health care team will help
you know how to make your child as comfortable a
possible. Medication and supportive equipment may
help.         The surgeon decides how much
weight bearing your child can have. These
restrictions will change over time.   2 The new
length and position of your childs muscles is
maintained.         Your childs therapists will
design a program of positioning and exercises
depending on your childs surgery and goals. This
program will take place throughout the
day.         You will learn how to position your
child to maintain muscle length. You will be
given an instruction sheet for Positioning after
surgery.  
27
Goals for rehabilitation when casts are off
  1. 1. Your child begins movement after the
casts or braces are removed.         After the
cast is removed your child will begin to move the
parts that were restricted.         You will be
given an instruction sheet for Range of motion
exercises.       2. 2. Your child does exercises
to strengthen muscles and build
endurance.     3. Your childs movement and
activity return to a level for them to
participate in their typical daily activities.
28
Other Information

• Pain management
• Constipation
• Cast care
• Transportation
• Exercises

29
Evaluation

• Qualitative evaluation
• Generally complementary
• Useful having contacts all in one document
• Allowed acute care staff to know what had been
  done, facilitated communication
• May be too much information for some families but
  pertinent information can be highlighted
• Some families forgot to bring the booklet with
  them.
• Plan
• Continue to use and update with feedback for next
  edition

30
(No Transcript)