Transcription:

Bill Klaproth: Okay, so quick question. Do you know what a nurse navigator is? Well, you're about to find out and you're going to find out how that person can help you prepare for joint replacement surgery. With us is Amy Blevins, a nurse navigator and Director of Orthopedic and Gender Alignment, Surgery Service Lines at Marin Health.

This is The Healing Podcast brought to you by Marin Health. I'm Bill Klaproth.

Amy, thank you so much for joining us. It is great to talk with you. So first off, can you explain to us what is the role of a nurse navigator?

Amy Blevins: That's a good question. Marin Health Medical Center is fortunate to have nurse navigators, who help patients find their way through the many requirements, pre-op appointments, now COVID testing, timing, the required pre-op joint replacement class, all of which are done before they arrive here.

Nurse navigators then provide oversight and care when the patients are here and also once they get back home again,

Bill Klaproth: Yeah, it's a really good program. So do all orthopedic programs have nurse navigators? Because it sounds like very valuable support to the experience of going through joint replacement.

Amy Blevins: Well, I believe most programs do have some type of patient support. Often here in Marin, patients live alone. So we work to offer them the support they need to get back home again, to live their fullest most independent lives after surgery. It's definitely a team effort and I work closely with our physical and occupational therapists, care coordination team, registered dieticians and spiritual care team here to provide the best care possible.

Bill Klaproth: So I like how you say we work to offer them the support they need to get back home again and to live their fullest life. That's really cool. So can you give us an example of your involvement in a patient's experience and how you were able to help them?

Amy Blevins: Oh, sure. So joint replacement surgery is elective surgery, meaning that it's not an emergency type of surgery. The patient and surgeon decide best together when the best time is for the patient to have their surgery. So besides doing the fun things of coordinating therapeutic massages and a therapy dog visit here in the hospital, which really do make a difference, there are some patients that require a little extra care and thought.

One of our patients lived alone and she needed to walk up four flights of stairs in order to get into her apartment for it had no elevator. So our team discussing her post discharge, back home care included the surgeon, our care coordination team, our physical and occupational therapists and myself. And together with the patient, we decide to slightly delay her surgery date until she had solid support in place and a safe plan to return back home. It may seem obvious, but patients succeed best when their home is safe and they have some type of available reliable support person.

Bill Klaproth: Yeah, that totally makes sense. So then when do you come into the picture, Amy? When do you usually meet a patient?

Amy Blevins: Pre-COVID, I would meet them at the joint replacement class in person. Teaching the class with me then were former patients, one of our physical therapists, one of our occupational therapists and sometimes an anesthesiologist would visit as well if their schedule would permit. Now that we have the classes online, I do get to see patient's faces and their support person, but I have to wait until the morning of surgery until we can meet in person.

Bill Klaproth: Got it. Well, thank you for explaining that. And I have a much better idea of how you work with the patients. So then how do you work with the physicians involved?

Amy Blevins: Before my role here as a nurse navigator, I was an operating room nurse for 18 years and also a family nurse practitioner in the community. I spent years here working as a trauma call nurse in the operating room. And that was certainly one way to build a trusting relationship with our surgeons. But currently I still work very closely with these surgeons. We co-manage the patient care and assure that the patients are prepared for their surgery and their return home.

If I might, I would like to say that we have nine terrific total joint surgeons here at Marin Health Medical Center who have excellent outcomes. And personally, it's very rewarding for me to work in this role as I get to see how well patients do after surgery. And often I hear, "I wish I'd done this sooner." And I just want you to know that I'm here for patients who might be interested and needs someone to talk with about the surgery and recovery.

Bill Klaproth: Well, you certainly are a resource. So let's talk about you helping people prepare for joint replacement surgery, because I know people have a lot of concerns about that when it comes to that type of surgery. So in helping patients prepare for joint replacement surgery, what are the usual steps?

Amy Blevins: Before COVID, as we said, patients would come and attend an in-person joint replacement class, and then patients would follow the checklist provided in the book to help prepare their home and family. There are other appointments to check off, including a visit with their primary care provider or what is called a history and physical exam as well as a visit with our pre-admission center team, or any lab work, EKG, COVID testing or history and physical elements needed for surgery.

So long gone are the days that patients come in the night before surgery and stay in the hospital for two weeks and then head to a skilled nursing facility for three months like my mother did 30 years ago and she had two total knees and two total hips. We have some patients that return home now in the day of surgery. But the majority of our patients spend a night here in the hospital. And we strongly encourage patients to return home and not go to a skilled nursing facility.

Bill Klaproth: How about that! Now, that is progress. What a difference from what your mother experienced. So how does this differ? Does this differ if a patient is having a knee replacement or a hip replaced? Or is every patient situation different? How does it differ between the different orthopedic surgeries?

Amy Blevins: Every patient is different and we treat them as unique, but because of the surgeries and recoveries are similar enough, we teach to both total hip and total knee surgery in the joint replacement class.

Bill Klaproth: And then let's talk about recovery a bit. You've just mentioned it. You try to get them, you know, up the day of, so what about planning for recovery? And then what about physical therapy post-surgery? How important is that?

Amy Blevins: Very important. So like you said, we get our patients up on the day of surgery with the physical therapist. And then home physical therapy is an option for some patients and that takes place within the first two weeks that they're home, two sessions a week. Some of our surgeons prefer that the patients do not have home physical therapy, that they just sort of let their joints settle a bit, and then proceed to outpatient, what's called outpatient physical therapy.

Walking is terrific exercise. What we do not want to see is the patient lying around at home afraid to use their newly replaced joints. So no bedrest and no sitting around.

Bill Klaproth: Okay, so you want them up and moving. Motion is lotion. Get them moving.

Amy Blevins: Yes. Exactly.

Bill Klaproth: So then for someone listening to this podcast, either they're facing a joint replacement surgery or they have a loved one who is going to have this surgery and they want to understand the process and recovery better, what are your best tips and advice for being well-prepared for a successful procedure and outcome?

Amy Blevins: We talk a lot these days about patient optimization and getting patients really prepared to have surgery. It's so important to be well-prepared going into what we call this elective surgery and we have a lot of tips. One is to exercise as much as one is able without causing pain. Walking, going up and down stairs, doing the exercise that you're preexisting physical therapist in our joint class recommends, all help in the weeks before surgery.

Preparing your home, friends, neighbors and family is very important. This is a time to call in those favors and ask your neighbors to bring in your mail for you. This is the time to stock your freezer with healthy comfort food. And this is also the time to focus on your own healing and give yourself plenty of time to heal after surgery. We like to say it's a marathon, not a sprint.

In addition, our pre-admission center, which is run by our anesthesia team, is one appointment that helps assure patients are physically prepared for surgery. That their cardiologist has cleared them, that their hemoglobin A1c is within a safe range if they're diabetic and that they have no existing dental or skin infections that might interfere with best outcome.

I listen to our patients also including my mother who has had two total knees and two total hips and her best recommendation is to remember that attitude is everything. And I had another patient who swore that neuro-linguistic programming helped him. So 10 times a day, he would say, "Every day in every way, I'm getting better and better and better." And he swore by that. And that made him heal a lot faster.

Bill Klaproth: That's pretty cool. Neuro-linguistic programming, 10 times a day. I love that. "I'm getting better and better and better in every way." That's really good. And attitude is everything. So those are really good tips, Amy. So thank you for sharing those with us. So does Marin Health offer a joint replacement class? And how can people learn more about that and sign up?

Amy Blevins: Absolutely. Interested folks can call me directly and leave me of course their phone number and also their email address. And I would be very happy to invite them to the next WebEx class that we offer. Generally, it's every other Wednesday from 1:00 to 3:00 PM. The class serves partial knee replacement patients, total knee replacement patients and total hip replacement patients and anyone who's thinking about these surgeries are more than welcome to hear more about our program.

Bill Klaproth: That sounds good. And to get a hold of you, (415) 925-7907. Is that correct?

Amy Blevins: Yes. Perfect.

Bill Klaproth: Wonderful. Well, Amy, you've been a wealth of knowledge. Very informative. Thank you so much for sharing your time with us today. We really appreciate it.

Amy Blevins: Thank you so much.

Bill Klaproth: That's Amy Blevins. And to learn more, please visit MyMarineHealth.org. Or again, you can call (415) 925-7907. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by Marin Health. I'm Bill Klaproth. Thanks for listening.