The article "Orthopaedic Snafus: When Adverse Events Happen in Orthopaedics" by Smith, Walsh, Levin, Eaten, and Yager (2017) highlighted many of the serious complications that the orthopaedic population face perioperatively and postoperatively. I agree that there needs to be an additional focus on ensuring that perioperative and bedside nurses are competent in assessing for these complications. However, there is an opportunity for orthopaedic nurse practitioners to use their expertise to promote nursing education and ensure that there is adequate assessment of these patients. The four adverse events covered within the article include nerve and blood vessel injuries, falls, surgical site infections (SSIs), and venous thromboembolism. Although falls, SSIs, and venous thromboembolism are issues that can affect various types of patients, nerve and blood vessel injuries are more common in orthopaedics but less common overall.
Although basic nursing education provides the fundamentals of orthopaedic assessment, it takes experience and training to be adept at evaluating for these complications. Simply knowing to how to remove a splint, or being aware of the "six Ps" of assessing for compartment syndrome, can impact the outcomes of these patients. Nurse practitioners not only are in an interesting position in their profession as they function as providers but can also be valuable sources of education for nurses. Ensuring that nurses are familiar with signs, symptoms, and treatment of nerve injury, blood vessel injury, and compartment syndrome can be the difference between a transient complication and loss of function. Nurse practitioners can serve as allies for nurses and provide continuing education on assessment procedures as well as prevention of these complications. As healthcare is moving to a value-based model of reimbursement, it is imperative that we all work together to ensure quality, safe care to our patients and decrease the occurrence of these complications.
-Jessica L. Heligman, MSN
Baptist Health South Florida
Miami
Smith M. A., Walsh C., Levin B., Eaten K., Yager M. (2017). Orthopaedic snafus: When adverse events happen in orthopaedics. Orthopaedic Nursing, 36(2), 98-109. doi:10.1097/NOR.0000000000000324 [Context Link]
Editorial Reply
I wholeheartedly agree that nurse practitioners are one of the key players in the promotion of safe, high-quality care that serves to minimize the incidence of adverse events among orthopaedic patients. This process relies heavily upon effective collaboration in a team-based fashion, and, in many cases, the nurse practitioner is the "glue" that keeps the team focused on evidence-based and patient-centered care that serves to encourage positive patient outcomes. The nurse practitioner is educated in a way that builds on the existing knowledge and competency skill set of a registered nurse to develop a deeper knowledge of underlying processes and greater competency in more complex clinical practice skills and interventions-This highlights nurse practitioners as an ideal source of education and guidance for registered nurses when it comes to the prevention of adverse events among orthopaedic patients. Team-based, interdisciplinary care led by nurse practitioners encourages the translation of evidence-based research into clinical practice, which is the foundation for patient safety and high-quality care (Sharp, 2012).
-Mary A. Smith, DNP, FNP-BC, ONP-C, CNOR, RNFA
Starkville Orthopedic Clinic
Starkville, MS
Sharp B. (2012). The changing role of nurses: Research activities, December 2012, No. 388. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from https://archive.ahrq.gov/news/newsletters/research-activities/12dec/1212RA1.html [Context Link]