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The introduction of 2017 also brought with it the beginning of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation related to the Quality Payment Program (QPP), in addition to alternative payment models and the merit-based incentive payment system. The successful implementation of the QPP within the specialty of orthopaedics will rely heavily on the active involvement of orthopaedic nurses when it comes to improving quality, lowering costs, and incorporating value. It is important for orthopaedic nurses to understand the QPP and the role it plays in determining value-based payment of orthopaedic care delivery, in addition to how the structure of the QPP correlates with nursing diagnoses and respective plans of care delivery. [ABSTRACT FROM AUTHOR]

With the projected increase of an aging population in the upcoming decades, coupled with increasing elderly longevity, the incidence of hip fractures among this vulnerable population is expected to grow. Current evidence reveals high mortality rates within 6 months to 1 year among frail elderly patients who suffer hip fracture. In addition, the presence of multiple chronic conditions negatively impacts mortality rates in this vulnerable population. The purpose of this article is to discuss both the importance of integrating early palliative care and the appropriateness for hospice referral among frail elderly hip fracture patients. Moreover, the role nurses' play in early recognition of the need for palliative and/or hospice services among this vulnerable population will be explored. [ABSTRACT FROM AUTHOR]

In the specialty of orthopaedics, methicillin-resistant Staphylococcus aureus (MRSA) is a major contributor to infections of the soft tissues, surgical sites, and joints, in addition to increasing disability, mortality, and healthcare costs. Inappropriate prescribing and misuse of antibiotics have led to bacterial resistance and the rapid emergence of MRSA. It is imperative for healthcare providers and facilities to improve quality, promote safety, and decrease costs related to MRSA infections. The healthcare profession and society as a whole play an important role in minimizing the transmission of pathogens, reducing the incidence of MRSA infections, and decreasing the development of future antibiotic resistant pathogens. This article discusses the epidemiology of MRSA and describes evidence-based guidelines pertaining to the prevention, minimization, and treatment of MRSA-related infections. Specific application to orthopaedics are discussed in the context of patient risk factors, perioperative and post-operative prophylaxis, and current trends regarding education and reporting strategies. [ABSTRACT FROM AUTHOR]

Tears of the anterior cruciate ligament (ACL) are common knee injuries experienced by athletes and people with active lifestyles. It is important for members of the healthcare team to take an evidence-based approach to the diagnosis, surgical management, and postoperative rehabilitation of patients with an ACL-deficient knee. Mechanism of ACL injury and diagnostic testing is consistent throughout the literature. Patients frequently opt for ACL reconstruction, and many surgical techniques for ACL reconstruction are available with no clear consensus regarding superiority. Surgeon preference dictates the type of reconstruction and graft choice utilized. No standardized pre- and postoperative rehabilitation protocol exists. However, rehabilitation plays an important role in functional outcomes. A comprehensive rehabilitation program is needed pre- and postoperatively to produce positive patient outcomes. [ABSTRACT FROM AUTHOR]

Clinical quality indicators have a strong influence on reducing the overall financial impact, improving the outcomes, and minimizing the adverse events among patients undergoing elective total knee arthroplasty. In today's era of healthcare reform and increasing healthcare costs, it is important for orthopaedic nurses to be aware of the vital role clinical quality indicators play in the perioperative and postoperative settings. [ABSTRACT FROM AUTHOR]

According to the Institute of Medicine (2011), "Clinical practice guidelines are statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." Nursing clinical practice guidelines provide defined best practice modalities that assist nurses in the diagnosis, management, or prevention of specific healthcare conditions, while including recommendations that are derived from the highest levels of evidence. These levels of evidence include high-quality systematic reviews of current literature, meta-analyses, or well-designed clinical trials. [ABSTRACT FROM AUTHOR]