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Improving Orthopedic Brace Ordering, Education & Utilization

The aim of this project was to improve the experience of multidisciplinary team members in learning and ordering braces to ensure timely delivery, fit, and utilization of Orthopaedic braces.  

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Orthopaedic braces are used to stabilize joints, bones, and muscles after injury and surgery.  Improvement in the accuracy and efficiency of brace orders along with standardized brace education was found to be an opportunity for multidisciplinary teams to improve patient safety, patient care and patient and staff experience. 

 

The aim of this operational project was to improve the experience of multidisciplinary team members in learning and ordering braces to ensure timely delivery, fit, and utilization of Orthopaedic braces used to stabilize joints, bones, and muscles after injury and surgery.  Through a multidisciplinary team and multimodal approach, the project facilitated Brace Table, Brace Orders Panel, and Brace e-Book creation and implementation. Various brace resources developed through this approach improved staff experiences with brace orders, education, and utilization.

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Created and led by the Orthopaedic Clinical Nurse Specialist and the Physical Therapy Clinical Specialist, the project team included orthopaedic nurses and providers, rehab staff, and brace vendors. This team began construction of an updated Brace Education module featuring a Brace table for ease of use in identifying commonly used braces by body region. Experienced service line staff from Trauma, Emergency Services, Neurosurgery and Orthopaedics were surveyed to evaluate the effectiveness of the brace table.   

Next, the interdisciplinary team created an electronic Brace Order panel to effectively and efficiently search and place various brace orders with the goal to reduce the number of brace orders, eliminate redundancies, and ensure essential information was included. A Likert-type survey was conducted to learn providers’ experience with the new orders panel. Order utilization data was collected and analyzed to evaluate the effectiveness of ordering braces. An informal survey of nursing and rehab staff was also conducted to learn their experience and perspectives of the orders panel.

Lastly, the team set out to create a one-stop-shop educational material regarding current braces. A standardized e-Book format was adopted, and the Brace Education e-Book was created. This visually appealing and searchable brace e-Book allows readers to selectively learn specific brace information. Nursing and rehab staff were informally surveyed to ascertain their experiences using the e-Book.

The streamlined brace ordering is directly linking to brace acquisition and utilization, and staff reported no missing or inappropriate brace orders or brace application delays after panel implementation. Published in August 2021, the Brace e-Book has gone through two major evidence-based revision in 2022 to reflect practice and supply change.

The Brace e-Book is available on education and nursing units’ web sites, and was incorporated in onboarding for nursing and rehab staff. The Brace e-Book was found by staff to be accessible, informative, up-to-date, and helpful for education.

Acknowlegments

  • Milena Matzinger, PT, DPT, GCS, Physical Therapist, Stanford Health Care

  • David Lowenberg, MD, Unit Based Medical Director, Orthopaedics, 

  • John Ratliff, MD, FACS, Unit Based Medical Director, Neurosurgery, 

  • Megan Winslow, DPT, Inpatient Manager, Rehabilitation Services, 

  • Jonathan Ching, Business Manager, Patient Care Services, 

  • Rhiana Gulesserian-Cone, MS, OTR/L, CLT, WCC, Inpatient Manager, Rehabilitation Services

  • Carol O’Connell, OTR/L, Senior Occupational Therapist, Rehabilitation Services, 

  • Maria Inah C. Mangalindan, PT, DPT, Physical Therapist, Rehabilitation Services, 

  • Betina Pelesic, MSN, NP, Orthopaedics, 

  • Aubrey Florom-Smith, PhD, RN, Nurse Scientist, Office of Research, Patient Care Services, 

  • Nanci Fleck, BSN RN, Lead Clinical Informatics Analyst, Inpatient orders/ClinDoc, Stanford Health Care

  • David Gordon, Informatics Educator, Informatics Education, 

  • Joseph Daly, PT, MBA, MHA, FACHE, Executive Director, Rehab, Respiratory, Clinical Nutrition, 

  • Jennifer Meaney, MS, BSN, RN-BC, Patient Care Manager, Orthopedics

  • Janice Bright Chou, Report Analyst, Clinical Reporting, Technology and Digital Solutions,  

  • Paige, E. Paige Huchro, MBA, MA, RN, Digital Development and Education Specialist: CBT, Center for Education and Professional Development, 

  • Joey Seijo, Cast Room Technician, 

  • Prudence Lin, OTD, OTR/L, OT Clinical Specialist, Neurosurgery, 

  • Aaron Sy, MS, Quality Consultant, High Value Care, Patient Safety & Effectiveness, 

  • Debbie Kutch, Voice Actor/Coach & Owner of Voices Connect, HAB video

  • Heidi Pugh, Certified Prosthetist/Orthotist, Hanger Clinic

  • Hillary Coates, PT, DPT, NCS, Physical Therapist IV, Inpatient Rehabilitation Services, 

Kudos to this interprofessional team for a successful project that improved care coordination and quality of care for their patients!

Submitted by Yanli Jiang, MSN, RN, CNS, ONC, PCCN, NPD-BC, AGCNS-BC

Clinical Nurse Specialist

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