To expand on the post about major orthopedic precautions following surgery, I decided to write a “Part Two” addressing home safety following orthopedic surgery.
This post covers the safety basics after discharge from a major orthopedic surgery. These home safety tips can be used for other surgeries as well, and can be used in any setting, from acute care to home health.
As we all know, home safety is a huge educational component of occupational therapy. Especially after a major surgery, self-care can be difficult and/or unsafe.
There are many aspects that may be hard to remember when you’re a student or new OT less familiar with the orthopedic setting. Because of this, I wanted to provide you with everything I’ve been taught in my acute post-op orthopedic setting.
To keep this post organized, I’ve categorized this list by the most common places your patients will find themselves at home and I added the main safety measures for each.
The number one place for falls is in the bathroom.
Low toilets make it difficult to transition from seated to standing following a knee or hip replacement. The first recommendation for the bathroom is to place a 3 in 1 bedside commode over the toilet as it raises the height and provides handles to push up from. It looks like this:
Most insurances cover a bedside commode, but if not, they can be purchased on Amazon.
For a safe toilet transfer, teach the patient to step back to the toilet until they feel it with both legs (starting with non-surgical leg if they have anterior hip precautions), then kick out the surgical leg, lowering down slowly with the bedside commode handles or grab bar.
For showering, this must only be attempted after the surgeon has approved the patient for showering (usually after the stitches or staples have been removed to avoid infection). The patient can side step into the shower and use the bedside commode as a shower seat.
If the patient has a bathtub, stepping in will be more difficult especially with posterior hip precautions. In either case, it is recommended to use a tub bench that sits partially outside of the tub, so the person can sit on the edge of the bench and simply swing their legs into the tub versus stepping over.
Suction grab bars are NOT recommended under any circumstances because they can and do come off of the wall. They are only meant to be used as a touch-point and are not stable like professionally installed grab bars.
In addition, I also teach patients not to use towel racks as they are not installed like grab bars and aren’t meant for putting weight onto.
Lastly, I always recommend non-skid shower mats or strips that won’t slip when wet or soapy. Non-skid bathmats are also a safer option instead of towels when stepping out of the shower/tub.
While the bathroom is the most common place for falls, the bedroom is the second most common place. This is because people are on their way to the bathroom and are oftentimes rushing.
To reduce this risk, bedside commodes angled at the head of the bed make toileting much easier and safer when it is still difficult to get to the bathroom. In addition, having a night lamp next to the bed to turn on during any night time toileting or getting out of bed will also reduce fall risk.
Getting into bed following orthopedic surgery is usually one of the bigger challenges due to the difficulty lifting the surgical leg. The way I learned to teach this is to back up to the bed until both legs are touching the bed, extend the surgical leg, and bring the non-surgical leg in first if possible to be able to use both hands to lift surgical leg in. Leg lifters or a rolled up sheet can also be used to assist in lifting the surgical leg into the bed.
Getting out of the bed is generally a bit easier. To do this, the patient can scoot towards the edge of the bed, bring non-surgical leg onto the floor and use arms or leg lifter to bring surgical leg onto the floor. From there, the patient can push up from the bed and stand up to the walker, which should be kept near the bed.
For getting dressed, educating orthopedic patients on using a hip kit is invaluable for most lower body surgeries. Not just for hips, these kits are great for knee surgery and back surgeries as well as other conditions limiting trunk and/or lower extremity range of motion. The hip kits include a reacher, sock aid, long-handled shoe horn, long-handled sponge and dressing stick to make lower body ADLs significantly easier.
Managing I-ADLs in the kitchen can be challenging immediately following an orthopedic surgery. To make things safer, you can educate the patient on the following measures.
First, educate on practicing safe reaching. The safe reaching distance (in any room, not just the kitchen) is from eye to waist level and only one arm’s length away.
Family members can assist to move most-used kitchen items and groceries to this height prior to returning home from surgery. Reachers can be used to lift objects less than five pounds at higher or lower surfaces.
I also remind patients to keep their walker with them and keep both hands on the walker when moving around the kitchen. To carry kitchen items, the patient can use a walker tray with a cup holder, walker basket, or they can tie a grocery or tote bag to the front of the walker to carry closed food items.
The Laundry Room
Doing laundry after orthopedic surgery is challenging but not impossible if the patient doesn’t have anyone to assist. While carrying a laundry basket is unsafe, patients can drape small amounts of clothes over the front of their walker or in their walker bag to walk to the washing machine. They can then use the reacher for lower or higher heights with one item at a time.
The Living Room
Seating is one of the bigger challenges in the living room. This is due to low seating surfaces like soft couches and recliners that rock or chairs that roll. Soft couches are especially difficult, so to make it easier the couch can have a pillow or wooden board placed under the cushions and the patient can sit on the armrest side closest to the non-surgical leg. This way they can use the armrest and unaffected leg to push up to stand.
To get into a favorite recliner that moves or rocks, a family member can support it from behind to keep it from moving while the person transfers in/out.
To keep it simple, the easiest seating options are chairs that are taller, firm, and have armrests to push up from.
If the person is going to be in the living room for a large amount of the day alone, a family member can have the bedside commode placed next to the patient as well as leaving a cooler with foods and drinks nearby.
Car transfers can be taught just like the other transfers using the method of backing up and kicking out the surgical leg. However, car transfers may be a bit more challenging due to the lower and tighter space.
For the easiest transfer, the patient will want to use the passenger’s side with the seat scooted back. The patient can then back up, reach for the backrest and car ceiling door handle to slowly lower into the seat. The back seat is not recommended as it is difficult to reposition and easy to get “stuck.”
The patient returning to driving themselves is allowed only when their surgeon clears them and they are off of their pain medications.
Bonus Tips for All Home Areas
Each room should be free of clutter, cords, and have clear walkways. Throw rugs may pose an extra risk by getting caught up in feet and walkers.
Patients should also be cautious during mobility with pets in the house as they could present a tripping hazard. Feeding/watering and changing litter may need to be adapted if the patient has certain precautions.
That wraps it up for home safety after orthopedic surgery! It’s definitely a lot to take in, but after several patient education sessions, you’ll have it down in no time.
I hope these tips proved helpful in your adventures in orthopedics and home safety. I want to give a big thanks to DeKalb Medical Joint Solutions and the super awesome therapists there for providing me with such useful information to share with you all.
If you have any other go-to tips, please feel free to share them in the comments!