Hip dd Prosthesis Replacement

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Your Pathway to
Hip Replacement Recovery

Mount Carmel New Albany
Surgical Hospital
Table of Contents

1. About our hospital

2. Information from your surgeon

3. About your surgery

Contact Numbers

Main Number 4. Planning ahead
614.775.6600

Pre-Admission Testing
614.775.6624
5. Your hospital stay
Case Management
614.775.6276 or
614.775.6277
6. Friends and family
Financial/Billing/
Insurance
614.546.3300
7. After your discharge

8. Rights and responsibilities

These two Daily activities
Certain illustrations contained in this
manual for which Joint Implant Sur- items are after joint replacement
geons, Inc., holds copyright have been located in the Goals and exercises
reproduced with the permission of Joint back pocket
Implant Surgeons, Inc. Mount Carmel of your
New Albany Surgical Hospital wishes
manual. Patient care plan
to gratefully acknowledge Joint Implant
Surgeons, Inc., for its generosity.
1.
Welcome to:
Mount Carmel
New Albany Surgical Hospital

W e are delighted that you have chosen the Mount Carmel New Albany Surgical Hospital to
meet your healthcare needs. Our staff is dedicated to providing you with the ﬁnest surgi-
cal care available today. Please take some time to review the materials enclosed in your Total
Hip Replacement Manual, as they are intended to:

• Acquaint you with our hospital and visitor facilities;
• Inform you about what to expect during your stay with us;
• Help prepare you for your recovery process and the steady increase you
will experience in your ability to participate in life more fully!

Your Care Team
At Mount Carmel New Albany Surgical Hospital, we are committed to providing the best care
as well as a positive healthcare experience for you and your family. Your care team is made up
of many dedicated individuals who will work with you to make your stay at our hospital pleas-
ant and your transition back to home as smooth as possible.

Your orthopaedic surgeon works with a network of orthopaedic specialists whose combined
skills provide excellence in treatment for virtually any musculoskeletal problem. These people
will work with you from pre-diagnosis through treatment and on to therapy and rehabilitation,
providing the best care available for a wide range of medical concerns.

2
Our Mission And Vision
To provide every patient with high quality, compassionate,
and cost-effective care in a family-focused environment.
To be a center of excellence providing comprehensive
musculoskeletal care, research and education.

Beliefs
We believe that every decision, every day, must be made in the best interest of
the patient.

We believe that patient care is best delivered when the doctor-patient-nurse
relationship is given the highest priority.

We believe in physician-directed, patient-focused care that strives for continu-
ous quality improvement in all aspects of patient care.

We believe that evidence-based medicine, research, and education are the foun-
dations of excellence in providing patient care.

We believe in fostering a collaborative work environment to ensure that our
patients beneﬁt from the collective expertise of a team of healthcare profession-
als.

We empower and encourage our associates to seek new, more effective ways to
serve our patients and their families.

We recognize and embrace the role we play in promoting musculoskeletal and
neurological health among our patients, their families, and the community at
large.

We foster a culture that enables our associates to fully realize their professional
potential.

3
A list of hotels in the immediate area has been provided below for your convenience.

Contact information for area hotels
Best Western Columbus Hilton Garden Inn, Airport Spring Hills Suites
North 4265 Sawyer Road, 665 Taylor Road,
888 E. Dublin-Granville Road, Columbus, Ohio Gahanna, Ohio
Columbus, Ohio 614.231.2869 614.501.4770
614.888.8230
Towne Place Suites by Hampton Inn Courtyard by Marriott
Marriott 4280 International Gateway, 2901 Airport Drive,
695 Taylor Road, Columbus, Ohio Columbus, Ohio
Gahanna, Ohio 614.235.0717 614.475.8530
614.861.1400

Directions
7333 Smith’s Mill Road, New Albany, Ohio 614.775.6600 (Main Number)

FROM THE SOUTH AND EAST Lost or not sure of the next turn?
- Take I-270 North to New Albany/161 East Call us, and we’ll talk you in! 614.775.6600
Exit. Take 161 East to the Rte. 62 Exit.
Turn left (north) towards Johnstown. Turn
right at the second light onto Smith’s Mill
Road. The hospital is on the right side of
Smith’s Mill Road.

FROM THE NORTH - Take I-270
South to New Albany/161 East Exit. Take
161 East to the Rte. 62 Exit. Turn left. Turn
right at the second light onto Smith’s Mill
Rd. The hospital is on the right side of
Smith’s Mill Road.

FROM THE WEST - Take I-270 East
to I-270 North. Take I-270 North to New
Albany/161 East Exit. Take 161 East to
the Rte. 62 Exit. Turn left. Turn right at the
second light onto Smith’s Mill Road. The
hospital is on the right side of Smith’s Mill
Road.

MILEAGE - The hospital is: 6.3 miles
from the I-270/New Albany/161 Exit to the
Rte. 62 Exit; 0.8 miles from the Rte.62 Exit
to the hospital.

4
Our ultimate goal is to help you regain your ability to engage in life at the level that gives you the
greatest satisfaction. While YOU are the most important member of our healthcare team, you may be
assured that there are a number of outstanding medical professionals serving on your team, such as
your:

General medical physician, who:
• Assesses and evaluates your medical needs while you are in the hospital
• Directs your medical care while you are in the hospital

Orthopaedic surgeon, who:
• Performs your surgery and directs your care
• Checks on you while you are in the hospital
• May evaluate you at follow-up appointments at the ofﬁce

Lab personnel, who:
• May run various tests before and after surgery
• Assist with blood transfusion if you need one

Radiology personnel, who:
• Perform any needed portable x-rays
• Perform any other radiological modalities such as MRI’s, CT scans, ultrasounds and routine
x-rays

Physician assistant, who:
• May take your medical history
• May assess your medical status and assist the doctors at the hospital
• May evaluate you at follow-up appointments at the ofﬁce
• May assist the orthopaedic surgeon during surgery

Consulting physician, who:
• Assesses and evaluates your medical condition and helps in your care
• Directs care in their specialty area

Anesthesia team (anesthesiologist, certiﬁed registered nurse anesthetist), who:
• Administers your anesthesia during your procedure in the operating room and constantly moni-
tors your condition during surgery
• May help direct your pain management postoperatively

5
O.R. (operating room), pre-operative/PACU (post anesthesia care unit) and inpatient unit
directors/coordinators, who:
• Provides clinical and administrative leadership in the O.R., PACU and on the inpatient care
unit
O.R. team, (consists of central sterile staff, anesthesia techs, registered nurses, surgical
technicians and orthopedic assistants) who:
• Plans and coordinates your care before, during and after your surgery
• Assists the surgeon and the anesthesia team during surgery
Pre-operative/PACU and inpatient team (consists of registered nurses and technicians),
who:
• Plans, coordinates/provides your care based upon physician orders
• Monitors your condition and communicates information about your condition to other team
members
• Teaches you and your family about your health care needs
• Helps you with your personal care needs
Case manager nurse/discharge planner, who:
• Is available to answer questions or handle concerns during your hospital stay
• Coordinates your discharge plans with the nursing staff and the physical therapist
• Makes arrangements for continued healthcare and equipment after discharge as needed
• Interacts with insurance companies as needed
Physical therapist, who:
• Teaches you exercises to increase your strength and range of motion
• Instructs and assists you with your exercise program after surgery
• Teaches you the correct way to walk and perform your activities of daily living
• Helps you to adapt to the temporary lifestyle changes following hip joint replacement sur-
gery
Respiratory therapist, who:
• Instructs you on the use of your oxygen
• Assists you with breathing exercises

Your healthcare team is already charting
your course of recovery!

6
What’s Wrong with my Hip?

A healthy hip consists of The Healthy Hip
a smooth ball on the end of the
thigh bone which ﬁts into the
end of the hip socket to form the
“ball and socket” joint. A layer
of cartilage cushions the ends of The Socket
these bones, allowing the ball to The Ball
glide easily within the socket. Smooth Cartilage
The Pelvis
The Thigh
Bone

A problem hip can be
the result of wear and tear to
the cushion of cartilage in the
hip joint due to osteoarthritis The Problem Hip
or other diseases. Without the Narrowed Joint Space
cushion of cartilage, the joint Bone Spurs
Worn Joint Space
surfaces become irritated and
pitted as bone rubs against bone.

The Hip Prosthesis
The hip prosthesis
consists of a specially designed
ball and socket that replace your
worn hip joint. The ball and
stem replace the worn ball of Cup or Socket
your thigh bone. A cup replaces The Ball
the rough hip socket. The pros-
thesis has smooth surfaces that The Stem
ﬁt together and allow the ball
to move easily and painlessly
within the socket, much like a
healthy hip.

7
What are the risks involved in having
a total hip replacement?
We want you to understand the beneﬁts and risks of joint replacement surgery. The ul-
timate goal is for you to regain function of your hip with minimal pain and discomfort.
Most people recover smoothly from surgery. However, complications are possible. These
occurences are rare and are almost always treatable.

Complications you should be aware of:
Blood clots may occur when blood ﬂow is slowed due to the break in activity you will experi-
ence after your surgery. The following measures are helpful in preventing this condition:
Ankle pump exercises after surgery
Elastic stockings or foot pumps to improve circulation
Medication to thin your blood
Getting out of bed several times each day starting either the day of surgery or the
next day

Even with the best of care, it is still possible for blood clots to form. It is important that you watch
for any signs of blood clots and let medical staff know immediately if you experience any of the
symptoms listed below:
Swelling
Redness
Pain
Tenderness and warmth in the calf or lower leg

Infection is a possibility with any surgery
With joint replacement surgery, infection may be at the incision (the surface) or
inside your body around your prosthesis. To help prevent infections, you will be
given I.V. antibiotics around the time of your surgery.
It is also possible to get an infection at home, after you leave the hospital. Again,
antibiotics generally take care of these types of infections, but in rare cases,
additional surgery may be needed to remove an infected prosthesis for replacement
with a new one.

Dental Injury
Teeth may become chipped, loosened or dislodged during your surgery and recov-
ery period. Please let your anesthesia team know of any dental problems you may
have. 8
Reactions to anesthesia or pain medication are other types of complications that can occur
Please let your doctor or anesthesiologist know if you have ever experienced a reac-
tion during a previous surgery.
Nerves close to the joint replacement may be damaged
Over time, these nerves may improve, or completely recover.
Hip prosthesis loosening
Many years after your joint replacement, your prosthetic hip can loosen from the
bone. Surgery may need to be performed to revise the joint replacement.
Prosthetic wear
Some wear is common on all joint replacements, but if this wear is severe, surgery
may be needed to revise the joint replacement.
Prosthetic breakage
While very rare, the metal or plastic joint in a replacement may break. Again, sur-
gery would be required to revise the joint if this occurs.
Loss of limb
Death
Consent
You will be asked to sign a consent form prior to
surgery to allow the surgeon to perform the re-
quired surgical procedure. Please make sure that
you understand the procedure, risks, and your
options prior to signing the form. It is important
to us that you completely understand the informa-
tion and are an active partner in your care.

A blood transfusion is the infusion of blood or blood com-
A Word ponents (parts of the blood) into a vein. The most common
about Blood kind of transfusion is a red blood cell transfusion. Red blood
cell transfusions are used to treat anemia (low red blood cell
Transfusions count). Anemia may be caused from blood loss or failure of the
body to make enough red blood cells.

There is a small chance of needing a blood transfusion during or after your surgery based on
several factors. The decision is largely based on post-operative hemoglobin and hematocrit lev-
els. Other considerations include certain symptoms, and age.

The low number of risks to patients resulting from blood transfusions is due, in large part, to
strict screening regulations for volunteer blood donors.
9
Blood donors are routinely screened for:
Blood type
Infections
HIV: the AIDS virus
Hepatitis B and C: an infection of the liver and the blood
Syphilis: a sexually transmitted disease that is also carried by blood
HTLV: a virus that causes certain infection
Other testing
Other possible risks include:
Fever Jaundice: yellowing of the skin due to liver problems
Chills Chest pain
Rash, itching or hives Trouble breathing and a fast heart beat
Infection

What are Your Choices?
In most cases you will not be asked to donate blood before your surgery. You also have the right
to refuse a blood transfusion after surgery. This decision may cause life-threatening problems
and should be discussed with your physician.
There are three types or sources of blood donations if recommended by your surgeon:

If you are asked to do so, The American Red Cross (ARC)/Hospital Blood Bank:
you may donate blood up to Blood from the Columbus area ARC is considered “low
40 days in advance of your risk” for any blood transmitted diseases. No cases of trans-
surgery. Blood should be fusion-transmitted AIDS in the Central Ohio Region have
donated as far ahead as possi- been reported since the initiation of testing in 1994.
ble. We respect patient rights
regarding blood transfusions, Autologous Donation: This is a process by which you
and encourage you to make donate your own blood to be used during surgery. Only
your choice regarding donor one unit of blood can be donated at a time. Should you
sources on a timetable that is choose to want this type of donation available, talk to your
compatible with your surgery physician who will need to make arrangements
date. with the American Red Cross.
Directed Donation: Check with your physician and your
Bring the transfusion services
donation center regarding their procedure. This type of
arm identiﬁcation band if you
donation comes directly from a family member or friend
received one prior to admis-
for your use. Blood samples must be taken from each
sion. Failure to do so will
prospective donor to insure blood type compatibility.
result in additional testing.

All donors must meet Red Cross guidelines prior to donating at your local Red Cross site.
It’s important to check with your donation center regarding their procedures.

10
FREQUENTLY ASKED QUESTIONS
1. What testing will I need before surgery?
All patients are required to have pre-admission testing (PAT) before surgery to assess if you are
medically ﬁt to tolerate the surgical procedure. This will be scheduled with General Medical
Consultants physicians or with your family physician. Pre-admission testing will include: blood
work, EKG, and chest x-ray. In some cases, other testing may be ordered. For example, if you
have a history of heart disease, a stress test may be ordered. PAT may also include a physical
therapy evaluation, education and/or the signing of consent forms. Your PAT will be scheduled
within the two weeks before your surgery date to allow for any additional testing that may be
needed. The pre-admission testing may take three to four hours. We recommend that you eat
before your PAT appointment, and may also want to pack a snack.

2. What about my daily medications before surgery?
At the time of your pre-admission testing, the doctor will review the medications you take rou-
tinely. You will be advised of any need to stop medications before surgery, such as anti-inﬂam-
matory pills. You will also be told which medications you may take the morning of the surgery.
Speciﬁc instructions will be given for blood thinning medications, and how far before surgery to
discontinue them.

3. How long will I be in the hospital?
For joint replacement surgery, the average length of stay is 1-2 days. Length of stay is deter-
mined by activity progress, medical progress, and wound condition. Insurance coverage is
usually not a problem. If additional hospital days are needed beyond what your insurance has
authorized, a case manager will contact your insurance company to request additional days.

4. What if I need extended care?
Your goal is to go home, as quickly and as safely as possible. However, for those who need it,
extended care facilities and rehabilitation units are an option to consider.

5. Will I have the opportunity to ask questions?
Questions and concerns will be addressed at the time of your visit with the surgeon. Other
opportunities include time of your pre-admission testing and when you sign your consents for
surgery.

11
“Before everything else, getting ready is the secret of success.”
- Henry Ford

A Positive Approach:

Preparing mentally for surgery is just as important for you and your family or support person as it is
for your surgeon and the rest of the medical team involved in your hip replacement procedure. Be-
cause of medical advancements, total joint replacement surgery is possible to relieve your pain and
discomfort and improve your activity level. It is important to remember that the pain and activity
limitations after surgery will be different than what you are experiencing now, and that they will be
short term. A signiﬁcant portion of the recovery process is using your new joint by walking and do-
ing the exercises that your doctor orders.

Depending on your condition, your recovery and exercise plan will be tailored to meet your needs.
Each patient recovers differently and joint replacement revisions often progress at a slower pace than
the initial surgery.

Your stay in the hospital will be short and your recovery will be continued after discharge in your
home, with family or at an extended care rehabilitation center. It is important for you to make a com-
mitment to follow your doctor’s instructions and work on your exercise plan after surgery in order
to beneﬁt most from the joint replacement. If you or your family need support, either physically or
emotionally, coping with surgery and recovery, please talk with the staff.

The improved life-style after recovery is worth the risk and stress of surgery!

The family’s role in your recovery
Your family and friends are very important in helping you during your recovery. They can help:

Stock up on canned and frozen or packaged food
Move food to cabinets between your waist and shoulder level, helping you avoid reaching and
bending
Prepare a room with all the needed supplies so that you can rest during the day
Remove rugs and other clutter for safe walking
Run errands, grocery shop, and drive you to follow-up doctor’s appointments
Arrange for needed equipment

12
Start your checklists to prepare for your hospital visit!
Infection...
To help prevent the occurrence of infection, a bath or shower is recommended the night before or
morning of surgery dependent upon your mobility. Do not apply lotion to the area where surgery is
to be performed and refrain from wearing perfumes the day of surgery. While either in the hospital
or at home, both pre-operatively and post-operatively, performing proper hand hygiene is essen-
tial. Remember to wash your hands before eating and after using the rest room. Also, if you have a
pet at home, wash your hands after petting your animal. Your defenses may be down after surgery
which is normal. Any step you can take to prevent infection is a step in the right direction.
Your physician’s ofﬁce will have provided you with this manual in advance of your surgery.
Please take time to read your manual, ask any questions, and make sure that you take care of
the things that need to be done several days or weeks ahead of your surgery date. Surgery is
your primary path toward getting yourself back to being the person you want to be -- so don’t
let any unnecessary delays stand in your way!
1. Make your decision regarding blood transfusions.
(Refer to pages 9-10.)
2. Prepare your home for your return. Taking care of a few items now will make less
work for your family while you are in the hospital. It will also make your discharge
smoother and your return home for recovery safer!
Make arrangements to have help. Ideally, someone should stay with you, especially at
night for the ﬁrst two weeks.
You won’t be driving until your doctor gives you the “okay.” Find someone who will
be able to help with groceries and errands, and drive you to your follow-up appointments.
Check to see if a local, smaller grocery store might deliver telephone orders. Be sensitive
to your family’s or close friend’s needs to take some personal time away from care giving
-- big hearts need extra time for their own rest!
Rearrange your most frequently used items. Store food, toiletries and other supplies at
a convenient level, somewhere between your waist and shoulder.
Stock up on easy to prepare foods such as canned, boxed and frozen foods.
If your bedroom is on the second ﬂoor, get creative! Your doctor may allow only one
trip up the stairs each day during your initial recovery. Sometimes, stairs are simply
“out” until your recovery reaches a certain point. Find a room or space on the ﬁrst ﬂoor
that you can call your own for a couple of weeks, and stock it with needed supplies so
that you can rest during the day.
Place a phone within easy reach.
Make sure that you have good lighting, and that the light switch is within easy reach.
13
“Fall-proof” your home!
Remove any throw rugs to avoid tripping.
Check the rooms for electrical cords, foot stools, or other small
objects that might be a safety hazard after surgery and reposition
those that could be potentially dangerous. Don’t forget small pets that
tend to get “under foot.”
Use a cart to move items around, and to keep them
within easy reach.
Use a cushion to raise the seat in a low chair.
Install a railing along the staircase!
Make a list of the adaptive equipment you might need during your
recovery. Insurance coverage varies. Knowing exactly what you need will
be helpful with the claims process. Be sure and ask your physician which
types of equipment you will need to use after surgery. Some insurance
plans require physician-authorization.
Say...that’s
Ask your insurance company for a listing of participating medical a great idea!
supply companies in your community. Having a company close by will
make it easier for you to obtain the equipment you need. Feel free to ask the medical staff
any questions you may have. One of our main concerns is to help you obtain the equip-
ment you need to enable a quick and healthy recovery.

Examples of equipment you might need include:
Dressing Stick

Reacher(s)

Long-handled
Raised toilet seat Walker shoe horn
Standard
Crutches Sock Aids
14
What should I bring As pleasant as we want your stay with us to be,
you won’t need to bring much in
to the hospital?
the way of luggage!

What to bring...
Eyeglasses or contact lenses with case
Knee-length light weight gowns, robes,
or nightshirts
Loose-ﬁtting shorts and T-shirts
Please leave at home... Dentures
Hearing aids, prostheses, ambulatory
aids, as applicable
Jewelry Your driver’s license and insurance card
Credit Cards A list of all medications you are current-
Large sums of money ly taking
(anything over $5.00) Your medications in their original con-
Keys tainer to the hospital to review and to
verify doses/strengths. Please designate a
family member to take these medications
home after veriﬁcation.

What else should I know?
• Do not eat, chew gum, suck on or eat mints, drink, or smoke after midnight the night
before your surgery unless instructed to do so by your physician.
• If diabetic, check with your primary care physician about how to adjust your diabe-
tes medication. Surgery usually lasts 1-2 hours for a single joint, and 2-3 hours for two
joints or a revision.
• During your surgery, your family will be free to visit our Founder’s Café or other desig-
nated areas. The surgeon will contact them either on their cell phone or a hospital as-
signed cell phone.
• All of the patient suites at the Mount Carmel New Albany Surgical Hospital are pri-
vate rooms with accommodations for one adult family member to spend the night.

15
Your hospital stay:
What to expect

from start... ...to ﬁnish

Before your surgery
Some of this information may have already been covered in material in earlier sections. This
summary, however, gives you a good idea of what the entire process looks like from an overall
standpoint. Your surgery will be scheduled in conjunction with your physician’s ofﬁce.
From that ofﬁce, you will be provided with preliminary education about your surgery and recov-
ery process.
You will be scheduled for special pre-admission testing (PAT). Your doctor’s ofﬁce will provide
you with the details as to where your pre-admission testing will take place, and at what time.
You will be given a surgery date by your physician’s ofﬁce.
You will be called with a surgery time during the late afternoon the day before surgery. Patients with
insulin dependent diabetes or latex allergies will be scheduled as early as possible on the surgery
schedule. Surgery usually lasts 1-2 hours for a single joint, and 2-3 hours for a revision. If a Mon-
day surgery, you will be called on Friday. You will be called the last business day before a holiday.
The day of your surgery
Please come through the doors at the main entrance of the main lobby and check in at the front
desk. Once you check in, you will be directed to registration where you will complete your
registration.
From registration you will leave your family and be admitted to the pre-op area where ﬁnal
preparations for your surgery will be made.
One family member can wait in our atrium area. Additional family members are welcome to
stay in our main lobby.
When you enter our institution, please let our pre-admission testing or registration team mem-
bers know of any special communication needs such as interpretive services or special hearing
or visual devices. All facilities at the Mount Carmel New Albany Surgical Hospital are acces-
sible to persons with disabilities.

16
Before your visit to the hospital, it is important to check with your surgeon about how to adjust
your diabetes medication (if applicable).
Do not eat, drink, or smoke after midnight the night before your surgery unless instructed to do
so by your physician.
Hospital chaplains are available to support you during your stay. Ask any member of your care
team to contact the chaplain on your behalf.

Anesthesia Options
Before Your Surgery, you will be visited by an anesthesia team member
in the preoperative waiting area. Your anesthesia team will consist of
a nurse anesthetist (a certiﬁed registered nurse anesthetist or CRNA)
and an anesthesiologist (a doctor with specialized training in the ﬁeld of
anesthesiology). One or both will be with you at all times during your
procedure. Your medical history will be reviewed and then the options,
beneﬁts and risks will be discussed with you. We will do our best to
answer any anesthesia related questions at that time.

What is Anesthesia?
Anesthesia is the loss of sensation, and usually consciousness, induced by the anesthesia
team, in order to prevent the feeling of pain during surgery. There are three major types
of anesthesia: general, regional, and sedation. These may be used individually or in
combination to provide the smoothest and safest possible anesthetic experience. The
anesthesiologist, the surgeon, and the patient will discuss how to best meet this need.

What is General What is Regional Anesthesia?
Anesthesia? Regional anesthesia involves the use of nerve blocks
General anesthesia is going to provide numbness for surgery and/or post-operative
into a deep unconsciousness pain control. After I.V. sedation, an injection of local
for surgery, so that the brain anesthetic is used to numb the nerves going to the part of
does not perceive pain. the body being treated. This can be used in conjunction
Typically, this is induced with either sedation or general anesthesia, to reduce the
using I.V. medications. If amount of medicine needed to keep a patient asleep.
necessary, a breathing tube
is placed so that anesthetic What is Sedation?
gas can be used to maintain Sedation is useful for less invasive surgeries. Sedative
this unconscious state. medication is given through an I.V. to produce a
Common side effects from “twilight” (relaxed and peaceful) sleep, which is
general anesthesia include: maintained throughout the surgery. Then, the surgeon
nausea, sore throat, and slow places local anesthetic into the area in which he/she is
awakening. working, so that area becomes numb.
17
In the Operating Room
Once your medical information has been completed, you will be taken to the Operating Room
(O.R.) on a patient cart. The O.R. team will greet you once you are in the O.R. and verify your
name and surgical procedure. Your pulse, blood pressure and oxygen level will be monitored
throughout surgery.

During your surgery
An intravenous line (I.V.) will be started in your arm before
surgery. Your operating room anesthesiologist will monitor
your breathing, heart rate and blood pressure throughout your
surgery. You will be given ﬂuids and medication through the
I.V. line.

Post-Anesthesia Care Unit (PACU)
After your surgery, your surgeon will contact your family or friends by personal cell phone or
a hospital assigned cell phone to discuss your procedure. You will be taken to the PACU (Post-
Anesthesia Care Unit), where nurses who are specially trained to care for individuals while they
are recovering from anesthesia will monitor your post-operative condition.

When you wake up in PACU, the nurse will tell you where you are and that your surgery is
over. You may experience some blurred vision, dry mouth, chills or nausea from the anesthe-
sia. You may also have a sore throat if a tube was placed in your windpipe during surgery. You
will experience some pain after your surgery. We will do all we can to control your pain. Your
nurse will be checking on you frequently to assess your condition. However, be sure to tell your
nurse if you are having pain or nausea. If so, medication is available to make you feel more
comfortable.

As you wake up, you will be aware of the nurse checking
your bandage and your blood pressure. You will be attached
to a heart monitor and an oxygen level monitor. It is normal
to hear these monitors “beep.”

You may also receive oxygen through a clear plastic tube in
your nose. Depending on the type of anesthesia you were
given and your reaction to it, you will stay in PACU for one
to three hours. No visitors are allowed in PACU.
18
The Facts About Pain Management
Pain and discomfort comes from many sources. Illness, injury and surgery are the three most
common sources of pain. The amount and intensity of pain that a person feels differs from one
person to another. No two people are exactly alike.

How will my pain be controlled?
During and immediately following your surgery, you will receive pain medication by I.V. or a
tube inserted into your back. As you begin to recover from your surgery, you will be switched
to oral pain medication.
What is the goal of pain control?
Simply stated: to make you as comfortable as possible. Some degree of pain is unavoidable.
Our goal will be to see that your stay in the hospital and throughout your recovery is as painless
as possible. While you are in the hospital, you will be receiving pain medication on a scheduled
basis to help control pain. It is important to tell your nurse if you are having pain. Don’t wait
until the pain is severe. The more severe the pain, the harder it is to control.

With this in mind, remember that we will try to reduce your pain without making you sleepy so
that you will be able to move, breathe deeply, and help to care for yourself. These activities will
help prevent complications and speed your recovery.

Important points:
• You will NOT be totally pain free.
• YOU are the expert on your pain.
• Please tell us when you hurt or are uncomfortable.
• Pain medication is usually taken regularly. Don’t try to be a “hero” and wait too long, or
skip a scheduled dose of pain medication in the day or two after surgery.
• Remember - the longer you wait to take pain medicine, the worse your pain will become,
thus taking longer to get under control.
• Tell us if your pain medication is not working or if you don’t like the way it makes you feel.
• It’s true - unrelieved pain robs your
energy and takes away important time
you could spend with your loved ones.
Your nurse will ask you to rate your
pain on a scale of 0-10, with 10
being the worst imaginable scale.
We cannot relieve all of your pain,
but we should be able to reduce it to
a level of ﬁve or less.

19
What else can I do to control my pain?
Don’t be afraid to try
Other activities that help control pain include: different things to ﬁnd
Listening to relaxation tapes
out what works best
Watching TV
Reading a book for you!
Changing positions
Having a massage

Your stay in the
Inpatient Nursing Unit
When you are released from the PACU, you will be taken to your hospital room.
We encourage family and friends to visit with patients. We believe that time with loved
ones is essential to healing. At the same time, people who are recovering from surgery
need to have plenty of rest and avoid stress; please be sensitive to these needs.
General visiting hours are from 10 A.M. to 8:30 P.M. Patients may have up to 3 visitors at
a time. Each patient is allowed to have one adult visitor stay overnight.
All of the patient suites at Mount Carmel New Albany Surgical Hospital are private rooms
with accommodations for one family member.

No Smoking No Smoking No Smoking No Smoking No Smoking No Smoking

EFFECTIVE JAN. 1ST, 2007, Mount Carmel New Albany Surgical Hospital
BECAME TOBACCO AND SMOKE FREE.

Smoking and the use of tobacco has been determined by the Surgeon General
to be causes of preventable disease as well as being implicated as the source of
hospital ﬁres. Therefore, in order to promote the health, well-being and safe-
ty of our patients and guests, smoking and tobacco use is prohibited anywhere
in the hospital or in the hospital campus. Should a patient insist on using
tobacco products, the patient’s physician will be notiﬁed.

Patients are encouraged to speak with their physician about alternatives to
smoking while being hospitalized. The Mount Carmel New Albany Surgical
Hospital supports patients in their efforts to abstain from smoking. Educa-
tional material promoting smoking cessation programs is available to patients
who use tobacco.

20
Diet
The day of surgery, your diet will start with ice chips. After that, we provide meals “at your
request.” All you need to do is pick up the phone and call our dietary department to order that
special meal at that special time.

If you do not participate in “at your request,” you will be called by our dietary department and
asked if you are feeling up to eating. You may even be tempted with a few suggestions from the
chef, or choose to make plans for a “late” lunch.

Patients may order guest trays from the menus in their rooms for family or friends for a nominal
fee. Orders are placed through room service, just as they are for patients.

Activities
Your physician will determine your activity orders. If you arrive on the inpatient unit before 3
p.m., physical therapy will get you up and moving the day of surgery. If you arrive on the inpa-
tient unit after 3 p.m., you will be getting out of bed the following morning. As your strength
and endurance improves, you will be able to get out of bed on your own and move around. In
the meantime, staff will be there to assist you with your needs at all times during the recovery
process. Just press your call button for help!

Medication
Your medication will be ordered for you by your physician and provided to you by the hospital.
Occasionally, because of a difference in the manufacturing company, the medication will not
look like the one that you take at home. Please ask your nurse if you have any questions about
your medication.

Constipation
Narcotics may cause constipation. You are already prone to constipation because of surgery and
lack of exercise. The nurses will monitor your bowel activity and work to get your bowels regu-
lated after surgery. Contact your physician if this persists.

I.V. (intravenous) ﬂuids and medications
You will get I.V. ﬂuid and medications until you are eating and drinking ﬂuids well.
You will also receive antibiotics to prevent infection.

21
Breathing exercises and/or incentive spirometry
Your doctor will order breathing exercises after surgery. It is important for you to breathe deep-
ly to help keep your lungs clear and avoid complications, such as pneumonia. Bed rest, drowsi-
ness, anesthesia and pain often keep you from taking normal deep breaths.

The incentive spirometer is a device to help you take deep breaths. To use the incentive spirom-
eter:

Just after you exhale normally, put your lips tightly around the mouthpiece.

Breathe in as deeply as you can. The meter will rise.

When you feel that you’ve taken a full breath, keep trying to breathe in more and more
for about two seconds.

Repeat this deep breath action 10 to 15 times each hour while you are awake. You can
see how much air you have taken in by reading the number on the meter. Your breathing
technique will improve as you are more awake, have less pain, and move around more. If
you have trouble using the spirometer on your own, please ask your nurse for help.

Rest
You may get drowsy the ﬁrst day. It is important to get plenty of rest. The pain medication will
help you relax and ease your pain so that you can sleep.

Equipment
When you arrive in your room after surgery, an over-the-bed frame will be on your bed with a
bar hanging down to help you move. The staff will show you how to use this equipment when
we begin advancing your activity.

You may have other equipment in your room, such as:
A Foley catheter to drain urine from your bladder
An IV (intravenous) pole
Other equipment needed to monitor your progress

Somebody’s waiting to
Discharge see you!
On the day of your discharge, please have your family or person who is picking you up arrive by
10 a.m. and report to the inpatient unit.

22
For Family and Friends
Welcome to Mount Carmel New Albany Surgical Hospital!

Family and friends are an integral part of the caring cycle, before, during and after the patient’s
procedure. At our hospital, we are committed to providing the best care for both you and your
loved one. As noted in the ﬁrst section of this manual, your family’s speciﬁc care team is made
up of many dedicated individuals who will be working with you to make your stay at our hospi-
tal and your return home for the patient’s recuperative period a successful experience. As fam-
ily, you are some of the most important members of the care-giving team!

On page 4 is a list of area hotels and contact information. Remember, however, that all of our
patient rooms feature personal touches designed to accommodate a comfortable night’s stay for
one adult family member.

Other features for your convenience are our:

Founder’s Café
We encourage you to visit our 1,500 square foot Founder’s Café, located off of the Front Lobby.
The café offers a variety of nutritional foods, including wellness entrees and salad recipes which
were developed by regional and national chefs and dieticians. Guest trays are available for pur-
chase.

Hours of operation:
Monday - Friday: 6:00 a.m. - 7:00 p.m.
Saturday: 6:30 a.m. - 1:30 p.m.
Sunday: Closed

A vending area with an ATM and change machine is located on the main ﬂoor across from the
elevators.

During Surgery

Remember that during or after surgery, the surgeon will contact family or friends by cell
phone, either their own or one that is provided by the hospital. Make sure you have one of
these available to you during the surgical procedure.

23
Going Home after Hip Replacement
Discharge Instructions
You will be given written discharge instructions and prescriptions for any medications needed
after discharge. We will go over these instructions with you. If there is any information that
you do not understand, please ask the staff before you leave.

Recovery
The past few weeks you have prepared for surgery, waited to enter the hospital, undergone
surgery, learned to walk with your new joint, and made plans for going home. You are stable
enough to be discharged from the hospital. For the next six to eight weeks, you will continue to
heal and recover from surgery. You should balance periods of activity with periods of rest. Do
not try to overdo or push yourself to the point of pain or exhaustion.

Medication
Resume medications that you were taking before surgery unless instructed otherwise by your
doctor. You will be given a prescription for pain medication. *Please read “Concerns about
addiction,” page 34.

As your pain decreases, you may take Tylenol®.Your doctor may prescribe medication to pre-
vent blood clots from forming, such as aspirin or Warfarin® (Coumadin®). If you are on Warfa-
rin®, it is important to closely follow instructions that your nurse or doctor gives to you.

24
Activity
Follow the activity guidelines and exercises as instructed by your doctor or
physical therapist.

Hip precautions

x Do not cross your legs
x Do not bend your hip to more than a 90o angle
x Do not lean forward more than 90o (such as
reaching to your feet for covers, or picking up
an object on the ﬂoor)
x Keep legs 6-10 inches apart
x Use an elevated toilet seat
x Use a cushion for all low chairs
*Refer to your “Daily activities guide” in the back pocket
of your manual for detailed illustrations.

Walking
• Use your walker or crutches for each step when walking. Progress to use of cane when
directed by your therapist or physician. You may feel you can walk without an aid but
the bones take six to eight weeks to heal.
• Walk daily for increasing distances, allowing for rests between activities.

Sitting
• Do not sit longer than 30 minutes at a time. Get up, walk, and change positions.
• On long car trips, stop at 30 minute intervals. Get out and move around. With lack of
movement, your hip may become stiff, swollen, and you are more prone to blood clots.
• Use a pillow or chair cushion on all low chairs.
• Use a raised toilet seat.
• Do not rest in recliners. The reclining position does not aide circulation or help reduce
swelling.

Stairs
If you need to use stairs, we recommend making only one trip up and down each day. Be careful
and hold onto the railing or another person for support when using the stairs.

25
Sports
Do not participate in sports during the ﬁrst three months after your surgery.
Do not use exercise equipment, whirlpools or spas until your doctor tells you it is okay.
Please talk with your doctor about the type of sports you like to do. You may eventually
resume some sports that do not put your hip at risk, such as golﬁng, swimming,
bicycling and dancing.

Sleeping
Avoid sleeping on your side until your doctor okays it.
If (when) you sleep on your side, sleep on your non-operative side, placing a pillow between
your knees to keep your operative side from crossing midline.

Driving
Do not drive until your doctor tells you it is okay.

26
Care of your wound
If your wound was closed with staples, arrangements will be made to remove the staples that
hold your incision together.
Wash your incision gently with a liquid antibacterial soap and water and pat it dry.
You may shower
Do not take a bath.
Do not use lotions powders or oils etc... on your incision until your doctor okays it.

Signs of infection
Each day with your sponge bath/shower, look at your incision for the
following signs:

*Redness
If you notice any of these signs,
*Swelling
call your doctor immediately.
*Drainage

Sexual activity
After hip surgery, many people are worried about resuming sexual ac-
tivity.
Resuming sexual activities
It is generally safe to resume sexual activity 6-8 weeks after hip replacement surgery as long as
you are not having signiﬁcant pain or stiffness in your hip joint.
Effect of hip replacement on sexual relations
In reality, the pain and stiffness associated with your bad hip before surgery probably already
interfered with intercourse. Since your surgery will help decrease most of that discomfort, you
may now be more comfortable during sexual activity.
Safe positions and precautions
There are certain guidelines to follow: Talk with your partner.
Be aware of hip precautions,
Do not bend at the hip more than 90° and follow them at all times.
Do not move the leg toward the midline
Do not rotate the leg inward
Do not do a combination of the above activities

Being on the “bottom position” initially is safer and more comfortable. You will be able to take
a more active role in sexual activity as your hip heals. Generally, several months after your sur-
gery, you may try any comfortable position.
27
Antibiotics
An infection in another part of your body (sinus, mouth, lungs, urinary tract, bowel, skin) could
possibly spread to your new joint. Contact your family doctor and orthopaedic surgeon with
any type of infection. To protect your joint you may need to take antibiotics before certain pro-
cedures, such as dental care or a surgical procedure.
Please share our antibiotic recommendations (pages 32-33) with your dentist and other
healthcare providers before you have any dental or surgical procedure.

Swelling
Swelling (also called edema) is common after surgery. Swelling may or may not occur in the
hospital or after you are home and more active. The most common areas for swelling are the
foot, ankle, knee, and at times, the thigh. To decrease swelling, lie with your operative leg el-
evated so that your foot is higher than your heart. This can be done during your rest periods for
at least 45 minutes, 2-3 times during the day. Also, place a cold pack on the affected area for 20
to 30 minutes. If swelling does not decrease during the night, call your doctor.
For more information, please read "Managing Swelling of the Leg,” pages 30 & 31.

Compression stocking (if ordered) and foot pumps
Foot pumps will be ordered for you after your surgery and must be on at all times while you are
in bed.

Follow-up
If staples were used to close your incision, an appointment for staple removal will be made for
you prior to discharge. You will need to contact your surgeon’s ofﬁce to schedule a six-week
follow-up appointment.
Continue using your medical equipment and doing your exercises until
your doctor evaluates you and gives you new instructions.

Call your doctor
if you have:

• Increased redness, bleeding, pain, or swelling on or around your incision
• Fever over 101° or as speciﬁed by your doctor
• Change in color or amount of drainage
• Separation along the edge of the incision
• Shortness of breath and/or chest pain, seek immediate attention at an emergency room
• Any other questions or concerns

28
Remember, until your six-week ofﬁce visit,
follow guidelines to protect your new hip.

1. 2.

Limit sitting to 30-45
minutes at a time. Use your walker
or crutches.

3. 4.
Watch for signs
of infection and
swelling.

RECONSTRUCTION
ZONE!

We recommend limiting stairs to one Follow your hip precautions
ﬂight up and down per day.

5. Use your adaptive 6. Do not bend your hip to more than a
equipment and do your 90° angle.
exercises to regain Do not lean forward more than 90° (such as
strength and function! when reaching your feet/covers, or picking
up an object on the ﬂoor). Keep your
legs 6-10 inches apart.
Do not turn your operated leg in or out.
Do not cross your legs.

29
Managing Swelling of the Leg
Leg swelling is common following total joint replacement surgery. Excessive swelling may
interfere with your recovery by prolonging pain symptoms and could lead to more serious com-
plications, including blood clots. By understanding the dynamics of leg swelling and the steps
that can be taken to reduce it, you can address and minimize post-operative leg swelling.

There are a number of factors that inﬂuence swelling after surgery. Swelling can be reduced by
positioning, regular use of cold packs, by performance of systematic muscle contraction and by
wearing thigh-high compression stockings.

Positioning: During the ﬁrst few days after total joint surgery, your activity level is decreased,
thus, activity related muscle contractions are helping pump blood away from the legs and back
toward the body.

Let gravity be your friend! Gravity can help “drain” the blood toward the heart and remove
excess ﬂuid. You should not sit or stand for prolonged periods of time with your legs hanging
down, as this position will create pooling of blood in the legs and will increase swelling. It is
recommended that you change position (from sitting to standing/walking) every 30 minutes dur-
ing the day throughout the ﬁrst few weeks after surgery.

Lie on your back several times during the day with
your legs elevated higher than your heart for at least 45
minutes. Place 2-3 pillows under the involved ankle
and calf to support your leg.

Correct!
Do not sit in a chair with the leg elevated on a stool or
on a recliner leg-rest. In this position, the heart is still
higher than the leg, the ﬂuid level cannot be effectively
reduced and gravity drainage cannot occur.

Please do not use any footstools or
reclining chairs for 6 weeks after surgery.

Wrong!
The heart must be
lower than the leg!

30
Cold packs: Both inﬂammation and pain are natural body healing responses following joint
surgery. Cold packs are effective in reducing both. Use cold packs often; up to 30 minutes per
hour is acceptable. Cold packs may also be applied after exercise.

Systematic muscle contraction: Muscle contractions decrease swelling mechanically through
a pumping action. After surgery you may be walking less and generally are not as active as
normal, resulting in your leg muscles not contracting quite as often. Try walking often during
the day to activate these muscles. You should also perform circulation exercises such as: ankle
pumps, quad sets, gluteal sets which you learned during your pre-admission physical therapy
session. (See page 9 of your PT manual for instructions of these exercises.) It is recommended
that you perform circulation exercises hourly, while awake, for several weeks following surgery.
These simple exercises will complement the cold packs and elevation, thereby also effectively
reducing swelling.

Compression stockings: These long white thigh-high stockings are part of your defense
against blood clots because they support circulation and help decrease joint swelling after total
hip surgery. They should be put on ﬁrst thing in the morning and removed at bedtime. Com-
pression stockings should not be worn at night. Check regularly for any signs of pressure sores
on your toes and heels especially if you are diabetic. Generally, you will wear support stock-
ings for 2-3 weeks. The degree and duration of swelling will inﬂuence the need for prolonged
use of support hose.

Tips to Remember:

• Prolonged leg swelling can lead to problems
• You can modify and/or control leg swelling after surgery
• Gravity drains the blood toward the heart to remove excess ﬂuid
• Change positions frequently during the day
• Cold packs reduce pain and swelling
• Perform circulation exercises hourly and walk frequently
• Wear compression stockings during the day and remove them at bedtime
• Do not lay back in the recliner

31
If you are having certain dental or surgical procedures
after your joint replacement...you will need
to take certain precautions.
Antibiotic therapy is recommended if you are having surgery or dental
work in the future. Please share the following recommendations with your
dentist or other healthcare provider.

Type of procedure
Dental/oral (including extraction, root canals and drilling, etc.)

Amoxicillin 2 grams 1 hour before the procedure and 1.5 grams 6 hours after the procedure.
If allergic to Penicillin give: Erythromycin 1 gram 1 hour before the procedure and 500 mg.
6 hours after the procedure.
For extractions, we prefer that you wait until 6 weeks after surgery.
*If high risk patient (prosthetic valve or surgical shunt):
Ampicillin 2 grams IV and Gentamicin 80 mg. IV 30 minutes before the procedure.
Repeat in 8 hours.
If allergic to Penicillin give: Vancomycin 1 gram IVPB 1 hour before the procedure
with no repeat dosing.

Upper respiratory (including bronchoscopy and upper endoscopy)

Amoxicillin 2 grams 1 hour before the procedure and 1.5 grams 6 hours after the procedure.
If allergic to Penicillin give: Erythromycin 1 gram 1 hour before the procedure and 500 mg.
6 hours after the procedure.
*If high risk patient (prosthetic valve or surgical shunt):
Ampicillin 2 grams IV and Gentamicin 80 mg. IV 30 minutes before the procedure. Repeat in
8 hours.
If allergic to Penicillin give: Vancomycin 1 gram IVPB 1 hour before the procedure with no
repeat dosing.

PLEASE SEE NEXT PAGE

32
Gastrointestinal and genitourinary tract surgery /procedures
(cystoscopy, TURP)

Ampicillin 2 grams po or 2 grams Amoxicillin po 30-60 minutes before starting the procedure
in non-PCN-allergic patients.
If unable to take oral medication, give: Ampicillin 2 grams IV/IM within 30 minutes before the
procedure.
If allergic to Penicillin, give: Clindamycin 600mg. po 1 hour before the procedure.
If allergic to Penicillin and unable to take orally, give: Clindamycin 600mg. IV within 30 min-
utes before the procedure.
Urinary tract infection - Prophylactic antimicrobial coverage needs to be individualized ac-
cording to microorganism.

Procedures requiring skin penetration (cardiac catheterization,
angiogram, podiatric surgery)

Ancef 1 gram IV 1 hour before the procedure.
If allergic to Penicillin give:
Cleocin 600 mg. IV before the procedure, or,
Cleocin orally 300 mg. before and 150 mg. 6 hours after the procedure.

Cataracts, pap smears, cervical biopsies

We do not advise antibiotic prophylaxis for cataracts,
pap smears or cervical biopsies.

This information is very important.
Please keep these sheets in a convenient
place for future reference.

33
Concerns about addiction
You are taking narcotics because you hurt.

When your pain from surgery decreases, your need for the pain medicine will decrease. The
fears you or your family may have about addiction could:

Prevent you from taking pain medicine

Result in you “holding off” as much as possible between doses

Result in taking lower doses of pain medicine when you still hurt

All of these result in needless suffering. Talk to the staff if you have concerns or fears about
pain medication, a history of drug abuse, sensitivity to pain medication, or low tolerance to pain.

Facts about addiction
Addiction rarely happens in patients taking pain medicine to relieve post-operative pain
(less than 1% of patients).

Most people are able to reduce or stop pain medicine when the pain decreases or disap-
pears.

Taking pain medicine at home
• You will be given a prescription for pain medication.

• To avoid needing prescriptions for pain medications during the weekends, evenings or
holidays, plan ahead if you are getting low on pain medication.

• By the 6th week, most patients can take Tylenol® for occasional pain. If you are still hav-
ing a lot of pain at this time it is important to see your doctor.

34
Financial Responsibilities
As a patient of Mount Carmel New Albany Surgical Hospital, we would like for you to
know exactly what to expect, ﬁnancially speaking, throughout your care process. Our
Registration Representatives will look carefully at the details of your upcoming proce-
dure and your medical insurance coverage. It is your responsibility to be aware of your
deductible, co-insurance and out-of-pocket expenses. If you have any questions, please
be sure to ask the Admissions representative at the time of admission.

When you arrive on the day of your scheduled surgery, you will go to the Information
Desk. You will then be directed to Patient Registration. At that time, a Mount Carmel
New Albany Surgical Hospital team member will verify your insurance coverage and
discuss any other ﬁnancial issues in order to clarify all aspects of your ﬁnancial responsi-
bilities as a patient.

Understanding Your Bill
The philosophy of Mount Carmel New Albany Surgical Hospital is founded upon being
not only a team of hard working, skilled professionals, but also compassionate healthcare
providers. As such, we value the importance of each individual’s circumstance and will
make every effort to help each patient understand the billing process.

After your surgery and once your claim has been processed by your insurance carrier,
you will receive a letter from our Billing Ofﬁce explaining your ﬁnancial responsibilities
for services rendered by Mount Carmel New Albany Surgical Hospital. If at any time
you have a question about your bill, please do not hesitate to call our Billing Ofﬁce at
614.546.3300, and we will be happy to explain your bill in detail.

Please be aware that Anesthesia, Don Joy and CPM companies are billed separately. De-
pending on your insurance plan, you may have a ﬁnancial responsibility for the anesthesia
services provided. Should you have any questions regarding your anesthesia bill speciﬁ-
cally, please call our Anesthesia Billing Ofﬁce at 614.761.1255, ext. 136 or 140.

35
Understanding Patient Rights

Many people today are worried about the medical care they would be given should they become
terminally ill and unable to communicate. They may not want to spend months or years depen-
dent on life-support machines, or they may want every measure taken to sustain their life.

You Have A Choice
A growing number of people are taking action before they become seriously ill. You may now
state your healthcare preferences in writing, while you are still healthy and able to make such
decisions.

Under federal law, this healthcare organization is required to provide you, the patient, an explana-
tion of your rights under Ohio law to make personal decisions regarding your medical care. We
are also required to ask whether or not you have written down your wishes.

These pages explain your options concerning the right to accept or refuse certain medical treat-
ment, and how you may make your wishes known about the care you want when you are unable
to decide for yourself. Information contained in this document is not legal advice, but merely
serves as general and useful information designed to help you understand your rights under the
law.

What are my rights regarding medical treatment decisions?
You have the right to make your own medical treatment decisions. If you do not want certain
treatments, you have the right to tell your doctor that you do not want them.

Most patients can express their wishes to their doctor, but some who are seriously injured or
unconscious cannot. However, you have the right to make your wishes known before such a
situation occurs.

What if I’m too sick to decide or unable to communicate my wishes?
Sometimes people can’t tell their doctor about the kind of care they want because they become
too sick and are unable to communicate. Under Ohio law, you have the right to ﬁll out a form,
while you’re still able, that tells your doctors what you want done if you are unable to commu-
nicate your wishes.

36
Understanding Patient Rights (continued)
What kinds of forms are available?
Under Ohio law, there are two forms you can use to make your wishes known.

1. Living Will
This form allows you to give advance written directions regarding the use of "life-sustaining
treatment" when you are terminally ill and unable to communicate or in a permanently uncon-
scious state.

These documents are also referred to as advance directives because they are signed in "ad-
vance" to let your doctor and others know your wishes concerning medical treatment.

2. Durable Power of Attorney for Healthcare
This form allows you to appoint someone to make healthcare decisions for you, if you are un-
able to make decisions for yourself.

Do I have to ﬁll out these forms before I get medical care?
No. No person or healthcare provider can require you to ﬁll out either of these forms. Complet-
ing one or both of these forms is a voluntary action on your part. However, if you decide that
you would like to have either or both of these advance directives, it is recommended that you
execute them prior to receiving medical care if possible.

Who can ﬁll out these forms?
Anyone at least 18 years old who can make their own decisions can ﬁll out these forms.

Do I need a lawyer?
No, you don’t need a lawyer to ﬁll them out. You may choose to discuss these matters with an
attorney, but there is no requirement to do so.

Do my healthcare providers have to follow my instructions?
Yes, if your advance directives comply with state law. However, Ohio law includes a conscience
clause in case your healthcare provider is unable to follow your directions because they are in
conﬂict with the caregiver’s conscience. In this case, you can be transferred to another health-
care provider that will comply with your instructions.

37
Durable Power of Attorney for Health Care
When does my Durable Power of Attorney take effect?
This document becomes operative only when you are unable to make your own decisions about
your treatment.
Who should I choose to make all my healthcare decisions for me when I am unable to? You
can choose any adult relative or friend you trust to speak for you when you’re unable to make
your own decisions. Be sure to talk with that person about what you want. Then write down
what you want or don’t want on your Durable Power-of-Attorney for Healthcare form. You
should also talk to your doctor about what you want.

Living Will
What is the basic difference between a Durable Power of Attorney for healthcare and a Living
Will?
Your Living Will is your set of written instructions regarding the use of “life-sustaining treat-
ment” when you become permanently unconscious or terminally ill and are unable to communi-
cate your wishes.
Your Durable Power of Attorney allows you to choose a person to make your healthcare treat-
ment decisions for you when you are unable to do so yourself.
If I have a Durable Power of Attorney, do I need a Living Will also?
Many people have both documents because they address different aspects of their medical care.
A Living Will gives your instructions directly to your doctors and applies only when you are
unable to make informed decisions regarding life-sustaining treatment, and you are permanently
unconscious or terminally ill.
A Durable Power of Attorney for healthcare appoints another person of your choice to make
healthcare decisions for you when you cannot make your own decisions.
How does a Living Will work?
It becomes operative only when you are permanently unconscious or terminally ill and unable
to communicate. It spells out to what extent you want life-support technology used to prolong
your life.
It requires your caregivers to follow instructions regarding the medical treatment you want un-
der these conditions.

38
Understanding Patient Rights (continued)

A Patient Without a Durable Power of Attorney or a Living Will
If I don’t have a Living Will or Power of Attorney, who will make my healthcare decisions
when I’m terminally ill and unable to communicate or in a permanently unconscious state?

Ohio law now recognizes an Order of Decision Makers when you are no longer able to make
healthcare decisions for yourself. This Order of Decisions Makers is very similar to the current
legally recognized next-of-kin priority order.

The law allows next-of-kin:

To make all your healthcare decisions if you are terminally ill and unable to communicate.

To make decisions for the withdrawal of life support if you are in a permanently unconscious
state only after a 12-month waiting period. However, this decision does not include the with-
drawal of artiﬁcially supplied nutrition and hydration (food and water) – except as explained
below.

Other Matters to Consider
What about withholding artiﬁcially supplied food and water?
Whether you can authorize the withholding of artiﬁcially supplied food and water (internal
feeding and ﬂuid tubes) depends on your medical condition.

If you are terminally ill and unable to communicate, and if your Living Will or Power of At-
torney simply states that you don’t want life-support technology used to prolong your life, then
artiﬁcially supplied food and water can be withheld.

If you are in a permanently unconscious state, artiﬁcially supplied food and water may be with-
held only if you have written speciﬁc instructions about artiﬁcially supplied food and water in
your living will.

If you don’t want to have either of these forms, Ohio law allows your next-of-kin to authorize
the withholding of artiﬁcially supplied food and water when you are terminally ill and unable to
communicate. If you are in a permanently unconscious state, your next-of-kin can make these
decisions for you only after a 12-month waiting period and approval from a probate court.

39
Understanding Patient Rights... (continued)

By ﬁlling out these forms, am I participating in euthanasia or assisted suicide?
No, Ohio law does not allow or condone euthanasia or assisted suicide.

Can I make changes to the forms?
Yes, at any time. In fact, if you already have a Durable Power of Attorney, it may be recognized
under state law if the document is substantially in compliance with Ohio’s new law which took
effect October 10, 1991.

It is a good idea to periodically review your forms to be sure they still reﬂect your views. In ad-
dition, old forms may not cover speciﬁc areas.

Where do I get a Living Will and Durable Power of Attorney forms?
If you’re interested in getting copies of these forms, ask your healthcare provider. Many hospi-
tals and other healthcare provider organizations will make these forms available upon request.

What do I do with my forms after ﬁlling them out?
You should give copies to your doctor and healthcare facility to put into your medical record.
Be sure to tell your family or friends (persons close to you) about what you have done and
consider giving them a copy as well. Do not simply put these documents in a “safe” place and
forget about them.

40
Understanding Patient Responsibilities
These responsibilities apply to patients, family members, signiﬁcant others and/or decision-
makers when they are acting for the patient.

You have the responsibility:
To answer questions about your past illnesses, hospital stays, medicines and other health matters
when asked by a doctor or staff member.

To cooperate with doctors and staff during your hospital stay.

For seeking clariﬁcation when necessary to fully understand your health problems and proposed
plan of action.

For making known to their physicians, caregiver, and Mount Carmel New Albany Surgical Hos-
pital, any advance directives or religious/cultural beliefs to be honored if/when they are unable
to speak for themselves.

For following the treatment plan as ordered by the physician responsible for care. The conse-
quences of non-compliance or refusal of recommended treatment and instruction rests with
them.

For following rules and regulations affecting patient care, conﬁdentiality, conduct and safety.

For reporting any perceived safety issue to any staff member.

For being considerate of the rights of others.

For providing information for insurance claims and for working with our business ofﬁce
to make payment arrangements when necessary.

41
Understanding Patient Privacy

The healthcare providers at Mount Carmel New Albany Surgical Hospital work together to
provide the best care for their patients. As allowed by law, and only if needed, information is
shared to provide the best treatment, arrange for payment, and improve how we provide care
in the future.

You may receive this notice in advance of a hospital visit, or you may receive it at the visit
location upon arrival. On the consent for treatment form for this visit, you will be asked to
acknowledge receipt of the Notice of Privacy Practice.

We have a legal duty to protect your health information.

By law, we must keep your medical information private, and tell you that we are doing so. This
includes your past, present, or future health information (your condition, care provided to you,
or payment). We must follow the terms of this notice. If they change, we will change the notice
so you will be aware of the changes. You can get a copy of any revised notice by contacting the
Mount Carmel NASH HIPAA Privacy Ofﬁcer; contact information is listed in Section 5 of this
notice.

We may use and disclose (share) your health information.
We may use and share your medical information for your treatment or care. For example: Doc-
tors, nurses, hospital chaplains and other staff involved in your care will use information in your
chart (medical record), so that we can provide you with the best care.

We may share your medical information with the physical therapy staff, so they can help plan
your activity.

We may also share your medical information with another healthcare facility or professional,
not associated with us, but who will be providing treatment or care to you. A speciﬁc example,
if you leave this healthcare facility to receive home healthcare, we may share your medical
information with that home healthcare agency so that your treatment and care plan can be pre-
pared for you.

42
Understanding Patient Privacy (continued)
For Payment of Your Treatment
We may use and share your medical information if needed for payment purposes.
For example:
We may share information about your tests and care with your insurance company to arrange
payment for services provided to you.

We may use your medical information to prepare a bill to send to you or to the person respon-
sible for your payment.

We may share your medical information with our business partners that help us with things like
billing. These businesses MUST protect the privacy of your information.

For payment purposes, we may share your medical information with other healthcare profes-
sionals who have treated you or provided services to you, such as ambulance or laboratory
services.

For Healthcare Operations
We may use and share your medical information, as necessary and permitted by law, to help im-
prove care and operate the hospital (such as improving clinical care, staff evaluations, managing
our business, auditing, legal services, accreditation and licensing).

For example:
We may share your medical information to evaluate the care our staff provides.

We may need to share your medical information with our business partners that help us with our
healthcare operations. These businesses MUST protect the privacy of your information.

We may also share your medical information with other healthcare professionals, facilities and
health plans to help them improve their care and operations, but only if they also have a patient
relationship with you.

For Fund Raising
We may use medical information to raise funds for our hospital. Money raised is used to im-
prove and support healthcare and educational programs that we provide to the community. We
may contact you to donate to a fund raising effort. You have the right to “opt-out” so that you
do not get fund raising information. You can opt-out by sending your name and address to this
facility’s foundation, with a statement that you do not wish to receive fund raising information
or communications.
43
Understanding Patient Privacy (continued)
For Appointment Reminders and Health-Related Beneﬁts or Services
We may use your medical information to send appointment reminders and test results.

For Health Products and Services
We may use your medical information to let you know about our health products and services,
those necessary for your care, to tell you of new products and services we offer and to give you
general health and wellness information.

For Worker’s Compensation
We may share your medical information with Worker’s Compensation or similar programs
which provide beneﬁts for work-related injuries or illness.

When Services are Requested by Your Employer
We may share your medical information with your employer when we have provided care to
you at the request of your employer. In most cases, you will get a notice that information has
been sent to your employer.

For Some Government Functions
We may share your medical information:
If you are a veteran or in the military and your information is requested by military command
authorities.
For National security or intelligence activities, such as protecting the President of the United
States, or:

To Avoid Harm
We may share your medical information with law enforcement or safety staff in order to avoid a
serious threat to the health or safety of one person or the public.

For Research
We may share your medical information for research when it is approved by our institutional
review board with special rules to ensure privacy.

For Purposes of Organ Donation
If you are an organ donor or are in need of an organ transplant, we may release medical infor-
mation to organizations that handle organ procurement or transplantation or to an organ dona-
tion bank, as necessary to facilitate organ or tissue donation and transplantation.
44
Understanding Patient Privacy (continued)
For Health Oversight Activities
By law, we must share your medical information, as needed to a government agency doing au-
dits, investigations, and civil or criminal proceedings.

For example: We will share information to help the government when it investigates a health
care provider or organization.

For Public Health Activities
We may share your medical information for public health activities, such as the prevention or
control of disease or injury, and reporting of births, deaths, child abuse or neglect and reactions
to medications or problems with products. For deceased patients, by law and only if needed, we
must share your health information with coroners and funeral directors.

For example, this may be necessary to determine the cause of death.
For Legal Cases or Law Enforcement (at the Federal, State, and Local Levels of Govern-
ment)
We may share your medical information as needed:

To report injuries and crimes.

If we believe you are a victim of abuse, neglect, or domestic violence.

To the Food and Drug Administration to report medicine adverse reactions, product defects, or
product recalls.

Under court order, administrative order and certain subpoenas.

Ohio law requires that we obtain your permission in many instances before disclosing informa-
tion about:

Performance or results of an HIV test or diagnoses of AIDS or an AIDS-related condition.

Drug or alcohol treatment you have received in a drug or alcohol treatment program.
You have the chance to object (“opt-out”) to the following uses and disclosures
This information is only shared with people (visitors/callers) who ask for you by name or by
clergy (not employed by this facility) who ask for patients by religious afﬁliation. You have the
right to have your information excluded from the facility directory.

45
Understanding Patient Privacy (continued)
Family and friends helping in your care
With your approval, we may share your medical information with your family, friends, or other
caregivers that help with your care or payment of your care. We may give health information to
an agency that is helping in disaster relief efforts so that they may ﬁnd your family or caregiver.

All other uses and disclosures need your prior written authorization
In any situation not mentioned in sections 2 or 3, we will ask for your approval. If you sign an
authorization form, you can later cancel that authorization (in writing) to stop any future uses.

Your rights regarding your health information
The right to access your own health information
You have the right to copy and look at most of your medical information that we keep on your
behalf.

All requests to copy and look at your health information must be made in writing and be signed
by you or your legal representative. You may get an access request form from this facility’s
Medical Records department. If there is a cost, we will tell you in advance. We may charge you
for copying the health information, postage (if mailed) and/or for a summary or explanation of
the health information.
The right to change your health information
If you think there is a mistake in your medical information or that information needs to be add-
ed, you can request that we amend (change) your health information.

You must make a written request and state your reason for amending your health information.
Contact this facility’s Medical Records department for an amendment form.

If we approve your request, we will place the amendment form in your medical record, tell you
that we have done it, and tell others that need to know about the change.

We may deny your request if it is not in writing or if the existing health information is correct or
complete, or was not created by us. If your request is denied, we will tell you in writing, with
the reason(s) for the denial.

46
Understanding Patient Privacy (continued)
The Right to a Listing of Certain Disclosures of Your Health Information
You have the right to get a list of when we shared your medical information and to whom.

The list will include:

The date and to whom (with the address, if known) health information was disclosed.

The reason and type of health information shared.

This list will not include disclosures:

That you have already authorized in writing.

Made for treatment, payment healthcare operations, or directly to you, to your family, or in our
facility directory.

For national security purposes.

For corrections, or law enforcement staff.

Before April 14, 2003:

Written requests must be signed by you or your legal representative. Contact this facility’s
Medical Records department for an accounting request form. The ﬁrst list in any 12-month pe-
riod is free. You may be charged for each extra list you request in the same 12-month period.
The Right to Ask for Limits on Using and Sharing Your Health Information
You have the right to ask that we limit the uses and disclosures of your medical information that
we are allowed to do by law, such as for treatment, payment or health care operations.

We are not obligated to agree to your request, but we will try to abide by your request.

We have the right to end an agreed-to-limitation if we believe that ending it is needed or that the
limit will be hard to complete. You will be informed of our decision to end an agreed upon limi-
tation.

You can end an agreed-to limitation by sending a written termination notice (signed by you or
your legal representative) to Mount Carmel New Albany Surgical Hospital’s Registration de-
partment.

47
Understanding Patient Privacy (continued)
The Right to Choose How We Send Health Information to You

You have the right to ask that we send information on you to a different address or in a different
method (e.g. via phone, fax). We must agree to your request as long as it is reasonable.

How to Complain About Our Privacy Practices

If you feel your privacy rights have been violated, or you disagree with a decision we made
about access to your health information, you may ﬁle a complaint in writing or by calling the
Mount Carmel New Albany Surgical Hospital Privacy Ofﬁcer.

7333 Smith’s Mill Road New Albany, Ohio 43054 (614.775.6630)

As a patient, you have the right to get a paper copy of this Notice of Privacy Practices, even if
you have asked for a copy by e-mail or other means.

Acknowledgment of Receipt of Notice

You will be asked to acknowledge receipt of this Notice of Privacy Practice on Mount Carmel
New Albany Surgical Hospital’s general consent form.

Effective Date

This Notice of Privacy Practices is effective April 14, 2003.

If you would like to speak personally with Mount Carmel New Albany Surgical Hospital’s
Privacy Ofﬁcer, please call 614.775.6630.

Additional information regarding HIPAA is available at local libraries, government agen-
cies, and on multiple Internet websites. A Fact Sheet summarizing the key points of HIPAA is
available from the United States Department of Health and Human Services website, located
on the Internet at www.hhs.gov/news/facts/privacy.html

48
THANK YOU

Your Teammates