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Current Orthopedic Interventions in Hemophilia with Inhibitors: Coordination of Care to Maximize Patient Outcomes

Release Date: September 2, 2011
Expiration Date: September 2, 2012

Target Audience
The intended learners for Current Orthopedic Interventions in Hemophilia with Inhibitors: Coordination of Care to Maximize Patient Outcomes are nurses and physical therapists interested in the treatment and care of patients with hemophilia with inhibitors.

Purpose Statement
The purpose of this learning activity is to enable the learner to articulate the significance of a collaborative team approach to achieving optimal outcomes from elective orthopedic surgery in patients with hemophilia with inhibitors. It will update nurses and physical therapists on the latest information regarding the management of these patients and how to integrate that information into their daily practice.

Program Overview
Patients with hemophilia face a number of challenges – physical, financial, and psychosocial – and most of them are made more difficult by the presence of inhibitors. Because bleeding into the joints is a common occurrence with patients with hemophilia, joint arthropathy is a frequent and sometimes severe complication. At a minimum, joint bleeds cause stiffness, pain, and temporary loss of mobility; at worst, they can develop into hemarthropathy severe enough to necessitate surgery. Until recently, elective orthopedic surgery was relatively uncommon in patients with hemophilia with inhibitors, due to the high risk of morbidity or mortality in this patient population. The advent of immune induction therapy to bypassing agents has made these procedures feasible, although they still carry substantial risk.

Central to optimizing health outcomes in the bleeding disorders community is the comprehensive care model, as is provided by the network of hemophilia treatment centers (HTCs) throughout the US. The World Federation of Hemophilia (WFH) recommends that surgeries on these patients be performed by a team experienced with managing hemophilia within a center having the ability to properly monitor clotting factor level. As the coordinator of the treatment team in the HTC, the nurse plays an essential role in the success of surgical interventions for these patients. Equally, the physical therapist's expertise in guiding both pre- and post-surgical therapy is vital to a positive outcome. At the end of this activity, participants will be able to explain and implement a framework for nurses and physical therapists to use when treating patients with hemophilia with inhibitors who elect orthopedic surgery, including surgical decision making, pre-surgical planning, during surgery, and post-surgery rehabilitation and long-term management to improve their treatment abilities as it relates to their overall care of patients with hemophilia with inhibitors undergoing elective orthopedic surgery and to improve outcomes in these patients.

Educational Objectives
After completing this activity, the participant should be better able to:

  • Propose three evidence-based interventions that could be used in the musculoskeletal management of patients with hemophilia with inhibitors.
  • Describe possible reasons why chronic synovitis may be ignored by hemophilia patients with inhibitors and/or their families.
  • Differentiate between the effects of blood on the synovial membrane and the articular cartilage.
  • Explain the importance of early detection of synovitis and thorough intervention to minimize joint damage in hemophilia patients with inhibitors.
  • Distinguish the roles of the nurse and the physical therapist in the management of elective orthopedic surgery for patients with hemophilia with inhibitors from the decision-making process to post-surgical rehabilitation.
  • Describe strategies to facilitate success of the patients' surgical outcomes throughout the stages of the surgical process.

Accreditation Statement
The University of Nebraska Medical Center College of Nursing Continuing Nursing Education is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is provided for 2.0 contact hours under ANCC criteria.

Participants who attended the live symposium are not eligible to receive contact hours for this enduring activity.


Faculty Information
Angela Forsyth, PT, DPT
Co-Chair
Penn Comprehensive Hemophilia Treatment Center
Philadelphia, PA

James Munn, RN, MS
Co-Chair
Hemophilia/Coagulation Program
University of Michigan Health System
Ann Arbor, MI

Workshop Facilitators
Kimberly Baumann, PT

Center for Bleeding and Clotting Disorders
University of Minnesota
Minneapolis, MN

Jennifer Maahs, PNP, MSN
Indiana Hemophilia and Thrombosis Center
Indianapolis, IN

Mack Womack, RN, BSN
Gulf States Hemophilia and Thrombophilia Center
Houston, TX

Nichan Zourikian, BSc, PT
Sainte-Justine Hospital Hemostasis Centre
Montreal, BC, Canada

Method of Participation
To receive a statement of credit, you must:

  • Review the full content of the program.
  • Successfully complete the post-test (70% or higher).
  • Complete the evaluation instrument.
  • You will have unlimited opportunities to successfully complete the program.

Your statement of credit will be issued immediately upon successful completion of the post-test and submission of the evaluation form.

Estimated time to complete this activity is 2 hours.

Fee
There is no fee to participate in this activity.

Commercial Support
The University of Nebraska Medical Center College of Nursing Continuing Nursing Education Program and the National Hemophilia Foundation thank Novo Nordisk for their generous support of this program in the form of an unrestricted educational grant.

Disclaimer Statement
The opinions or views expressed in this continuing education activity are those of the faculty and do not necessarily reflect the opinions or recommendations of the National Hemophilia Foundation, the University of Nebraska Medical Center College of Nursing Continuing Nursing Education, or Novo Nordisk.

Participants who received contact hours for attending the live symposium, Current Orthopedic Interventions in Hemophilia with Inhibitors: Coordination of Care to Maximize Patient Outcomes on November 20, 2010, are not eligible to receive contact hours for this online enduring activity.

Disclosure Declaration
All planners and faculty participating in continuing education activities provided by the University of Nebraska Medical Center College of Nursing Continuing Nursing Education are expected to disclose to the audience any significant support or substantial relationship(s) with providers of commercial products and/or devices discussed in this activity and/or with any commercial supporters of the activity. In addition, all faculty are expected to openly disclose any off-label, experimental, or investigational use of drugs or devices discussed in their presentation. The planners and faculty have been advised that this activity must be free from commercial bias and based upon all the available scientifically rigorous data from research that conforms to accepted standards of experimental design, data collection, and analysis.

The following speakers and planning committee members have stated they have no significant or substantial relationship with providers of commercial products and/or devices discussed in this activity and/or with any commercial supporter of this activity.

  • Kimberly Baumann, PT
  • Catherine Bevil, EdD, RN
  • Mack S. Womack, RN, BSN
  • Kathleen Yao, MSN, APRN-WH
The following speakers and/or planners have stated that they have the following financial relationship(s) and they have agreed to see that all information they planned and/or present is done so fairly and without bias:

Angela Forsyth, PT, DPT
states that she is a member of the speaker's bureau for Baxter, Bayer, and Novo Nordisk. She receives an honorarium for her contributions.

Jennifer Maahs, MSN, PNP states that she is a member of the speaker's bureau for Baxter and Novo Nordisk. She is a member of the nursing advisory board for Wyeth.

James Munn, RN, MS states that he is a member of the advisory board for Baxter, CSL Behring, and Pfizer. He is also a member of the speaker's bureau or a consultant for Baxter, Bayer, CSL Behring, Pfizer, and Novo Nordisk.

Nichan Zourikian, BSc, PT states that he receives honorarium for his speaking contributions for CSL and Novo Nordisk.

Non-Endorsement of Products
Accredited status as a provider of continuing nursing education refers only to the University of Nebraska Medical Center College of Nursing Continuing Nursing Education continuing education activities, and does not imply UNMC or American Nurses Credentialing Center's Commission on Accreditation endorsement of any commercial supporters.

Off-label Use
No product purposes, other than those approved by the FDA, will be discussed.

Software Requirements

PC
Flash Player Plugin v9 or greater
Internet Explorer 7 or greater or Firefox (Latest Version)
Windows XP or greater

Adobe Acrobat Reader

MAC
Flash Player Plugin v9 or greater
Internet Explorer is not supported on the Mac
Mac OS 10.4
Safari (Latest Version) or Firefox (Latest Version)
Adobe Acrobat Reader

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