Comprehensive Fragility Care Program Comprehensive Fragility Care Program Nursing PerspectivesNursing Perspectives

on Care of Patient with Hip Fractureon Care of Patient with Hip Fracture

Jessica Chan Jessica Chan Nurse SpecialistNurse Specialist

Department of Orthopaedics and Traumatology Department of Orthopaedics and Traumatology Prince of Wales HospitalPrince of Wales Hospital

Hong Kong SARHong Kong SAR

EpidemiologyEpidemiology-- Falls in ElderlyFalls in Elderly

Falls are a serious public health problem among older adults. Falls are a serious public health problem among older adults.

More than a third of elderly fall at least once each yearMore than a third of elderly fall at least once each year 50% of elders who fall, do so repeatedly50% of elders who fall, do so repeatedly. 20% to 30% fallers suffer moderate to severe injuries that 20% to 30% fallers suffer moderate to severe injuries that

reduce mobility and independence, and increase the risk reduce mobility and independence, and increase the risk of premature deathof premature death

Elderly are five times more likely to be hospitalized due to Elderly are five times more likely to be hospitalized due to falls than to injuries from other causesfalls than to injuries from other causes

Falls Falls -- 29% of injury deaths among elderly29% of injury deaths among elderly

Why did the patient fall? Why did the patient fall?

the fall might be the presenting the fall might be the presenting symptom of an underlying infection, symptom of an underlying infection, myocardial ischemia, or myocardial ischemia, or gastrointestinal bleedinggastrointestinal bleeding

A detailed chronology of the fall, A detailed chronology of the fall, from the patient or witnesses, should from the patient or witnesses, should include history of syncope, lightinclude history of syncope, light--headedness, chest pain, palpitations, headedness, chest pain, palpitations, and leg weakness, as well as a and leg weakness, as well as a description of environmental description of environmental circumstances circumstances

Consequence of Hip FractureConsequence of Hip Fracture

Unable to walk immediately after the injuryUnable to walk immediately after the injury Confined to bedConfined to bed Severe painSevere pain Difficulty in passing urine/ bowel openDifficulty in passing urine/ bowel open Alteration in self careAlteration in self care

How did the patient feel?How did the patient feel? Unfamiliar environmentUnfamiliar environment Severe painSevere pain Impaired mobilityImpaired mobility Change of urinary/ bowel patternChange of urinary/ bowel pattern Poor appetitePoor appetite Lack of knowledge on managementLack of knowledge on management AnxietyAnxiety

frequent monitoring of vital sign, frequent monitoring of vital sign, blood taking, blood taking, venupuncturevenupuncture, IV , IV injectioninjection

transfer for radiological investigation, transfer for radiological investigation, operation operation

physical examinationphysical examination body exposure body exposure

What can we do ?What can we do ? Reduce anxietyReduce anxiety Relieve painRelieve pain Promote comfort Promote comfort Restore mobility function Restore mobility function Early regain of independenceEarly regain of independence Prevent complicationsPrevent complications

PrePre--operative Nursing Considerationoperative Nursing Consideration Adequate pain reliefAdequate pain relief Maintain proper alignmentMaintain proper alignment Prevent DVT/ pressure ulcers /Prevent DVT/ pressure ulcers /

chest infectionchest infection Urinary retention/ bowel impactionUrinary retention/ bowel impaction Maintain hydration / nutritional statusMaintain hydration / nutritional status Optimize the medical condition and prepare Optimize the medical condition and prepare

for surgeryfor surgery Explore the social support and discharge planExplore the social support and discharge plan Gain patientsGain patients/ / carerscarers understanding and understanding and

compliancecompliance

PostPost--op Nursing Careop Nursing Care Prophylactic antibioticsProphylactic antibiotics Protect the wound by waterProtect the wound by water--proof dressingproof dressing Keep dressing intact till postKeep dressing intact till post--op D3op D3 Monitoring of neurovascular statusMonitoring of neurovascular status Remove urinary catheter Remove urinary catheter asapasap PositioningPositioning

abduction pillowabduction pillow BraunBrauns Frames Frame

Monitor and prevention of complicationsMonitor and prevention of complications wound infectionwound infection Dislocation of hip (AMA)Dislocation of hip (AMA) chest infectionchest infection DVT/ PEDVT/ PE UTIUTI

Assist in ADLAssist in ADL Aware of deliriumAware of delirium

Advantage of Good Pain ReliefAdvantage of Good Pain Relief allows deeper breaths allows deeper breaths prevent chest complicationprevent chest complication improved mobility improved mobility avoid pressure sore formationavoid pressure sore formation fuller participation with physical therapy fuller participation with physical therapy regain ADL regain ADL able to perform ankle pump exercise able to perform ankle pump exercise prevent DVTprevent DVT improve appetite improve appetite promote wound healing and improve promote wound healing and improve

body resistancebody resistance

Provision of Hip ProtectorsProvision of Hip Protectors

Proper insertion of the Proper insertion of the protective pad into the protective pad into the pantspants

Way to put on & take off Way to put on & take off the pantsthe pants

Proper positioning of the Proper positioning of the padspads

Washing instructionWashing instruction

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www.No-Fall.hk

Nursing ResponsibilitiesNursing Responsibilities

Identify the major physical, psychological and Identify the major physical, psychological and environmental risk factors of fallenvironmental risk factors of fall

Assess the underlying chronic and acute Assess the underlying chronic and acute condition e.g. reviews of medication, physical condition e.g. reviews of medication, physical functioning and mental status functioning and mental status

Provide measures that can prevent falls at home, Provide measures that can prevent falls at home, and longand long--term care settingsterm care settings

Educate caregiver on change physical, mental, Educate caregiver on change physical, mental, nutritional and functional status nutritional and functional status

Promote selfPromote self--confidence and reduce confidence and reduce fear of fallsfear of falls

Roles of Trauma Team Nursing StaffRoles of Trauma Team Nursing Staff

Health care providerHealth care provider EducatorEducator AdvisorAdvisor CoordinatorCoordinator AssessorAssessor InstructorInstructor CounsellorCounsellor Liaison officerLiaison officer

Comprehensive Management of Comprehensive Management of Fragility FractureFragility Fracture

Acute Hospital(5-7 days)

Fragility Fracture Clinic

(6 months)

RehabilitationHospital

(2-4 weeks)

Community Fragility

Fracture Centre(long-term)

MultiMulti--disciplinary Collaborationdisciplinary Collaboration

Orthopaedic surgeonOrthopaedic surgeon GeriatricianGeriatrician AnaesthetistAnaesthetist Family physicianFamily physician Orthopaedic nurseOrthopaedic nurse Medical/ Community Medical/ Community

social workersocial worker

Rehabilitation specialistRehabilitation specialist PhysiotherapistPhysiotherapist Occupational therapistOccupational therapist DietitianDietitian Research staffResearch staff

Our GoalsOur Goals

Standardize clinical management in:Standardize clinical management in: surgical techniquesurgical technique medical & medical & anaestheticanaesthetic supportsupport nursing carenursing care rehabilitation training programrehabilitation training program community fall prevention & treatment of osteoporosiscommunity fall prevention & treatment of osteoporosis

Prevent recurrent fracture of our patientsPrevent recurrent fracture of our patients Improve the quality of life after fracturesImprove the quality of life after fractures Establish multiEstablish multi--disciplinary community programdisciplinary community program

Our ActionsOur Actions Compile protocol for different stages of Compile protocol for different stages of

managementmanagement Acute careAcute care RehabilitationRehabilitation Fragility fracture clinic Fragility fracture clinic Community fragility fracture Community fragility fracture centrescentres

Set up a network to facilitate communication, Set up a network to facilitate communication, information transfer and efficient feedback information transfer and efficient feedback and monitoringand monitoring

Set up a joint clinic Set up a joint clinic Fragility Fracture Clinic Fragility Fracture Clinic Set up an integrated multiSet up an integrated multi--disciplinary disciplinary

program in communityprogram in community

Expected OutcomesExpected Outcomes

Minimize complicationsMinimize complications Shorten acute hospital stayShorten acute hospital stay Shorten the rehabilitation periodShorten the rehabilitation period Decrease the visit of specialist clinicDecrease the visit of specialist clinic Full utilization of the community resourceFull utilization of the community resource Patient return to community safely Patient return to community safely