The Next Steps…..

Dr Helen Wilson Regional Meeting, Peterborough, March 2014

Hip Fracture Programme • Agreed protocols shared by orthopaedics / orthogeriatrics /

anaesthetics • Patient information • Joint orthopaedic / orthogeriatric care • Daily trauma meetings • Dedicated trauma lists • Hip fracture nurse / co-ordinator • Consultant led MDT meetings at least weekly • Early supported discharge team • Clinical governance meetings • Audit (NHFD +)

Analgesia

• Analgesia protocol

• Monitoring pain – pain scores

• Useful recent joint publication BGS

• Paracetamol

• Opiates

• Fascia-iliaca nerve blocks

Hemocue in recovery +/- Early Transfusion

End of Life Care

• AMBER care bundle

• Liverpool care pathway – – ‘More care, less pathway’ July 2013 Baroness

Neuberger

– Leadership Alliance for the care of dying people (LACDP)

– HEE engagement exercise closed 6th January 2014

• Anticipatory care plans / Gold standards framework

After the Metalwork –The Long Road Home

• In-patient rehabilitation

• Early supported discharge

• Falls assessment and intervention

• Bone health assessment and intervention

• Exercise programmes

30 day/ 120 day/ 360 day follow-up

• In-put data onto NHFD

• 30 day completed by hip fracture nurse

• 120 day

– 1/3 seen in clinic

– 2/3 followed up by telephone

• 360 day telephone follow-up

• PROM / satisfaction questionnaire

Clinical Governance Meetings

• All members of hip fracture programme represented

• Minuted meeting

• Discussion about service improvements / local audit

• M&M

• Review of key performance indicators

– Those that failed to meet BPT and why

Falls and Fragility Fracture Audit

Programme (FFFAP)

Falls Audit

NHFD

Fracture Liaison Service Database

Non-hip fragility fractures

• Data

• Memorandum between services

• FLS

Capture the Fracture Campaign

Falls and Fragility Fracture Network

Madrid 4th - 6th

September 2014

POPS service

Proactive care of Older People undergoing Surgery

Robens Suite, Guys Hospital, London

Thursday 13th – Friday 14th March 2014

BGS, BOA and NHFD

• BOA and BGS representatives on FFFAP

• Regional meetings / network meetings / National and International conferences

• Orthogeriatric network

• Training programme

Falls and Fractures Alliance • Falling standards, broken promises: the report of the

national audit of falls and bone health in older people 2010 • Revealed variation in the quality of falls and fracture

management across England. • National Osteoporosis Society and Age UK hosted a national

summit in October 2011 • Breaking Through: Building Better Falls & Fractures services in

England, Feb 2012 (NOS and AGE UK) • Brings organisations together to try to reduce falls and

fractures, specifically hospital admissions for hip fractures in over 65s

Declaration

• Members have signed declaration of interest to advocate for good practice with fragility fractures within wider scope – health & social care community, public, patients/carers and wider professional organisations

FFA – Areas of Work

• Providing Alliance Members with overview of national policy in falls and fractures. (Includes scoping of key NHS & Social Care framework documents)

• Progressively identifying gaps in national policy and changes to be made

• Working together with new National Clinical Directors

• Sharing best practice amongst members

• Developing ideal care pathway for falls and fractures

• Influencing commissioning of falls and fractures services, e.g FLS

How many steps? Every step, every time

NOF bleep Communication with patient / relatives Pain score and Analgesia Fluid resuscitation Dementia screen VTE risk assessment Fascia-iliaca compartment block Medication review Waterlow score and Air mattress Bed on orthopaedic ward within four hours Pre-operative ortho-geriatric review Antibiotic prophylaxis Appropriate anaesthetic Appropriate operation HemoCue check and early transfusion

Day one physiotherapy Daily mobilisation Catheter use Monitoring bowels Delirium screen Nutritional assessment OT assessment Referral for ESD / in-patient rehabilitation Falls assessment Bone health assessment Dexa scans VTE prophylaxis to four weeks Follow-up 30/120/365