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