NHFD
GP Surgery:
Next of Kin:
Ortho-Geriatric Department
Integrated Care Pathway
for Patients with Fractured Neck of Femur
All patients with fractured neck of femur should be transferred to an orthopaedic ward within four hours
Blood Test Results
|Date | | | | | |
| | | | | | |
[pic] Heart Sounds:
[pic]
Basic Neuro:
Abbreviated Mental Test Score
|How old are you? | |Address for recall by patient | |
|What is the time (to nearest hour)? | |What year did the first World War start? | |
|What is your date of birth ? | |What is the name of the current monarch? | |
|What year is it? | |Count backwards from 20 to 1 | |
|What is the name of this place? | |Who is this? (recognition of two people) | |
Pressure Ulcers
None
Present on admission (specify)
Waterlow risk score
Investigation Results
Bloods: complete results grid
Chest X Ray:(comment on findings)
ECG:(comment on findings)
ABG: (if indicated)
Impression / Diagnosis
Orthopaedic Fracture Type:
Intracapsular Displaced / Undisplaced
Basalcervical
Intertrochanteric
Subtrochanteric
Likely pathological fracture: yes no possible
Other Fractures (specify):
Other Current Medical Diagnoses:
*Management
Fluids prescribed
Appropriate Analgesia prescribed
Prophylactic Antibiotics prescribed
DVT prophylaxis considered
Laxatives prescribed
Nutritional supplements prescribed
Bone Protection prescribed
Bed requested Ewhurst / Bramshott
Group and save
Consider withholding antihypertensive
Other…………………………………………
*Refer to Ortho-geriatric Handbook
( available A&E Majors or G-Drive in G:\shared\surgery\orthopaedics\ORTHO\orthogeriatrics)
Contains specific management guidelines if
• Haemoglobin < 10g/dl
• K+ < 3.5
• Na+ < 130
• If tachycardic or poorly controlled AF
• If patient diabetic
• Patient has pacemaker
Orthopaedic SpR informed on Bleep 0603 at (time):
Name: Signature:
Date: Time:
Orthopaedic Review
Aim to get all patients with fractured neck of femur who are medically fit to theatre within 24 hours
Meets Anaesthetic requirements Yes / No
If not consider urgent medical SpR review or discuss with Consultant Ortho-geriatrician
Time referred for Anaesthetic review:
Proposed theatre list:
NBM from:
Consent and Marking:
Skin Traction required: Y / N Pounds / Kgs
Discussion with Next of Kin/ Relatives:
Name: Signature:
Date: Time:
Consultant Geriatrician Review Date:
Consultant Name: Time:
Proposed Estimated Discharge Date:
Likely Rehabilitation Plan:
Name: Signature:
Date: Time:
Falls Assessment:
Previous falls / syncope
Previous fractures
Balance / mobility problems
ECG review
Lying / standing BP
Visual impairment
Medication review
Other relevant PMH
Osteoporosis risk:
Previous fragility fracture Family History
Rheumatoid arthritis Smoking / alcohol
Myeloma Immobility
Malabsorption Thyroid disease
Cushings syndrome Parathyroid disease
Steroid therapy Early menopause
Bone Protection:
Continued from pre-admission
Await Dexa scan
Referral to Rheumatologists (bone clinic)
Not appropriate
Started on this admission (specify)
Name: Signature:
Date: Time:
Nursing Day of Operation
Operation procedure performed:
Time returned to the ward:
Wound status:
Nil ooze
Little ooze
Lots of ooze ( seeping through dressing onto bed )
Drain in situ Yes (record output) / No
IV fluids running Yes / No
What :- Time Due :-
Oxygen level required :- % Litres
IV Antibiotics :- 8 hrly
16 hrly
Ensure BP, Pulse, Respiration rate and urine output are recorded hourly, for 4 hours until stable. Early warning score completed.
Pain Scoring completed:
PCA Y / N Epidural Y / N
Follow PCA and Epidural protocol.
Name: Signature:
Date: Time:
Ortho-Geriatric MDT continuation sheet
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Ortho-Geriatric MDT continuation sheet
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Ortho-Geriatric MDT continuation sheet
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Ortho-Geriatric MDT continuation sheet
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Ortho-Geriatric MDT continuation sheet
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-----------------------
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|Operation: Left / Right |
| |
|Date: Consultant: |
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|Surgeon (include grade): Assistant: |
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|Pre operative antibiotics given: |
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|Surgical approach: |
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|Implant used: |
Adverse events (list actions taken):
Note: For cemented hemiarthroplasty follow National Patient Safety Agency recommendations:
: thoroughly irrigate / clean femoral canal (to decrease embolic events)
: anaesthetist warned prior to cementing
: use of cement gun to retrograde fill the canal
If not followed please give reason:
N.B. report any significant cement reaction to trauma coordinator bleep 6940
Details of wound closure:
Dressing:
Post Op Instructions:
Mobilise FWB as soon as possible
IV antibiotics at 8 and 16 hours post op
Check bloods 24hrs
Check XR for hemiarthroplasty as soon as can safely be done
No routine change of wound dressing unless edge becomes unstuck.
Additional instructions / amendments if different from above:
Post-op antibiotics written up Y / N Thromboprophylaxis written up Y / N
Name: Signature:
Date: Time:
OPERATION NOTE
Reversal of Warfarin – see full guidelines in handbook
INR 8.0 give Vitamin K IV 5mg
Check INR after 6 hours and repeat treatment as necessary
For urgent reversal see orthogeriatric handbook
re Beriplex
-----------------------
Please use addressograph label or complete
Name:
Date of birth:
Hospital Number:
Home town:
Hom
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