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Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
Tracey Finigan - Gold Coast Hospital
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Tracey Finigan - Gold Coast Hospital

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Tracey Finigan, Acting Clinical Nurse Neck of Femur Patient Flow, Gold Coast Hospital delivered this presentation at the 2nd Annual Hip Fracture Management Conference 2013. This conference is the only …

Tracey Finigan, Acting Clinical Nurse Neck of Femur Patient Flow, Gold Coast Hospital delivered this presentation at the 2nd Annual Hip Fracture Management Conference 2013. This conference is the only regional event to discuss practical innovations and improvement processes for the management of Hip Fractures in the hospital setting.

Find out more at http://www.healthcareconferences.com.au/hipfracture2013

Published in: Health & Medicine, Sports
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Transcript

  • 1. The Gold Coast Experience Tracey Finigan Clinical Nurse # Neck of Femur Liaison Nurse. Nurse Practitioner Trainee
  • 2. Demographics Gold Coast  Has an average of 33.9% of it’s population over the age of 50Yrs  One of fastest growing populations in the country  Total population estimated to grow from 385,000 in 2001 to 730,000 in 2026.  People over 50 yrs in 2001 was 128,000 estimated to grow to 2026 will be 248,000 people (33.9%)
  • 3. Demographics  It is projected that  Hip fracture numbers will increase by 15% every five years until 2026  With a fourfold increase in hip fractures by 2051  When 23% of Australia's projected population will be 65yrs and over.  With 8% being over 85 yrs
  • 4. Epidemiology 2001  It was estimated that there will be approx 3 Million people in Australia with Osteoporosis by 2021  More than a 3:1 against women.  Someone is admitted to hospital with an osteoporotic fracture every 5-6 minutes. Around 262 admissions per day.
  • 5. Epidemiology 2001  64,000 hospital separations in Australia for bone fractures.  Hip fractures accounted for 37% of all admissions for fractures in people over 55 yrs increasing to 55% in people 85 yrs and over
  • 6. Mortality and Morbidity  It is estimated that  25% of people who sustains a hip fracture will die in the first 12 months and  Those that do not die  50% will require ongoing assistance with ADL’S and IADL’s with  25% requiring full time care in a RACF
  • 7. Costs  In 2001  $1.9 Billion was spent on direct costs  Costing between $15,000 and $19,500 for acute hospital episodes for hip fracture admissions  Depending on procedure  Not including sub acute episodes  Several billions more spent on indirect costs  Lost earnings  Modifications  Volunteer carers etc
  • 8. Cost of prevention  Pathology  Vit D $32.64  Ca+ $12.68  Bone mineral density $102.40 (MBS)  Medications  Prolia $597.80 (PA)  Aclasta $589.38 (PA)  Orals between $260 - $600 (PA)  Total $850 per annum
  • 9. Treatment  Estimated that Osteoporosis accounts for only 0.6% of all problems treated by GP’s.
  • 10. Gold Coast Numbers  Increase from 266 presentations in 2008 to 309 in 2012  A total of 1398 in the 5 years  To October of 2013 a total of 178 presentations  Excluding high impact  Younger than 60 yrs  Non osteoporotic fractures E.g. Pathological  92% of these where operated on within 48hours
  • 11. Background Not looked on as a special group – not sexy. Found that patients were waiting for surgeries up to 5 days. Constantly starving waiting for surgery. No specialising physician - aged care. Commonly cared for by junior orthopaedic interns and junior nurses Care disjointed among Allied Health professionals.
  • 12. Barriers to achieving surgery within 2 days  Patient factors     Supra-therapeutic INR’s Other injuries Decompensated heart failure CVA  Organisational factors  Limited theatre time  Number of admissions  Lack of co-ordinated care
  • 13. The Start  Introduction of a dedicated Ortho-Geriatrician . Specifically for older patients with NOF #     This improved the optimisation for readiness for theatre. Dedicated rounding Initially no registrar or junior resident – getting better Main aim to reverse the reversible       Arrhythmias Electrolyte imbalance Infections – chest/ urinary Anaemia Coagulation Heart failures
  • 14. Dedicated Ward Pharmacist       Medication reviews on admission Chart reviews Aged care focus Discharge planning VTE prevention Osteoporosis prevention
  • 15. The Pre Op Drink  Background  Is a 0.5kcal/ml, clear, non-carbonated, lemon flavoured, iso-osmolar carbohydrate drink.  Pre-Op is designed to switch patients from a fasted to a fed state prior to surgery.  It has been shown to moderate     metabolic responses to surgery, improve well-being, decrease post-operative insulin resistance and attenuate loss of lean body mass.  Pre-Op comes in a 200ml bottle.  Routinely given at 05:00 1-2 tetra packs on day of surgery.
  • 16. The Emergency Department NOF Pathway.  Currently under reconstruction  Initially to assist the flow of patients through the emergency department  To assist the non orthopaedic doctor to assess, investigate and prescribe appropriately.  To assist nursing staff both in ED and the wards to facilitate handover.  Unfortunately ED is where it stops at the present.
  • 17. NOF Liaison Nurse  Introduced August 2012  Following an influx of VLADS regarding length of stays and higher mortality rate.
  • 18. NOF Liaison Nurse Role  Ensure patients are ready for theatre     Blood work -Nurse initiated pathology Consents Theatre booked Seen by appropriate teams  Management of delirium  Education  Manage by cause     Infections Pain Constipation etc
  • 19. NOF Liaison Nurse Role        Discharge planning Post operative management Advocacy Patient assessment Complex care planning Education Mentoring
  • 20. NOF Liaison Nurse Role  Committee member on  PIP  Falls prevention  Department of surgery planning
  • 21. NOF Co-ordination Team  Multidisciplinary         Surgeons Ortho Geriatrician Physiotherapists Dedicated Ward Pharmacists Occupational therapists Speech therapy Dietician ME
  • 22. Not to Mention        ED staff Theatre staff Ward staff Administration Officers Kitchen workers Cleaners Porters
  • 23. Function of Team  Collaborate to formulate a best practice clinical pathway from each discipline.  Discuss strengths  Discuss weaknesses  Seek solutions  Collaborate in future research  Aim for pre injury function as quick as possible
  • 24. Transforming Care  Bedside handovers  Involvement of care with patient and family.  Care plans done with patient – not away at a desk  Updating back boards with relevant information – diets, mobility  Peer review
  • 25. Transforming Care  Journey Boards     Overall summary of ward activity Theatre dates Expected discharge dates Multidisciplinary referrals
  • 26. Transforming Care        Morning Scrums 8:30 10-15 minutes Multidisciplinary Concerns Priorities Discharges
  • 27. How are we travelling  We have seen a reduction in  Episodes of Delirium  Length of stay  2008-2012 average acute stay was between 10-16 days  To 6 days acute stay (Sept 2012– Feb 2013)  Mortality 10 inpatient deaths since September 2012 (14 Months).  Reduction in VLADS
  • 28. How are we travelling- Spin off  Reduction in elective surgery cancellations, due to reduced lengths of stay.  More available bed days  Lesser wait lists
  • 29. Why?  Aged care  Unattractive to society – compared to paediatrics.  Largely a group with no voice.  It’s the responsible thing to do  Maintain dignity
  • 30. Thank You

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