A & E Protocol: Suspected Neck of Femur # Patient sticker:
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1 Proforma for Fractured Neck of Femur Audit: FAST TRACK 1 of 10 A & E Protocol: Suspected Neck of Femur # Date: / / Time of Arrival: Name of triage nurse: Time of triage : A& E member of staff: Resuscitate the patient: please Oxygen: Intravenous Line & Fluids: 12hrly Hartmann s 1 litre Drug Chart: Analgesia Given Co-codamol 30/500 QDS Morphine 2-5mg 2 hourly PRN Cyclizine 50mg TDS (PRN) Criteria: Age (above 65 years): >65 yrs AP Pelvis: Diagnosis: Hip Lateral: Diagnosis: Chest X ray: Any abnormality: ECG: Findings: Patient is NOT appropriate for fast track if:- Any evidence of cardiorespiratory compromise? The patient needs urgent medical care? BEFORE Fast track please complete: Bloods; FBC: Clotting: U&E; Calcium G&S; Examination: Neurovascular Status: Distal Pulses? D.P present T.P present Any Other Findings: Orthopaedic On call informed Time: Name of person fast tracking: Position: Signature: Bleep:
2 Proforma for Fractured Neck of Femur Audit: FAST TRACK 2 of 10 Orthopaedic on Call: Admission Details: Date: / / Method of Arrival: Ambulance Own GP referral Other (please specify) O&T Admitting Doctor: Bleep: Admitting Consultant: Time Seen in A&E Decision to Admit: Referred to O&T: Patient Left Dept.: Ward: O&T on call saw pt: Where: A&E Ward (It is not necessary for the pt to be seen by the O&T on call in A&E. If a bed is available and the pt is well, transfer!) History: Who is giving the history? Patient Other HPC: Did the patient sustain a head injury YES NO Lose consciousness? YES NO (please specify) Where did the patient fall? Mechanism of fall: Does the patient need a falls clinic referral? YES NO (OT TO REFER) (Criteria: Recurrent falls, dizzyness, syncope, postural hypotension, imbalance, CVA, visual impairment, muscle weakness, Parkinsonism, poor gait, UTI, no dementia) Is there a medical reason for the fall?
3 Proforma for Fractured Neck of Femur Audit: FAST TRACK 3 of 10 Past Medical History: CVS RS NEURO GI / GU MSK Diabetes Rheumatoid Arthritis Drug History: ALLERGIES: Smoke: NO Details: Alcohol: NO Details: If no mechanical heart valve present, stop the following PRE-OP, ANTIPLATELETS, METFORMIN, WARFARIN Correct INR Social History: House / Flat / Bungalow / Sheltered / Residential / Nursing / other: Live alone? Home help Meals on wheels Mobility: Unaided /Stick /Crutches /Frame /Assisted /Wheelchair /Bedbound O/E General appearance: Temperature: HR: Rhythm: Heart sounds: BP: RR: JVP: Oedema: Chest: Abdomen: Trachea: Sat on air: % Sat on.% O2 : % CNS: CN I XII: Upper: Lower: Evidence of CVA: YES NO OLD NEW
4 Proforma for Fractured Neck of Femur Audit: FAST TRACK 4 of 10 Mini Mental Test: (if unable, give reason) Give the patient an address to remember: Age: Date of Birth: Time: Year: Hospital: Identify 2 people: World War 1: Monarch: Count from 20 to 1: Recall address: Total: /10 Other Findings: Investigations: Bloods: Hb: Ur: Clotting: WCC: Na: Calcium: Plts: K: CrP: G&S: / Cr: Glucose: ECG: ECG findings: X Rays: Time ordered: CXR findings: Time done: Other X rays performed? Why? Hip / Pelvis X-Ray findings: Right Left Intrapcasular Extracapsular Basicervical Intertrochanteric Subtrochanteric Reverse oblique Undisplaced Displaced How many fracture parts? Does it look pathological: YES NO Start Discharge Planning NOW! Convalescence / rehabilitation / Boxley Unit Referral to: Social services / Upgrade to nursing home? / Other:
5 Proforma for Fractured Neck of Femur Audit: FAST TRACK 5 of 10 Management: Old notes requested: YES NO What operation does this patient need? Inform Anaesthetist on call now! Are they fit for theatre: YES NO Comment Does patient require additional urgent medical treatment: YES NO If involve other specialties as necessary. Fluids commenced: YES NO Time started: Analgesia given: YES NO What analgesia: ular turning YES NO Pressure mattress: YES NO What type: Is patient marked & consented? YES NO Antibiotic prophylaxis: IV Cefuroxime 1.5g OR Teicoplanin 400mg DVT / PE prophylaxis: (OWN HOME) / (RESIDENTIAL HOME) routine echo. If valvular stenosis suspected, use invasive monitoring (AA line, pulse contour continuous cardiac output) & meticulous haemodynamic control & vasoactive agents Anaesthetists Comments: ASA grade: GA Spinal Block
6 Proforma for Fractured Neck of Femur Audit: FAST TRACK 6 of 10 Resus status: Decision by Consultant in morning meeting DNR completed: YES NO ASA 3 to 5 MUST COMPLETE PREOP NFACPR: YES NO (For ACTIVE CPR) Suitable for ITU: YES NO Nursing Staff: Pressure Sores present: YES NO Waterlow Score: Site & Condition: Measures taken: REFERRAL LETTER TO OSTEOPOROSIS NURSE : YES NO Nutritional support: YES NO Ensure Dietician Operation:
7 Proforma for Fractured Neck of Femur Audit: FAST TRACK 7 of 10 Wendy Needham Osteoporosis Nurse Specialist CNS Maidstone Hospital Tel: Maidstone Pembury Department of Trauma & Orthopaedics Maidstone Hospital Hermitage Lane Maidstone Kent ME16 9QQ Date: Re: Osteoporosis referral for neck of femur fragility fracture Calcium and Vitamin D prescribed Patient Sticker: Alendronate 70 mg once weekly Dear Wendy Needham, The patient above has been admitted for a fragility fracture. We would greatly appreciate an osteoporosis clinic review and management regime (including DEXA Scan) being arranged. In accordance with BOA-BGS and NHFD guidelines, Alendronate 70mg once weekly & Calcium and Vitamin D (Adcal D3 Forte one tablet, bd), have been prescribed by the orthopaedic team. Many thanks for your time and efforts. Sincerely Trauma & Orthopaedic SHO PLEASE FILL OUT, ATTACH STICKER AND SEND THIS SHEET TO WENDY NEEDHAM VIA INTERNAL MAIL
8 Proforma for Fractured Neck of Femur Audit: FAST TRACK 8 of 10 Pre-op assessment: ne / routine by Geriatrician Reason if delay > 24hours [Delay is calculated from time of admission to A&E] Routine by specialist nurse Medical review requested delay- surgery < 24hrs Medically unfit awaiting orthopaedic Dx / Ix Medically unfit awaiting medical management Administrative awaiting inpatient or HDU bed Administrative awaiting space on theatre list Administrative problem in theatre /equipment Administrative problem with anaesthetic staff Cancelled due to theatre over-run Dead Other Reason if delay > 48hours delay- surgery < 48hrs Medically unfit awaiting orthopaedic Dx / Ix Medically unfit awaiting medical management Administrative awaiting inpatient or HDU bed Administrative awaiting space on theatre list Administrative problem in theatre /equipment Administrative problem with anaesthetic staff Cancelled due to theatre over-run Operation Internal fixation SHS/DHS Re-operation within 120 days (most significant procedure only) Internal fixation Screws Internal fixation IM nail (long) Internal fixation IM nail (short) Arthroplasty Unipolar hemi (uncemented) Arthroplasty Unipolar hemi (cemented) Arthroplasty Bipolar hemi (uncemented) Arthroplasty Bipolar hemi (cemented) Arthroplasty THR (uncemented) Arthroplasty THR (cemented) Other Reduction of dislocated prosthesis Washout or debridement Implant removal Revision of internal fixation Conversion to Hemiarthroplasty Conversion to THR Girdlestone/excision arthroplasty Surgery for periprosthetic fracture ne Anti resorptive therapy Started on this admission Continued from pre-admission Awaits DXA scan Awaits bone clinic assessment ne Other
9 Proforma for Fractured Neck of Femur Audit: FAST TRACK 9 of 10 Discharge destination from acute Orthopaedic ward Date & time of discharge from acute Orthopaedic ward Own home/sheltered housing Residential care/nursing home/ltc hospital Rehabilitation unit Acute hospital Dead / / AM / PM Discharge destination from Trust Own home/sheltered housing Residential care/nursing home/ltc hospital Rehabilitation unit Acute hospital Dead Follow up 30 days 120 days 1 y Residential Status Walking indoors Own home/sheltered housing Residential care/ nursing home/ LTC Hospital Rehab unit Acute hospital Dead ularly walks without aids one aid two aids or frame Wheelchair or bedbound Own home/sheltered housing Residential care/ nursing home/ LTC Hospital Rehab unit Acute hospital Dead ularly walks without aids one aid two aids or frame Wheelchair or bedbound Ow hou Res nur Hos Reh Acu Dea with one two Wh bou Unk Patient sticker: Walking outdoors ularly walks without aids one aid two aids or frame ularly walks without aids one aid two aids or frame with one two
10 Proforma for Fractured Neck of Femur Audit: FAST TRACK 10 of 10 Wheelchair or bedbound Wheelchair or bedbound Wh bou Unk Accompanied to walk indoors Accompanied to walk outdoors Anti resorptive therapy Unk Unk Unk
Accompanied to walk Yes No Accompanied to walk Yes No Side of Fracture
Fracture Neck Of Femur / Fast Track Criteria: Admission where femoral neck fracture is the primary diagnosis Accident & Emergency Assessment (To be completed by A/E Nurse and/or A/E doctor) Patient label
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