None listed
Conditions
Brief summary
Delirium is a common complication of patients admitted for hip fracture surgery, and is associated with increased risk of mortality, morbidity, and loss of functional independence, as well as high social, nursing and health care costs. National guidelines describe care plans and delirium reduction strategies, but inadequate education and lack of coordinated clinical management results in large variations in quality of care in Australian and New Zealand hospitals. This study will investigate if a multidisciplinary care bundle, which includes evidence based clinical interventions and regular educational initiatives reduces the risk of delirium in hip fracture patients classified as intermediate or high risk by 40%.
Interventions
Multidisciplinary care bundle including:
1. Ward and staff education on causes and risks of delirium. Education on national guidelines for clinical management of post-operative delirium
Particulars include:
- oral powerpoint presentations at fortnightly department training sessions over study period (prospective recruitment of 150 patients managed under care bundle), designed specific for this study
- hardcopy handouts of national guidelines during sessions
- laminated cognitive aids describing
Multidisciplinary care bundle including: 1. Ward and staff education on causes and risks of delirium. Education on national guidelines for clinical management of post-operative delirium Particulars include: - oral powerpoint presentations at fortnightly department training sessions over study period (prospective recruitment of 150 patients managed under care bundle), designed specific for this study - hardcopy handouts of national guidelines during sessions - laminated cognitive aids describing protocol placed on noticeboards, designed specific for this study - all delivered by researchers 2. Initial fascia iliaca block for analgesia when presented to the emergency department set protocol of 30ml of 0.2% plain ropivacaine, single dose, via ultrasound-guidance, prior to discharge to ward 3. Second fascia iliaca block to continue analgesia when presenting for hip fracture surgery set protocol of 30ml of 0.2% plain ropivacaine, single dose, via ultrasound-guidance, prior to surgical incision 4. Rationalisation of medications to reduce polypharmacy and known drug triggers for post-operative delirium by emergency physicians, anaesthestists, orthogeriatricians, and ward medical staff 5. compliance to above audited weekly by researchers. Compliance rates published fortnightly as educational newsletters sent electonically to all clinical staff, and as hardcopy on department notice boards. Compliance data compiled by manual search through hardcopy medical record of each patient, as well as electronic clinical notes, and of medication charts
Sponsors
A/Prof Alwin Chuan
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
emergency surgery isolated single hip fracture, defined as between femoral head and 5cm below the lesser trochanter age greater than 50 years old
Exclusion criteria
elective admission multiple fractures age less than 50 years old
Outcome results
None listed