Abstract
It is important to optimise not only the operative treatment, but also the general medical condition of hip fracture patients to achieve the best rehabilitation result. Patients with a hip fracture are old and often suffer from concomitant diseases. They are prone to be affected by complications such as pneumonia, urinary tract infection and pressure ulcers. The total treatment situation with sufficient intake of food and drink, pain management, prevention of pressure ulcers and a rapid handling from arrival at the Acute and Emergency unit until the patient has been operated is crucial. We have studied the nutrition and drink in patients with a hip fracture and in spite of repeated instructions to eat and drink sufficiently the patients with the hospital standard food achieve only 54% of their optimum energy needs and 64% of the fluid necessary. With an extra addition of nourishment to the hospital food the total energy and fluid intake reach almost the calculated level of need for these patients. The amount of complications, particularly infections, were significantly lower in the well nourished group.
We have also started to optimise the immediate acute treatment and already in the ambulance the patients now receive pain treatment, intravenous fluid and oxygene administration. The patients receive 3 litres of oxygene/min preoperatively and the first days postoperatively. The waiting time on hard surfaces has diminished through change of mattresses, but also with a much more rapid handling time through the X-ray department and the Emergency department. Routines have changed so the patients will not have to return to the Acute and Emergency after X-ray. Instead they are transported directly to the orthopaedic ward. Furthermore, the patients are given a higher priority in the waiting list among the acute surgery cases. All patients are evaluated for the risk of development of pressure ulcers and those at risk get special mattresses. With these measures the development of pressure ulcers during the time in hospitals has diminished by half. Special attention is also given to the patients’ mental status. At admission to hospital one third of the patients are not lucid.
All these factors are of major importance for the rapid mobilisation of the patient in the acute ward and the continued rehabilitation.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
References
Hommel A, Ulander K, Thorngren KG. Improvements in pain relief, handling time and pressure ulcers through internal audits of hip fracture patients. Scand J Caring Sci2003;17:78–83. Google Scholar
Eneroth M, Olsson U-B, Thorngren K-G. Insufficient fluid and energy intake in hospitalised patients with hip fracture. A prospective randomised study of 80 patients. Accepted for publication in Clinical Nutrition Google Scholar
