5 * EVALUATING THE EFFECT OF ORTHOGERIATRIC INTERVENTION ON BOWEL CARE AND ANALGESIA FOLLOWING HIP FRACTURE

Abstract

Evidence base: Constipation in elderly people with hip fracture is a common problem due to immobility, opioid prescription and lack of privacy. It can result in a numerous complications and ultimately an increased length of hospital stay. There is a dearth of meaningful evidence, both in the way that constipation is recognised and its subsequent treatment. The orthogeriatric team in this large University Hospital Trust investigated the effectiveness of bowel care for elderly inpatients following hip fracture. Each audit followed a cohort of 40 people aged 60 or above following surgical fixation of hip fracture.Change strategies: Laxatives to be prescribed from the day of surgery.Stool charts for all patients; recording frequency and type.Review analgesia daily; promoting ‘as needed’ (prn) oral opiate prescription.Local dissemination of audit results and encouragement of change strategy implementation.Change effects: Audit Results:201020112013Stool chart used? 0%35%100%4 ≥days between bowel movements since admission?92.5%90%37.5%Laxative prescribed?92.5%90%87.5%PRN oral Opiate prescribed?7.5%85%95%Medical and Nursing staff aware of patients current bowel habit;51%60%75%Patient satisfied with current analgesia?90%95%97.5%Conclusion: Patients with hip fracture are now significantly less constipated.The results are of national interest.The improvements demonstrate the vital importance of a combination of medical and surgical care for this group of frail vulnerable patients.All patients now have an accurate record of bowel movements.There is an increased awareness within the ward team. 75% now identify patients' bowel habit without consulting charts.Whilst the prescription of laxatives is important, a motivated ward team encouraging their uptake is vital.Improved patient satisfaction of their pain relief, almost all patients now have a prn oral opiate prescription.