Quality Indicator Project
As ICON leaders, our goal is to translate best practice knowledge into everyday patient care. In 2012, a task group consisting of representatives from eight nations and four continents collaborated to publish a landmark article on the nursing care of patients with hip fractures. A hip fracture is a devastating injury for patients and families and the associated health care costs are growing exponentially in many countries world wide as the population ages. The article was written to present evidence on and strategies for the prevention, detection and management of foreseeable risks and complications for this population including pain, delirium, pressure ulcers, fluid balance, malnutrition, constipation and urinary tract infection.
While this best practice knowledge is important, we know that knowledge alone will not change practice. For best practice to flourish, structures are required to help nurses consistently ‘do the right things’ while making it harder to ‘do the wrong things’. We tapped into the wisdom of a team of international nursing leaders to learn how best practice for hip fracture patients is supported in their care settings. This team was comprised of the following representatives:
Ireland: Louise Brent, nursing lead for the Irish Hip Fracture Data Base
Great Britain: Karen Hertz, nursing lead for Great Britain NHS Data Base
Sweden: Ami Hommel, lead of the Swedish National Rikshoft Registry for hip fracture quality improvement
Canada: Valerie MacDonald, Bone and Joint Canada Steering Group, Nursing lead for the British Columbia Hip Fracture Redesign Intiative
Ann Maher, former editor of Orthopedic Nursing and co-author of the seminal orthopaedic nursing text
Denmark: Hanne Mainz, nursing lead for hip fracture improvement work in Denmark
USA: Anita Meehan, Director for NICHE and clinical nurse specialist in geriatrics.
Australia: Anita Taylor, Nurse Practitioner and nursing lead for Australia and New Zealand Orthopedic Nurses Association.
Pressure ulcer prevention was selected as the first risk to study for this endeavour. A draft practice audit tool was developed, tested, revised and then applied by each leader to identify the structures in place within each of their care settings. While the final summary report is still in development, the preliminary results were compared across sites and many common themes emerged.
1, Head to toe skin inspection on admission and minimum daily.
2. Use of a validated risk screening tool to identify patients at added risk for pressure ulcer development: on admission and every two days until the patient is able to mobilize independently (e.g. Waterloo, Braden).
3. Use of pressure reduction or pressure relief mattresses on beds for these patients.
4. Partnerships with ER and the OR to ensure patients have preventive care and appropriate mattress surfaces.
5. Turning schedule, minimum every two to three hours.
6. Up walking beginning the day after surgery.
7. Minimize preop fasting and provide postoperative high calorie, high protein diet as soon as possible.
8. Regular audits and reports to physicians and staff regarding pressure ulcer incidence.
In September the report outlining the comparisons of the sites will be released with recommended supports for preventing pressure ulcers. In the coming months, we will be exploring other areas of risks such as malnutrition, delirium and pain. Stay tuned!!
Collaboration with NiCHE
ICON members are currently working together with colleagues from NICHE (Nurses Improving Care for Healthsystem Elders) nicheprogram.org on a series of resources. NICHE is the leading nurse driven program designed to help hospitals and healthcare organizations improve the care of older adults. The vision of NICHE is for all patients 65-and-over to be given sensitive and exemplary care. The mission of NICHE is to provide principles and tools to stimulate a change in the culture of healthcare facilities to achieve patient-centered care for older adults. NICHE, based at the NYU College of Nursing comprises hospitals and healthcare facilities located in 46 states, Canada, Bermuda, and Singapore.
The first two resources are handouts in the “Need to Know by NICHE” patient and family series. The Need to Know on Hip Fracture & Repair explains to patients and families the types of hip fractures as well as the ways a hip fracture may be treated. The Need to Know on Care After Hip Fracture Surgery discusses pain management and function following hip fracture surgery. Both handouts give patients and families simple lists of what they should know as well as what they can do to prevent problems. These resources are available online for download at nicheprogram.org/need_to_know.
E-mentoring Leadership Project
Several new members of the RCN/SOTN committee were partnered with members from ICON member associations who had leadership experience with their respective associations. Using a leadership competency model developed by NAON and a self evaluation tool developed by members of the ICON mentor group, the participants engaged identifying leadership strengths and areas for opportunities. There four partner groups formed and their conversations are continuing. Evaluations from the mentees have been very positive.
Development of a Leadership Competency Self Assessment Tool
Members of the e-mentoring group developed a self assessment survey tool based on the 5 domains of leadership as identified in the Leadership Competency Model developed by members of the NAON leadership search committee. This tool provides an opportunity to evaluate leadership competencies with identified resources that can be accessed to enhance those skills where there is an identified opportunity for improvement. This tool could be as a resource for mentoring of new Board members. .html your ICON representative to inquire about getting a copy.
Geriatric Hip Fracture Consensus Document Workgroup
Hip fractures are an increasing global health concern. Projects suggest that the number of fractures will increase from 6.26 million in the mid 1990’s to 6.26 million by 2050. Older adults are at increased risk for hip fracture. Given this global health imperative several clinical experts from ICON association member associatons formed a workinggroup in 2010. You find two published papers under publications.