Nurses Helping Nurses
allnurses Network: Central | Jobs | Books | Newsletter
allnurses: A Nursing Community for Nurses
Home General News Blogs Articles Students Region Specialty Degrees F.A.Q.
Orthopaedic Nursing /

Fractured HIP patient - Need question answered



Did You Know?
allnurses is the largest community for nurses on the web. We now have over 385,824 members! Join today to network with other nurses, laugh, share, and much more.
Page 1 of 2 1 2 >

Jun 10, 2004 03:03 PM

Fractured HIP patient - Need question answered

by lcbaird

I manage a general med/surg was that has some (mostly geriatric) orthopedics. We often have fractured hip patients who stay pre op for at least 24 hours prior to going to OR for repair. We just had a fractured hip patient who was scheduled for a bipolar prothesis as a repair since his fracture broke the femoral head. Several of my nurses moved him (with his hip splinted) from the bed to a gurney on a slide board and the OR supervisor insists that we violated a common standard of care that you never move a fractured hip. Our Nurse practitioners who cover these patients disagree and believe that the patients need to be moved to prevent numerous complications (i.e. dvt's, pneumonia). I understand that you would certainly stablilze a fracture by splinting but we move patients from bed to gurney to take to Xray, CAT scan and we turn them Q2 while in bed. Is there anyone that can tell me what you do, as this had gone to the Chief Nurse who wants me to look for references and standards to support our practice. Help!


Share: Submit Thread to Facebook Submit Thread to Twitter Submit Thread to Technorati Submit Thread to Google Submit Thread to Reddit

Search Tags
None
Top

 
Advertisement
Sponsored Links
 
Page 1 of 2 1 2 >
Reply
12 Comments
No. 1
from jax
Old Jun 10, 2004, 08:36 PM

Hello Icbaird,

Our #nofs come to us via A&E on a trolley and are then pat-slid into bed. We provide pressure care, wash them in bed etc,, and this, obviously involves moving them. We use 5lb of skin traction or bucks bootie if ordered or if the pt has a lot of muscle spasm and we think it may help. They go to OT on their bed and come back on it. Same goes for all of our orthopaedic patients. I prefer it, I don't want them coming back to the ward, having to transfer to a bed thus provoking a fresh bout of pain and nausea. Much easier this way... If they need to go to xray they go on their bed, if possible they are xrayed whilst staying on the bed, but they of course get slid across for CT/MRI etc.
Top
 
No. 2
from P_RN
Old Jun 10, 2004, 10:50 PM
Updated Jun 12, 2004 at 09:21 PM by P_RN

http://www.edu.rcsed.ac.uk/HowIDoIt/...0fractures.htm

.....Preoperative traction has no value in relieving pain. (9) It has been claimed to reduce the risk of further fracture displacement occurring, but this remains unproven. The injured leg should always be treated with care as further movements of the joint may jeopardise the precarious blood supply to the femoral head.

For an undisplaced intracapsular fracture, delay from fracture to surgery will not influence the risk of fracture healing complications, other than for the risk of the fracture becoming displaced. Surgery, therefore, is recommended as soon as the patient is appropriately prepared, but need not be out of hours. For displaced intracapsular fractures there is contradictory evidence regarding the timing of surgery. Limited evidence suggests that surgery must be performed as soon as possible after injury to reduce the risk of fracture healing complications.(10) Other studies indicate that a delay of up to a week have no effect on fracture healing but after that time the risk of nonunion is markedly increased.(11,12)
You may want to look into the National Association of Orthopaedic Nurses publication the Core Curriculum. http://www.orthonurse.org/estore/practice.cfm
Your library may be able to get it for you. In it you will find almost everything you need to know about ortho.

Good luck with convincing your colleague in the OR that she is WRONG.
Top
 
No. 3
from P_RN
Old Jun 10, 2004, 10:54 PM

Did I misunderstand? Did your nurses move the patient TO the stretcher? Or from it?
Top
 
No. 4
from lcbaird
Old Jun 14, 2004, 01:34 PM

Originally Posted by P_RN
Did I misunderstand? Did your nurses move the patient TO the stretcher? Or from it?
From the bed to the stretcher on a slide board with the hip splinted.
Top
 
No. 5
from P_RN
Old Jun 14, 2004, 03:57 PM

Originally Posted by lcbaird
From the bed to the stretcher on a slide board with the hip splinted.
I'm not sure you will get much positive input on this. The easiest on the patient and on the nurses/transporters is to transfer them in the bed. That way to the OR table and back to the bed..only 2 moves. If you're concerned about losing your bed, have someone bring it back up to the room.
I've been a certified ortho nurse for 18+ years and that's the way it's done.
Top
 
No. 6
from lcbaird
Old Jun 14, 2004, 04:33 PM

Originally Posted by P_RN
I'm not sure you will get much positive input on this. The easiest on the patient and on the nurses/transporters is to transfer them in the bed. That way to the OR table and back to the bed..only 2 moves. If you're concerned about losing your bed, have someone bring it back up to the room.
I've been a certified ortho nurse for 18+ years and that's the way it's done.
We usually do transport to the OR in the bed but in this case the bed the patient was on was not one of our beds and we were going to get an appropriate bed for post op and take it to the OR when it arrived. When we used the gurney to transfer we were accused of some "great" breach in the standard of care that could cause major complications. I agree it's much easier for all to take them over on the bed and bring them back on the bed. The ward nurses thinking was this was not different than taking them to the CAT scan. Transfer to gurney and then to the OR table, post op bring the bed to the OR. Another interesting note is the doctors and their nurse practioners are not using "Bucks traction" much any more, just splinting with pillows.
Top
 
No. 7
from meownsmile
Old Jun 14, 2004, 11:10 PM

Minimizing the transfers with a hip fx is always the optimal situation. We transfer to bed from gurney when they come from the ER, that is the only transfer they undergo until after surgery and they are starting to get up post op. Any xrays are done prior to their coming up to the unit and if others are needed, they come up and do portable x-rays at the bedside. We do turn the patients, use tx, but they go to surgery in their bed, and come back to the unit in the bed they left in. Dont know about any breaches of care standard. Dont know that its actually written a patient cant be transferred, its just the lest disruptive/painful for the patient if they arent.
Top
 
No. 8
from armyrn
Old Jun 19, 2004, 08:56 AM

i tend to agree that you should minimize transfers, which it sounds like y'all tried to do. ideally it should be bed-table-bed. one additional transfer should not "make or break" a postop hip though.

now watch this be the one time...
Top
 
No. 9
from reecie54
Old Oct 24, 2008, 05:38 AM

Default Re: Fractured HIP patient - Need question answered
I have a question...when boosting a patient in the bed, do you remove the weigh from the traction and then slowly reapply or do you pull the patient with the weight still on or does someone move the weight as the pt is moved? And where might I find some literature on this issue. I'm in the ICU and have a pt who requires freqent repositioning and we have some disagreements here...Thanks!
Top
 
Page 1 of 2 1 2 >
Reply




Thread Tools


Who's Online
132 members
1,429 guests
1,561

8

Doctors-in-short-supply-responsibilities-for-nurses-may-expa...

7

Less regular sleep for ICU nurses may lead to errors

14

Nurse sends unused medical supplies to needy nations

23

Premature Births Are Fueling Higher Rates of Infant...

6

MRSA Strain Linked to High Death Rates

22

RI hospital fined $150,000 in 5th wrong-site surgery since...

64

Nursing: One of the 6 Thriving Jobs that are Here to Stay???

89

Dad Fights Hospital to Keep Baby on Life Support

12

A nurse can dream...about awesome nursing

16

California Nursing Situation - CINHC's plan to help New...



7

Why am I doing this, anyway?

0

Nurse Heal Thyself

7

My Papa, why I am the nurse I am today.

15

I made it through

11

An angel's gaze

13

A Sister Never Forgets

16

Ruby's Marbles

29

What Do Operating Room Nurses Do?

14

My Little Old Jedi

16

I love this job......

23

"I hear voices"

17

Preventing FRUTI (Foley Related Urinary Tract Infection) in...

23

Error and Attitude

10

It's Just a Shower

6

Searching for the Purpose





Sponsored Links

Currently Reading This Page: 1 (0 members & 1 guests)

Interested in the hottest topics of the week? Subscribe to the Nurse-zine Newsletter.
Enter email address: