Fractured HIP patient - Need question answered

Specialties Orthopaedic

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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! :uhoh21:

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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.

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

http://www.edu.rcsed.ac.uk/HowIDoIt/Internal%20fixation%20of%20intracapsular%20fractures.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.

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Did I misunderstand? Did your nurses move the patient TO the stretcher? Or from it?

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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.

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.
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.

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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.

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Specializes in Med/Surg, Ortho.

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.

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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... :crying2:

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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!

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Ok. This is a little different than the above question, but also about moving. Pt found on floor, no complaints of pain, no noted injuries. CSM fine, no difference in the two legs ect. ect. Patient was placed back in bed by staff, THEN complained of hip pain. Was it wrong to move him? He did get sent out for eval and did have a fracture.

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Specializes in Ortho/Neurosurgical.
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.

We use bucks.....on almost every hip fracture....depending on the break of course....but 9/10 we use 5lbs bucks.

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