Table 1 Organisation, routines, staffing and resources in the orthogeriatric unit
From: Older hip fracture patients: three groups with different needs
Unit size and location | 20 beds (3 single rooms and 7 double rooms, 1 three-person room) 4 observation beds for pre- and postoperative care |
Staff | Nurse factor 1.65 2 physiotherapists 0.8 occupational therapist (specialized in geriatrics) 0.2 clinical nutritionist |
Training and education | Two weeks training for all nursing staff before work-start. Weekly teaching-lessons of 45 min for all staff. |
Interdisciplinary team | Nurse, nurse-assistant, physiotherapist (PT), occupational therapist (OT), clinical nutritionist, pharmacist, orthopaedic surgeon and geriatrician. |
Comprehensive geriatric assessment | Assessment of pre-fracture ADL (Barthel Index) and cognitive function (IQCODE-SF) by interview with next-of-kin (OT or nurse). ADL assessment 1.-3. day after surgery and at discharge. MMSE at discharge (OT). An integrated care plan including rehabilitation and discharge planning approved by the interdisciplinary team meeting (twice weekly). |
Prevention of complications | Systematic prevention of complications: delirium, falls, tromboembolism, nosocomial infections, pressure sores and wound infections. Screening for urinary tract infections. Removal of bladder catheter within 24 hours after surgery. Screening for urinary retention by bladder scans. Prevention of constipation. Blood transfusion at haemoglobin less than 8 mg/l, at higher levels in patients with coronary artery disease. Systematic pain control (by protocol). |
Nutrition | Oral liquid supplements to all patients up to two hours before surgery. Fortified diet; small energy-dense portions Measurement of weight and height, calculation of BMI. Patients with BMI < 22 are assessed by a clinical nutritionist. Additional nutritional supplements to patients with low BMI. |
Rehabilitation | Mobilisation on day one after surgery. Daily ADL-training and walk training with help from nursing staff. Counselling and training with PT and OT. Patients are emphasized to be as independent as possible, to leave their rooms and to take all meals in the dining room. Follow up by PT at three months. |
Prevention of subsequent fractures | Fall assessment and multifactor intervention to prevent new falls. Bone mineral density measurement and assessment for osteoporosis treatment (calcium, vitamin D and bisphosphonates). |