Authors: (including presenting author): :
Chau WW(1), Kwong WF(1)
Affiliation: :
(1)Department of Orthopaedics & Traumatology, Queen Mary Hospital
Keyword 1: :
Fragility fractures
Keyword 2: :
Evidence-based nursing
Keyword 3: :
Patient repositioning
Introduction: :
Spontaneous fracture is referred as fracture caused by normal or physiological stress on weakened bone. There are multiple contributing factors, including comorbidities and extrinsic factors like turning and repositioning techniques. Concerns were raised on spontaneous fracture incident during hospitalization. In year 2021- 2023, there were 3 reported cases of spontaneous fractures in Department of Orthoapedics & Traumatology, Queen Mary Hospital. Nursing activities involving patient turning and diaper changing were reported before the incidents in 2 of the cases.
Objectives: :
Develop systematic nursing interventions to prevent inpatient fractures for patients at risk of spontaneous fractures.
Methodology: :
Gap analysis by Ishikawa Diagram was adopted to review current practice. Over 380 literatures were screened and 8 of them were appraised by the John Hopkins evidence-based practice model. Interventions in this program were formulated according to the findings in literature appraisal, which include improving turning technique, increasing staff and relative awareness and adopting fracture risk screening mechanism.
Result & Outcome: :
For improving turning technique, new turning sheet and repositioning pads were acquired to better handle fragile or high-risk fracture patients. Moreover, in-house training video and scenario based turning and repositioning workshop were developed. There was over 80% of nurses and patient care assistants received training. For increasing staff and relative awareness, a new bedside signage with clear care instructions and diagram to label high risk fracture body part was designed and applied clinically. A new set of care plan was formulated for better documentation and clinical handover. For fracture risk screening, patient with bone erosion, bone lesion, bone metastasis or severe osteoporosis were screened on admission under this program and appropriate nursing interventions would be applied respectively. The primary outcome is inpatient spontaneous fracture incident related to nursing activities. There is no reported incident since the implementation of this program. The secondary outcomes include staff competency and knowledge related to the program. A pre- and post-test was conducted after training workshop and over 90% of the respondents showed improvement.
