Reducing delirium in elderly patients with hip fracture: a multi‐factorial intervention study

Björkelund, Karin Björkman; Hommel, Ami; Thorngren, Karl–Göran; Gustafson, Lars; Larsson, Sven; Lundberg, Dag

doi:10.1111/j.1399-6576.2010.02232.x

Cited by 159 publications

(152 citation statements)

References 45 publications

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“…Delayed ambulation obstructs this goal, and peri-operative anaesthetic management should aim to optimise the chance of ambulation, as one facet of early postoperative, multidisciplinary rehabilitation [65,86]. Strategies include the implementation of prescriptive postoperative care bundles (detailing fluid therapy, analgesia, and management of anaemia, for example) [11], provision of critical care facilities and physiotherapy, and the avoidance of delirium [87].…”

Section: Postoperative Carementioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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SummaryNational reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients. More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary 70

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Section: Postoperative Carementioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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“…At our hospital we are trying to improve early access to FIB in order to avoid the complications described above, and are developing a training program to enable emergency staff to perform FIBs at their initial assessment. This has been shown to be achievable and provides safe and effective analgesia in the emergency department [3].We agree with the accompanying editorial calling for a more prominent role for nerve blocks in the pain management of this patient population [4]. We also suggest that the delayed use of FIBs on the analgesic ladder is incorrect, and will potentially create a serious complication that will tarnish the reputation of a very useful block.…”

mentioning

confidence: 62%

“…We agree with the accompanying editorial calling for a more prominent role for nerve blocks in the pain management of this patient population [4]. We also suggest that the delayed use of FIBs on the analgesic ladder is incorrect, and will potentially create a serious complication that will tarnish the reputation of a very useful block.…”

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confidence: 66%

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Griffiths

2012

Anaesthesia

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Excellence (NICE) guidelines issued in June 2011 [2].Within our institution we have an established a fascia iliaca block (FIB) service provided by Trauma and Orthopaedic Nurse Practitioners for patients with a fractured neck of femur. We find this nerve block very useful for pain control, and patients subsequently require minimal systemic analgesia. During a recent audit the only complication noted, other than block failure, was excessive sedation following administration of an effective FIB. Without exception, these cases had received their FIB after significant amounts of morphine had been given for pain control. Approximately 1 h after FIB, naloxone was required to reverse the excessive opioid sedation. We are concerned that the NICE guidelines advocate a delayed approach to FIB placement whereas the AAGBI guidelines suggest a 'single shot ⁄ continuous nerve block may be successfully administered' [1,2]. If the NICE guidelines are rigorously applied then the FIB should be used after paracetamol and opioid administration if pain is still an issue. This approach increases the risk of complications associated with FIB and delayed opioid sedation.We strongly believe that the correct timing for the FIB is immediately after radiographic confirmation of the diagnosis, or earlier in cases of high clinical suspicion, and FIB should be offered to all in whom it is not contraindicated. This maximises pain relief in the most painful early period and negates the need for strong systemic analgesia in this physiologically frail group. At our hospital we are trying to improve early access to FIB in order to avoid the complications described above, and are developing a training program to enable emergency staff to perform FIBs at their initial assessment. This has been shown to be achievable and provides safe and effective analgesia in the emergency department [3].We agree with the accompanying editorial calling for a more prominent role for nerve blocks in the pain management of this patient population [4]. We also suggest that the delayed use of FIBs on the analgesic ladder is incorrect, and will potentially create a serious complication that will tarnish the reputation of a very useful block.

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“…Systematisk screening og tidlig identifikasjon av symptomer kan redusere tilfellene av delirium (6). Internasjonalt er CAM (Confusion Assessment Method) det mest brukte diagnos tiske instrumentet for delirium (7).…”

Section: Lett å Brukeunclassified

Ny screening gir sikrere diagnose

Berg¹,

Watne²,

Gjevjon³

2016

Sykepleien

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Reducing delirium in elderly patients with hip fracture: a multi‐factorial intervention study

Abstract: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%.

Cited by 159 publications

References 45 publications

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

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Ny screening gir sikrere diagnose

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