Related resources - Hip Fracture Clinical Care Standard

A number of related resources have been identified which are relevant to the Hip Fracture Clinical Care Standard.

The Hip Fracture Clinical Care Standard includes links to resources that may help healthcare services and clinicians to implement the standard. These resources are listed under the relevant quality statements below.

Quality Statement 1: Care at presentation

Resources including local protocols and clinical pathways for hip fracture care have been shared by hospitals that contribute to the ANZHFR; these can be found on the ANZHFR website.
The Australasian College for Emergency Medicine Care of older persons in the emergency department (Policy P51) relates to the recommended standards of care for older persons in the emergency department; it has been developed in consultation with, and endorsed by, the Australian and New Zealand Society for Geriatric Medicine.
People with hip fracture have a high risk of delirium; to prevent, diagnose and manage delirium in these people, they should be treated according to the Delirium Clinical Care Standard.
The 4AT has been validated for both cognitive impairment screening and delirium assessment, and is available in 17 languages.
Some validated tools for cognitive impairment screening include
- Abbreviated Mental Test Score (AMTS), incorporated in the NSW Health Delirium Screen for Older Adults (available from the Agency for Clinical Innovation)
- Kimberley Indigenous Cognitive Assessment tool, available from the Dementia Centre for Research Collaboration.
The Clinical Frailty Scale can predict adverse outcomes in older people in hospital, including hospital-based harm, emergency department and inpatient length of stay, the need for placement in an aged care facility, and death.

Quality Statement 2: Pain management

The Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard describes the key components of care that patients can expect when they are prescribed opioid analgesics for acute pain in acute care settings.
Pain scales support the identification of symptoms and signs associated with pain in people with altered cognition; examples include
- Pain Assessment in Advanced Dementia scale
- Abbey pain scale.
Some pain assessment tools use facial expressions, such as the Wong-Baker FACES pain rating scale.
Some patients may have needs that require particular attention (for example, patients who are opioid-tolerant or have a substance use disorder, Aboriginal and Torres Strait Islander people, Māori, patients with cognitive behavioural and/or sensory impairments, and non-English speaking people); evidence-based information related to the management of acute pain in these patient groups and situations is included in the fifth edition of Acute Pain Management: Scientific Evidence, published by the Australian and New Zealand College of Anaesthetists and the Faculty of Pain Medicine.
The Society of Hospital Pharmacists of Australia’s Standard of practice in pain management for pharmacy services outlines important strategies to optimise pain management while minimising harm, including implementing opioid or analgesic stewardship services.

Quality Statement 3: Orthogeriatric model of care

People with hip fracture have a high risk of delirium; to prevent, diagnose and manage delirium in these people, they should be treated according to the Delirium Clinical Care Standard.
The Venous Thromboembolism Prevention Clinical Care Standard supports clinicians and healthcare services to deliver high-quality care that prevents VTE from being acquired both in hospital and following discharge.
The Commission has developed several resources for clinicians, managers and executives, governing bodies and others that can help them adopt strategies that reduce the occurrence of hospital-acquired complications such as VTE, delirium and malnutrition.
The National Safety and Quality Health Service Standards Comprehensive Care Standard includes actions on nutrition and hydration (5.27 and 5.28), preventing falls and harm from falls (5.24 to 5.26) and preventing delirium and managing cognitive impairment (5.29 and 5.30).

Quality Statement 5: Mobilisation and weight bearing

The Commission has developed several resources for clinicians, managers and executives, governing bodies and others that can help them adopt strategies that reduce the occurrence of hospital-acquired complications and provide comprehensive care, including for pressure injury.
The National Safety and Quality Health Service Standards Comprehensive Care Standard includes actions on preventing and managing pressure injuries (5.21 to 5.23).

Quality Statement 6: Minimising risk of another fracture

The Australian and New Zealand Hip Fracture Registry fact sheet Reducing the risk of future fractures: Osteoporosis and fall prevention.
Healthy Bones Australia resources and fact sheets about osteoporosis, treatment, diet, exercise and falls; this information can be used by clinicians in discussions with patients when developing a plan to reduce the risk of another fracture.
The Clinical Standards for Fracture Liaison Services in New Zealand underpin a nationwide strategy to prevent older adults who sustain a fragility fracture from breaking other bones in the future.
The Therapeutic Guidelines Osteoporosis and minimal-trauma fracture guideline includes information on assessing and interpreting bone status and preventing minimal‑trauma fracture.
The National Safety and Quality Health Service Standards Comprehensive Care Standard includes actions on preventing falls and harm from falls (5.24 to 5.26).

Quality Statement 7: Transition from hospital care

Additional ANZHFR resources are available on the ANZHFR website including the Hip Fracture Care Guide which provides important information about care after a hip fracture and has been translated into 15 different languages. This guide and other information specific to patients, carers and families can be found on the ANZHFR My Hip My Voice webpage.
Te Tāhū Hauora has helped to develop the Recovering from a hip fracture: Pikinga ora i tētahi whainga hope information booklet to meet the needs of the population in Aotearoa New Zealand; an important part of the booklet is for the patient to be able to work through and document a personal plan with their healthcare team before discharge from hospital.

In addition to these, a number of implementation resources have been developed to support the Hip Fracture Clinical Care Standard, including fact sheets for consumers, clinicians and healthcare services.