Guide to NICE: Hip Fracture Management in Adults
A hip fracture refers to a fracture between the edge of the femoral head and five centimetres below the lower trochanter. On average, around 70,000 hip fractures occur each year in the UK, costing the NHS around £2 billion.
The NICE guidelines are designed to provide direction on managing hip fractures in adults. They aim to improve care from the time people aged 18 and over are admitted to the hospital to when they return to the community.
This article will look at the NICE guidelines for hip fractures in detail. We’ll look at the scope of the guidelines, the key messages included and what you need to be able to implement them effectively.
- What Are NICE Guidelines?
- What Are the Key Messages In the Guidelines?
- What Do You Need to Implement the Guidelines?
What Are NICE Guidelines?
The National Institute for Health and Care Excellence (NICE) guidelines are evidence-based recommendations for health and care in England. They set out the care and services suitable for most people with a specific condition or need and people in particular circumstances or settings.
People with a hip fracture, including those cared for in the community, often have comorbidities and complex care needs. However, with assessment and continuous rehabilitation, we can collectively improve functional outcomes and reduce mortality for hip fracture patients.
What Are the Key Messages In the Guidelines?
Within the NICE guidelines, some key messages and recommendations should be followed to help people with hip fractures recover and regain their mobility faster. Some of these include:
Timing of Surgery
When someone suffers a hip fracture, surgery must be performed on the day of or the day after the fracture has happened.
About 10% of people with a hip fracture die within one month and about one-third within 12 months. Although most of the deaths are due to associated conditions and not to the fracture itself, surgery must be undertaken as soon as possible to avoid further complications.
Mobilisation and Rehabilitation Strategies
It’s also essential to work with local hospitals and Trusts to ensure a mobilisation strategy is in place. This involves offering patients a physiotherapy assessment and mobilisation on the day after surgery.
Once the patient undergoes surgery, they need to have a plan to help them rehabilitate. The individual programme will depend on the person's fitness level and mobility. The programme should include a range of activities, such as:
- Weight-bearing exercises – where your feet and legs support your weight, such as walking
- Non-weight-bearing exercises – where your feet and legs don’t support your weight, such as swimming or cycling
- Treadmill exercises – such as walking at different speeds and inclines
- Intensive physical training – such as meeting with an exercise instructor three or more times a week to exercise
- Strength training and balance training exercises
Patient and Carer Information
Patients (or, as appropriate, their carer and/or family) should also be offered verbal and printed information about their treatment and care. Several areas should be covered here, such as:
- Their diagnosis and the severity of it
- The choice of anaesthesia, analgesia and other medications
- The surgical procedures that will or have been performed
- Any possible complications and long-term outcomes they might potentially suffer from
- Details about the patient's postoperative care and rehabilitation programme
- A list of all the healthcare professionals that will be involved
So, these are some of the key messages included in the NICE guidelines. But what do you need to implement? Read on to find out.
What Do You Need to Implement the Guidelines?
Preparation and understanding are key when implementing NICE guidelines. For this to happen, there are some steps you should follow:
Understand Current Ways of Working
Before you start planning changes to services or implementing new guidance, you need to understand how the service works at the moment. This is your baseline and can be used to measure the effect of any changes you make.
Be sure to look outside your organisation and see how your service fits the wider community. Some questions to ask yourself are:
- What resources are we using to support us when implementing the guidelines?
- How much will it cost to implement the guidelines?
- What outcomes will be measured?
- Are these outcomes important to patients or people using services?
Once you’ve asked yourself these questions, the next step involves making a plan.
Make a Plan
Now, you should take the information you gathered in the last step and map the results against our guidance or quality standards. Note what you’re doing already, what might need to change and what’s missing or might need to be stopped.
There are plenty of NICE resources available on the official website to manage hip fractures in adults.
Improve and Measure
Your plan is in place and you’re ready to start carrying out your actions to improve the quality of hip fracture management. Whatever changes you make, be sure to measure their effectiveness.
Collating feedback from your patients and staff is key here. There are some questions you should ask them to see whether services are improving:
- Have the changes improved the service?
- How do service users feel?
- How are staff adapting?
- Is there anything that could be done better?
Keeping up with NICE guidelines isn’t the easiest of tasks, especially when you’re working a busy schedule and there’s a lot of information to take in. That’s why we’re running a one-day interactive training course to help you learn more about strategies and initiatives to improve hip fracture management.
Learn More About NICE Guidelines
At Inside Government, we’re always dedicated to hosting the most insightful and engaging events, summits and conferences — spanning over a range of specialisms. Throughout the year, we have events coming up that expand on the importance of NICE guidelines and what can be done to improve patient care in the UK.
Take a look at our full list of 2022 events by scrolling through the sectors and sign up today.