A new project is working to enhance patient recovery after trauma injuries by encouraging early mobilisation following orthopaedic surgery.
Our Ward 6 team have recently achieved success in improving the number of patients mobilised following surgery with the ‘Out Of Bed Project’ – a new quality improvement initiative which has seen the number of patients mobilised the day after their surgery increase from 60% to 85% over the two month period of the trial.
The number of patients who are mobilised following femoral fracture is monitored nationally by the National Hip Fracture Database (NHFD) as this is linked to a better outcome for this patient group. The aim of the project was to increase the percentage to above the national average – something that has been achieved during the project trial.
An audit completed by the orthopaedic integrated therapy team last year highlighted that a disproportionate number of patients remain in bed if not seen by a physiotherapist and that they were more likely to have issues related to post-operative confusion, pain or low blood pressure.
The ward based Out Of Bed Project involved Orthopaedic Therapists, Ward Sisters, Health Care Assistants (HCAs), Consultants and the team Matron, with training and education provided to the HCAs to empower them to mobilise patients, or attempt to mobilise patients, prior to their physiotherapist assessment.
Rene Gray, Orthopaedic Physiotherapist, said; “The idea was to give our HCAs the confidence and competence to attempt to mobilise these patients early and if barriers were identified to flag these up to the nurse to help resolve these issues.
“This not only increased the number of patients mobilised prior to their physiotherapy assessment but it also helped to improve the success rate when the physiotherapist attempted to mobilise the patient later in the day as lots of the barriers to mobilising we normally encounter were already resolved.
“It has been great to be involved in this project which has had fantastic buy-in from our Health Care Assistants, Orthopaedic Sisters, Matron and Lead Consultant, which has, I believe, been the key to such rapid success.”
The training for this Physiotherapy-led project was completed by Rachel Dance, Senior Physiotherapist, supported by the Fracture Femur Key Worker, Patsy Hindley, Senior Physiotherapist Anna Mellows and Jess Buck, to provide an awareness and understanding of the barriers to mobilising, the importance of mobilising and when not to mobilise.
Ward 6 Sister Sue Pinkney said; “Our nurses and Health Care Assistants have really embraced this project and the results have helped to demonstrate the importance of what they do day in and day out to help their patients.”
Rachel Dance, Senior Physiotherapist, said; “We have been really pleased with the rapid improvement we have seen in the number of patients mobilised out of bed since we launched this project. Not only has it meant that more patients are mobilised out of bed earlier post-surgery but it also allows more time for physiotherapy and occupational therapy assessments and rehabilitation to focus on progressing patients towards their goals for discharge, improving their independence and ultimately getting them home sooner.”
Kirsty Gilham, one of the Ward 6 HCAs who took part in the project, said; “I have increased my confidence when mobilising patients following their surgery,” while Taylor Dewhurst, also an HCA said; “It has been nice to be able to get patients up without having to wait for the physios…. I have noticed that patients who are up early do better.”
The next phase of the improvement project, which will be led by our orthopaedic Occupational Therapists with support from the ward team, will focus on improving patient cognition, and function post-surgery, looking at reducing post-operative delirium.