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Health Quality Ontario’s Hip Fracture Quality Standard includes 15 quality statements addressing care for adults aged 50 years and older undergoing surgery for fragility hip fractures from the emergency department to three months following surgery. Fragility fractures are fractures caused by low-energy trauma, such as falls from standing height.

Below is a sample of tools that may help you with the implementation of the quality statements into practice, organized according to purpose. Some of these tools will help to support multiple quality statements.

Are there other tools or resources you use? Do you have experience implementing these tools? If so, please use the comments section below to share!

Comprehensive Tools and Resources

The following tools and/or resources may apply to more than one quality statement in the Hip Fracture Quality Standard:

• National Hip Fracture Toolkit—a resource edited by Bone and Joint Canada that provides best-practice recommendations throughout the hip fracture patient’s continuum of care, and addresses considerations for surgery within 48 hours, multimodal analgesia, postoperative management, management of osteoporosis and delirium, rehabilitation and information for patients, families and caregivers
• Improving Time to Surgery: Emergency Room, Preoperative and Immediate Postoperative Clinical Practice Guidelines for the Management of Hip Fracture Patients —a resource by the Bone and Joint Health Network that outlines the best emergency department, pre-operative, and immediate post-operative clinical practices to support hospitals and clinicians in achieving surgery within 48 hours for hip fracture patients
• Ontario Pain Management Resources—an up-to-date list of educational resources on pain management for health care professionals from Health Quality Ontario 

Tools to Support Clinical Practice

Examples of clinical order sets for hip fracture:

• Emergency Department Hip Fracture Adult Orders—an emergency department clinical order set for hip fracture developed by Alberta Health Services
• Orthopaedic Hip Fracture Preoperative Orders—a preoperative clinical order set for hip fracture developed by Vancouver Island Health Authority
• Post-Operative Fractured Hip Order Set —a postoperative clinical order set for hip fracture developed by Grey Bruce Health Network

The following tools and/or resources applies to Quality Statement 10: Screening for and Managing Delirium in the Hip Fracture Quality Standard:

• Confusion Assessment Method (CAM)—a standardized, evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately
• Delirium Senior Friendly Care Toolkit —a toolkit from the Regional Geriatric Program of Toronto on screening, detecting, prevention, management, monitoring and evaluation of delirium
• Delirium, Dementia and Depression (3 D’s)—information for clinicians from Bone and Joint Canada on the importance of assessing and managing the 3 D’s in hip fracture patients
• Mini Mental State Examination (MMSE) —an 11-question screening tool for cognitive impairment in older adults to test five areas of cognition: orientation, registration, attention and calculation, recall, and language

Educational Resources for Health Care Professionals

• Pain Assessment Scales—a resource compiled by the National Initiative on Pain Control that includes the Wong-Baker FACES Pain Rating Scale, 1-10 Numeric Pain Rating Scale, and the Pain Quality Assessment Scale
• Functional Recovery of Hip Fracture Patients—a resource from Bone and Joint Canada that provides a detailed look at rehabilitation strategies to maximize functional recovery of hip fracture patients
• Osteoporosis Guidelines—a resource repository by Osteoporosis Canada that includes clinical practice guidelines for osteoporosis and fracture risk assessment tools
• Canadian Fall Prevention Education Collaborative —a centre for fall prevention education that offers workshops and e-learning courses and serves as a platform for sharing evidence-based practices, programs and events related to fall and injury prevention for older adults
• Fall Prevention Month—a website focused on fall prevention that offers resources, communications, and promotional materials to help organizations disseminate and implement fall prevention activities

Resources for Patients and Families

• Patient Reference Guide: Hip Fracture—a resource by Health Quality Ontario to help people with hip fractures and their families or caregivers know what high-quality care looks like and ask informed questions when receiving treatment in hospital and after discharge
• Hip Fracture Recovery Pathway: Before Surgery to Day 7—a visual guideline for patients and caregivers by Alberta Health Services that details the care that the patient will receive each day from before their hip fracture surgery to Day 7 post-surgery
• Recovery from a Hip Fracture: Information for Patients and Caregivers —a patient information booklet by the Canadian Orthopaedic Foundation that outlines what patients and their caregivers can expect during recovery from a hip fracture, and provides recommendations on managing different aspects of the patient’s health, such as mental health, pain, exercise, and fall prevention
• Osteoporosis Booklets and Fact Sheets—a resource repository by Osteoporosis Canada that includes booklets and fact sheets for patients on osteoporosis and related topics, such as nutrition, exercise and drug treatments
• Exercise and Falls Prevention Programs—information on free classes for seniors (aged 65 and older) in Ontario to help maintain balance and strength or prevent falls

Other Tools and Resources

• Health Quality Ontario’s Quality Standards—other quality standards from Health Quality Ontario that focus on pain management may also be useful, including:
  • Opioid Prescribing for Acute Pain
• Quality-Based Procedures Clinical Handbook for Hip Fracture—a clinical handbook created by Health Quality Ontario and the Ministry of Health and Long-Term Care to serve as a compendium of the evidence-based rationale and clinical consensus driving the development of the policy framework and implementation approach for hip fracture patients seen in hospitals
• Regional Geriatric Program Senior Friendly Care Tools—a database of senior-friendly care tools and resources aimed at clinicians and patients from the Regional Geriatric Program of Toronto

Comment below to describe your experience with these tools or share any others you have found useful!