NOW UPDATED: In 2023, Ontario Health completed a review of
the evidence to capture new or updated clinical practice guidelines and health
technology assessments published since the original release of this quality
standard in 2017. This update aligns the quality standard with the most recent
clinical evidence and with current practice in Ontario. You may refer to page 7
on the
Hip Fracture quality standard for a summary of updates.
Ontario Health’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 Ontario Health (formerly Health Quality Ontario)
- Clinical Pathway for Inpatient and Outpatient Hip and Knee Arthroplasty - a resource
by the Healthcare Excellence Canada that provides clinicians in Canada with evidence-based
strategies to improve surgical outcomes in hip and knee arthroplasty by
applying principles emerge from Enhanced Recovery After Surgery, including
patient and family engagement, surgical best practices, multimodal
opioid-sparing pain management, mobility and physical activity, and fluid and
nutrition management.
Tools to Support Clinical Practice
The following tools and/or resources apply 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 Ontario
Health 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