An integrated care pathway for fractured neck of femur patients

Onslow, L., Roberts, H., Steiner, A., Roberts, A., Powell, J. and Pickering, R. (2003) An integrated care pathway for fractured neck of femur patients. Professional Nurse, 18 (5), 265-268.

Abstract

This paper describes how an integrated care pathway was introduced for patients with fractured neck of femur in an acute hospital. Femoral neck fracture is the most common traumatic condition requiring admission to adult orthopaedic wards, and is currently approaching epidemic proportions among older people, especially women (Audit Commission, 1995).

Femoral neck fracture is a high-volume, high-cost procedure with a typically well-defined starting point, and therefore a good candidate for an integrated care pathway.

These pathways have been defined as 'a multidisciplinary outline of anticipated care, placed in an appropriate time frame, to help a patient with a specific condition or set of symptoms move progressively through a clinical experience to a positive outcome' (Middleton et al, 2000).

Their development involves a multidisciplinary team collaborating to evaluate current practice in the light of available evidence on clinical effectiveness. From this, protocols are developed and incorporated, described by the Royal College of Nursing (1993) as 'an agreement to a particular sequence of activities which assist health staff to respond consistently in complex areas of clinical practice'.

Any variance from the anticipated care pathway is recorded, outlining what occurred differently, why, and what was done instead. This ensures the standardised pathway can be adapted to meet individual patients' needs.

Once a group of patients have been through a pathway, analysis of all the variances recorded gives the multidisciplinary team a picture of what is happening to them and why. The team can then review, update and improve their patient care practices, which lies at the heart of proactive clinical governance (Johnson et al, 2000).

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Contributors

Author: H. Roberts

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