waht-phy-005 v5.2

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WAHT-PHY-005It is the responsibility of every individual to ensure this is the latest version as published on the Trust Intranet

Post operative physiotherapy regimes following fracture neck of femur

WAHT-PHY-005 Page 1of 6 Version 5.2

POST OPERATIVE PHYSIOTHERAPY REGIMES

FOLLOWING FRACTURE NECK OF FEMUR

This guidance does not override the individual responsibility of health professionals tomake appropriate decision according to the circumstances of the individual patient in

consultation with the patient and /or carer. Health care professionals must be prepared tojustify any deviation from this guidance.

INTRODUCTION

This physiotherapy guideline has been agreed within the Worcestershire Acute HospitalsNHS Trust Consultants and Physiotherapy Managers for physiotherapy regimes followingelective and trauma and orthopaedic surgery.

The physiotherapy departments across the trust aim to provide equality of serviceregardless of location.

All patients with fractured neck of femur are covered by this guideline.

THIS GUIDELINE IS FOR USE BY THE FOLLOWING STAFF GROUPS:Physiotherapists

Lead Clinician(s)

Treena Currie

Helen Hawkes

Senior Physiotherapist

Senior Physiotherapist

Approved by Physiotherapy Clinical Governancecommittee on: 21stJanuary 2015

This guideline should not be used after end of: 21stJanuary 2017

Key amendments to this guidelineDate Amendment By:

March 2003 Approved by Clinical Effectiveness Committee

June 2011 Minor changes to change for step by step guidelineseach day as patients are encouraged to progress at

their own rate.

Helen Hawkes

June 2011 Changes to contribution list Helen Hawkes

Dec 2012 Changes to layout to combine protocols as they arenow similar regardless of procedure

Helen Hawkes

Jan 2015 Reviewed by Clinical Lead and resubmitted with nochanges

Helen Hawkes

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INTRODUCTION

This physiotherapy protocol has been agreed with the Worcestershire Acute Hospitals NHSTrust Consultants and Physiotherapy Managers for physiotherapy regimes following electiveand trauma and orthopaedic surgery.

The physiotherapy departments across the trust aim to provide equality of service regardlessof location.

COMPETENCIES REQUIRED

All qualified physiotherapy staff working in orthopaedic area should be aware of theexistence of this protocol and the location of where a copy of the protocol is kept.

The Senior

Physiotherapist in each location will advise the physiotherapy assistants of anyprotocols which apply to them. It is the responsibility of individual staff to keep themselvesupto date with any policies that would apply to them (checked at annual PDR)

PATIENTS COVERED - ALL CONSULTANTS

All patients with fractured neck of femur that undergo surgical fixation. This may be fixed witha variety of methods including cannulated screws, dynamic Hip Screw (DHS), Hemi-arthroplasty or a total Hip replacement. It would be decided by the surgeon taking intoaccount the site of the fracture, bone quality, patients previous mobility and co-morbidities.

It is not always possible to see patients pre-op as surgery is unplanned but if possible tryand do a quick pre-op assessment.

Pre-operatively (all patients)

Chest assessment

Teach post-op exercises if patient has capability to follow instructions, breathingexercises, Static quads, Static gluts and active dorsi/plantar flexion of ankles.

All documentation for these patients is found in a care pathway, which is kept beside thepatients medical notes. Physiotherapy problem list and continuation sheets are found at theback.

Post operative:

DAY 1:

Check chest.

Deep Breathing exercises, circulation exercises.

Static quads, static gluts.

Issue exercise sheet where appropriate.(info booklets available for DHS,Hemiarthroplasty and THR)

Assist board exerciseship flexion, hip abduction.

Inner range quads, static quads.

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Check post op instructions for weight bearing status. Routine protocol would be FWB butyounger patients/cannulated screws/poor bone quality or poor fixation may need TTWBor PWB for a period of time post-op.

Sit out with appropriate mobility aid if medically fit

DAY 2 ONWARDS:

Continue with exercises.

Progress mobility as preoperative state and weightbearing status allows.

Stairs assessment when/if appropriate.

Send patient home when safe or refer to community hospital.

Refer to community physiotherapy if further progress expected.

Refer to falls group if appropriate criteria.

MONITORING TOOL

STANDARDS:

Item % Exceptions

# NOF Mobilised 1stday post op 95% Sunday. Extended Bank Holidays.Medically unfit.

How will monitoring be carried out? Audit physiotherapy notes

When will monitoring be carried out? Random per rotation

Who will monitor compliance with the guideline Site team lead

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CONTRIBUTION LIST

Key individuals involved in developing the document

Name Designation

Helen Hawkes Clinical lead Orthopaedic Physiotherapist

Katie Gromski Orthopaedic Team Lead Physio - WRH

Katie Williams Orthopaedic Team Lead Physio - ALEX

Circulated to the following individuals for comments

Name Designation

Jenny Robinson Therapies Manager

Melwyn Periera Clinical Director - Orthopaedics

Circulated to the following CDs/Heads of dept for comments from their directorates /departments

Name Directorate / Department

All current orthopaedic consultants across

the acute trust.

Orthopaedics

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Supporting Document 1 - Equality Impact Assessment Tool

To be completed by the key document author and attached to key document when submittedto the appropriate committee for consideration and approval.

If you have identified a potential discriminatory impact of this key document, please refer it to

Human Resources, together with any suggestions as to the action required to avoid/reducethis impact.

For advice in respect of answering the above questions, please contact Human Resources.

Yes/No Comments

1. Does the policy/guidance affect one groupless or more favourably than another on the

basis of:

Race no

Ethnic origins (including gypsies andtravellers)

no

Nationality no

Gender no

Culture no

Religion or belief no

Sexual orientation including lesbian, gayand bisexual people

no

Age no

2. Is there any evidence that some groups areaffected differently?

no

3. If you have identified potentialdiscrimination, are any exceptions valid,

legal and/or justifiable?

4. Is the impact of the policy/guidance likely tobe negative?

no

5. If so can the impact be avoided?

6. What alternatives are there to achieving thepolicy/guidance without the impact?

7. Can we reduce the impact by takingdifferent action?

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WAHT-PHY-005It is the responsibility of every individual to ensure this is the latest version of the document



Supporting Document 2 Financial Impact Assessment

To be completed by the key document author and attached to key document when submittedto the appropriate committee for consideration and approval.

Title of document: Yes/No

1. Does the implementation of this document require any additionalCapital resources

no

2. Does the implementation of this document require additionalrevenue

no

3. Does the implementation of this document require additionalmanpower

no

4. Does the implementation of this document release anymanpower costs through a change in practice no

5. Are there additional staff training costs associated withimplementing this document which cannot be delivered throughcurrent training programmes or allocated training times for staff

no

Other comments:

If the response to any of the above is yes, please complete a business case and which is

signed by your Finance Manager and Directorate Manager for consideration by theAccountable Director before progressing to the relevant committee for approval.

waht-phy-005 v5.2

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