Clinical Order Set
Demographics
Hip Fracture Preoperative
Orthopaedic Orders
 Elder friendly – if patient 75 years or older
Page 1 of 7
Key:
Req – Requisition
MAR – Medication Administration Record
K – Kardex
Dis – Discontinued
P – Drug Profile
KEY
Admit to Orthopaedics. MRP is __________________________________
Code Status:
Full Code
No-CPR
see further written orders regarding CPR/DNR
MRP to determine
Consults
Hospitalist
Dr________________________________________
Unnecessarily prolonged fasting andaware
poor____
perioperative
Anaesthesiologist
nutritional intake lead to debility, increased
Dr________________________________________
aware____
Geriatric medicine
Other
Diet
susceptibility to complications and mortality. One third
of hip fracture patients are malnourished prior to injury,
Dr________________________________________
aware____
placing them at added risk for complications,
prolonged stays and mortality.
Dr________________________________________ aware____
 Universal Swallow Screen
Clear fluids up to 2 hours pre-op (water, pulp-free juice, coffee and tea without milk or broth)
Light meal and other liquids for up to 6 hours pre-op (e.g. milk, toast, or cereal, not meat or nut butters)
Hip fracture patients are at risk for bacterial and
Meal up to 8 hours pre-op
aspiration
pneumonia. Avoiding sedation and promoting hourly deep
Diabetic
Renal Other __________________________________
breathing and coughing exercises help prevent the pooling of
NPO 2h before surgery
secretions. Screening for dysphagia, modifying the nutritional
care plan accordingly and keeping the head of the bed at 30
Pre-Operative Preparation
degrees, helps prevent aspiration. Attention to oral care can
 Follow Pre-Operative Skin Prep Clinical Standard
reduce the incidence of infectious pneumonia by decreasing the
 Do not remove cast or splint
bacterial load in the oral secretions.
 Patient to brush teeth & tongue within 4h of OR
Activity
Bedrest
Elevate extremity
Activity
Buck’s traction _________
kg section
 Reposition q2h
 Ensure heels and sacrum are checked q2h and pressure is off loaded
 Head of bed elevated minimum 30 degrees
recognizes the need
to prevent skin breakdown for the
frail elderly.
Vitals
 Vital signs q4h and prn
 Neurosensory assessments of affected limb(s)
q2h
q4h
as per Unit Guidelines
Tubes/Respiratory
Urinary Catheter
 If patient normally continent but unable to void using a bedpan, insert silver alloy catheter and affix securement device
on unaffected leg as per surgical services urinary catheter guidelines
Respiratory
 Titrate O2 to maintain SpO2 92% or greater
 Incentive spirometer q1h while awake
 Clean teeth and tongue BID
Silver alloy catheter effective in preventing UTIs
within the care context of hip fracture patients.
Securement device imperative best practice.
Incentive spirometer usage and oral care effective
in prevention of pneumonia and other respiratory
complications.
Signature, Designation
Document1
College License #
Date
Time
Page 1/7
C/8/HipFracture/MD/01-14/V1/Pre-op
1
Clinical Order Set
Demographics
Hip Fracture Preoperative
Orthopaedic Orders
 Elder friendly – if patient 75 years or older
Page 2 of 7
Key:
Req – Requisition
MAR – Medication Administration Record
K – Kardex
Dis – Discontinued
P – Drug Profile
KEY
Investigations (If not already done)
Hematology profile
Sodium, potassium, chloride, carbon dioxide total, creatinine, phosphate, magnesium, glucose
INR, PTT
Data collected has shown up to 35% of
Macroscopic and Microscopic
Culture if pyuria or nitrite present
hip fracture patients are admitted with
Blood Group and Antibody Screen
UTI.
ECG
Other________________________________________
Hip fracture patients are at high risk for
anaemia, impaired renal function,
Medical Imaging
diabetes, malnutrition and cardiac
X-ray_______________________________________events. Low haemoglobin, and high
serum creatinine are predictors of
IV Fluids
mortality. Electrolyte disturbances are
Solution
common due to dehydration.
0.9% sodium chloride
D5W and 0.9% sodium chloride
2/3 + 1/3
D5W + 0.45% sodium chloride
Ringer’s Lactate
Additive
KCl 20 mmol/L
IV fluids and rates must be carefully
considered as the hip fracture patient
is susceptible to electrolyte
imbalance, dehydration and CHF. It’s
Bolus 500 mL Ringer’s Lactate over 90 minutes X 1 PRN when
less than 30mL/h for 2 hours and if no
a fineurine
likeoutput
to walk.
Rate
75 mL/h
125 mL/h
100 mL/h
150mL/h
Or __________ mL/h
increase in urine output notify surgeon
Bolus 500 mL 0.9% sodium chloride over 90 minutes X 1 PRN when urine output less than 30mL/h for 2 hours and if
no increase in urine output notify surgeon
Antibiotic Prophylaxis
ceFAZolin 2g IV to be given at induction of anesthesia
Timing
and largerangioedema
doses are best
For patients with severe beta-lactam (penicillin/cephalosporin) allergy
eg. anaphylaxis,
clindamycin 900 mg IV 30 minutes pre-op
practice. Safer Health Care Now
Or
recommendation.
vancomycin 1 g IV 90 minutes pre-op infused over 60 minutes
Bowel Management
 Ensure fluids/adequate hydration within prescribed limits, frequent/encourage mobility within prescribed limits, regular
bowel routine
Acute care: Bowel Intervention – Adult Non-ICU
if NPO:_______________________________________
 RN, RPN and/or Pharmacist to complete thorough assessment of bowel function including review of Pre-Hospital
Functional Screening Tool to determine if regularly scheduled laxatives are required
Laxatives as indicated RN, RPN and/or Pharmacist based on assessment above and Best Possible Medication
History
Contact MRP to discuss
docusate 100 mg PO BID; hold if patient develops. Reassess need for docusate
Signature, Designation
Document1
Proactive bowel management is recommended to prevent
constipation as the patient is at high risk due to opioids,
College License #
Date
Time
Page 2/7
dehydration and immobility.
C/8/HipFracture/MD/01-14/V1/Pre-op
1
Clinical Order Set
Demographics
Hip Fracture Preoperative
Orthopaedic Orders
 Elder friendly – if patient 75 years or older
Page 3 of 7
Key:
Req – Requisition
MAR – Medication Administration Record
K – Kardex
Dis – Discontinued
KEY
P – Drug Profile
Delirium
 CAM assessment Q shift
 If CAM positive, notify MD to investigate/ address underlying cause within 12 hours
Medication orders only for persistent agitation with risk of harm or injury
 Notify MD if agitation medication given
CAM = Delirious if both 1 and 2 and either 3 or 4 checked
1.
Acute onset and fluctuating course
QUEtiapine 6.25 mg to 12.5 mg PO Q____h PRN to a maximum
of 18.75 mg in 24h
2. Inattention
loxapine 2.5 to 5 mg q2h PO PRN to a maximum of 10 mg in 24h
3. Disorganized thinking
If unable to use oral route give
4. Altered level of consciousness
loxapine 2.5 to 5 mg q2h subcutaneously PRN to a maximum of 10 mg in 24h
Insomnia
Up to 40% of hip fracture patients experience delirium. We
need to recognize and treat in a timely manner.
zopiclone 3.75 mg PO at bedtime as required for sleep
If patient has been taking another sleeping pill regularly, continue the same:________________________
Diabetes Management:
The routine use of HS sedation is not recommended. If
Follow either IV or Subcut Insulin Order Set – MRP to complete
Other:___________________________
the patient
was regularly taking a benzodiazepine for sleep
prior to this fracture, it may be necessary to continue it in
hospital to avoid withdrawal. Sedation is a leading cause of
Pain
 acetaminophen 650 mg PO or RECTAL suppository QID tofalls.
a max of 4,000 mg per 24 hours
Pain and Nausea Management
Other:
______________________________________
***Do not use IV/subcutaneous and PO simultaneously***
HYDROmorphone 0.5 mg PO q4h
Regular administration of low dose opioid titrated to
effect with break through doses is the recommended
HYDROmorphone 1 mg PO q4h
standard of care. Relying on frail older patients, many with
For patients unable to tolerate oral route
cognitive impairment, to request pain medication results in
HYDROmorphone 0.25 mg subcutaneously q4h
under treatment and poor pain management. Poor pain
Or
management is a serious stressor leading to immobility,
HYDROmorphone 0.5mg subcutaneously q4h
delirium and long term functional impairment.
 Hold opioid dose if frequently drowsy (or per sedation scale).
Or
 May hold opioid if sleeping.
Breakthrough pain
HYDROmorphone 0.5 to 1 mg PO Q2h PRN
Or
HYDROmorphone 0.25 to 0.5 mg subcutaneously Q2h PRN
Ondasetron is recommended as the first line
antiemetic as it is well tolerated and efficacious.
Dimenhydrinate or prochlorperazine are not
recommended as these drugs are highly anticholinergic
and increase the risk of delirium and sedation in older
adults.
For patients unable to tolerate oral route
Nausea and Vomiting
ondansetron 4 mg IV/PO Q8h PRN
metoclopramide 10 mg IV/PO Q6h PRN if ondansetron ineffective
Other:
__________________________________________________
Signature, Designation
Document1
College License #
Date
Time
Page 3/7
C/8/HipFracture/MD/01-14/V1/Pre-op
1
Clinical Order Set
Demographics
Hip Fracture Preoperative
Orthopaedic Orders
 Elder friendly – if patient 75 years or older
Page 4 of 7
Key:
Req – Requisition
MAR – Medication Administration Record
K – Kardex
Dis – Discontinued
KEY
P – Drug Profile
VTE Prophylaxis
VTE prophylaxis is rarely required preop for hip fracture patients yet if the
patient is waiting for extended periods
No Anticoagulation required ________________________________________
(reason)
dalteparin 5,000 units subcut q24h
prophylaxis may be engaged due to
Patients less than 40 kg or age greater than 85 years
elevated risk. Support tool on page
Give 6.
first dose
dalteparin 2,500 units subcut q24h
 Complete VTE Risk Assessment (page 6)
 Consult Anaesthesia if patient requires dalteparin q12h
Patients greater than 100 kg Or at very high risk of VTE (DVT/PE)
dalteparin 5,000 units subcut q 12h (not recommended in patients with epidural)
heparin 5,000 units subcut
q12h  q8h (not recommended in patients with epidural)
 Hematology profile q4days while on heparin
Mechanical: Specify
at
_________
(time/date)
Warfarin Reversal (See Page 7)
**In patients with high risk of stroke (eg atrial fibrillation with CHADS2 score greater than 3,
previous stroke/TIA, mechanical heart valve) or thrombosis (eg VTE within past 3 months, cancerassociated thrombosis, thrombophilia, antiphospholipid antibody syndrome), algorithm may not be
appropriate; Hematology/ Internal Medicine consultation is recommended**
Consult
There are times when a patient needs
warfarin reversal in order toaware
have____
surgery.
Hematology/ Internal Medicine Dr______________________________________
A clinical decision support tool is on page 7
to provide evidence based best practice.
 Hold warfarin
vitamin K :
2 mg PO STAT if INR between 1.2 and 5.0 and surgery is in more than 24 hours
2 mg in 50 mL NS IV STAT if INR between 1.2 and 5.0
5 mg in 50 mL NS IV STAT if INR greater than 5.0 or on-going major bleeding
***Prothrombin Complex Concentrate is appropriate only if emergent surgery is required. ***
Prothrombin Complex Concentrate_________ units IV x 1 as per protocol in Blood Product Monograph
STAT (active bleeding)
Within 1 hour of booked surgery time
At _______ hours
(Consult hematopathologist for appropriate dose)
Information provided by the Provincial Hip Fracture Redesign
STAT INR 15 minutes after Prothrombin Complex Concentrate infusion. Notify ordering physician STAT if INR greater
Project best practice focus group.
than 1.5
Additional Laboratory Testing:
INR at 0600 morning of surgery. Call MD STAT if INR greater than 1.5
INR at _________ H (within 6 hours of surgery). Call MD STAT if INR greater than 1.5
STAT INR 12 hours after Prothrombin Complex Concentrate infusion if ongoing bleeding. Notify ordering physician of
result
John Kristiansen for Island Health
Signature, Designation
Document1
College License #
Date
Time
Page 4/7
C/8/HipFracture/MD/01-14/V1/Pre-op
1
Demographics
ACUTE CARE: BOWEL INTERVENTION – ADULT Non ICU
Clinical Decision Support
Clinical Regimen
Note: not for use in patients who have had bowel surgery in the last year
 Newly-admitted patients experiencing constipation longer than 4 days or those unable to identify date of last bowel
movement start at step 2
 All other patients requiring bowel care per protocol including those where assessment not possible begin at baseline


Notify physician if vomiting and abdominal pain develop
Discontinue protocol and notify MRP if step 4 reached more than once in 10 days
Intervention for Constipation
Medication
Baseline
 No medication
Step 2: Last BM more than
48 hours ago
 lactulose 30 mL PO x 1 today and
If no results by next AM proceed to next step
Step 3: Last BM more than
72 hours ago
 Increase lactulose to 30 mL PO BID today, and
 sennosides 24 mg PO after breakfast today, and
If no results in 24 hours proceed to next step
Step 4: Last BM more than
96 hours ago
 Continue with lactulose 30 mL PO BID
AND sennosides 24 mg PO after breakfast today, and
 glycerine suppository (2.65 g) PR after breakfast today x 1
 If no results after 3 hours give sodium citrate enema (Microlax) 5 mL PR x 1
today
 If no results from sodium citrate enema perform rectal examination for
presence or absence of stool and inform physician
Return to baseline once desired results are achieved
RN’s Signature
College License #
Date
Time
Page 5/7
1
RN to sign. Send addressographed/labelled order to pharmacy
ABOWELJul2013
Document1
C/8/HipFracture/MD/01-14/V1/Pre-op
VTE Risk Assessment
Clinical Decision Support
Step One
 assess all patients admitted to hospital for level of mobility (tick one box). All surgical patients and all medical patients with
significantly reduced mobility, should be considered for further risk assessment
Step Two
 review patient-related factors against thrombosis risk, ticking each box that applies (more than one box can be ticked)
 any tick for thrombosis risk should prompt thromboprophylaxis according to NICE guidance. Risk factors identified are not
exhaustive. Clinicians may consider additional risks in individual patients and offer thromboprophylaxis as appropriate
Step Three
 review the patient-related factors against bleeding risk and tick each box that applies (more than one box can be ticked)
 any tick should prompt clinical staff to consider if bleeding risk is sufficient to preclude pharmacological intervention
Balancing risk/benefit is at the discretion of the ordering physician
Mobility – all patients
(tick one box)
Tick
Surgical patient
Tick
Medical patient expected to have
ongoing reduced mobility relative
to normal state
Assess for thrombosis and bleeding risk below
Tick
Medical patient NOT expected to
have significantly reduced mobility
relative to normal state
Risk assessment now complete
Thrombosis Risk
Patient related
Tick Admission related
Tick
Active cancer or cancer treatment
Significantly reduced mobility for 3 days or more
Age greater than 60
Hip or knee replacement
Dehydration
Hip fracture
Known thrombophilias
Total anaesthetic + surgical time greater than 90 min
Surgery involving pelvis or lower limb with a total
anaesthetic + surgical time greater than 60 minutes
Obesity (BMI greater than 30 kg/m2)
One or more significant medical comorbidities (eg heart
disease; metabolic, endocrine or respiratory
pathologies; acute infectious diseases; inflammatory
conditions)
Personal history or first-degree relative with a history of
VTE
Use of hormone replacement therapy
Acute surgical admission with inflammatory or
intra-abdominal condition
Critical care admission
Surgery with significant reduction in mobility
Use of estrogen-containing contraceptive therapy
Varicose veins with phlebitis
Pregnancy or less than 6 weeks post partum (see NICE
guidance for specific risk factors)
Bleeding Risk
Patient related
Tick Admission related
Tick
Active bleeding
Neurosurgery, spinal surgery or eye surgery
Acquired bleeding disorders (such as acute liver failure)
Concurrent use of anticoagulants known to increase
risk of bleeding (eg warfarin with INR greater than 2.0)
Other procedure with high bleeding risk
Lumbar puncture/epidural/spinal anaesthesia expected
within the next 12 hours
Lumbar puncture/epidural/spinal anaesthesia within
the previous 4 hours
Acute stroke
Thrombocytopaenia (platelets less than 75)
Uncontrolled systolic hypertension (230/120 mmHg or
higher)
Untreated inherited bleeding disorders (such as
haemophilia and von Willebrand’s disease)
Reference: Risk Assessment for Venous Thromoboembolism (VTE). National Institute for Health and Clinical Excellence, London UK. March
2010. See http://www.nice.org.uk/guidance
Document1
C/8/HipFracture/MD/01-14/V1/Pre-op
Warfarin Reversal for Invasive Procedures/ Surgery
Clinical Decision Support
**In patients with high risk of stroke (e.g. atrial fibrillation with CHADS2 score greater than 3, previous
stroke/TIA, mechanical heart valve) or thrombosis (e.g. VTE within past 3 months, cancer-associated
thrombosis, thrombophilia, antiphospholipid antibody syndrome), algorithm may not be appropriate and
Hematology/ Internal Medicine consultation is recommended**
INR 1.2 or greater
URGENT reversal for Invasive
Procedures/Surgery within 6 hours
Vitamin K 2 mg IV if INR 1.2 – 5.0
Vitamin K 5 mg IV if INR is greater than 5.0
Order Prothrombin Complex
Concentrate within 1 hour of booked
surgery time –Hematopathologist will
determine dose
Consider STAT INR 15 minutes after
Prothrombin Complex Concentrate
INR greater
than 1.5
Consult
Hematopathologist
(Transfusion
Medicine
Laboratory)
INR less
than or
equal to
1.5
NON-URGENT reversal for Invasive
procedures/ Surgery in 6 hours or later
Surgery in 6-24 hours
Vitamin K 2 mg IV if
INR 1.2-5.0
STAT INR at 0600 day of
surgery or within 6 hours of
surgery
INR greater
than 1.5
INR less
than or
equal
to 1.5
Surgery in more
than 24 hours
Vitamin K 2 mg PO/ IV
if INR 1.2-5.0
Repeat INR 24 hours
after Vitamin K
INR
greater
than 1.5
INR
less
than
or
equal
to 1.5
Consult
Hematopathologist
(Transfusion
Medicine
Laboratory)
Warfarin effect is reversed. Proceed to surgery if indicated.
Footnotes:
1. This algorithm is recommended for Warfarin reversal ONLY and should not be used for reversal of other anticoagulants
2. Rationale for initial INR of 1.2 requiring Vitamin K is in anticipation of increasing INR due to undernourishment post surgery
3. Half-life of Prothrombin Complex Concentrate is approximately 6 hours therefore, ordering physician should reassess INR 12 hrs after
Prothrombin Complex Concentrate infusion if ongoing bleeding
4. For rivaroxaban, apixaban and dabigatran half-life see toolkit. There is no acute reversal agent. Consider waiting.
Document1
CONSULTATION WITH SITE HEMATOPATHOLOGIST IS AVAILABLE – CONTACT TRANSFUSION MEDICINE LABORATORY
Page 7/7
C/8/HipFracture/MD/01-14/V1/Pre-op
References
Activity
Bone & Joint Canada Hip Fracture Tool Kit 2011 Wasdell ed.
Handoll HH SCMJ. Interventions aimed at improving and restoring mobility after hip fracture. Cochrane
Database Syst Rev. 2011;3.
Kristensen MT, Andersen L, Bech-Jensen R, et al. High intertester reliability of the cumulated ambulation
score for the evaluation of basic mobility in patients with hip fracture. Clin Rehabil. Dec
2009;23(12):1116-1123.
Overgaard J, Kristensen MT. Feasibility of progressive strength training shortly after hipfracture surgery.
World journal of orthopedics. 2013;4(4):248-258.
Sherrington C, Lord SR, Herbert RD. A randomized controlled trial of weight-bearing versus non-weightbearing exercise for improving physical ability after usual care for hip fracture. Arch Phys Med Rehabil.
May 2004;85(5):710-716.
Pashikanti, L., Von Ah, D. Impact of Early Mobilization Protocol on the
Medical-Surgical Inpatient Population: An Integrated Review of Literature. Clinical Nurse Specialist,
Lippincott 2012.
Laboratory
Flesher, M.E. Archer K.A., Leslie, B.D. McCollom, R. Martinka, G. P. Assessing the Metabolic and Clinical
Consequences of Early Enteral Feeding in the Malnourished Patient JPEN J Parenter Enteral Nutr March
2005 vol. 29 no. 2 108-117 .
Holidk, M. F., Binkley, N.C., Bischoff-Ferrairi H. A. , Gordon C.M., Hanley D. A., Heaney R. P. Hassan, M.
H., Weaver, C. M. Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical
Practice Guideline. DOI: http://dx.doi.org/10.1210/jc.2011-0385 Received: February 14, 2011
Laulund AS, Lauritzen JB, Duus BR, Mosfeldt M, Jørgensen HL.
Routine blood tests as predictors of mortality in hip fracture patients. Injury. 2012 Jul;43(7):1014-20.
doi: 10.1016/j.injury.2011.12.008. Epub 2012 Jan 10.
Portsmouth Hospital NHS Trust. Guidelines for the management of patients at risk for refeeding
syndrome.
Document1
C/8/HipFracture/MD/01-14/V1/Pre-op
References continued
Diet Type
Björkelund,K., Hommel,A., Thorngren K.G. Lundberg, D., Larrson, S. The Influence of Perioperative
Care and Treatment on the 4-Month Outcome in Elderly Patients With Hip Fracture AANA Journal ß,
February 2011, ß Vol. 79, No. 1
Hearing, S. D. Refeeding syndromeIs underdiagnosed and undertreated, but treatable BMJ. 2004 April
17; 328(7445): 908–909. doi: 10.1136/bmj.328.7445.908
Hommel, A., Hertz K. & Mainz, H. Personal communication: International Collaboration of Nursing Hip
Fracture Working Group. Feb 16th, 2014.
Eneroth M, Olsson UB, Thorngren KG. Insufficient fluid and energy intake in hospitalised patients with
hip fracture. A prospective randomised study of 80 patients. Clin Nutr 2005; 24: 297–303.
Fossi B, Jensen P & Kehlet H. Risk factors for insufficient perioperative oral nutrition after hip fracture
surgery within a multi-modal rehabilitation programme Age and Ageing 2007; 36: 538–543
Lawson RM, Doshi MK, Ingoe LE, Colligan JM, Barton JR, Cobden I. Compliance of orthopaedic patients
with postoperative oral nutritional supplementation. Clin Nutr 2000;
19: 171–5.
Radtke, F. M; Franck, M.; MacGuill, M.; Seeling, M.; Lütz, A.; Westhoff, S.; Neumann, U.; Wernecke, K.
D; Spies, C. Duration of fluid fasting and choice of analgesic are modifiable factors for early
postoperative delirium. European Journal of Anaesthesiology: May 2010 - Volume 27 - Issue 5 - p 411–
416
Volkert D,Kreuel H, Heseker H, Stehle P. Energy and nutrient intake of young-old, old-old and very-old
elderly in Germany. Eur J Clin Nutr 2004; 58: 1190–200.
Assessments & Treatments
Hommel, A., Hertz K. & Mainz, H. Personal communication: International Collaboration of Nursing Hip
Fracture Working Group Meeting. Feb 16th, 2014.
British Orthopaedic Association (BOA). Care of Patients with Fragility Fractures Blue Book, 2007.
Document1
C/8/HipFracture/MD/01-14/V1/Pre-op
References continued
Analgesics
Bédard,D., Purden, M.A., Sauvé-Larose,N., Certosini,C. Schein C., The Pain Experience of Post Surgical
Patients Following the Implementation of an Evidence-Based Approach, Pain Management Nursing,
Volume 7, Issue 3, September 2006, Pages 80-92, ISSN 1524-9042,
Http://dx.doi.org/10.1016/j.pmn.2006.06.001.
(http://www.sciencedirect.com/science/article/pii/S1524904206000841)
Feldn, L., et al., (2011). Comparative clinical effects of hydromorphone and morphine: a meta-analysis.
British Journal of Anaesthesia, 107(3): 319-28
Osborne, R. J., Joel, S. P., & Slevin, M. L. (1986). Morphine intoxication in renal failure: the role of
morphine-6-glucuronide. BMJ. 292:1548-9
Maher, A., Meehan, A., Hertz, K, Hommel, A., MacDonald, V., O’Sullivan, M., Specht, K., Taylor, A. Acute
nursing care of the older adult with fragility hip fracture: An international perspective (Part 1)
International Journal of Orthopaedic and Trauma Nursing Volume 16, Issue 4 , Pages 177-194,
November 2012
Meineke, I. et. al, (2002). Pharmacokinetic modelling of morphine, morphine-3-glucuronide and
morphine-6-glucuronide in plasma and cerebrospinal fluid of neurosurgical patients after short-term
infusion of morphine. Br J Clin Pharmacol 54:592-603.
Morrison, S.r., Magaziner, J, Gilbert, M. Koval, K. McLaughlin, M.A. Orosz, G. Relationship Between Pain
and Opioid Analgesics on the Development of Delirium Following Hip Fracture J Gerontol A Biol Sci Med
Sci (2003) 58 (1): M76-M81. doi: 093/gerona/58.1.M76
Zywil, M. G., & Perruccio, A. V. (2013). The influence of anaesthesia and pain management on cognitive
dysfunction after joint arthroplasty. Clin Orthop Relat Res, DOI: 10.1007/s11999-013-3363-2
Trelle, S. Reichenbach, S., Wandel, s. Hildebrand, P, Tschannen, B., Billiger, P. Egger, M. Ju’ni, P.
Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis BMJ
2011;342:c7086doi:10.1136/bmj.c7086
Document1
C/8/HipFracture/MD/01-14/V1/Pre-op
References continued
Antiemetic
Kloth, D. D. (2009). New pharmacologic findings for the treatment of PONV and PDNV. AM J Health-Syst
Parm, 66(supp1): S11-S18.
The American Geriatrics society, (2012). American geriatrics society updated Beers criteria for
potentially inappropriate medication use in older adults, JAGS 2012, accessed from
http://www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf
Delirium
Hawkins, S., Bucklin, M. & Muzyk, A. Quetiapine for the treatment of delirium. Journal of Hospital
Medicine Volume 8, Issue 4, pages 215–220, April 2013
Clinical Practice Guidelines for the Management of Delirium in Older People Clinical Epidemiology and
Health Service Evaluation Unit, Melbourne Health in collaboration with the Delirium Clinical Guidelines
Expert Working Group. Commissioned on behalf of the Australian Health Ministers’ Advisory Council
(AHMAC), by the AHMAC Health Care of Older Australians Standing Committee (HCOASC). 2011
Sedation
The American Geriatrics society, (2012). American geriatrics society updated Beers criteria for
potentially inappropriate medication use in older adults, JAGS 2012, accessed from:
http://www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf
Pneumonia prevention
Yoon, M.N. & Steele, C.M. (2007). The oral care imperative: The link between oral hygiene and
aspiration pneumonia. Topics in Geriatric Rehabilitation, 23(3), 280-288.
Skin Preparation
Safer Healthcare Now! (Mar, 2011). Prevent Surgical Site Infections:Getting Started Kit. Retrieved from
http://www.saferhealthcarenow.ca/en/interventions/ssi
Document1
C/8/HipFracture/MD/01-14/V1/Pre-op
References continued
Bone Health
Bischoff-Ferrari H.A., Willett W. J., Endel P.H., Oray, J., Meunier P. J., Lyons R. A., Flicker L., Wark, J.,
Jackson R.D., Cauley J.A., Meyer H. E., Pfeifer,M., Sander, K., Stahelin,H., Theirler. R., Dawson-Hughes,
B. A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention. N Engl J Med 2012;
367:40-49July 5, 2012DOI: 10.1056/NEJMoa1109617
British Orthopaedic Association (BOA). Care of Patients with Fragility Fractures, 2007.
Parker MJ, Gillespie WJ, Gillespie LD. Effectiveness of hip protectors for preventing hip fractures in
elderly people: a systematic review. BMJ. 2006;332(7541):571-574.
Stone, K.L., Seeley, G., Lui L., Cauley, J., Ensrud, K., Browner, W. Nevitt, M. Cummings, S. BMD at
Multiple Sites and Risk of Fracture of Multiple Types: Long-Term Results From the Study of Osteoporotic
Fractures. JOURNAL OF BONE AND MINERAL RESEARCH Volume 18, Number 11, 2003.
VTE
Scottish Intercollegiate Guidelines Network. Management of Hip Fracture in Older People: A national
guideline. 2009
Antibiotic Prophylaxis
Bratzler, D. W., Dellinger, P, Olsen, K.M., Perl, T.M., Auwaerter, P.G.,
Bolon, M.K., Fish, D.N. Napolitano, l.M. , Sawyer, R.G. Slain, D., Steinberg,J.P. Weinstein R.A. Clinical
practice guidelines for antimicrobial prophylaxis in surgery Am J Health-Syst Pharm. 2013; 70:195-283
Gehrke, T., Parvize, J. Chairmen. Proceedings of the International Consensus Meeting on Periprosthetic
Joint Infection. Philidelphia 2014
Bowel Care
Rao, S.C. & Go, J.T. Update on the management of constipation in the elderly: new treatment options.
Clin Interv Aging. 2010; 5: 163–171.Published online 2010 August 9.
Document1
C/8/HipFracture/MD/01-14/V1/Pre-op