Clinical Order Set
Demographics
Orthopaedic Hip Fracture Post-Op Orders
 Elder friendly – if patient 75 years or older
Page 1 of 7
Key:
Req – Requisition
Admit to Orthopaedics MRP is
Code Status:
Full Code
MAR – Medication Administration Record
K – Kardex
Dis – Discontinued
KEY
P – Drug Profile
_______________________________________________
No-CPR
see further written orders regarding CPR/DNR
MRP to determine
Consults
Dr________________________________________
aware____
Consider referring to a geriatric physician,
hospitalist or
Hospitalist
internal medicine for ongoing medical
management.
Dr________________________________________
aware
____
A
dietary
consult
is
recommended
as
malnutrition
is
common.
Other
Dr________________________________________ aware____
Home Health and or social work should be consulted for
Inpatient Rehab referral
timely resolution of barriers to discharge.
Physiotherapy/Occupational Therapy referral
Geriatric medicine
Diet
 Universal Swallow Screen
Clear fluids as tolerated
If no nausea progress to full fluids
If tolerating full fluids progress to:
General
Screening for dysphagia, modifying the nutritional care
plan accordingly and keeping the head of the bed at 30
Diabetic
High Protein, High Calorie
degrees,
helps prevent aspiration.High Fibre
Other_____________________________________
Swallowing Assessment Referral
Registered Dietitian Referral
Early mobilization is associated with reduced complication
risk, shorter length of stays and earlier return to function
Or
(Pashikanti). Early post-operative mobility should focus
Other_____________________________________________________
on functional ability 1) getting in and out of bed. 2) sit to
 Post-op day 0 dangle/stand/walk
stand from a chair and 3) walking ability.
 Post-op day 1 up for meals or walk/stand daily X 2 minimum
Activity
Weight Bearing As Tolerated
Other_____________________________________________________
Vitals
 Neurosensory assessments of affected limb(s)
 Vital signs as per unit protocols
q2h
q4h
as per Unit Guideline
Tubes/Respiratory
Drains
 Remove drain when drainage less than ______ mL in
UTI prevention:
______ hours or POD_____
Urinary Catheter


 Discontinue Foley Catheter POD 1 at 0600 h or ________________
 Use commode or toilet to promote effective bladder emptying. Avoid bedpans
 If unable to void: In and out catheterization X 2 PRN (if then unable to void, notify surgeon) 
 If urine output less than 150 mL in 6 hours consult MRP (goal minimum output 25 mL/h) 
 Peri-care BID and PRN
Respiratory
 Titrate O2 to maintain SpO2 greater 92% or ______________
 Incentive spirometer q1h while awake
_______________________
___________
Signature, Designation
College License #
Document1
Foley out ASAP
Pt. up to void as best
way to empty bladder.
Proper pericare BID
In and out cath. less
likely to cause UTI.
Fat embolism common in hip
surgery. Sudden drops in SpO2 can
also be associated with PE even if
________
______
no other symptoms
present.
Date Incentive Spirometer
Time
7
is a Page
good1/way
to cue
deep breathing for
C/8/OrthHipFracture/MD/03-15/V1/Post-op
prevention of complications.
1
Clinical Order Set
Demographics
Orthopaedic Hip Fracture Post-Op 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
Wound Management
 Orthopaedic dressing as per unit guidelines
 Remove clips/staples in _____________ days
Hip fracture patients are at high risk for
anaemia, impaired renal function,
diabetes, malnutrition and cardiac
Investigations
events. Low haemoglobin, and high
Hematology profile: Day 1 and 3
creatinine are predictors of
Sodium, potassium, chloride, carbon dioxide total, creatinine, eGFR: Day 1 and serum
3
mortality.
Electrolyte disturbances are
Phosphorus, magnesium Day 1
common due to dehydration.
INR Day_____
Calcium, phosphorus, albumin, protein, alkaline phosphatase, TSH
Other_____________________________
Medical Imaging
X-ray __________________________________________________________ POD__________
IV Fluids
Solution
0.9% sodium chloride
2/3 + 1/3
D5W + 0.45% sodium chloride
D5W and 0.9% sodium chloride
Ringer’s Lactate
IV fluids and rates must be carefully
considered as the hip fracture patient
is susceptible to electrolyte
imbalance, dehydration and CHF. It’s
a fine like to walk.
Additive
KCl 20 mmol/L
Rate
75 mL/h
125 mL/h
100 mL/h
150mL/h
Or __________ mL/h
Bolus 500 mL Ringer’s Lactate over 90 minutes X 1 PRN when urine output less than 30mL/h for 2h and if no 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 2h and if
no increase in urine output notify surgeon
IV to infusor/saline lock when tolerating fluids; discontinue when IV access no longer required
Antibiotic Prophylaxis
The newest best practice standards
reflect higher antibiotic doses preop and
fewer dosesangioedema
postop than previously
For patients with severe beta-lactam (penicillin/cephalosporin) allergy eg. anaphylaxis,
clindamycin 900 mg IV q8h x 2 doses. Start 8 hours after pre-op dose
recommended.
ceFAZolin 2g IV q8h X 2 doses. Start 8h after pre-op dose
Or
vancomycin 1 g IV to be given 12h after pre-op dose. Infuse over 1h
_______________________
___________
________
______
Signature, Designation
College License #
Date
Time
Document1
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C/8/OrthHipFracture/MD/03-15/V1/Post-op
1
Clinical Order Set
Demographics
Orthopaedic Hip Fracture Post-Op 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
Bowel Management
 Ensure fluids/adequate hydration within prescribed limits; frequent/encourage mobility within prescribed limits, regular
bowel routine
Proactive bowel management is recommended to prevent
Acute care: Bowel Intervention – Adult
constipation as the patient is at high risk due to opioids,
if NPO:_______________________________________
dehydration and immobility.
 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 diarrhea. Reassess need for docusate
Delirium
 CAM assessment Q shift
 If CAM positive, notify MD to investigate/ address underlying cause within 12 hrs
CAM = Delirious if both 1 and 2 and either 3 or 4 checked
Medication orders only for persistent agitation with risk of harm or injury
1. Acute onset and fluctuating course
 Notify MD if agitation medication given and document
2. Inattention
3. of 18.75
Disorganized
QUEtiapine 6.25 mg to 12.5 mg PO Q4h PRN to a maximum
mg in 24h thinking
loxapine 2.5 to 5 mg q2h PO PRN to a maximum of 10 mg
4.in 24h
Altered level of consciousness
If unable to use oral route give
Up to 40% of hip fracture patients experience delirium. We
needofto10recognize
loxapine 2.5 to 5 mg q2h subcutaneously PRN to a maximum
mg in 24h and treat in a timely manner.
Insomnia
Quetiapine is a new generation antipsychotic
as it has a lower
side effect profile than traditional
antipsychotics. Quetiapine is dopamine sparing
and therefore a better choice for patients with
Lewy Body Dementia and Parkinsons.
zopiclone 3.75 mg PO at bedtime as required for sleep
and is the first line medication
If patient has been taking another sleeping pill regularly, continue the same:________________________
Diabetes Management
Follow either IV or Subcut Insulin Order Set – MRP to complete
Other________________________________________
The routine use of HS sedation is not recommended. If
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
falls.
_______________________
___________
________
______
Signature, Designation
College License #
Date
Time
Document1
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C/8/OrthHipFracture/MD/03-15/V1/Post-op
1
Clinical Order Set
Demographics
Orthopaedic Hip Fracture Post-Op 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
*** Systemic narcotics or other CNS depressants ordered by Anesthesiologist take precedence
over those ordered by surgeon ***
Pain and Nausea Management
Pain
 acetaminophen 650 mg PO or RECTAL suppository QID to a max of 4,000 mg per 24 hours
Other:
______________________________________
***Do not use IV/subcutaneous and PO simultaneously***
HYDROmorphone 0.5 mg PO q4h
Or
HYDROmorphone 1 mg PO q4h
For patients unable to tolerate oral route
HYDROmorphone 0.25 mg subcutaneously q4h
Or
HYDROmorphone 0.5mg subcutaneously q4h
Regular administration of low dose opioid titrated to
effect with break through doses is the recommended
standard of care. Relying on frail older patients, many with
cognitive impairment, to request pain medication results in
under treatment and poor pain management. Poor pain
management is a serious stressor leading to immobility,
delirium and long term functional impairment.
 Hold opioid dose if frequently drowsy (or per sedation scale)
 May hold opioid if sleeping
Breakthrough pain
HYDROmorphone 0.5 to 1 mg PO Q2h PRN
Or for patients unable to tolerate oral route
HYDROmorphone 0.25 to 0.5 mg subcutaneously Q2h PRN
Ondansetron is recommended as the first line
antiemetic as it is well tolerated and efficacious.
Dimenhydrinate or prochlorperazine are not
Nausea and Vomiting
recommended as these drugs are highly anticholinergic
ondansetron 4 mg IV/PO Q8h PRN
and increase the risk of delirium and sedation in older
metoclopramide 5 to 10 mg IV/PO Q6h PRN if ondansetron ineffective
Other______________________________
adults.
VTE Prophylaxis (See Page 6 )
Mechanical method can be combined with anticoagulant in very high risk patients Or used alone in patients with
a high risk for bleeding
 Anticoagulation not to start any earlier than 8h post-operatively
No Anticoagulation required
________________________________________
dalteparin 5,000 units subcut q24h
Patients less than 40 kg or age greater than 85 years
dalteparin 2,500 units subcut q24h
(reason)
Give first dose
at
_________
(time/date)
Other_________________________________________________________
Mechanical: Specify_______________________________________________
VTE prophylaxis is usually required
Other________________________________________________________
postop for hip fracture patients. The natural
response to surgery is increased clotting.
Early mobilization will also help prevent
VTE in conjunction with anticoagulants.
Be on the look-out for PE as well
_______________________
___________
________
______
Signature, Designation
College License #
Date
Time
Document1
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C/8/OrthHipFracture/MD/03-15/V1/Post-op
1
Clinical Order Set
Demographics
Orthopaedic Hip Fracture Post-Op Orders
 Elder friendly – if patient 75 years or older
Page 5 of 7
Key:
Req – Requisition
MAR – Medication Administration Record
K – Kardex
Dis – Discontinued
P – Drug Profile
KEY
Vitamin and Mineral Supplements
Hip# patients are commonly vitamin deficient.
 cholecalciferol(Vitamin D3) 2,000 units PO daily
Vit
D3 and
Calcium
 multivitamin PO daily:
1 tablet
5 mL liquid(RN:
Indicate
which
prep) supplementation has been
associated with both increasing bone density
 calcium carbonate 1250 mg PO daily
ferrous fumarate 300 mg (99 mg elemental iron) PO daily
starting
POD 5
and falls
prevention.
Iron supplementation is
Increase ferrous fumarate 300 mg (99 mg elemental frequently
iron) to BID necessary
POD 10 to promote hemoglobin
Or
production.
ferrous sulphate liquid – 300 mg (60 mg elemental iron) PO daily starting POD 5.
Increase ferrous sulphate liquid – 300 mg (60 mg elemental iron) to BID POD 10
Discharge
Patient may be discharged when meets unit criteria or as per physicians order
Follow up in ______ weeks post-op with
Surgeon’s office or
Fracture/Cast Clinic
Follow-up out-patient physiotherapy as appropriate
Follow-up Island Osteoporosis Clinic
 OT/PT to arrange home safety assessment
 PT to assess & prescribe home exercise program and fall prevention in the community
Patients will require individualized
assessment for osteoporosis and should be
____________________________________________________________________
referred to a clinic or their physician to
____________________________________________________________________
ensure this risk is addressed.
Additional Orders
____________________________________________________________________
____________________________________________________________________
All patients are at risk for falls and require individualized risk
____________________________________________________________________
assessment with patient and family education. Home environment
assessment with a Home OT/PT should be considered. A physiotherapist
could prescribe and teach home exercises to improve strength and
balance as well as identifying an appropriate community based fall
prevention and or exercise program. Check out the FReSH START
booklet for useful information throughout the patient stay.
Information provided by the
Provincial Hip Fracture Redesign
Project best practice focus group.
John Kristiansen for Island Health
_______________________
___________
________
______
Signature, Designation
College License #
Date
Time
Document1
Page 5/ 7
C/8/OrthHipFracture/MD/03-15/V1/Post-op
1
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/CG92
Document1
Page 6/7
C/8/OrthHipFracture/MD/03-15/V1/Post-op
ACUTE CARE: BOWEL INTERVENTION - ADULT
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
RN to sign. Send addressographed labelled order to pharmacy
Page 7/7
ACUTE CARE: BOWEL INTERVENTION - ADULT
References
References
Clinical Decision Support
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 nonweight-bearing 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):101420. doi: 10.1016/j.injury.2011.12.008. Epub 2012 Jan 10.
Page 8/7
Portsmouth Hospital NHS Trust. Guidelines for the management of patients at risk for refeeding
syndrome.
ACUTE CARE: BOWEL INTERVENTION - ADULT
Clinical Decision Support
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, Page
2007.9/7
ACUTE CARE: BOWEL INTERVENTION - ADULT
Clinical Decision Support
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 metaanalysis. 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 177194, 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 shortterm 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/s11999-0133363-2
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
Page 10/7
ACUTE CARE: BOWEL INTERVENTION - ADULT
Clinical Decision Support
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
Page 11/7
ACUTE CARE: BOWEL INTERVENTION - ADULT
Clinical Decision Support
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.
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