Development of an Early Activation Hip Fracture Care Bundle and Implementation Strategy to Improve Adherence to the National Hip Fracture Clinical Care Standard

Abstract

Kate Curtis,1– 4 Peter Moules,2 John McKenzie,2,3 Lauren Weidl,2 Tanya Selak,2 Simon Binks,2 Daniel Hernandez,2 Joshua Rijsdijk,2 Dante Risi,2 James Wright,5 Lauren O’Rourke,2 Myles Knapman,6 Meagan Ristevski,2 Teala Stephens,2 Ian Harris,7 Jacqueline CT Close8,9 1Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; 2Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia; 3Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; 4George Institute for Global Health, Newtown, NSW, Australia; 5Agency for Clinical Innovation, St Leonards, NSW, Australia; 6Western NSW LHD, Department of Surgery, Dubbo, NSW, Australia; 7Ingham Institute of Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia; 8Prince Wales Clinical School, UNSW, Sydney, NSW, Australia; 9Neuroscience Research Australia, UNSW, Sydney, NSW, AustraliaCorrespondence: Kate Curtis Email [email protected]: To develop and implement a multidisciplinary early activation mechanism and bundle of care (eHIP) to improve adherence to ACSQHC standards in a regional trauma centre.Methods: Barriers to implementation were categorised using the Theoretical Domains Framework, then linked to specific strategies guided by the Behaviour Change Wheel and Behaviour Change Technique Taxonomy (BCTT). The resulting implementation strategies were assessed using Affordable, Practical, Effective, Acceptable, had Side-effects (APEASE) criteria.Results: Eighty-three barriers to implementation of the hip fracture care bundle were identified. The behaviour change wheel process resulted in the identification of 41 techniques to address these barriers. The predominant mechanisms to achieve this were development and implementation of 1) formal policy that outlines eHIP roles; 2) video promotion; 3) pager group; 4) fascia iliaca block enabling; 5) eMR modifications; 6) face-to-face reinforcement and modelling; 7) communication and prompts; 8) environmental restructuring.Conclusion: We applied behaviour change theory through a pragmatic evidence-based process. This resulted in a codesigned strategy to overcome staff and organisational barriers to the implementation of a multidisciplinary early activation mechanism and bundle of care (eHIP). Future work will include evaluation of the uptake and clinical impact of the care bundle.Keywords: hip fracture, implementation, clinical pathway, emergency, behaviour change, injury, older persons, orthopaedic

Keywords

• hip fracture
• implementation
• clinical pathway
• emergency
• behaviour change
• injury
• older persons
• orthopaedic