Authors (including presenting author) :
Chiu TC (1), Leung LM (1), Chan CM (1), Kong CY (1)
Affiliation :
(1) Orthopaedic and Traumatology, United Christian Hospital
Introduction :
While FLN service in most cluster is outpatient focused, FLN service in UCH has driven into a different path; by integrating inpatient and outpatient element, it not only focuses in OPD domain but also extend into inpatient area to provide nurse-lead assessment, education and intervention.
Objectives :
1. Reduce perioperative risk 2. Reduce operation waiting time and optimized operation session usage 3. Prevent post-operation complications and early detection of deterioration 4. Liaise with multi-disciplinary team to maximize team effort 5. Fast-track inpatient osteoporosis interventions to prevent secondary fracture 6. Maximize patient’s rehabilitation potential and coordinate discharge planning
Methodology :
Outpatient FLN service include phone follow up and nurse clinic. Inpatient FLN service operate under the philosophy of “PEOPLE”. “P” – Perioperative assessment: Perioperative assessment follow by protocol-driven interventions aiming to reduce surgery related complications include delirium intervention, pressure injury prevention, peptic ulcer prophylaxis screening (Pantoloc), hemorrhage prophylaxis screening (Transamin) and VTE prophylaxis (SCD/Clexane). “E” – Early detection of red flags with nurse- led interventions: Screening for potential ‘Red flags’, such as pacemaker/ NOAC/ chest infection/ anemia with timely referral, interventions and collaboration with team doctors. “O” – Operation coordination: Daily report and review all case with Orthopaedic Consultant. Prioritized case between EOT and elective session based on patient’s condition and waiting time to minimize operation cancellation, waiting period, maximize theatre utilization and avoid prolonged fasting of patient. “P” – Post operation fast-track osteoporosis interventions: Personalized osteoporosis planning since admission. Fast- track program with FLN initiated screening and treatment suggestions includes Calcichew, anti-osteoporosis medications, DXA scan and dental referral. Anti-osteoporosis medication could commence early as post operation Day 4. “L” – Liaise with multi-disciplinary team: FLN continuously liaise with PT/OT/MSW/ICM on patient’s rehab and discharge planning. Weekly Ortho- Geri multi-disciplinary round for collective insight. Complicated cases are presented by FLN to geriatric consultant for suggestions or takeover at weekly consultation round. “E” – Early discharge planning and coordination: Liaise with discharge coordinator to facilitate discharge planning and prioritize patient flow to rehabilitation unit.
Result & Outcome :
Case number in 2023 is 808. Operation session utilization rate 100%. Calcichew prescription rate 94%. Anti-osteoporosis medication initiation rate in 2023 is 25%. 97% of osteoporosis treatment suggestions made by FLN inpatient/outpatient is followed by doctors.
