Jane Christie1, Maureen Macmillan2, Colin Currie3, Gerri Matthews-Smith4. 1. NHS Lothian, Community Health, East Lothian, UK. Electronic address: christiejane1@aol.com. 2. School of Nursing, Midwifery and Social Care, Edinburgh Napier University, UK. Electronic address: m.macmillan@napier.ac.uk. 3. Formerly Geriatric Medicine, University of Edinburgh, UK; Formerly Ortho-Geriatric Medicine, NHS Lothian, UK. Electronic address: drcolintcurrie@hotmail.com. 4. School of Nursing, Midwifery and Social Care, Edinburgh Napier University, UK. Electronic address: g.matthews-smith@napier.ac.uk.
Abstract
BACKGROUND: Hip fracture care is well supported by national guidelines and audit that provide evidence of safe interventions and an improved process. In the drive for organisational efficiency, complications have been reduced and length of stay shortened. Prioritising targets and performance alone can lead to poor multidisciplinary communication that potentially omits the psychosocial needs of older people recovering from hip fracture. AIM: To explore a multidisciplinary collaborative approach to implementing evidence-based, person-centred hip fracture care. DESIGN: Collaborative inquiry. METHODS: Sixteen clinical leaders (n = 16) from different disciplines, working with older people with hip fracture at different stages of the care pathway participated in eight two-hourly facilitated action meetings. Data collection included strengths and limitations of the present service, values clarification, clinical stories, review of case records and reflections on the stories of three older people and two carers. RESULTS: Hip fracture care was driven by service pressures, guidelines and audits. The care journey was divided into service delivery units. Professional groups worked independently resulting in poor communication. Time away from practice enabled collaboration and the sharing of different perspectives. CONCLUSIONS: Working together improved communication and enhanced understanding of the whole care experience. IMPLICATIONS FOR PRACTICE: Enabling teams to find evidence of safe, effective person-centred cultures requires facilitated time for reflective practice.
BACKGROUND:Hip fracture care is well supported by national guidelines and audit that provide evidence of safe interventions and an improved process. In the drive for organisational efficiency, complications have been reduced and length of stay shortened. Prioritising targets and performance alone can lead to poor multidisciplinary communication that potentially omits the psychosocial needs of older people recovering from hip fracture. AIM: To explore a multidisciplinary collaborative approach to implementing evidence-based, person-centred hip fracture care. DESIGN: Collaborative inquiry. METHODS: Sixteen clinical leaders (n = 16) from different disciplines, working with older people with hip fracture at different stages of the care pathway participated in eight two-hourly facilitated action meetings. Data collection included strengths and limitations of the present service, values clarification, clinical stories, review of case records and reflections on the stories of three older people and two carers. RESULTS:Hip fracture care was driven by service pressures, guidelines and audits. The care journey was divided into service delivery units. Professional groups worked independently resulting in poor communication. Time away from practice enabled collaboration and the sharing of different perspectives. CONCLUSIONS: Working together improved communication and enhanced understanding of the whole care experience. IMPLICATIONS FOR PRACTICE: Enabling teams to find evidence of safe, effective person-centred cultures requires facilitated time for reflective practice.