Hip fracture patients benefit from combined efforts for care

Patients who fracture their hips in Victoria, Richmond, and on the North Shore in BC are benefitting from the combined efforts of two quality improvement initiatives funded by the Joint Collaborative Committees (JCCs), partnerships of Doctors of BC and the BC government.

At the Royal Jubilee Hospital (RJH) in Victoria, Shared Care's Polypharmacy Risk Reduction initiative has teamed up with the Specialist Services BC Hip Fracture Redesign project, to improve outcomes for hip fracture patients, and to prevent future falls and other adverse events from medications.

"The priorities of the Polypharmacy Risk Reduction Initiative have merged quite nicely with the priorities of the Hip Fracture initiative and the result is better outcomes and prevention of future falls," said John Kristiansen, project manager of the Royal Jubilee Hospital Hip Fracture Redesign project.

Hip fractures in BC have a significant impact on individual patients and on the health care system. Each year close to 4,000 patients are admitted to BC hospitals with broken hips - of those, 30 per cent will die within the year, and 50 per cent will lose a level of mobility or independence. Each hip fracture costs the health system between $26,000 and $47,000.

Gaps and barriers to providing optimal hip care are being addressed by the Specialist Services BC Hip Fracture Redesign Project. The project started at eight pilot sites and has expanded to all BC facilities that treat hip fractures. Shared Care's Polypharmacy Risk Reduction Initiative began working closely with Pharmacy Services at RJH and the Hip Fracture Redesign project in February 2015, to provide thorough medication reviews of patients admitted with hip fractures.

"Certain prescription medications (such as sleep aids) are known to increase the risk factors for falls, but taking multiple medications also increases the risk, regardless of what medications are being taken", states Dr. Sean Spina, Clinical Coordinator Department of Pharmacy at RJH.  

Within 48 hours of a patient's admission for a hip fracture, the goal is to have an RJH pharmacist meet with the patient or family to reconcile their prescription history, check it against Pharmanet data and provide recommendations to the physicians about medications. When the patient is discharged, the family doctor receives a discharge summary of what medications were discontinued or changed in hospital and why.

"Prescription medications are increasingly complex. Physicians are grateful for the contribution that our specialized skill set can make to patient care," said Dr. Amanda L. Johnson, Clinical Pharmacist in Orthopaedics, who leads the RJH pharmacy/hip fracture review team.

Evaluation results from the first six months of the project already show improved outcomes. Patient hospital stays are down from 16 to 15 days; in-hospital death rates have reduced from 9.2 per cent to 4.4 per cent; and the number of patients needing to go into residential care has decreased from 28.2 per cent to 20.2 — and more patients are returning home. "This is a great example of a collaborative team effort to achieve better patient results," says Spina.

Further evaluation of the project is taking place, such as tracking the type and number of medications reduced, as well as identifying other medications that could have risk factors for falls. These results will be included in the provincial evaluation of Polypharmacy Risk Reduction Initiative.

"Evaluation is essential," said Spina. "Results let us know whether programs are really making a difference and whether we should continue or expand to other hospitals."