A Broken Hip, Moving Forward Local Health Integration Network LHINS – Brant Community Healthcare System, Hamilton Health Sciences, Joseph Brant Memorial Hospital, Niagara Health System, and St. Joseph’s Healthcare Hamilton, 2009 Reviewed: 2016 Table of contents Topic Page A broken hip 1 Going home: discharge planning 2 How long you can expect to stay in the hospital 2 While waiting for surgery 3 Risks and complications 5 Health care providers 5 Eating and drinking 6 Tips for reducing your falls 6 Bones of the hip 10 Types of breaks 11 After surgery and hospital stay 13 Confusion and Delirium 19 Therapy 23 Being safe – getting ready to go home 25 Hip replacement 28 How to get in a car 43 Safety at home 47 Equipment 50 Preventing the next broken bone 55 Your Health Care Team 56 Additional appointments 57 Questions 57 A broken hip, moving forward Welcome The information provided is to help you: have a successful hospital stay prepare for going home During your stay, our team of health care providers will help you learn how to care for yourself after surgery to repair your broken hip. We encourage you and your family to participate in your care. We ask that you keep this book with you during your stay so that you and your family refer to it as needed. A broken hip Most patients come to the Emergency Department after they have broken their hip. A doctor will talk with you about what needs to be done to fix your hip. Surgery is often needed to fix the broken bone. After surgery you will need time to recover and the bone will need time to heal. You will need to change the way you do things. Some daily activities and getting around will be hard in the beginning but will get easier with time and effort. The information in this book will help you learn about the surgery and what you need to do to recover and heal. We are here to help you. Please talk with us about your concerns. Page - 1 A broken hip, moving forward Going home: discharge planning Plans for your recovery when you leave the hospital are started right away when you arrive for surgery. This is called discharge planning. You and your family will be a part of this planning. As part of the discharge planning, we need to know how you were doing with day-to-day activities before you fell and broke your hip. This information will help us work together and develop a plan that meets your needs. A social worker may assist and work closely with you and your family to figure out what will work best for your recovery. You may feel anxious as you get ready to leave. There is a lot of information to remember. Please ask us to repeat information you do not understand and clarify what you need to know and do. How long you can expect to stay in the hospital If you are coming from home or a retirement home, most patients can expect to either: Return home with community supports within 5 days. If needed, you may go to the Rehabilitation Unit where you will receive active rehabilitation for up to 3 weeks. May need longer and slower rehabilitation. You would then go to convalescent care for up to 3 months and then return home. Page - 2 A broken hip, moving forward Other options If you are coming from a long-term care facility, you can expect to be transferred back within 5 days after surgery, providing that there are no complications after surgery. If you have come from another hospital that does not perform this surgery, you will be transferred back within 3 days after surgery, providing that there are no complications from surgery. While waiting for surgery While you wait for surgery, it is important that you do not move your broken hip. Our goal is that you will have your surgery within 48 hours of when you arrived in Emergency. Pillows or special rolls may be used to keep the hip and leg from moving. Medication is given to control pain. After it is confirmed that you have broken your hip and you need surgery, surgery is done as soon as possible. Before surgery many tests are done, including: blood and urine tests x-rays heart tests, such as an electrocardiogram or ECG Your nurse will: ask you questions about your health check your blood pressure, heart rate and temperature put an intravenous tube into a vein in your arm. This is called an IV. The IV is used for fluids and medications. give you medication to control pain Page - 3 A broken hip, moving forward Urinary catheter You may also need to have a tube put into your bladder to drain urine. This is called a urinary catheter. The urine is drained into a bag. The catheter will be removed the day after surgery. Home medications Before surgery, we will need a list of all of your present medications, including prescription, non-prescription, herbals and vitamins. Contact person Please provide us with the phone number of a contact person. This person can keep your family and friends informed. Please have someone bring: eyeglasses, hearing aids dentures and mouth care products a pair of non-slip shoes (shoes without backs are NOT safe) clothing – underwear, comfortable pants and top books, magazines personal hygiene items such as deodorant, hairbrush, comb, toothbrush and toothpaste We are a fragrance restricted hospital. Please do not wear or bring perfume, cologne, aftershave, scented hair spray or other scented products. Page - 4 A broken hip, moving forward Risks and complications There are risks and complications related to surgery. These include: infection blood clots the broken bone may not heal damage to nearby blood vessels, bones or nerves lung problems dislocation of the hip joint if a hip replacement is done confusion and delirium (see page 19) falls Health care providers You will meet many health care providers while in the hospital. The surgeon will talk with you and/or your family about the surgery. The anesthesiologist will also discuss with you the type of anesthetic that will be used for surgery. You may see an internist, cardiologist or nurse practitioner who will talk with you about any heart problems that you may have. An internal medical doctor will talk with you about any medical problems such as diabetes or kidney problems that you may have. Our team of health care providers will follow you during your stay. Page - 5 A broken hip, moving forward Eating and drinking Surgery for patients who have broken a hip is often done in the evening. On the day you have surgery, you may be told when to stop eating and drinking. If you have not eaten all day and you have not had your surgery by early evening, ask the nurse to call the operating room. The nurse can ask if the surgery is to take place. If the surgery is not going to take place, you will be provided with food and drink until midnight. It is very important that you eat and drink! The surgery will then be scheduled for the next day. Tips for reducing your falls Why are falls a major concern in the hospital? Falls lead to injury and loss of independence. 1 in 3 people who have fallen in the past few months will likely fall again. Wear your glasses and hearing aids when awake. You must use the gait aid (such as a walker) provided when you are getting up. Page - 6 A broken hip, moving forward Am I at risk for falling? If you can answer yes to any of these questions you are at risk for falling. Have I ever fallen or lost my balance? Do I ever feel unsure or unsteady when I walk? Have I stopped doing things because I am afraid of falling? Am I confused at times? Am I taking medications for pain? Am I taking new medications that make me feel sleepy, dizzy, light headed or weak? Here are some ways to help you to reduce your risk for falling and help you maintain your independence: Get to know your room Look for: the call bell, make sure it is within reach the bedrail, there is at least 1 bedrail down overhead light switch, the cord is within your reach Be safe in your room Call for help when getting up until we feel you are safe to do this by yourself. Know your way to the bathroom! Map out a safe, clutter-free path to the bathroom. Use the grab bars if available. Page - 7 A broken hip, moving forward Ask for help to clean up spills or to pick up items you may have dropped such as tissues and clothes. Do not lean on overbed tables with wheels. Keep frequently used items such as the phone nearby. Use a “reacher” for hard to reach items. Equipment Keep your wheelchair, walker or cane nearby, so you do not have to reach for them. Lock your wheelchair or walker brakes before you begin to stand up or sit down. Lock brakes when not in use. Clothing Should be easy to put on. Many people wear sweat pants. Shoes should have good support, fit well, and have rubber soles. Get up safely Ring the call bell for help when getting up until we all decide it is no longer necessary. If you feel lightheaded or dizzy when you sit up from lying down, pump your feet until the feeling goes away.