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JFSF Vol 9, No 1, March 2024, p.32-50

doi: 10.22540/JFSF-09-032

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Original Article

Implementation of a Frailty Care Bundle (FCB) Targeting Mobilisation, Nutrition and Cognitive Engagement to Reduce Hospital Associated Decline in Older Orthopaedic Trauma Patients: Pretest-Posttest Intervention Study

Corina Naughton1, Marguerite de Foubert1, Helen Cummins1, Ruth McCullagh2, Teresa Wills1, Dawn A. Skelton3, Darren Dahly4, Denis O’Mahony5, Emer Ahern6, Salvatore Tedesco7, Bridie O. Sullivan8

  1. School of Nursing, Midwifery, University College Cork, Cork, Ireland
  2. School of Clinical Therapies, University College Cork, Cork, Ireland
  3. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
  4. School of Public Health, University College Cork, Cork, Ireland
  5. Department of Medicine, University College Cork, Cork, Ireland
  6. Department of Geriatric & Stroke Medicine, Cork University Hospital, Cork, Ireland
  7. Tyndall National Institute, University College Cork, Cork, Ireland
  8. South South West Hospital Group, Erinville, Western Road, Cork, Ireland

Keywords: Hospital associated decline, Mobility, Nutrition, Orthopaedic

Abstract

Objective: To implement and evaluate a Frailty Care Bundle (FCB) targeting mobilisation, nutrition, and cognition in older trauma patients to reduce hospital associated decline. Methods: We used a two group, pretest-posttest design. The FCB intervention was delivered on two orthopaedic wards and two rehabilitation wards, guided by behaviour change theory (COM-B) to implement changes in ward routines (patient mobility goals, nurse assisted mobilisation, mealtimes, communication). Primary outcomes were patient participants' return to pre-trauma functional capability (modified Barthel Index - mBI) at 6-8 weeks post-hospital discharge and average hospital daily step-count. Statistical analysis compared pre versus post FCB group differences using ordinal regression and log-linear models. Results: We recruited 120 patients (pre n=60 and post n=60), and 74 (pre n=43, post n=36) were retained at follow-up. Median age was 78 years and 83% were female. There was a non-significant trend for higher mBI scores (improved function) in the post compared to pre FCB group (OR 2.29, 95% CI 0.98-5.36), associated with an average 11% increase in step-count. Conclusion: It was feasible, during the Covid-19 pandemic, for multidisciplinary teams to implement elements of the FCB. Clinical facilitation supported teams to prioritise fundamental care above competing demands, but sustainability requires ongoing attention. ISRCTN registry: ISRCTN15145850 (https://doi.org/10.1186/ISRCTN15145850)
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