LAUSR

Patients who suffer neck of femur fractures (NOF#) are typically frail and at risk of postoperative anaemia which can contribute to a high mortality in this demographic. This QiP reviewed how well postoperative haemoglobin (Hb) was being monitored on a Orthopaedic unit and assessed the effectiveness of a teaching session to improve this. A secondary measure was to compare day 1 and day 3 Hb to establish an evidence base for the timing of postoperative Hb monitoring. Two cycles (1st loop: 8/3/21–21/3/21, n = 21. 2nd loop:3/7/21–16/7/21, n=15) were performed either side of a teaching session. Day 1 and day 3 post-op Hb were recorded. Inclusion criteria were patients who fitted NOF# best practice tariffs. Pre-intervention saw 90% of patients have day 1 Hb and 52% have day 3 Hb taken, this increased to 93% and 67% post intervention. 81% of patients showed a Hb drop between day 1 and day 3 (mean = 11 g/dL), with 90% of day 1 bloods already below reference range. We demonstrated that a teaching session highlighting the importance of Hb monitoring in this patient demographic can improve the monitoring of postoperative haemoglobin and thus improve patient safety. Secondly, a Hb drop is possible from day 1 to day 3 and therefore a day 1 Hb should not be relied on. Future work will aim to investigate the longer-term trend of postoperative Hb to establish when an outpatient Hb should be performed.