Delirium is also called acute confusional state. Patients appear to be anxious, disoriented and confused. The condition is often temporary. Relatives or healthcare staff may experience that an otherwise mentally stable person suddenly becomes confused about time, has a memory deficit and lack of recognition. The person loses his/her orientation, does not know who he/she is and why. The person may be either apathetic and quiet or very restless. Delirium typically lasts for hours or days but can, in rare cases, last for weeks or longer. Older people and weakened persons (or persons with dementia) are at greater risk of developing delirium. This is also the case if you are admitted to hospital with a physical disease such as a hip fracture. The reason is that the brain responds to physical stress. Delirium may also develop in connection with inadequate fluid intake or pain, e.g. after a fall. Treatment is vital for the patient’s recovery and can be in the form of liquid, adjustment of medicine and treatment of any infections.
The participants in Prohip examined the relationship between hip surgery (with focus on acute surgeries) and delirium at the hospitals in the two regions and have introduced procedures to ensure that delirium is diagnosed and treated as quickly as possible.
Urine retention is a condition in which you are unable to pass urine or completely empty your bladder. You may feel that your bladder is full and have lower abdominal pain but you cannot pass urine. The condition may arise after surgery involving anaesthesia. For some people it can be difficult to pass urine when lying in bed. A nurse can check whether there is urine in the bladder by scanning the bladder. The patient’s bladder can be emptied by inserting a catheter into the bladder. If you cannot empty your bladder completely, there is an increased risk of inflammation of the bladder. It is not a life-threatening condition to have a full bladder, but the condition should not last long because it could damage the bladder nerves and make it more difficult to return to a normal condition. The Prohip project has focused on finding the best treatment and to reduce any inconvenience to the patients. The literature has been studied to find the results of either scanning and inserting a catheter every second hour during the first few days after a hip surgery or inserting a catheter in the bladder and letting it stay for the first few days. It shows that inserting a catheter after surgery produces the best results. The catheter is removed as soon as the patient is able to pass urine.
Pressure ulcers develop when sustained pressure is placed on a particular part of the body, where bones are close to skin without any muscles or fatty tissue in between. You may develop pressure ulcers if you have been confined to your bed in connection with, for instance, a fall or if you have been bed-ridden for a long period without a regular change of position. Pressure ulcers typically start with a light discolouring of the skin and, if not relieved or treated, a wound may develop which may extend to the bone. This is obviously very painful for the patient and should therefore be prevented. In the case of patients admitted with hip fractures, it is particularly important that the healthcare staff is aware of any case history. Whether the patient, for instance, has been lying waiting for help and been unable to move. You can prevent a deterioration of the tissue damage by using particular pressure-relieving mattresses and take precautions when changing the patient’s position.
Prohip has particular focus on the prevention of pressure ulcers. The project supports the ongoing efforts already being taken with the Danish Safer Hospital Programme, which focuses on improving work procedures and putting knowledge into practice. Næstved Hospital is one of five hospitals particularly engaged in the prevention of pressure ulcers.
Rehabilitation is about providing persons with reduced functional capacity the same opportunities as everyone else.
This is effected through collaboration between the citizen, the relatives and the healthcare professionals. Rehabilitation focuses on the everyday life of the citizen including participation in own activities and society. A good rehabilitation process ensures that treatment and exercise reflect the citizen’s lifestyle and wishes for the future.
In Prohip, the nursing staff has focused on how to ensure the best rehabilitation for hip patients. Studies (see more under Results) show that older people who are discharged from hospital have fewer health problems and fewer readmissions if they are contacted by a nurse after being discharged. In consequence, a development project has been initiated involving a nurse from Næstved Hospital phoning discharged hip patients. The nurse will ask questions about pain, daily functions, inconveniences relating to the surgery, etc.
When hospitalised, your appetite often decreases and you eat differently and less than when at home. This is not a good basis for quick recovery. If you are underweight or lose weight, you are more susceptible to infections and wounds heal more slowly. When going into hospital for a planned surgery, your diet during admission is important. You should not necessarily eat the same food when you are ill as when you are well. When you are well, you should follow the diet pyramid but when you are ill what you eat and drink is slightly different. Surgery and rehabilitation require a high protein content in the food and drink you consume.
Prohip is particularly focused on helping hip patients getting the right diet. A booklet has therefore been made to inform hospitalised patients about how to best compose the food they eat.