Page 211 - Hospital Authority Convention 2017

Service Enhancement Presentations

F5.3 Healthcare Advances, Research and Innovations 09:00 Room 421

An Inter-disciplinary Team Approach for the Prevention of Minimal Trauma Fractures in Long-term Care
Residents
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Lam K , Tang KC , Yui S , Wong LSY , Leung C , KAM WC , Yuen YK 1 HOSPITAL AUTHORITY CONVENTION 2017
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1 Medical Team, Nursing Team, Occupational Therapy Team, Physiotherapy Team, Dietetic Team, Cheshire Home (Shatin),
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Hong Kong
Introduction
Minimal trauma fractures (MTFs) or care-related fractures occur mostly in debilitated and dependent long-term care
residents, without the degree of trauma that usually causes a broken bone. MTF are devastating events in long-term care
residents, causing pain and suffering, and increasing morbidity and mortality. Moreover, there may be medico-legal issues
raised after MTFs for the possibility of mistreatment and inadequate care procedures.
Despite their impact, currently there is a lack of data on the risk factors associated with MTFs, and no evidence-based
prevention strategies have been published.
Objectives
(1) To identify the risk factors of MTFs in long-term care residents; and (2) to develop prevention strategies accordingly.
Methodology
This was a longitudinal cohort study of prospectively collected data. Participants were followed from March 2007 to March
2016 or until death.
Setting: Shatin Cheshire Home (SCH), a 300-bed long-term care hospital in Hong Kong.
Participants: All long-term care residents who were in need of continuous medical and nursing care for their activities of daily
living.
Measurements: Information on patients’ demographic data, severe contracture defined as a decrease of 50% or more of
the normal passive range of joint movement of the joint, and severe limb spasticity defined by the Modified Ashworth Scale
higher than grade three, medical comorbidities, functional status, cognitive status, nutritional status including body mass
index and serum albumin, past history of fractures, were evaluated as potential risk factors of subsequent MTF.

Results
396 residents (148 males, mean age=79, SD=16) were included for analysis. The presence of severe contracture and limb
spasticity was highly prevalent among the study population. 12 residents (3%) suffered from subsequent MTF over a median
follow-up of 33 (SD =30) months. Seven out of these 12 residents died during the follow-up period. The following two
factors were found to independently predict subsequent MTF in a multivariate Cox regression: severe bilateral spastic knee
contractures (hazard ratio=16.5, P< .0001), and diabetes mellitus (hazard ratio =4.0. P=0.018).

Based on these results, an inter-disciplinary team approach has been adopted in SCH for prevention of MTFs. Strategies
include spasticity management and prevention of contractures which are combined with educational programmes for
caregivers to identify the high-risk residents and apply proper handling techniques during routine care. Moreover, nutritional
programme is implemented to ensure adequate nutrition, and supplementation of calcium and vitamin D. Pharmacological
treatments for osteoporosis are also given to high-risk tolerated residents. Wednesday, 17 May

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