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Non-ambulatory fragility fracture (NAFF) pathway aims to ensure patients with similar needs receive good and equitable care

GIRFT has shared a new national pathway outlining the best practice concepts for ensuring patients with all types of fragility fracture receive excellent and equitable NHS care.

Many thousands of older people are admitted to hospital with a fracture every year; hip fractures alone lead to around 70,000 older people hospital admissions in England annually, and the number is significantly higher when all anatomical sites of fracture (eg; shoulder, spine) are taken into account. While the anatomical site of injury may be different, fragility fracture patients have similar needs, such as pain relief, restoration of mobility, management of co-morbidities and the prevention of delirium.

The GIRFT Non-Ambulatory Fragility Fracture (NAFF) pathway offers guidance for all stages of the patient journey – from presentation in secondary care, to admission and initial care, ongoing ward care and discharge and follow-up – which should be applied to all NAFF patients, regardless of their injury.

Learn more at our webinar

A GIRFT webinar is being held on Tuesday, 21st May (12.30pm) to introduce the new pathway. The session will hear from clinicians in emergency medicine, geriatric medicine and physiotherapy, plus the team from North Bristol NHS Trust, who are successfully managing their older injured patients under one agreed process as a cross-specialty team.

Existing pathways for this significant patient cohort are complex, involving input from different departments and professional groups, and are often shaped by the organisational structure of a trust. This has led to marked variation both within and between trusts in how this group of patients with similar needs is cared for.

The NAFF pathway is the result of a collaboration between 38 stakeholders with geographic and cross-specialty representation, and aims to address those operational practicalities, offering universal concepts trusts can adopt to work towards a more equitable service, using existing resources.

For example, key recommendations in the pathway include:

  • Nominating a trust board member to be responsible for, and to report on, equitability of care for NAFF patients, with regular oversight and governance of the pathway provided through an oversight group.
  • Designating a Single Point of Contact (SPOC) – either an Advanced Clinical Practitioner (ACP), Advanced Nurse Practitioner (ANP) or doctor – to be consulted from the point of admission, who liaises with senior management, delegates decisions and informs discharge planning.

The NAFF pathway is supported and co-badged by eight professional organisations: the Royal College of Emergency Medicine (RCEM), British Geriatrics Society (BGS), the British Orthopaedic Association (BOA), the Chartered Society of Physiotherapy (CSP), the Royal Osteoporosis Society (ROS), the Royal College of Occupational Therapists (RCOT), the Royal College of Physicians’ National Hip Fracture Database (NHFD), and the Association of Trauma and Orthopaedic Chartered Physiotherapists (ATOCP).

Bob Handley, GIRFT’s clinical lead for orthopaedic trauma surgery, led the working group which developed the pathway. He said: “During my GIRFT reviews I have seen that many units have rightly put considerable effort into improving their hip fracture pathways. The combination of the National Hip Fracture Database, national guidelines and Best Practice Tariff has created an environment for constructive change. Now it is important that units take steps to extend these benefits to all NAFFs to ensure equitable access to care for all fragility fracture patients.

“The first steps are to recognise that this group of patients with similar needs exists, and that the scale of the group makes it an important issue to address.

“We are confident we have identified an approach which will foster the team management required – not based on significant new investment but on equitable and efficient use of currently available resources – with a key component being the Board responsibility to oversee and report on equitability.”

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