MR 44D

PATIENT STICKER

CLINICAL PATHWAY

ORIF ANKLE FRACTURE (ADULT)

Date ALLERGIES
Yes No
Department
Unknown

Please specify

ALLERGY:
What Reaction:

DISCHARGE OUTCOMES ‐ To be completed before discharge

States support at home is adequate to meet their needs following

discharge Able to ambulate to optimum level

Demonstrates an understanding of post operative care

VARIANCE CODE LIST‐record any variations as a "X" on care path and document in integrated progress notes

1 PATIENT 2 INTERNAL SYSTEM 3 SOCIAL/COMMUNITY

1.A Vital sign/observation 2.A Unplanned cancellations 3.A Delay in transport availability
1.B Consult & Investigation 2.B Delay in Consultations 3.B Delay in home/community
1.C Pain Management 2.C Delay in Discharge Planning Family support
1.D Treatments 2.D Others 3.C Equipment/supplies not
1.E Wound Care 3.D Others
1.F Nutrition & Hydration
1.G Elimination
1.H Mobility & Physical Therapy
1.I Hygiene & Skin Integrity
1.J Patient Safety
1.K Education & Discharge Need

ADDITIONAL NAMES, SIGNATURES, DESIGNATION AND INITIALS

COMORBIDITIES/RISK FACTORS
Print name Signature Designation Initials

ASTHMA

HYPERTENTION

DIABETES

CARDIOVASCULAR

OTHER DESCRIBE
 MR 44D
CLINICAL PATHWAY Please fill in with  if done
̶ if not done X if abnormalities found ‐ please document in integrated progress notes
ORIF ANKLE FRACTURE (ADULT)
N/A When not applicaable
**please document reason in the box below if marked ( ̶ ) and (X)
Day Pre Operation Day 0 (until 24:00hrs) Day 1
Date MA N MA N
1.A. Assessment 1
Complete medical assessment Program in accordance with doctor Program in accordance with doctor

Vitals signs and Bromage score Vital sign every 6‐8 hrs or
2 Complete nursing assessment
observations (if spinal anesthetic) post op according to the patient's
every 30 mins for 2 hours condition
Vitals signs and Bromage score
3 Surgery Inform Consent observations (if spinal anesthetic) post op
every 60mins for further 4 hours

Vital signs and Bromage score observations

4 Anesthetic Inform Consent
5 Complete Pre‐Op Checklist
6 Other information ( surgery information,
Blood transfusion,………………………………….)
7 Complete Falls Risk and Interventions
8 Complete Braden Scale and Interventions
9 Complete Phlebitis Scale and Interventions
10 Complete VTE Risk Assessment
11 Monitoring bleeding for open fracture
12 Monitoring compartment syndrome sign
1.B Consultation 1 Assessment by GP
& examination 2 Assessment by orthopedic surgeon
3 Assessment by anesthesiologist
4 Assessment by internist if > 40 years old
5 Lab examination: 1.CBC, ABO-Rh, Liver
Function, Electrolytes, BUN/SC, PT/APTT,
Random Glucose.
(if spinal anesthetic) every 4‐6 hrs or
according to the patient's condition
Complete Falls Risk and Intervention
Complete Braden Scale and Intervention
Complete Phlebitis Scale and Intervention
Complete VTE Risk Re- Assessment on OR
Monitoring bleeding sign and drainage
Monitoring compartment syndrome sign
Examination by GP
Assessment by orthopedic surgeon
Lab examination : CBC as required
Other:
Complete Falls Risk and Intervention
Complete Braden Scale and Intervention
Complete Phlebitis Scale and Intervention
Monitoring bleeding sign and drainage
Monitoring compartment syndrome
Examination by GP
Assessment by orthopedic surgeon
Lab examination : CBC as required
Other:

6 RADIOLOGY: Ankle, Mortice.

CHEST XRAY > 40 years
7 ECG (>50 years)
8 Report case manager for surgery time
1.C. Pain 1 Assess pain on vital signs chart, analgesia as Assess pain on vital signs chart, analgesia as Assess pain on vital signs chart, analgesia
Management required. required. as required.
2 Document sedation score hourly if on Document sedation score hourly if on
Document sedation score hourly if on
narcotic infusion narcotic infusion narcotic infusion
1.D. Care & 1 IV therapy IV therapy IV therapy
treatment 2 Medication Medication Medication
3 Antibiotic Antibiotic Antibiotic
4 O2 Therapy as required O2 Therapy as required O2 Therapy as required
5 Start VTE Prophylaxis VTE Prophylaxis
1.E. Wound Care 1 Apply wood splint Observe wound dressing Wound dressing
2 Apply back slap Apply back slap
1.F. Nutrition & 1 Fasting 6 hrs prior surgery (min) Observe for nausea & vomiting Diet : Free Diet
Hydration 2 Last meal:……….. Fast 6 hours post op or as per surgeon Observe for nausea & vomiting
instruction than start with normal diet
3 Last drink:………..
Monitor intake, output every hours and Monitor intake, output every hours and
according doctor instruction according doctor instruction
Monitor fluid balance Monitor fluid balance Monitor fluid balance
Observation Bowel movement Observation Bowel movement Observation Bowel movement
1.G. Elimination 1
2 Monitor IDC as required Remove IDC as required
1.H. Hygiene 1 Assist as required (chlorhexidine sponge) Personal hygiene assisted Personal hygiene assisted
1.I. Mobilization 1 Bed rest Assist as required Assist as required
2 Active mobilization as orthopedic doctor
recommendation
1.J. Patient 1 Surgical Site Marking
safety 2
1.K. Discharge 1
Orientation to ward Explanation of post op condition Explanation of post op condition
planning/ Patient
Education 2 Explanation of Condition pre and post op.
3 Education about breathing Education about breathing exercises, pain Education about exercises, pain and
Exercises, pain and mobilization post op and mobilization post operatively mobilization post operatively
4 Estimated Discharge Date
Sign: Sign: Sign:
Reason: Reason: Reason:
 CLINICAL PATHWAY

MR 44D
Please fill in with  if done
̶ if not done , X if abnormalities found ‐ please document in integrated progress notes
ORIF ANKLE FEMUR (ADULT) N/A When not applicable
**please document reason in the box below if marked ( ̶ ) and (X)

Day Day 2 Day 3 Day 4

Date M A N MA N M A N
1.A. Assessment 1
Program in accordance with doctor Program in accordance with doctor Program in accordance with doctor
Vital sign every 6‐8 hrs or according
Vital sign every 6‐8 hrs or according to Vital sign every 6‐8 hrs or according to
2 to the patient's condition
the patient's condition the patient's condition
3 Complete Falls Risk and Intervention Complete Falls Risk and Intervention Complete Falls Risk and Intervention
4 Complete Braden Scale and Intervention Complete Braden Scale and Intervention Complete Braden Scale and Intervention
5 Complete Phlebitis Scale and Intervention Complete Phlebitis Scale and Intervention Complete Phlebitis Scale and Intervention
6 Monitoring compartment syndrome Monitoring of compartment syndrome Monitoring of compartment syndrome
1.B. Consultation 1 Examination by GP Examination by GP Examination by GP
& Examination 2 Examination by Orthopedic Surgeon Examination by Orthopedic Surgeon Examination by Orthopedic Surgeon
3 Lab examination : CBC as required Lab examination : Lab examination :
4 Other: Other: Other:
5
1.C. Pain 1 Assess pain on vital signs chart, analgesia Assess pain on vital signs chart, analgesia Assess pain on vital signs chart, analgesia as
Management as required. as required. required.
2 Document sedation score hourly if on Document sedation score hourly if on Document sedation score hourly if on
narcotic infusion narcotic infusion narcotic infusion
3

1.D. Care & 1 IV therapy IV therapy

treatment 2 Remove IV Cannula Remove IV Cannula
3 Medication Medication Medication
4 Antibiotic Antibiotic Antibiotic
5 VTE Prophylaxis VTE Prophylaxis VTE Prophylaxis
1.E. Wound Care 1 Wound Dressing Wound Dressing Wound Dressing
2 Apply back slap Apply back slap Apply back slap
1.E. Nutrition & 1 Diet : Free Diet Diet : Free Diet Diet : Free Diet
Hydration 2 Observe for nausea & vomiting Observe for nausea & vomiting Observe for nausea & vomiting
3
Monitor intake, output every hours Monitor intake, output every hours Monitor intake, output every hours
according doctor instruction according doctor instruction according doctor instruction
4 Monitor fluid balance Monitor fluid balance Monitor fluid balance
5
1.F. Elimination 1 Observation Bowel movement Observation Bowel movement Observation Bowel movement
2
1 Assist as required Assist as required Assist as required
1.G. Hygiene
2
1.H. Mobilization 1 Assist as required Assist as required Assist as required
2 Active mobilization as orthopedic doctor Active mobilization as orthopedic doctor Active mobilization as orthopedic doctor
recommendation recommendation recommendation
3
1.I. Patient safety 1 Bed rails attached Bed rails attached Bed rails attached
2 Lower bed position Lower bed position Lower bed position
1.J. Discharge 1 Wound dressing Wound dressing Wound dressing
planning/ 2 Pain management Pain management Pain management
Patient Education 3 Activity after discharge Activity after discharge Activity after discharge
4 Nutrition after discharge Nutrition after discharge Nutrition after discharge
5 Medication on discharge Medication on discharge Medication on discharge
6 Mobilization after discharge Mobilization after discharge Mobilization after discharge
7 Equipment needed as discharge Equipment needed as discharge Equipment needed as discharge
8 Follow up with orthopedic doctor and Follow up with orthopedic doctor and Follow up with orthopedic doctor and
Prophylaxis before flight Prophylaxis before flight Prophylaxis before flight
Sign: Sign: Sign:
Reason: Reason: Reason: