016–Utilization of Evidence for the Development of Preoperative Practice Guidelines for Patients with Femur Fracture Who Are Admitted to the Emergency Department

Abstract

Background: Femur fractures are a frequently seen traumatic injury encountered in the emergency department of the Children's Hospital in Denver. The current standard practice involves placing a child who has sustained a closed femur fracture on skin traction while awaiting surgical intervention and fixation. Preoperative skin traction is utilized to exert a pulling force and decrease muscle spasms. Historically, at the Children's Hospital, the nursing staff on the orthopedic unit prepared a bed for traction setup and assisted the orthopedic resident in placing the child on traction. However, with recent restrictions on residents' on-call time, they are no longer available to come in during the middle of the night to place a child on traction and instead prescribe the nursing staff to initiate skin traction. This has resulted in a process problem. Most nursing staff do not feel that it is in their scope of practice to place a patient with a fracture on traction. In addition, staff members noted that the process of placing a patient on traction is a significantly painful procedure frequently requiring large doses of antianxiety agents and narcotic analgesia and occasional deep sedation.