Date of Award
2025
Document Type
Doctor of Nursing Practice (DNP)
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
Committee Chair
Shikha Modi
Subject(s)
Older people--Nursing, Hip joint--Fractures--Treatment, Pain--Treatment, Postoperative pain--Treatment, Hospital utilization--Length of stay
Abstract
Over 95% of hip fractures are related to falling, which equates to approximately 300,000 hip fractures annually in the United States. Poorly managed pain and immobility are risk factors predisposing patients to prolonged hospitalization, permanent disability, and mortality. At an academic medical center, low adherence to the use of a multimodal pain management order set contributes to the sequelae of unfavorable outcomes. Through stakeholder education, this quality improvement project sought to improve adherence to an MPM order set to promote effective pain management, early mobilization, and decreased length of stay. On a surgical unit, surgeons (n=6; 100%) and nurses (n=46; 88%) received education on the surgical stress response, mitigating the response, and the impact of multimodal pain management (MPM) and mobilization. The physical therapists received a summary of hip fracture care. Order set adherence was monitored with ongoing feedback provided to the surgeons. Nurses and physical therapists received support and feedback through daily patient rounds, unit huddles, and an education board. Patient outcomes were monitored; pain scores, daily morphine milligram equivalents, early mobilization, functional level, and length of stay (LOS). Provider order set adherence increased by 52%. Early mobilization was 75% (n=30), which was an improvement. The mean LOS was 5.87 and decreased to 5.19. By promoting the use of MPM, thereby enhancing pain control, patients can progress more readily to functional restoration, reducing their complication risk and LOS.
Recommended Citation
Mangruen, Donna, "The impact of hip fracture multimodal pain management on mobilization and length of stay for hospitalized older adults" (2025). Doctor of Nursing Practice (DNP). 134.
https://louis.uah.edu/uah-dnp/134