In response to long waiting times for orthopaedicsurgery, the Division of Orthopaedics at TorontoWestern Hospital in Ontario developed a ‘‘tworoom model’’ using two OR’s overlapping toincrease the number of orthopaedic surgeries donein a day. Concomitant with this plan, a new role, aregistered nurse first assistant (RNFA) was intro-duced to make this model function smoothly, aswell as more involvement from the whole team,including surgeons, anaesthesia, anaesthesia assis-tants and peri-operative nurses. The RNFA acquiredan advanced skill set through an RNFA program, toprovide skills such as assisting, suturing, and ad-vanced physical assessment to provide additionalperi-operative care. The RN’s and the RPN’s tookon additional responsibilities and workload as thenumber of cases increased.

Change is a difficult, yet universal concept innursing and medicine today; however it requiresadjustment and acceptance. This paper describesthe process of introducing new nursing roles, andan increase in peri-operative nurses responsibilitiesinto an established, well functioning surgical area,and reviews some of the enablers and challenges ofacceptance of these changes.

doi:10.1016/j.joon.2009.02.051

Barriers related to the timing of surgical inter-vention for hip fracture repair (Concurrent)

Karen Robinson

Hamilton Health Sciences, Hamilton, Ontario,Canada

Background: Hip fractures are often life-alteringevents for older adults. Patients are confined tobed and may wait several days for surgery. Waitingfor surgery may increase risk of bed rest complica-tions, urinary tract infections, pressure ulcers, re-peat episodes of fasting and mortality. Mortalityrates associated with hip fractures can be as highas 18–36% (CIHI, 2007). Risk factors include: age,sex, co-morbidities, the number of fracture proce-dures that the hospital performs, ASA scores andthe timing to surgical intervention. There are sev-eral modifiable risk factors, specifically, timing ofsurgical intervention (CIHI, 2007; Holt, Smith, Dun-can, et al. 2008). Although an acceptable time be-tween fracture onset and surgical repair has notbeen clearly established, the literature suggeststhat a period of 48 h may be generally accepted(CIHI, 207; Grimes et al., 2002; Weller et al.,2005).

Purpose: The purpose of study was to examinethe barriers related to the timing of surgical inter-vention for fractured hip patients.

Methods: A retrospective chart review (n = 231)was conducted for patients admitted/dischargedwith a hip fracture between January and December2007. About 210 cases were surgically repaired.About 70% of the patients were female. The datawas analyzed in two groups: patients going to theOR either within 48 h and patients waiting greaterthan 48 h.

Results: About 63.3% of the patients receivedsurgical intervention within 48 h. Of the 36.7% ofpatients receiving surgical intervention after 48 h,the primary barriers to surgical intervention in-cluded: lack of operating room time, medical sta-bility, lack of critical care bed post-operatively,delay of pre-op investigations, antiplatelet treat-ments and NPO status. A significant number of sur-gically delayed patients died in hospital. Thispresentation will share the results of our studyand provide strategies aimed at reducing the waittimes.References supplied by presenter.

doi:10.1016/j.joon.2009.02.052

Orthopaedic nurses have the right skills(Concurrent)Terry Kane

Kane Rehabilitation Services, Ontario, Canada

When you decided to become a nurse, you nodoubt pictured yourself at the patient’s bedside.If that’s where you still picture yourself – great!However bedside care may no longer be an optionfor some nurses so you may be interested to know– there are many ways in which nurses can transfertheir capabilities from the bedside setting to thebusiness environment, working in management,training, operations, physician services and more.My oral presentation will outline Case Managementas an option and also why Orthopaedic Nurses aresuited for this position.

Due to its inherently collaborative and multidis-ciplinary nature, the process of case managementinvolves the client, family, and other members ofthe health care team. Coordination of care fostersthe efficient use of resources. However, even inthe era of managed care, cost-control, whileessential, is not the only goal. Quality of care, con-tinuity, and assurance of appropriate and timelyinterventions are also crucial. In addition to help-ing reduce the cost of health/rehabilitation care,

Selected abstracts from the 32nd Annual Canadian Orthopaedic Nurses 37