What does NHFD stand for?
National Hip Fracture Database

Who manages the NHFD Project?
The NHFD Workstream Delivery Team consists of:
Lara Amusan – Falls and Fragility Fracture Audit Programme Manager
Antony Johansen - Clinical Lead - Orthogeriatric Medicine
Dominic Inman - Clinical Lead - Orthopaedic Surgery

How do I get access to the NHFD I belong to an acute Trust?
The lead clinician for the NHFD in your hospital should send an email (from his/her NHS email address) to nhfd@rcplondon.ac.uk requesting access to the database. The email should include the names, designations and contact details of any personnel as well as the type of access required, within the hospital requiring NHFD access. All subsequent requests for access must also come from the lead clinician.

Registering new lead clinicians
In order to maximise the security of patient data, lead clinicians should register a replacement on the webtool before leaving post. They should then contact nhfd@rcplondon.ac.uk to have their own access removed.
In cases where this has not been possible, an email of approval from sites’ Caldicott Guardian must be sent to nhfd@rcplondon.ac.uk in order to approve new lead clinicians.
NB. If the new lead clinician is an existing user, contact nhfd@rcplondon.ac.uk for support.

I belong to a Clinical Commissioning Group - how do I get access to reports?.
CCG reports have been withdrawn from the NHFD from July 2020.
BPT reports are now provided via the NHS Digitals DSCRO service.
Please contact your CCG Regional Office DSCRO service to obtain claim validation data.

What do I do if I forget my username and password?
Follow the instructions on the log in page to either resend your username or reset your password - if you have any difficulty contact the audit support team.

Caldicott Guardian approval - do they need to sign something to agree to their hospital participating?
No, but they should be informed as a matter of courtesy and may have specific questions about data security that we will be happy to answer.

Is the NHFD covered by Ethical Approval?
Yes, the NHFD is approved by the NHS England HRA Confidentiality Advisory Group (CAG) to collect patient data without consent under Section 251 exemption. (This approval was formerly administered under the NIGB-ECC / PIAG).

Do patients consent to participate?
No, patients do not need to give formal consent and they may opt out if they wish.
We ask that all Trusts give each patient a copy of the NHFD leaflet.
NHFD Patient Information Leaflet NEW.pdf

NB. Please add your Hospital's NHS logo.
We encourage the use of this leaflet and ask that you blow some up to A3 size and display in ward areas, for information to relatives, carers etc.

Is there any information for patients on what level of care they should expect when they have a hip fracture?
Yes, created by Robert Smith, Patient Representative on the NHFD Steering Group.
This is not a mandatory NHFD document but could be distributed with the Patient Information Leaflet when the patient is admitted to hospital.


Definition of Multidisciplinary Rehabilitation Assessment Team
A group of people of different professions (and including as a minimum a physiotherapist, occupational therapist, nurse and doctor)
with job plan responsibilities for the assessment and treatment of hip fracture patients,
and who convene (including face to face or virtual ward round) regularly (and at least weekly) to discuss patient treatment and care,
and plan shared clinical care goals.

Definition of a Ward Round
The ward round is a parade through the hospital, of professionals where most decision making concerning patient care is made
The round provides an opportunity for the multidisciplinary team to listen to the patient's narrative and jointly interpret his concerns.
From this unfolds diagnosis, management plans, prognosis formation and the opportunity to explore social, psychological, rehabilitation and placement issues.
Physical examination of the patient at the bedside still remains important.
Anatomy of the ward round, James A. O'Hare European Journal of Internal Medicine - July 2008 (Vol. 19, Issue 5, Pages 309-313, DOI: 10.1016/j.ejim.2007.09.016)
Can I view anyone else's data?
No, each hospital (not Trust) is registered separately.
You can see your data compared with your SHA and the national average on your on-line report.

Can more than one person in a Trust be given access to the database for data entry?
Yes, as many as you wish but only the lead clinician and the data inputters should have full access - other non-clinical roles should have read only access.

How long will it take to enter data?
This will vary according to experience - but no more than approximately 1~2 minutes per patient entry.

Once submitted, can I retrieve records to edit content?
Yes, at any time

If I have imported data (via CSV file) and some records have not been imported - how do I check what is missing?
- Log onto the website
- Click 'Import Data' tab
- Open 'import logs' from the left hand menu and you will see all imports made by your hospital - open the relevant dated import log and it will tell you the reasons why records have not imported.

How can I export data entered into NHFD?
You can export your data at any time – you may wish to capture data each month – to do this:
- Log in to website, Home page,
- Click 'Export data' tab
- Choose Live or Archived data
- You need to give the system a date range to export or export all data
- An Excel spreadsheet will be created for to analyse locally as you wish.

How do I enter the correct dates in a patient record?
Use the on-line calendar picklist feature or enter the date/time in the fields directly.
Note you can use the 'quick-type' feature to enter part of the data and the system will complete the date for you.
For instance, entering a '3' will result in a date for the 3rd day of the current month, in the current year. Entering '3 6' will enter 3 June for the current year.

How do I complete a Facilities audit?
Please log in to the website and complete the facilities audit online by clicking the facilities audit link on the side bar menu.
Once you have completed all fields please click the ‘mark as complete’ link at the top of the page, then ‘save’ and ‘close’.
Please be aware that a completed facilities audit is a mandatory requirement for inclusion in the NHFD annual national report.
Please make every effort to ensure your clinical lead completes the audit by the due date.

I am 'locked out' - my facilities audit has not been completed yet - what do I do?
Contact audit support team to be allocated a new completion date.

When does the clock start ticking for all assessments?
As soon as the patient enters A&E or is seen as in-patient by the trauma team.
Scenario 1: Hip pain, initial X-ray, no fracture seen, trial of mobilisation then MRI/CT identifies fracture – time of first presentation to A&E to be used
Scenario 2: SHO misses fracture, radiologist report shows fracture – time of first presentation to A&E to be used
Scenario 3a: Impacted or old fracture, treat conservatively, trial of mobilisation fails – time of presentation to A&E to be used
Scenario 3b: No surgical intervention on preliminary admission. Patient is discharged but returns at a later date complaining of pain and inability to mobilise. Patient is readmitted for surgery. -  NHFD only collects data on the primary fracture episode so the second admission should NOT be entered onto the database or it will be displayed as a duplicate. This patient will not qualify for BPT as surgery has not been performed during the primary episode.
Scenario 4: A&E diagnosis? Fracture awaiting MRI/CT – time of first presentation to A&E to be used
Scenario 5: The patient is seen at another hospitals A&E department and transferred to my hospital for treatment - The first presenting hospital should be documented, the operating hospital puts the patient on their NHFD database. The time starts ticking from presentation at the first A&E department.

When is considered time of primary surgery?
For 'Payment by Results' Best Practice Tariff (BPT) purposes time of primary surgery is taken from the time of induction of anaesthesia.

What if I enter someone's details twice?
This should appear in your duplicates report. Check the 'Duplicates' report and delete the any unneeded records after checking that the details are correct on the duplicate you want to keep.

We have an overseas patient who has no NHS number
Do not leave the field blank you can use 'OVERSEAS' - this will then enable the record to save.

We do not have an NHS number for a UK resident patient
Please contact your medical records department who will be able to provide you with one.

If the patient is admitted from within my hospital - how do I record this?
We recognise that some patients may sustain a hip fracture whilst already in hospital or may require acute medical management (i.e. are not admitted primarily as a fractured hip). On the database entry sheet enter 'no' to 'admitted via A&E', this will open a new box allowing you to enter 'date and time seen by trauma team'. The time to theatre will be calculated from this time.

What do I record for Pressure Ulcers?
This should be answered as 'yes' only if the patient has developed a grade 2 pressure ulcer or above during their acute orthopaedic admission if nothing is documented in the notes and the patient has left the hospital 'unknown' must be recorded. Please do not record moisture lesions.

What is the definition of a pressure ulcer?


Moisture lesions
The following article from the Nursing Times explains the difference between a pressure ulcer and a moisture lesion.
http://www.nursingtimes.net/nursing-practice/clinical-zones/wound-care/understanding-the-differences-between-moisture-lesions-and-pressure-ulcers/1951849.article

What is the NHFD'S definition of a Falls Assessment?
A systematic assessment by a suitably trained person e.g. Geriatrician or a specialist assessment trained nurse which must cover the following domains:- Falls history (noting previous
falls), cause of index fall (including medication review), risk factors for falling and injury (including fracture) and from this information formulate and document a plan of action to prevent further falls.

AMTS [Abbreviated Mental Test Score]
This 10 item version is a simple and robust screening tool in the acute patient.
Full assessment for confused people (AMTS less than 7) requires more detailed tools for cognition (MMSE) or presence of delirium (CAM)


What drugs constitute bone protection medication?
Bone protection options for v11, July 2017.pdf


What is an ASA Score?
The American Society of Anaesthesiologists (ASA) devised a preoperative risk score based on the presence of co-morbidities at the time of surgery. An ASA score >2 is associated with increased risk of wound infection and this risk is additional to that of classification of operation and duration of surgery.


What is a Pathological fracture?
A bone broken, caused not by trauma alone, but so weakened by disease as to break with abnormal ease. Pathological fractures are characteristic of metastatic malignant disease, myeloma. or Atypical presentation.

What is an Atypical fracture?
Atypical fractures are transverse femoral fractures, with an unusual cortical spike medially, that occur in the subtrochanteric and shaft regions [you should only enter subtrochanteric ones to the database]. They follow low trauma injuries and are associated with bisphosphonates, glucocorticoids or proton pump inhibitor use. Patients may report pre injury pain. Please check our elearning section for further clarification.

Issues surrounding delay to surgery....
Please document only the main reason for delay.

What is the difference between discharge from Orthopaedic Ward and Trust?
- Discharge from orthopaedic ward is the date and time the patient leaves the orthopaedic ward - or if transferred to a second orthopaedic ward when the patient leaves the last orthopaedic ward
- Discharge from the Trust is the date and time the patient leaves the Trust as an in-patient, either to their final place of residence or to a CCG bed
These date and times will all be the same if a patient goes directly home
The first two date and times will all be the same if a patient goes from the orthopaedic ward to a CCG bed
All three date and times will be different if a patient goes from an orthopaedic ward to a rehab ward then to a CCG bed

Follow up - how do I inform patients that contact may be made by the hospital at 30, 120 days and at 1 year?
- They will be aware of the NHFD as they will have been able to view a copy of the patient leaflet
- Follow-up will be managed by different hospitals in different way, usually carried out over the telephone or by letter - see examples in Resources

How do I know that follow up is due?
We have created a prompt for you regarding the 30, 120 day and 1 year follow-ups, this can be found on data-tab labelled ‘Followup’

	Not Due Days to appear in report	Due for input Days post admission date record becomes	Overdue Days when followup becomes overdue	Completed or Expired Follow up is completed or Days when patient disappears from view
120 day follow up:	100	115	125	140

All days are calculated from admission date.

How can I add additional or 'custom' fields to collect data in addition to what is currently collected on the NHFD Audit tool?
This document explains custom/additional fields:


What is the difference between V6 and V7 BPT Reports
V6 BPT Reports are for patients admitted on or before 31st March 2012
V7 BPT Reports are for patients admitted on or after 1st April 2012
V10A BPT Reports are for patients admitted on or after 1st April 2017
Patients will appear the the quarter in which they were discharged.