First-day mobilisation after hip hemiarthroplasty in a patient with delirium

Mobilisation should be attempted today if her pain is controlled and she is safe to handle, because prolonged bed rest increases delirium, pressure injury, pneumonia, and thrombosis. However, she has several risks: post-operative anaemia with haemoglobin 92 g/L, a low-grade temperature, new confusion suggestive of delirium, catheter pulling, and pain on movement. These do not absolutely contraindicate sitting out or standing, but they require assessment first. I would check orthostatic blood pressure, hydration, pain, and whether she is rousable enough to cooperate. I would review the notes for the anaesthetic, blood loss, and any plan for transfusion.

Prerequisites are: a medical review of the delirium and temperature; adequate analgesia before handling; a hoist or standing aid with at least two staff; and secure catheter and wound management. If she is too drowsy or combative, I would defer standing and start with sitting on the edge of the bed with a hoist, then reassess. The decision must be documented, and the medical team should be informed if she cannot participate.

Use a hoist or standing hoist with two staff, not a manual lift, because she is confused, has a recent hip replacement, and is at risk of falls. Explain the procedure calmly and orient her to time and place. Give analgesia 30 minutes before handling if prescribed. Check the catheter bag is not pulling, secure the wound dressing, and ensure the correct leg is not adducted or internally rotated beyond the surgeon's precautions. Sit her on the edge of the bed with the hoist, check blood pressure and symptoms, then stand with the hoist or a frame if she can bear weight. Take a few steps to a chair if safe.

Environment: clear the bed space, use a non-slip floor, ensure the bed height is correct, and have a chair behind her. Stop for dizziness, chest pain, desaturation below 92%, or a fall in blood pressure. Keep the session short. Document the level of assistance and any pain. Because she lives in a walk-up flat, do not practise stairs today; involve occupational therapy for a home assessment.

Discharge planning should start now. She lives alone with 12 steps, so a home assessment by occupational therapy is essential before discharge. Arrange grab rails, a raised toilet seat, a shower chair, and adequate lighting. Consider a community rehabilitation programme and a personal alarm. Review her medications for sedatives or antihypertensives that may contribute to falls and delirium. Discuss osteoporosis treatment with the medical team. Involve her family or carers, with consent, and clarify who will support her at home.

Falls prevention includes strength and balance training after discharge, footwear advice, and a review of home hazards. Because she has mild cognitive impairment, she may need a supervised medication box and a daily check. Document the plan, the referrals, and the patient's and family's understanding. If she cannot safely return home, escalate to the medical social worker for alternative accommodation. The physiotherapist's role is to coordinate with the multidisciplinary team, not to discharge her alone.