This project is designed to promote the use of fascia iliaca block as a method of analgesia for patients who present to Nepean Hospital with a neck of femur fracture (NOF), as recommended by the ACI guidelines.1
Aim
By May 2020, 90% of patients who present with a hip fracture will receive regional analgesia preoperatively within two hours of diagnosis, at or on arrival to Nepean Hospital.
Benefits
- Improved pain relief
- Quality of life and patient satisfaction
- Prevention of delirium
- Reduced length of stay in emergency departments.
Background
- Neck of femur fracture is a common presentation in elderly patients.
- The ACI recommends use of nerve blocks as a method of providing pain relief under Minimum Standards for the Management of Hip Fracture in the Older Person - Standard 2: Optimal pain management.1
- A Cochrane Review into the use of nerve blocks in hip fracture concluded that nerve blocks do reduce pre- and post-operative pain in hip fracture.2
- At Nepean Hospital however, it was discovered there are no formal clinical pathways for the care of patients with fractured neck of femur. This means that not all patients receive recommended care, including nerve blocks.
Implementation
- A workshop took place for medical staff in emergency and anaesthesia departments, to increase the number of skilled staff who can perform fascia iliaca blocks within these two departments.
- Education of nurses was also promoted to raise awareness of this issue and emphasise the need for frequent pain assessment
- A nursing care pathway for patients with hip fracture was introduced, and is in progress.
- A formal procedure guideline was released for fascia iliaca block, to standardise techniques within the hospital. By adopting safest approach as a standard technique within the hospital, complication rates will be minimised, teaching and assessment of competency will be streamlined, and the range of equipment required for the block procedure will be readily available.
Status
- Implementation - The initiative is ready for implementation, is currently being implemented, piloted or tested.
Implementation site
- Nepean Hospital
Partnerships
- Collaborative workshop between two clinical departments – Anaesthesia and Emergency Departments
- Outcomes research interest between two clinical departments – Anaesthesia and Orthogeriatric Departments
- Collaboration between Operating Theatres, Orthopaedic Department and Anaesthesia Department will improve other indicators in Hip Fracture Care Standards such as patients receiving timely surgery.
Results
- Workshop and education program have been delivered.
- Outcomes are being monitored.
Lessons learnt
- Majority of clinicians and front-line health care workers already possess knowledge to deliver good care.
- Often simple education and raising awareness is all it takes to make a difference in patient care, by converting knowledge to action.
- Services that anaesthesia department can provide, such as regional analgesia service, is under-used yet there are other departments around the hospital that know about systemic benefits of such service for patients and would like them for their patients.
- There are numerous staff and committees in the hospital system that seek clinician input.
References
- NSW Agency for Clinical Innovation. Minimum Standards for the Management of Hip Fractures. 2017. p. 9-10.
- Steenberg J, Moller AM. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth. 2018;120(6):1368-80.
Contact
Jeff Kim
Staff Specialist
Department of Anaesthesia and Pain Management
Nepean Hospital
Nepean Blue Mountains Local Health District
Phone: 0423 161 381
jeff.kim@health.nsw.gov.au
