Improving the delivery of prompt and effective analgesia for fractured neck of femur patients in the Emergency Department

Quality Improvement Poster Download

Background & Problems

Quality Improvement project focusing on the administration of fascia-iliaca blocks (FIB) in the ED setting for patients with fractured neck of femur (#NOF).

• #NOF is a common presentation to ED
• 70% of #NOFs are sustained in patients over the age of 80
• Patients are often frail and have multiple co-morbidities

The Safety Concerns

• CQC highlighted that patients did not consistently receive prompt pain relief in ED
• Analgesia options in #NOFs is limited
• Side effects of morphine are more pronounced in the elderly
• FIBs reduce morphine requirement e.g. a study conducted by Leeper et al in 2012 showed that FIBs reduced the average morphine requirement by 41%.

Aim

90% of patients with a fractured NOF to have an effective block within 1 hour of admission to ED by April 2016.

Method

PDSA Cycles:

• Cycle 1: Email sent out to ED doctors encouraging documentation of time of FI block
• Cycle 2: Posters
• Cycle 3: F2 teaching
• Cycle 4: Liaison with radiographers
• Cycle 5: F1 teaching

Results

Extreme points:

• Friday 25/09/15
  • Arrival: 22:11
  • XR: 00:46
  • FIB: 04:00
• Thursday 15/10/15
  • Arrival: 00:35
  • XR: 03:16
  • FIB: 06:30

Implications

• Time to block remains very variable
• Encouraging signs of earlier analgesia
• Documentation of time of block and efficacy post-block remains very poor

Next steps

• Collect data for PDSA 4 and 5
• Lasting changes:
  • ED induction for juniors
  • FIB proforma under development