Aims/Objectives/Background Fractured neck of femur is a common presentation and is associated with high rates of morbidity and mortality. RCEM Best Practice specifies that Fascia Iliaca Block should be available in Emergency Departments as part of the pain management strategy.
Improve compliance with RCEM guidance for safe administration, documentation and post-procedure monitoring following FIB.
Employ QIP methodology to create a FIB protocol.
Empower the junior SHO workforce to gain competence in FIB administration through structured teaching.
Improve understanding of post-block monitoring in nursing and medical staff.
Methods/Design Data collection identified the number of blocks administered to those presenting with fractured neck of femur in November 2019. Documentation and post-procedure monitoring were evaluated.
Interventions were piloted in January 2020. These were: pre-made block packs, a block checklist sticker incorporating post-procedure monitoring chart and laminated ‘quick prompt’ guide.
Nurse champions facilitated MDT teaching sessions and junior SHOs were empowered to gain competence in block administration through teaching sessions.
Retrospective data from January 2020 was compared to November 2019, allowing us to establish the efficacy of changes.
Results/Conclusions October 2019 results demonstrated 59% of patients received a FIB, this increased to 78% in January 2020. Pre-intervention, 45% of patients had the correct dose of local anaesthetic. This increased to 79% post-intervention. Initially, documentation was correct in just 5% of cases, improving to 59% after re-auditing.
Feedback from teaching sessions was positive with nursing staff better understanding the need for post-procedure monitoring. SHOs gained increased confidence delivering FIBs, freeing up senior doctors for other tasks.
The new protocol has improved the administration of FIBs with better post-procedure care and standardised dosing of local anaesthetic. Interventions are embedded in departmental practice; this will be re-audited in 6 months. Following the transition to e-noting we are developing an electronic template to translate these successes onto the new system.
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