Analgesia and Fascia Iliaca Compartment Block Utilisation for Neck-of-Femur Fracture Patients: A Closed-Loop Audit

Area of Science:

• Emergency Medicine
• Pain Management
• Surgical Outcomes

Background:

• Neck-of-femur (NOF) fractures are a significant cause of morbidity and mortality in older adults.
• Effective pain management, including fascia iliaca compartment block (FICB), is crucial for optimizing outcomes and minimizing opioid complications.

Purpose of the Study:

• To assess improvements in analgesic practice and FICB utilization following targeted interventions.
• To evaluate adherence to national guidelines for NOF fracture pain management.

Main Methods:

• Two retrospective audit cycles (n=40 each) in an emergency department.
• Intervention: Introduction of a mandatory checklist after Cycle 1.
• Outcomes measured: Time to analgesia, time to FICB, FICB proportion, pain re-evaluation, complications.

Main Results:

• FICB utilization remained stable (65%).
• Significant improvements in time to first analgesia (130 to 38.8 min) and time to FICB (228 to 63.4 min).
• No significant change in pain re-evaluation documentation; no FICB-related complications reported.

Conclusions:

• A mandatory checklist can significantly expedite first analgesia and FICB administration for NOF fractures.
• Further quality improvement initiatives are needed to increase block utilization and ensure consistent pain reassessment documentation.