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

TL;DR

This study shows that a checklist improved pain management timing for hip fracture patients but didn't increase use of a specific pain block or documentation.

Contribution

Demonstrates effectiveness of a mandatory checklist in improving analgesia timing for NOF fracture patients in emergency settings.

Findings

Time to first analgesia decreased from 130 to 38.8 minutes after checklist implementation.

FICB administration time improved from 228 to 63.4 minutes with no reported complications.

FICB utilization rate remained unchanged at 65% between audit cycles.

Abstract

Introduction

Neck-of-femur (NOF) fractures are a major source of morbidity and mortality among older adults. Timely and effective pain management, including fascia iliaca compartment block (FICB), is recommended to optimise outcomes and minimise opioid-related complications. This study compares two audit cycles assessing improvements in analgesic practice, FICB utilisation, and adherence to national guidelines following targeted educational and procedural interventions.

Methods

Two retrospective audit cycles were conducted in the emergency department at a district general hospital. Cycle 1 (September-October 2023, n = 40) and Cycle 2 (November-December 2024, n = 40). Audit standards were derived from NICE CG124 and RCEM guidance. Following the first cycle results, a mandatory checklist was introduced and disseminated amongst relevant team members, aimed at improving clinical practice. Measured outcomes included time to first analgesia, time to FICB, proportion receiving FICB, pain re-evaluation documentation, and complications. Continuous data were compared using independent samples t-tests; categorical data were analysed using chi-square tests (p < 0.05).

Results

FICB provision remained similar (Cycle 1: 65.0%, n=26 vs Cycle 2: 65%, n=26, p = 0.74), but both time to first analgesia and time to FICB improved significantly, from 130 minutes to 38.8 minutes (p < 0.001) and from 228 minutes to 63.4 minutes (p = 0.002), respectively. Documentation of pain re-evaluation showed no significant change (52.5%, n=21 versus 50.0%, n=20, p = 0.99). No FICB-related complications were reported.

Conclusion

Simple interventions such as the use of a mandatory checklist can significantly improve the timing of first analgesia and FICB administration. However, it did not lead to an increase in block utilisation or documentation of pain reassessment. Further quality improvement projects should focus on system-level strategies to embed pain management protocols for neck of femur fracture patients presenting to the emergency department.

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