Service evaluation of ultrasound guided fascia iliaca compartment block (FICB) for hip fracture patients in a District General Hospital, London

Abstract

Background: Hip fractures are very common in UK population (excluding Scotland) accounting for 64102 hospital admissions in 2014. FCIB is part of a best practice tariff and a quality indicator audited annually by the National Hip Fracture Database in UK, as part of NICE clinical guidelines. The ED protocol for fracture neck of femur (NOF) includes fascia Iliaca compartment block (FICB), which is a new service development as part of treatment. Study objectives: To assess whether all patients with NOF were getting FICB prior to transfer from ED and to asses if FICB gave adequate pain relief. Methods: A retrospective study new service evaluation was carried out on 58 patients admitted to orthopaedic ward from the ED with a diagnosis of fracture NOF. Exclusion criteria was contraindication to compartment blocks. This study focussed on the care received by the patients in the ED during the period from October 2014 to March 2015. A data collection spread sheet was developed with parameters based on the NICE guidelines, RCEM guidelines and the trust policy for performing FICB. Results: Of the 58 cases, 51.72% of these received FICB and were documented. Of these 63.3% of patients had FICB performed within 4 hours of arrival to ED. The other 49% lacked evidence for FICB, assumed it was not done. Post-block pain scores were poorly documented. 82% of the blocks were performed by non-consultant doctors. One case of block failure and side effect. Conclusion: This new service benefited patients with hip fracture, however has issues relating to compliance and consistency of service delivery and all efforts should be made to improve these.