Background: Hip fractures are associated with significant mortality1 within 1 month (10%) and 1 year (∼33%) with >65 000 hip fracture operations being carried out per year. Anaesthetists play crucial roles for these patients, including provision of effective analgesia to expedite postoperative ambulation (in-line with the DrEaMing concept2) and facilitation of effective multidisciplinary perioperative management, including rehabilitation. This is a retrospective audit of preoperative analgesia assessing prescriptions of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and fascia iliaca compartment blocks (FICB) against National Institute for Health and Care Excellence (NICE) recommendations.1 Methods: A total of 47 patients were retrospectively identified using the Nottingham Hip Fracture Database, between November and December 2021. Case notes were reviewed to assess frequency of pain assessments, analgesic prescriptions, and conduct of FICB. A literature review was conducted to review the role of ultrasound guidance in the performance of FICB. An online survey was distributed to Emergency Department (ED) clinicians regarding familiarity and operator confidence in performing nerve block for patients with hip fractures. Focus groups identified areas for lasting organisational change to facilitate best patient care. Results: Pain assessments were most reliably performed at patient presentation. Paracetamol and opioids were often co-administered for initial analgesia, although in 48.6% of these cases opioids were potentially avoidable. NSAIDs were not prescribed to any patient. Nerve blocks were often considered in relevant patients, but with suboptimal analgesic benefit. The literature review demonstrated that ultrasound guidance would likely result in a more effective and safe procedure, compared with a landmark technique. The ED staff survey highlighted a desire to learn about ultrasound-guided FICB. Conclusion: Scope for improvement across all areas was identified, with the hospital engaging thoroughly with the audit to optimise patient experience and outcomes. Analgesia prescribing should follow a step-wise approach to reduce side-effects of opioid analgesia. Nerve blocks should be considered more and should be performed with ultrasound guidance. Multi-departmental consensus was to promote nerve block performance; this is being achieved through teaching, updating of visual reminders for ultrasound nerve blocks, and updating relevant paperwork for procedure performance and clerking. We plan to re-audit in the future. 1.National Institute for Health and Care Excellence. 2011. Hip fracture: management. (NICE clinical guideline No. 124). Available from https://www.nice.org.uk/guidance/cg124 (accessed 20/03/23)2.Oliver CM, Warnakulasuriya S, McGuckin D, et al. Br J Anaesth 2022; 129: 114–26