Title : Fascia iliaca block administration– A new key performance indicator for neck of femur fracture care. QIP cycle 5
Abstract:
Introduction: Fascia iliaca block (FIB) in patients with fragility neck of femur (NOF) fractures provides more effective pain control than conventional systemic analgesia. In fact, FIB administration is now a key performance indicator for NOF fracture care introduced by the National Hip Fracture Database (NHFD). All NOF fracture patients without absolute contra-indications should receive a FIB. In 2021, the average FIB administration rate across England and Wales was 64%.
Method: Our aim was to measure our FIB administration rate as part of an ongoing quality improvement (QI) project with four previous cycles. We conducted a retrospective chart review of patients diagnosed with fragility NOF fractures at Kettering General Hospital from January to April 2023. We examined for factors associated with FIB administration, using multi-variate logistic regression, to identify barriers to improvement.
Results: 96 patients were included – four were not suitable for a FIB due to absolute contra-indications to administration. Median age was 83 years (range = 76-89 years), and male-to-female ratio 1:2.2. 79 patients (83.3%) received a FIB. Multi-variate analysis showed that cognitively impaired patients were 9 times less likely to receive a FIB (p=0.002) and patients assessed in the absence of our trauma nurse practitioners were 10 times less likely (p=0.002).
Conclusion: FIB is a vital part of NOF fracture care and has been shown to improve patient outcomes by reducing the incidence and severity of peri-operative delirium. At our trust, the FIB administration rate increased from 13.1% to 54.5% over the course of four QI cycles. In our fifth cycle we report a dramatic further improvement to 82.3%, exceeding the national average. Similar QI projects may be led by trauma and orthopaedic departments elsewhere to improve initial NOF fracture care as per the NHFD.
