Fascia Iliaca Compartment Blocks for Patients with Acute Hip Fracture

Abstract

Purpose. The purpose of this quality improvement (QI) project was to increase anesthesia provider utilization of the fascia iliaca compartment block (FICB) for perioperative pain management in patients with acute hip fractures through an educational workshop and development of a clinical practice guideline (CPG).Background. At a Level I trauma center in south Texas, opioids continue to be the primary source of perioperative pain management among geriatric patients with acute hip fracture. Currently, no standard pain management protocol exists for this special population. Optimizing quality pain control while limiting opioid-related adverse effects presents a unique challenge for the anesthesia provider, as both adverse effects and uncontrolled pain produce unfavorable problems in this population, resulting in prolonged hospital stay and increased costs (Bordi 2018; Castillon et al., 2017). Methods. This doctor of nursing practice (DNP) project was completed by three DNP-Nurse Anesthesia (NA) students whom each had a role in organizing this educational workshop. A CPG was developed by the students and evaluated by a group of certified registered nurse anesthetists (CRNAs) in Arizona. The educational workshop included a PowerPoint (PPT) presentation and hands-on FICB regional training. A pre- and post-education survey, proficiency quiz, and 30-day follow up survey were used to measure knowledge and whether this project resulted in a practice improvement. A convenience sample of 30 CRNAs employed at this facility were invited to participate in this one-day educational workshop. Results. A total of 17 (57%) CRNAs participated on the day of the educational workshop. Data from pre- and post-education surveys demonstrated a significant increase in knowledge (24%) and intent to utilize (24%) FICB in the perioperative setting. The 30-day follow-up survey had a limited response (n=5) compared to initial participants (n=17), but the results showed anesthesia providers (80%) utilized the CPG, thirty days following education. All 30-day follow-up survey participants (100%) acknowledged that the educational workshop was beneficial. Conclusion. The educational workshop was useful in increasing implementation of the FICB for pain management among patients with hip fractures. Future projects should focus on sustainability of evidence-based practices and barriers to implementation.