Education and Implementation of the Fascia Iliaca Block for Acute Hip Fracture Patients

Abstract

Purpose: This quality improvement (QI) project aimed to increase anesthesia providers knowledge on the use of the fascia iliaca compartment block (FICB) for patients with acute hip fractures through an educational presentation, hands on training, and clinical practice guideline (CPG). The goal was to increase confidence in administering this block so providers feel more comfortable implementing this in their clinical practice.Background: Adequate pain management can decrease morbidity and mortality by decreasing overall opiate consumption, improving mobility, decreasing hospital length of stay, and avoiding adverse side effects of untreated pain. This Doctor of Nursing Practice (DNP) project was implemented at a Level I trauma center in Texas which did not have a FICB CPG in place for patients with acute hip fractures. Pain control for hip fractures were often managed with systemic opioids with minimal regional analgesia implementation at this facility. Literature review supports the use of a FICB as a first line analgesia in patients with acute hip fractures. Lack of knowledge leads to lack of implementation resulting in suboptimal pain management. Methods: The Model for Improvement methodology identified the lack of implementation of this regional block and the Plan-Do-Study-Act (PDSA) cycle guided this project. An educational presentation was delivered to anesthesia providers (n=17) that outlined FICB administration, a CPG for acute hip fracture patients, and hands-on training with the ultrasound. Results: Pre-survey results revealed that 64% (n=11) of CRNAs had not performed any FICBs within the last six months. Likelihood of FICB administration in patients with an acute hip fracture increased from 29% (n=5) to 58% (n=10) following the educational presentation. The post-quiz at the hands-on workshop identified 97.4% of participants were able to identify contraindications, anatomy, and treatment for complications. Recognition of lidocaine toxicity and appropriate dosage for this block resulted in a 76.47% rate. The 30-day survey resulted in 80% of CRNAs (n=4) implementing at least 1 FICB and all (100%) of CRNAs (n=5) reported this training was beneficial for their anesthesia department. Conclusions: In conclusion, CRNAs increased their knowledge with the educational training and there has been increased implementation after the hands-on workshop.