Fascia Iliaca Compartment Block for Hip Fractures: Improving Clinical Practice by Audit

Background Hip fractures are the most frequently occurring serious injury in older people. They are the most common reason for people over the age of 65 to need emergency anaesthesia and surgery, and account for the most cause of death following an accident. A fascia iliaca compartment block (FICB) is the injection of anaesthetic agents into the fascia iliaca compartment with the effect of blocking the lumbar plexus via an anterior approach. FICB targets nerves that are in the fascia iliaca compartment that include the femoral nerve and the lateral femoral cutaneous nerve. A FICB is clinically safe and efficient providing consistent analgesic effects irrespective of the performing doctor's experience in managing hip fractures. Clinical audits and feedback are a veritable tool for quality improvement. Methods Data from the National Hip Fracture Database (NHFD) for all patients admitted with a hip fracture between October 2018 and May 2019 at a District hospital was interrogated and audited. Results of this audit were discussed in the department's and the Trust's mortality review meetings. In addition, teaching sessions on the safe administration of FICB using the Loss of Resistance (LOR) technique were held for junior doctors. A re-audit was carried out in May 2020 where a retrospective study of patients admitted with a hip fracture over six months from October 2019 to April 2020 was done to assess improvement in compliance rates in the administration of fascia iliaca blocks. Results This study showed a statistically significant increase in the number of patients who got a fascia iliaca block on presentation with a fractured neck of the femur from after our second audit (p < 0.00001). There were no complications associated with the administration of FICB to patients with hip fractures. Conclusions The administration of FICB for patients with hip fractures by admitting junior doctors using the loss of resistance (LOR) technique is a safe, simple, and rapidly effective pain management method that reduces the need for excessive systemic analgesia and provides consistent simultaneous blockade of the lateral cutaneous femoral and femoral nerves. This study showed that clinical practices could be improved through audits, staff education and by enforcing the proper utilization of clinical proformas to ensure compliance.