Can trained emergency nurses safely and effectively insert Fascia Iliaca Blocks in patients with hip fractures?
Tracks
Concurrent Stream 2
| Friday, October 18, 2024 |
| 11:40 AM - 12:00 PM |
| Tuscan Room |
Overview
Julie Gawthorne
Speaker
Ms Julie Gawthorne
Clinical Nurse Consultant
St Vincent's Health Network, Sydney
Can trained emergency nurses safely and effectively insert Fascia Iliaca Blocks in patients with hip fractures?
11:40 AM - 12:00 PMAbstract
Aim: To compare the effectiveness and safety of ultrasound-guided fascia iliaca block insertion in patients with fractured neck of femur by trained emergency nurses, with insertion by doctors.
Background: Pain in elderly patients presenting to emergency departments is often poorly managed causing undesirable side effects including delirium. Fascia iliaca blocks are an effective and safe form of analgesia for patients with hip fractures. While they have traditionally been inserted by medical doctors, no evidence exists comparing the effectiveness and safety of fascia iliaca block insertion by nurses compared with doctors.
Methods: Our prospective cohort study comprised a retrospective medical record audit of consecutive emergency department patients presenting to an Australian metropolitan emergency department between January 2013-December 2017. Eligible patients were those admitted to ED with suspected or confirmed fractured neck of femur who had a fascia iliaca block inserted under ultrasound guidance by either a trained emergency nurse or doctor.
Results: Of the 472 patients eligible for a fascia iliaca block, 322 (68%) had one inserted. A majority were inserted by doctors (n=207, 64.3%) with 22.4% (n=72) by nurses and in 13.3% (n=43) of patients the clinician was not documented. There were no differences between the nurse-inserted and doctor-inserted groups for: mean pain scores one-hour post-fascia iliaca block insertion; clinically significant reduction (≥ 30%) in pain score one hour post-fascia iliaca block insertion; pain score four hours post FIB insertion; delirium incidence; opioid use post-fascia iliaca block insertion; or time to fascia iliaca block insertion. No adverse events were identified in either group.
Conclusion: Insertion of fascia iliaca blocks by trained emergency nurses is as effective and safe as insertion by doctors in patients with fractured neck of femur in emergency departments. Trained emergency nurses should be inserting fascia iliaca blocks as part of routine practice in emergency departments.
Background: Pain in elderly patients presenting to emergency departments is often poorly managed causing undesirable side effects including delirium. Fascia iliaca blocks are an effective and safe form of analgesia for patients with hip fractures. While they have traditionally been inserted by medical doctors, no evidence exists comparing the effectiveness and safety of fascia iliaca block insertion by nurses compared with doctors.
Methods: Our prospective cohort study comprised a retrospective medical record audit of consecutive emergency department patients presenting to an Australian metropolitan emergency department between January 2013-December 2017. Eligible patients were those admitted to ED with suspected or confirmed fractured neck of femur who had a fascia iliaca block inserted under ultrasound guidance by either a trained emergency nurse or doctor.
Results: Of the 472 patients eligible for a fascia iliaca block, 322 (68%) had one inserted. A majority were inserted by doctors (n=207, 64.3%) with 22.4% (n=72) by nurses and in 13.3% (n=43) of patients the clinician was not documented. There were no differences between the nurse-inserted and doctor-inserted groups for: mean pain scores one-hour post-fascia iliaca block insertion; clinically significant reduction (≥ 30%) in pain score one hour post-fascia iliaca block insertion; pain score four hours post FIB insertion; delirium incidence; opioid use post-fascia iliaca block insertion; or time to fascia iliaca block insertion. No adverse events were identified in either group.
Conclusion: Insertion of fascia iliaca blocks by trained emergency nurses is as effective and safe as insertion by doctors in patients with fractured neck of femur in emergency departments. Trained emergency nurses should be inserting fascia iliaca blocks as part of routine practice in emergency departments.
Biography
Julie started her career in emergency nursing in 1995 and is the Clinical Nurse Consultant in the Emergency Department at St Vincent's Hospital Sydney. Julie has a Master in Critical Care and is a PhD candidate at the University of Sydney. Ocean swimming, her husband teenage boys and dog keep her sane.
