Fascia Iliaca Blocks in acute hip fracture in the older person

TOOLKIT

ACI Pain Management Network

Collaboration. Innovation. Better Healthcare.

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person

The Agency for Clinical Innovation (ACI) works with clinicians, consumers and managers to design and promote better healthcare for NSW. It does this by:

• service redesign and evaluation – applying redesign methodology to assist healthcare providers and

consumers to review and improve the quality, effectiveness and efficiency of services

• specialist advice on healthcare innovation – advising on the development, evaluation and adoption of

healthcare innovations from optimal use through to disinvestment

• initiatives including Guidelines and Models of Care – developing a range of evidence-based healthcare

improvement initiatives to benefit the NSW health system

• implementation support – working with ACI Networks, consumers and healthcare providers to assist

delivery of healthcare innovations into practice across metropolitan and rural NSW

• knowledge sharing – partnering with healthcare providers to support collaboration, learning capability

and knowledge sharing on healthcare innovation and improvement

• continuous capability building – working with healthcare providers to build capability in redesign, project

management and change management through the Centre for Healthcare Redesign.

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specialties and regional and service boundaries to develop successful healthcare innovations.

A priority for the ACI is identifying unwarranted variation in clinical practice and working in partnership with

healthcare providers to develop mechanisms to improve clinical practice and patient care.

www.aci.health.nsw.gov.au

AGENCY FOR CLINICAL INNOVATION

Level 4, Sage Building

67 Albert Avenue

Chatswood NSW 2067

PO Box 699 Chatswood NSW 2057

T +61 2 9464 4666 | F +61 2 9464 4728

E aci-info@health.nsw.gov.au | www.aci.health.nsw.gov.au

SHPN: ACI 150484

ISBN: 978-1-76000-280-0.

Produced by: ACI Pain Management Network

Further copies of this publication can be obtained from the

Agency for Clinical Innovation website at www.aci.health.nsw.gov.au

Disclaimer: Content within this publication was accurate at the time of publication. This work is copyright. It may be reproduced

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permission from the Agency for Clinical Innovation.

Version: V1

Date Amended: 01/09/2015

© Agency for Clinical Innovation 2015

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person

St Vincent’s Hospital Pain in the Elderly Working Party members 2013 and 2014:

Associate Professor Steven Faux, Chair (Director of Rehabilitation & Pain Service)

Dr Andrew Finckh (Staff Specialist, Emergency Department)

Dr Jennifer Stevens (Visiting Anaesthetist)

Dr Elizabeth Harper (Staff Specialist, Geriatric Medicine)

Julie Gawthorne (Clinical Nurse Consultant, Emergency)

Jacqueline Jensen (Registered Nurse, Chronic Pain)

Karon McDonell (Clinical Nurse Consultant, Trauma)

Susan Welch (Pharmacist)

Thomas Jennings (Registered Nurse, Orthopaedics)

Melissa O’Brien (Quality Manager, Clinical Practice Improvement)

Dr Julia Nelson (Orthogeriatric Registrar, 2011).

Fascia Ilaica Blocks (FIB) in Acute Hip Fracture in the Older Person Steering Group committee members:

Dr Phil Corke, Chair of steering group (Anaesthetist, Concord Hospital)

Dr Laura Ahmad (Orthogeriatrician, Royal North Shore Hospital)

Dr Steven Faux (Director Rehabilitation & Pain Service, St Vincents)

Dr Gerald Wong (Anaesthetist, Royal North Shore Hospital)

Dr John Mackenzie (ACI Emergency Care Institute)

Glen Pang (Network Manager, Aged Health)

Jenni Johnson (Network Manager, Pain Management).

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person

Contents

Section 1 Introduction 1

1.1 Fascia Iliaca Blocks as a method of pain relief in acute hip fractures of older people 1

1.2 Background 1

1.3 Objectives 1

1.4 Training benefits 2

1.5 About the implementation toolkit 2

Section 2 Ascertain facility readiness and capability 3

Section 3 Plan 4

3.1 Allocate an executive sponsor to authorise the work 4

3.2 Identify a project lead 4

3.3 Establish a working group 4

3.4 Define the goal, objectives and scope 5

3.5 Communication plan 5

Section 4 Assess 6

4.1 Conduct an audit of current practice 6

Section 5 Operationalise 7

5.1 FIB training 7

5.2 Evaluation 7

Section 6 Further Information 8

6.1 Feedback 8

6.2 Redesign methodology 8

6.3 Links to other ACI work 8

Section 7 Acronyms 9

Section 8 Bibliography 10

Appendix 1 Pain in the elderly with hip fracture – clinical audit tool 11

Appendix 2 Elderly trauma pain guidelines – hip fracture 13

Appendix 3 Patient / carer brochure 14

Appendix 4 Fascia Iliaca Blocks for preoperative pain management in the older person with hip fracture 16

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 1

Section 1

Introduction

In Australia, there are 17,000 hip fractures each

year. These predominantly affect older people.

Traditionally, pain relief is in the form of

opiates. Use of opiates alone or in high doses

is known to have adverse effects, such as

delirium. There is therefore a need to improve

outcomes. Reduction in opiates by use of Fascia

Iliaca Blocks (FIB) has been shown to improve

preoperative pain control.

1.1 Fascia Iliaca Blocks (FIB) as a method

of pain relief in acute hip fractures of

older people

This implementation guide has been developed on the

initiative of the St Vincent’s Hospital Acute and Chronic

Pain Services and with the guidance of an ACI Steering

Group. The objective is to provide a guide and training

materials for those centres wishing to pursue FIB as a

means of improving pain management in the care of

older people with hip fractures. The objective is to

minimise the risk of delirium and associated harm

related to unmonitored opioid prescription in the

ambulance, emergency departments and wards prior

to surgery.

1.2 Background

St Vincent’s Hospital Pain Service had begun a process

of using FIBs as the preferred method of pain

management for older people admitted with suspected

or confirmed hip fractures to minimise the incidence of

delirium and harm before and after surgery. Many

supporting tools and resources were developed as part

of this project. St Vincent’s Hospital approached the

ACI as it felt that there was relevance to other hospitals

wishing to pursue this technique, and duplication of

effort would be avoided if the materials were

supported through an ACI process.

A Steering Committee was convened and has overseen

the development of the resources to ensure alignment

with evidence, current practice, variation in service

design and staffing, and applicability across the state.

1.3 Objectives

• To provide tools and resources to enable the use of

FIB as an option in providing effective pain relief in

patients with acute hip fracture.

• To ensure patients with suspected or confirmed

acute hip fracture are provided with safe and

effective best practice preoperative pain relief.

Specifically the documentation refers to ultrasound

guided Fascia Iliaca Block (FIB) utilising an out of

plane approach.

NB: Other options or techniques for administration

of regional analgesia for fractured neck of femur,

including in-plane ultrasound guided and blind

double-pop Fascia Iliaca Block and femoral nerve

blocks, are not addressed in this documentation but

may be considered as local governance, clinical

preference and proficiency allow.

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 2

1.4 Training benefits

The benefits of implementing FIB training include:

• reduction in adverse events or poor patient

outcomes

• reduced length of stay and less complications

related to delirium

• improved patient experience

• improved skill sets for staff involved in treating

patients with hip fractures

• improved staff satisfaction

• improved efficiencies.

Source: National Institute for Health and Care

Excellence. Hip fracture. Earlier operations and better

care can improve the lives of thousands of hip fracture

patients. Accessed on 2 July 2015 at www.nice.org.uk/

guidance/cg124/resources/earlier-operations-and-

better-care-can-improve-the-lives-of-thousands-of-hip-

fracture-patients

1.5 About the implementation toolkit

This implementation toolkit has been developed to

support the successful implementation of FIB in NSW

health facilities having the appropriate governance.

This includes competency, training, staffing,

equipment, patient volume, infrastructure and

supervision in place. www.anzca.edu.au/resources/

professional-documents

The implementation support materials provided by

the ACI and St Vincent’s Hospital Chronic Pain Service

include:

• implementation guide

• explanatory guide and notes

• video material of how to conduct the procedures

• competency and training materials

• audit tool

• patient and carer information brochure.

The toolkit outlines the following steps to implement

FIB in your facility:

• ascertain facility readiness

• plan

• assess

• operationalise

• evaluate.

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 3

Section 2

Ascertain facility readiness and capability

A review of local governance and service

structure will be necessary to consider whether

the service has the capacity to provide

adequate clinical competence, supervision and

training to safely carry out the procedure on a

routine basis.

A review of the volume of patients and outcome

presenting with hip fracture attended by the service

may be useful to inform the local governance review.

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 4

Section 3

Plan

Purpose

The purpose of the project planning phase

is to:

• obtain local sponsorship to support the

implementation of FIB

• define the key members of a project team

and working group

• set a clear goal, objectives and scope.

3.1 Allocate an executive sponsor to authorise

the work

It is essential to identify a member of the local health

district (LHD) executive as the project sponsor. This

should preferably be the director of clinical governance.

A clinical lead also needs to be identified. This could be

the head of the anaesthetic or emergency department,

a nominated anaesthetist, emergency physician or

other critical care specialist or a nurse educator.

The role of project sponsor and clinical lead is not just

to support the project, but to:

• determine and monitor progress and outcomes

• support and promote cultural change

• provide visible and active leadership and

commitment to the project with all levels of staff

• align the goals and objectives of the project at

executive and strategic level to the hospital and

LHD operational plans

• assess, monitor and manage risks associated with

implementation and assist in resolving issues and

barriers escalated by the project manager or

working group.

3.2 Identify a project lead

It is recommended that for the implementation period,

a member of the team is allocated the role of project

lead. The project lead will:

• lead the implementation

• facilitate meetings

• effectively communicate with and engage staff

and clinicians in the project

• evaluate the process, communicate and monitor

outcomes

• escalate ongoing implementation issues to the

executive sponsor.

3.3 Establish a working group

It is recommended that the working group is

multidisciplinary and represents clinical and non-clinical

teams that care for patients undergoing FIB procedures.

Where possible, the working group should include

membership from affected specialty departments.

Representatives should include:

• physicians in emergency medicine

• physicians in geriatric medicine

• pain management specialists

• anaesthesists

• consumers

• nurse educators, clinical nurse consultants

or educators

• pharmacists.

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 5

In rural areas, representatives can include:

• general practitioners

• nurse managers or nurse educators

• clinical nurse consultant (CNC)

• pharmacists

• consumers

• specialists in fields such as geriatrics, orthopaedics

or anaesthetics as available.

Clinical governance professionals and managers should

also be involved as appropriate and available. Both

nursing and medical staff should be represented.

The role of the working group is to:

• execute the implementation ensuring that agreed

actions and project milestones are delivered

• effectively communicate and engage staff and

clinicians in the project

• develop local solutions as needed

• monitor and evaluate project outcomes.

3.4 Define the goal, objectives and scope

A clear project goal, specific project objectives and a

well-defined scope are important to ensure that

members of the project team are working towards the

same goal. As the project team is likely to include

multiple specialty groups, it is important that the

project goal, objectives and scope are agreed up-front

by all members of the working group.

3.5 Communication plan

Well-planned communications with staff and

stakeholders within the LHD will be essential to the

success of the project. Planning includes:

• developing consistent key messages

• identifying and targeting communications to

specific stakeholders

• scheduling communications to align with key time

points during your project

• ensuring that feedback loops are in place for

all communication.

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 6

Section 4

Assess

Purpose

The purpose of the assessment phase is to

collect and analyse data about current

processes for the provision of FIB.

4.1 Conduct an audit of current practice

Collecting baseline data allows the service to identify

the key issues or gaps in current practice.

Understanding the current context will allow the

service to identify where improvements can be made.

• Determine the service’s baseline measures and

outcomes pre-implementation; for example,

conduct an audit of roughly 20% of the elderly hip

fracture population (see Appendix 1 for example of

an audit form).

• Identify and prioritise issues raised through the

audit and other measures.

• Review local policy and modify to ensure

consistency with protocol.

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 7

Section 5

Operationalise

5.1 FIB training

Adopt a ‘train the trainer’ approach, using the

competency documents, resources, training video and

checklists attached as a framework. The working group

may wish to modify or add additional items to meet

local governance arrangements. Identify key champions

such as an emergency department physician,

anaesthetist or nurse educator to oversee the

training process.

Contact St Vincent’s Hospital Pain Service if there is a

need to access training off site.

5.2 Evaluation

The purpose of evaluation is to assess the success of the

implementation of the FIB protocol. It is important to

measure the outcomes of your project to:

• determine if there has been any improvement in

practice

• identify any solutions that are not working and

require reassessment

• satisfy accountability requirements

• enable more informed decisions in regards to

future improvement planning.

Evaluation measures, such as audits, patient satisfaction

and outcome measures should be considered during

the project development and aligned to the project

aims. They are critical to measuring success. Clear

and measurable objectives will help clarify what is

to be evaluated.

Reassess your performance

During the baseline assessment phase, data will have

been collected through a number of methods.

Repeating this assessment after implementation and

for the purposes of ongoing monitoring will allow you

to measure change or improvements in practice.

Sustainable implementation

Remember that the implementation project end date is

not really the end.

The project manager or working group should plan to

review the provision of FIB at regular intervals. This may

be quarterly, half-yearly or yearly depending on the

extent of changes that occurred during the

implementation project.

Communicate your success

By this point in the implementation project, many staff

and other stakeholders will be familiar with the project

and may have contributed to it in some way.

It is important to recognise and celebrate the

contribution of the project manager, working group,

staff and the stakeholders involved in the

implementation at your site. Communicate the

outcomes of the reassessment, particularly if there is

significant improvement.

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 8

Section 6

Further information

6.1 Feedback

If you have feedback about the resources and materials,

please provide it via Appendix 4 to aci-web@health.

nsw.gov.au

6.2 Redesign methodology

For further information about redesign methodology,

see the ACI Centre for Healthcare Redesign www.aci.

health.nsw.gov.au/centre-for-healthcare-redesign

The e-Learning platform Gem contains valuable

modules on the fundamentals of project management

including redesign methodology and accelerating

implementation methodology (AIM).

Redesign methodology tools are designed to provide

access to flexible learning opportunities. Modules and

assessments can be completed at each individual’s own

pace and at a time that suits them.

The online e-learning modules are available to all NSW

Health employees statewide, who can register

themselves at gem.workstar.com.au

6.3 Links to other ACI work

Minimum standards for the management of hip

fracture in the older person

These guidelines identify best practice for the

management and care of patients with hip fractures for

healthcare providers across NSW. They aim to improve

outcomes for patients with hip fractures requiring

surgery and management in the state. www.aci.health.

nsw.gov.au/networks/aged-health/min-standards-hip-

fractures

Key principles for care of confused hospitalised

older persons

The Care of Confused Hospitalised Older Persons

Program aims to improve the early identification and

management of older people with confusion in

hospital. Patients who experience greater pain are at

higher risk of delirium and depression. Early

identification of confusion, treatment of the underlying

cause and management of symptoms can prevent these

adverse effects and minimise their duration and

severity. www.aci.health.nsw.gov.au/chops

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 9

Section 7

Acronyms

Abbreviation Description

ACI Agency for Clinical Innovation

AIM accelerating implementation

methodology

ECG electrocardiogram

ED emergency department

GP general practitioner

CIN clinical initiatives nurse

CNC clinical nurse consultant

FIB Fascia Iliaca Block

GP general practitioner

IV intravenous

LHD local health district

MRN medical record number

NSW New South Wales

PRN when necessary (lit. pro re nata)

VMO visiting medical officer

VNRS Verbal Numerical Rating Scale

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 10

Abou-Setta AM, Beaupre LA, Rashiq S et al. Comparative

effectiveness of pain management interventions for hip

fracture: a systematic review. Annals of Internal Medicine,

2011;155:234–245, accessed on 29 June 2015.

Agency for Clinical Innovation. Care of confused hospitalised

older persons. Accessed on 29 June 2015 at www.aci.health.

nsw.gov.au/chops

Agency for Clinical Innovation. Minimum standards for the

management of hip fractures. Accessed 29 June 2015 at

www.aci.health.nsw.gov.au/networks/aged-health/min-

standards-hip-fractures

Agency for Clinical Innovation. Orthogeriatric model of care

– clinical practice guide, 2010. Accessed on 29 June 2015 at

www.aci.health.nsw.gov.au/__data/assets/pdf_file/0013/153400/

aci_orthogeriatrics_clinical_practice_guide.pdf

Australian and New Zealand College of Anaesthetists.

Guidelines for the management of major regional analgesia,

2014. Accessed on 29 June 2015 at www.anzca.edu.au/

resources/professional-documents/pdfs/ps03-2014-guidelines-

for-the-management-of-major-regional-analgesia.pdf

Australian and New Zealand College of Anaesthetists.

Guidelines on infection control in anaesthesia, 2015. Accessed

on 29 June 2015 at www.anzca.edu.au/resources/

professional-documents/pdfs/ps28-2015-guidelines-on-

infection-control-in-anaesthesia.pdf

Australian and New Zealand Hip Fracture Registry Steering

Group. Australian and New Zealand guideline for hip fracture

care: Improving outcomes in hip fracture management of

adults, September 2014. Accessed on 29 June 2015 at

www.anzhfr.org/images/resources/Guidelines/ANZ%20

Guideline%20for%20Hip%20Fracture%20Care.pdf

Australian Commission on Safety and Quality in Health Care.

National safety and quality health service standards,

September 2012. Accessed on 29 June 2015 at www.

safetyandquality.gov.au/wp-content/uploads/2011/09/

NSQHS-Standards-Sept-2012.pdf

Mak JCS, Cameron ID, March LM. Evidence-based guidelines

for the management of hip fractures in older persons: an

update. Med J Aust. 2010;192(1): 37-41, accessed on 29 June 2015.

Section 8

Bibliography

National Health and Medical Research Council. Emergency

care acute pain management manual, 2011. Accessed on 29

June 2015 at www.nhmrc.gov.au/guidelines-publications/

cp135

National Institute for Health and Care Excellence.

Earlier operations and better care can improve the lives of

thousands of hip fracture patients. Accessed on 29 June 2015

at www.nice.org.uk/guidance/cg124/resources/earlier-

operations-and-better-care-can-improve-the-lives-of-

thousands-of-hip-fracture-patients

National Institute for Health and Clinical Excellence.

Hip fracture: evidence update March 2013: A summary of

selected new evidence relevant to NICE clinical guideline 124

‘The management of hip fracture in adults’, 2011. Accessed

on 29 June 2015 at arms.evidence.nhs.uk/resources/

hub/946207/attachment

Neuraxiom.com. Ultrasound guided regional nerve blocks.

Fascia iliaca compartment block. Accessed on I July 2015 at

www.neuraxiom.com/html/ficb.html

NHS Institute for Innovation and Improvement.

Fractured neck of femur facts. Retrieved on 05/03/2013 from

www.institute.nhs.uk/quality_and_value/high_volume_care/

fractured_neck_of_femur_facts.html

Rat P, Jouve E, Pickering G, Donnarel L, Nguyen L, Michel M,

Capriz-Ribière F, Lefebvre-Chapiro S, Gauquelin F, Bonin-

Guillaume S. Validation of an acute pain-behavior scale for

older persons with inability to communicate verbally:

Algoplus(R). Eur J Pain. 2011 Feb;15(2):198.e1-198.

dx.doi.org/10.1016/j.ejpain.2010.06.012

Scott DM, Chuan AC. Regional anesthesia: Blocks of the head,

upper and lower extremities and para-axial region,

Interactive desktop guide, 2nd ed. Accessed on 29 June 2015

at members.iinet.net.au/~achuan01/

AnaesthesiaDesktopGuide.pdf

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 11

Appendix 1

Pain in the elderly with hip fracture – clinical audit tool

MRN

Age _________________ years

Gender Male Female

Total length of stay _________________ days

Pre Emergency DeptAnalgesia administered(NSW Ambulance Form) Other Nil Not documented

Date of ED Presentation _____ / _____ / _____ ED arrival time (see EDIS) _______hrs ______mins

Date of ED Discharge _____ / _____ / _____ ED departure time (see EDIS) _______hrs ______mins

Did the patient have a diagnosis of dementia on or during admission? Yes No

In Emergency Department Yes No N/A Comments

Verbal Numerical Rating Scale (VNRS) documented on arrival

Algoplus Pain Scale documented on arrival for those with cognitive impairment

Analgesia administered in less than 30 mins

Paracetamol charted 6 hourly regularly

Additional opioid charted (Oxycontin, Oxycodone regular +/- PRN)

Coloxyl charted regularly

Post analgesia administered VNRS pain assessment documented

Fascia Iliaca Block (FIB) inserted

FIB insertion date ______ / ______ / _____

Not recorded FIB insertion time _____ hrs _____ mins

ECG attended prior to FIB

FIB sticker present

Post FIB VNRS documented

Post FIB Algoplus documented

Orthogeriatric Checklist completed

Clinician inserting FIB Staff Specialist Registrar CIN / CNC Other please specify _______________________________

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 12

In Ward Yes No N/A Comments

VNRS documented on arrival

Algoplus Pain Scale documented on arrival

Did the patient have a second FIB inserted?

Date ______ / ______ / _______

Time ______ hrs ______ mins

Did the patient have surgery within 48 hours?

Did the patient have an orthogeriatric review within 72 hours?

Post Operatively Yes No N/A Comments

VNRS documented on arrival to ward

Algoplus Pain Scale documented on arrival to ward

Paracetamol charted 6 hourly regularly

Additional opioid charted(Oxycontin, Oxycodone regular +/- PRN)

Coloxyl charted regularly

Post analgesia VNRS assessment documented

Geriatric Referral completed

Documentation of confusion or delirium on or during admission

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 13

Appendix 2

Elderly trauma pain guidelines – hip fracture

Confirm pre-hopital analgesia (type and amount)

Reassess and document pain and sedation score

Patient has pain > 7/10 or severe

1. Consider PCA as per policy*

2. Consider referral to acute pain team

3. Consider reapplication of FIB 12 hourly x 2

*Confused pts excluded from PCA

Assess pain using:

1. Visual Numerical Rating Scale (VNRS)

2. Algoplus Pain Scale for confused patients

Confirmed or suspected fractures NOFSuspected must have two or more of the following signs :1. Groin/hip pain2. Unable to weightbear3. Shortening of lower limb4. External rotation of the lower limbs

1. Administer (if required) once only fentanyl 1 mcg increments to a max dose 0.1 mcg/kg until pain score < 3 or mild

2. Accredited MO/CIN insert Fascia Iliaca BlockPLUS3. Chart PRN

Oxycodone 2.5 mg QID, unless reviewed by geriatrician PLUS Paracetamol 1 g q6h P/O or P/R PLUS Coloxyl with Senna 2 bd

1. Administer (if required) once only fentanyl 1mcg increments to a max dose 0.1 mcg/kg until pain score < 3 or mild

2. Chart – Regular Oxycodone 2.5 mg QID, unless reviewed by a geriatrician PLUS Paracetamol 1 g q6h P/O or P/R PLUS

Coloxyl with Senna 2 bd

3. Chart PRN pain relief Oxycodone 2.5 mg q1h PRN x 3 doses in 4 hours (then Registrar R/V)

Elderly (>75 years old) Non-intubated patient presents with traumatic injury

Commence elderly traumatic pain guidelines

Other traumatic injury

Refer to MO if:

1. Patient sedated

2. Patient takes regular Opioid, Naltrexone or Buprenorphine Assess level of sedation

using sedation score

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 14

Appendix 3

Patient / carer brochure

ACI Gastroenterology and Nutrion Network – A Clinician’s Guide: Caring for people with gastrostomy tubes and devices – FAQ Page 1Collaboration. Innovation. Better Healthcare. September 2015

What is a Fascia Iliaca Block?

This is an injection given near your hip that numbs the

nerves in the hip and thigh. If you have a broken hip,

it should give you pain relief for up to 12 hours. This

injection can be given while you are awake.

How is it given?

A doctor or nurse trained in giving the injection will

ask you to lie on your back so that the groin area on

the side of your broken hip can be accessed.

The skin on your groin will be cleaned (this may feel

a bit cold) and you will then have a small injection to

numb the skin.

A deeper second injection will then numb the nerves.

Is it painful?

The first injection to the skin will sting for a few

moments but this will make the area numb so that the

doctor or nurse can put the second needle in with

minimal discomfort.

The whole procedure should not be painful but it can

be uncomfortable. If you feel pain, you should let the

doctor or nurse know.

How long does it take before the injection

starts to work?

It usually takes 30 minutes for the injection to work, but

every patient is different.

What are the benefits of a Fascia Iliaca Block?

The block provides pain relief to the area of the

fracture, reducing the need for other strong drugs

which can have side effects such as sickness, drowsiness

and chest problems.

This leaflet gives patients and their carers information about the benefits and risks of fascia

iliaca block to help them make an informed decision about undergoing this procedure.

FREQUENTLY ASKED QUESTIONS

Fascia Iliaca Block: Treating and managing pain for patients with hip fractures

ACI Pain Management Network

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 15

ACI Pain Management Network – Fascia Iliaca Block: Treating and managing pain for patients with hip fractures – FAQ Page 2

What if I do not want to have the injection?

If you choose not to have the injection, you will be

given alternative pain relief for your broken hip until

you have surgery.

Are there any side effects with a Fascia

Iliaca Block?

Side effects are very rare but may include:

• not enough pain relief – the injection

may not work

• temporary leg weakness

• infection

• reaction to the drugs

• bleeding

• nerve damage

• absorption of the anaesthetic into the blood

stream, which in turn may cause you to:

| feel unwell

| feel light-headed

| have a tingling or numbness of the lips

| feel drowsy

| have fits.

If you get any of the above symptoms, including pain at

the site of injection, please let the doctors or nurses

know as soon as possible.

Should you have any questions that this leaflet does not

answer, please ask your nurse, doctor or any member of

the healthcare team.

Adapted from NHS Nottingham University Hospital,

Fascia iliaca compartment block: alternative pain relief

for patients with a hip fracture brochure, 2012.

With thanks to Acute and Chronic Pain Services,

Department of Pain Medicine, St Vincent’s Hospital.

Pain Management Network

NSW Agency for Clinical Innovation

Level 4, Sage Building, 67 Albert Ave, Chatswood

Tel 02 9464 4636 | Fax 02 9464 4728

www.aci.health.nsw.gov.au/chronic-pain

If you are taking warfarin or have a

known blood clotting disorder, this

injection is not suitable for you.

If you have forgotten to let doctors

and nurses know, please tell them

as soon as possible.

Important note

ACI Pain Management Network – Fascia Iliaca Blocks in acute hip fracture in the older person Page 16

Appendix 4

Fascia Iliaca Blocks for preoperative pain management in the older person with hip fracture

The Agency for Clinical Innovation has worked with expert clinicians in NSW to develop a toolkit and guideline

to implement Fascia Iliaca Blocks in acute hip fracture in the older person where appropriate. The objective of

the toolkit is to provide guidelines and training materials to implement best practice in the Emergency Department

in relation to pain management in the care of the older person with hip fracture, thus minimising the risk of

delirium and/or harm related to unmonitored opioid prescription in the ambulance, Emergency Department or

ward prior to surgery.

We welcome ongoing feedback on the toolkit using the form below. If you have any questions regarding any of

the information, please contact: Jenni Johnson, Network Manager, Chronic Pain, ACI, Ph: 02 9464 4636

Email: Jenni.johnson@health.nsw.gov.au

Contact details

Name:

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Specific feedback:

Document/resource Section no./Page no.

Comments

Implementation Toolkit including: • training framework• patient brochure• stickers• competency process and

assessment• log book

Clinical Guideline

Flow chart

Audit tool

General comments: