16 January 2013
Easing the pain of hip fractures
13 07 2012 | Frontline First Team
Hip fracture is a common and serious injury, mainly affecting older people. Around 75,000 cases occur in the UK each year, causing real pain and distress to those affected. These fractures are difficult to control with standard analgesia which is normally administered while a patient waits for surgery.
In Poole, nurse Mandy Layzell and her team developed a service to reduce pain for patients who have fractured their hip, by providing a nurse-led femoral block service, delivered by injection. As soon as possible after a patient arrives in A&E, the team makes an assessment, obtains consent and performs the block.
This intervention has been shown to improve the whole care pathway for the patient, eliminating the side effects associated with opiate pain relief. Very little pain will be experienced after the block is applied, so it improves fitness levels for the wait prior to surgery. It also enhances mobility, which impacts on the patient's ability to access nutrition and fluids, and on tissue viability.
This simple but effective step has been delivered to over 1,000 patients. The results have been hugely positive - there has been good follow-up of patients, very few complications have occurred and no serious adverse events have been reported.
This innovation is not only improving care, it is also cutting costs. The Trust estimates that the intervention has helped towards reducing bed days.
Not content with what is already proving to be a positive innovation, the team is not stopping there. Femoral nerve blocks can be performed in two different ways, either by using a nerve stimulator to identify the femoral nerve or by using a blind technique, known as a fascia iliaca block. The team is currently running a Randomised Controlled Trial, which will be completed this year, involving 100 patients to identify which technique provides better outcomes for the patients.
This is a very striking example of the fact that seemingly simple changes can lead to vast improvements in patient care.