Fascia Iliaca Compartment Block for Acute Hip Fracture Patients

Purpose: This quality improvement (QI) project aimed to increase anesthesia provider knowledge and utilization of a fascia iliaca compartment block (FICB) for hip fracture pain by developing a clinical practice guideline (CPG), an educational session, and a hands-on workshop. Background: At a Level I trauma center in southern Texas, opioid administration remains the primary pain management method. This site currently lacks a pain management guideline for acute hip fractures. The risk factors associated with opioid use include altered mental status, respiratory depression, hemodynamic instability, and prolonged hospitalization. A regional anesthesia technique, the FICB is an efficient and safe pain management technique for a patient with an acute hip fracture. Methods: This three-group Doctor of Nursing Practice (DNP), nurse anesthesia (NA) students led this project and developed a CPG for the FICB. The CPG was evaluated by a group of Certified Registered Nurse Anesthetists (CRNAs) from Phoenix, Arizona. Once the CPG was finalized, a PowerPoint with FICB content was made and presented to anesthesia providers at this facility. Participants (n=30) were recruited to attend a one-day educational presentation starting with a PPT and followed by a hands-on regional workshop. Participants completed a pre-and post-education survey, proficiency quiz and 30-day follow-up survey to measure knowledge and to determine if this project led to a practice improvement. Results: The CPG was scored to be of good quality. Following the educational presentation, there was an increase (24%) of participants who could correctly identify a patient which would benefit from a fascia iliaca compartment block. A positive indicator of our education and hands-on tutorial is the increased number of participants (52%) who responded they’re likely to administer a fascia iliaca compartment block. The 30-day survey indicated that 80% of CRNAs have performed a FICB post-education training and 100% agreed that the educational training was beneficial at their facility. Conclusions: Educating anesthesia providers about current evidence for pain management in acute hip fracture patients resulted in increased implementation at this Level I facility. Replication of this project and other types of regional blocks can be beneficial in increasing knowledge and implementation at other facilities lacking regional block administration. Future projects should focus on the sustainability of evidence-based practices along with barriers to implementation