Can emergency nurses safely and effectively insert fascia iliaca blocks in patients with a fractured neck of femur? A prospective cohort study in an Australian emergency department

Abstract

Aims and objectives:To compare the effectiveness and safety of ultrasound-guided fascia iliaca block (FIB) insertion in patients with fractured neck of femur by trained emergency nurses with insertion by doctors. Background:The FIB is an effective and safe form of analgesia for patients with hip fracture presenting to the emergency department (ED). While it has traditionally been inserted by medical doctors, no evidence exists comparing the effectiveness and safety of FIB insertion by nurses compared with doctors.Design: A prospective cohort study. Methods:The study was conducted in an Australian metropolitan ED. Patients admitted to the ED with suspected or confirmed fractured neck of femur had a FIB inserted under ultrasound guidance by either a trained emergency nurse or doctor. A retrospective medical record audit was undertaken of consecutive ED patients presenting between January 2013-December 2017. Reporting of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for cohort studies.Results: Of the 472 patients eligible for a FIB, 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 1 hr post-FIBinsertion;clinicallysignificantreduction(≥30%)inpainscore1hrpost-FIB insertion; pain score 4 hr post-FIB insertion; delirium incidence; opioid use post-FIB insertion; or time to FIB insertion. No adverse events were identified in either group. Conclusion:Insertion of FIBs by trained emergency nurses is as effective and safe as insertion by doctors in patients with fractured neck of femur in the ED. Senior 750 patients identified as admitted via ED with a fractured neck of femur based on Australian National Diagnosis Related Group 166 patients excluded: Transfer from another hospital directly to the ward or rehabilitation unit: 67 No fracture (incorrect coding): 57 Fracture diagnosed on CT or bone scan post discharge from ED: 22 Fall in hospital causing fracture: 11 Major trauma with multiple injuries: 9 584 patients assessed for FIB eligibility 112 patients excluded: Contraindications to FIBs including Anticoagulant medication: 74 Did not consent to FIB: 22 Medical record missing: 16 472 patients eligible for FIB 150 patients did not receive FIB 322 patients received FIB 72 nurseinserted FIBs 207 doctorinserted FIBs 43 clinician unknown

Multimorbidity and Polytherapy in Patients with Femoral Neck Fracture: A Retrospective Observational Study

“…This is in line with the literature data because femoral neck fractures are the most frequent among all osteoporotic-related fractures of the hip (40–50%) and are three times more frequent in women than in men [ 22 ]. All patients arrived at IOR in the emergency room, since femoral neck fracture is an acute trauma and should be usually operated on within 24–48 h [ 23 ].…”

Ultralydveiledet fascia iliaca compartment-blokade hos pasienter med hoftenære brudd

“…Flere studier viser at sykepleiere oppnår like vellykkede resultater som leger ved administrering av UL FICB. Forskerne fant at sykepleiere hadde tilstrekkelig kunnskap og kompetanse til å utføre prosedyren nøyaktig og trygt (7,8,24).…”

Development of a Workplace-Based Training Program for Nurse-Led Ultrasound-Guided Femoral Nerve Blocks: A Feasibility Study with the Patients’ Perspective in Focus

“…Te choice to include three supervised procedures was based on studies describing fascia iliaca nerve blocks or femoral nerve blocks using ultrasound. Tese studies had from one to fve supervised blocks on either volunteers, cadavers, or patients [29][30][31][32].…”