Improving Analgesia Prescriptions in Femoral Fracture Patients in Older inpatients

Introduction

Adequate analgesia prescribing is essential in older inpatients with femoral fractures to improve patient care, reduce delirium and to shorten hospital admission duration with their associated complications. Current NICE analgesia guidelines for femoral fractures suggest regular paracetamol with offering additional opioids if required. These guidelines were amended at Hereford County Hospital to recommend that patients should receive 5 days of regular prolonged release opioids due to the practical limitations of inpatients not receiving adequate quantities of as required opioids.

Methods

50 patients with femoral fractures on the orthopaedic ward in Hereford County Hospital were identified and the following data was collected: demographics, admission date, renal function, analgesia, laxative and anti-emetic prescriptions along with if there was any consideration of end date for regular opioids.  After this electronic prescribing order sets were introduced in June 2025. These included regular paracetamol, regular prolonged release opioid prescriptions (morphine or oxycodone MR depending on renal function),  as required short acting opioids and venous thromboembolism prophylaxis. This was followed by data collection in a group of 54 inpatients with femoral fractures in the summer of 2025. 

Results

When no electronic order sets were available, patients tended to receive little or inadequate analgesia. The majority of patients were prescribed codeine which accounted for two-thirds of incorrect prescriptions. The introduction of order sets to the electronic prescribing system resulted in a significant improvement in the rates of regular opioid prescriptions for older patients. Regular morphine or oxycodone was prescribed in 76% of patients when the order sets were available compared to 22% in cycle 1 when there were no order sets.

Conclusions

Electronic prescribing ordersets have significantly improved regular analgesia prescriptions in patients with femoral fractures. A further quality improvement project is required to ensure that the regular opioids are discontinued after a short defined period.