Improving delivery and safety of Fascia Iliaca Blocks in patients with Neck of Femur fractures in Tunbridge Wells Hospital

Introduction

Fascia Iliaca (FI) nerve blocks are recommended for patients presenting with neck of femur fractures to provide effective analgesia and reduce opioid requirements. We conducted a quality improvement project (QIP) in a busy district general hospital to increase the proportion of patients receiving FI blocks and improve compliance with post-procedural safety precautions, in line with Royal College of Anaesthetists (RCoA) guidance.

Methods

Data were collected retrospectively from the local orthopaedic trauma database and electronic patient records over two separate two-week periods: December (baseline, n=29) and March (post-intervention, n=26). Key stakeholders, including orthopaedic, geriatric, anaesthetic, and emergency medicine consultants, as well as resident doctors, were engaged.

Interventions included the introduction of a standardised, fully stocked FI block equipment box, alongside targeted education on safe block administration, RCoA-recommended safety precautions, and the importance of accurate, contemporaneous documentation.

Results

The proportion of patients receiving an FI block increased from 69% (20/29) to 88% (23/26). The rate of undocumented FI blocks decreased from 24% to 0%. Availability of correctly stocked FI block equipment improved from 74% to 98%. Documentation of RCoA-recommended safety precautions increased from 16% to 57%.

Conclusion

This QIP demonstrated that simple, low-cost interventions can significantly improve both the uptake and safety of FI block administration. Improved access to standardised equipment and focused education enhanced timely delivery of analgesia and eliminated undocumented procedures, addressing key patient safety concerns. Increased adherence to RCoA safety recommendations may reduce the risk of adverse events.

Further work is required to sustain these improvements and achieve higher compliance with safety documentation standards.