National Institute for Health and Clinical Excellence (NICE)
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Audit reveals variation in use of pain relief for hip fracture

Almost half of all hip fracture patients in England are being denied NICE-recommended pain relief as part of their care, audit results reveal.

Between 70,000 and 75,000 hip fractures occur each year among people at an average age of 83 years old. This figure is likely to rise in the future as the UK population ages.

The injury often causes considerable pain, and is one of the most common reasons for older people requiring an operation under anaesthetic.

In guidance first published in 2011, NICE recommends a certain pain relief protocol for patients with hip fracture, which includes an anaesthetic known as nerve block.

NICE says that clinicians should consider adding nerve blocks if paracetamol and opioids do not provide sufficient preoperative pain relief, or to limit opioid dosage. In addition, intraoperative nerve blocks should for be used all patients undergoing surgery.

Figures from the latest audit by the National Hip Fracture Database (HFD) found that only 56 per cent of hip fracture patients received nerve block for pain relief.

The audit was conducted between May 2013 and July 2013 and included data on 16,904 hip fracture patients from 184 participating hospitals. Consequently, the report recommends that nerve block should be offered to all hospital patients who present with hip fracture.

Professor Finbarr Martin, lead for the Falls and Fragility Fracture Programme at the Royal College of Physicians and Non-Executive Director at NICE, said: "Hip fracture is the most common reason a frail elderly patient will need an anaesthetic and an operation and care of hip fracture requires the collaboration of several specialist teams and departments in the hospital to deliver care to these patients.

"It is good that over half of hospitals have adopted the use of nerve blocks as pain relief for hip fracture patients, but as this is the approach that NICE have judged most advantageous for most patients, we would expect that anaesthetists reflect on this result and guidance when making clinical decisions."

Dr Richard Griffiths, honorary secretary of the Association of Anaesthetists of Great Britain and Ireland added: "This audit has highlighted considerable variation in the quality of perioperative care provided to this vulnerable and rapidly growing patient group in the NHS.

"The fantastic enthusiasm of anaesthetists throughout the UK in trying to address some very important clinical dilemmas has resulted in some important findings that will benefit patient safety and improve care in the future."

The NICE hip fracture pathway contains all that NICE recommends on treating patients with hip fracture.

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