Audit reveals variation in use of pain relief for hip fracture
31 Mar 2014 11:55 AM
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.