Analgesia in emergency department for patients with hip fracture

Abstract Introduction Pain following Neck of Femur (NOF) fracture can have negative effects on mortality and morbidity in older patients. We conducted an audit to assess the pain management and effectiveness of NOF analgesia bundle in patients with hip fracture in Emergency Department (ED). NOF analgesia bundle was introduced to ensure consistent prescription of evidence based analgesic regimen for these frail patients. Methods We retrospectively collected data of 50 NOF patients in ED from April to August 2024 to identify any deficiencies in initial management of pain and make improvements if necessary. We assessed compliance against NICE guideline CG124. Results Average age 77.8 was lower than the national average of 84 in men and 83 in women. 96% patients had cognitive assessment using 4AT scoring. Initial pain assessment was done in 82% patients. 70% patients had analgesia within 2 hours of hospital admission. Only 46% patients had further regular pain assessment. Pain in cognitively impaired patients was inadequately assessed. All patients were prescribed Paracetamol. None were given NSAIDs. Fascia Iliaca Block was performed in 82% patients. NOF analgesia bundle used in 78% patients. Conclusions and suggestions Cognitive assessment and regular paracetamol had improved from the previous audit. Time to first analgesia should be improved to ensure every patient gets analgesia within 1 hour of arrival. More should be done to ensure NOF analgesia bundle is used in all patients. Fascia Iliaca blocks should be performed in all patients and documentation should be improved. Pain assessment using ‘PAINAD’ score should be implemented in cognitively impaired patients.