Abstract
Title: Block the Pain: Implementing Ultrasound-Guided Regional Anesthesia in the Emergency Department for Patients with Hip Fractures
Authors & Affiliations: Genevieve Boldin, MSN, AGACNP-BC, DNP Student, University of Virginia; Beth Quatrara, DNP, APRN, CMSRN, ACNS-BC, University of Virginia; Dina Hood, MPH, MSN, APRN, ACCNS-AG, University of Virginia Health System
Background: Annually, more than 319,000 hip fractures occur in the US. More than 80% are individuals over age 65. Pain management is a complex balance between risk of adverse events and achieving adequate pain control. Ultrasound-guided regional anesthesia (UGRA) is an effective, opioid-sparing intervention.
Purpose: The purpose of this project was to develop and implement an evidence-based framework to facilitate the use of UGRA in the Emergency Department (ED) as part of a multimodal approach to pain management for older patients presenting with hip fractures.
Methods: A systematic literature review was conducted to identify best practice recommendations for the implementation of UGRA in the ED. Development of a clinical decision pathway, nursing education, and a standardized order set were identified as the core components. A team composed of Emergency Medicine, Orthopaedic Surgery, Anesthesia, Nursing, Pharmacy and Information Technology facilitated the development and revisions through collaboration.
Outcomes: The clinical decision pathway was developed and approved by the provider team. The standardized order set that defined the monitoring parameters, nursing interventions and medications was approved. Targeted training material that covered the order set and associated topics was created and provided for the nursing staff.
Conclusion: Developing a standardized framework to facilitate the use of UGRA in the ED is feasible with key stakeholder engagement, interdisciplinary collaboration, and structured education. Increased utilization of UGRA as part of a multimodal strategy can provide targeted, effective pain management in the ED for geriatric patients with hip fractures while decreasing the opioid requirements and associated risks.
