Interprofessional Practice Based Research
Project title: Improving care of hip fracture patients by identifying factors influencing the implementation of peripheral nerve blocks as an evidenced-based treatment in the perioperative setting
- Marjorie is trained in medical and traditional Chinese medicine and acupuncture.
- Vivian has a great topographic memory
October 15, 2018
Improving care of hip fracture patients by using peripheral nerve blocks
“She was doing so well until she fell,” or “he was in great health until he broke his hip.” These are common stories that you might hear about an elderly loved one. The sad truth is, as we get older our bones increase in frailty and are more likely to break. Hip fractures are particularly common in the elderly. They can lead to loss of independence, health complications and death. Sustaining a hip fracture in addition to being a sentinel event for the patient it is often a life-changing event for their loved ones particularly if the patient was the primary care giver for their partner. Hip fractures can be very painful and managing the pain with opioids, the most conventional treatment is well known to be associated with undesirable adverse events.
“Suboptimal pain management and opioid related adverse events can negatively impact patient recovery, and cause unnecessary emotional distress for the patient and their loved ones”, said Marjorie Hammond, a clinical nurse specialist in Geriatrics at St. Michael’s Hospital.
Clinicians are looking for other ways to manage acute pain in hip fracture patients. One other pain management method is the use of a peripheral nerve block. A peripheral nerve block involves an ultrasound guided injection of local anesthetic into an area in upper thigh near the groin. The injection solution spreads to the nerves, effectively shutting down fractured hip pain. The technique is similar to “freezing” needles that the dentist might use before pulling out a tooth. Nerve blocks are safe, inexpensive, effectively reduce pain and decrease the need for opioids. This helps the patient get on their feet faster and reduces the length of stay in the hospital.
Nerve blocks sound like a great strategy for managing hip fracture pain; so why aren’t they being used as routinely as a standard of care? Marjorie and her colleague, pharmacist Vivian Law, are trying to find out the answer to this question. Her team is talking to clinicians and using implementation science based research methods to figure out factors that promote or prevent the use of nerve blocks. Her team hopes in the future to design and test strategies to increase the use of nerve blocks for hip fracture pain management as a first step toward providing this pain management intervention as a routine standard of practice.
When asked why she is interested in this research question, Marjorie stated that “older adults 65 years and older comprise 88 per cent of hip fractures in Canada. We are facing an opioid crisis in the country, and importantly older adults are at significant risk for adverse events associated with the use of opioids. The reduction of potential adverse events and provision of more optimal pain relief can be achieved by fascia iliac blocks.”
Connecting with IPBR
The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research. Marjorie Hammond and Vivian Law are recipients of a 2018-2020 Interprofessional Practice Based Research Grant. This grant provides research funding and mentorship.
“The IPBR program has not only funded this study but provided additional mentorship with respect to the complexities of moving a research proposal forward to actually conducting the study.”
- Marjorie Hammond