title: Audit improves emergency department triage, assessment, multi-modal analgesia and nerve block use in the management of pain in older people with neck of femur fracture.
abstract: BACKGROUND
  The use of NBs as a mode of analgesia for #NOF in the ED is not common practice despite the reported clinical benefits of quicker onset of pain relief, decreased use of additional analgesia and decreased amounts of analgesia required when more than one mode of analgesia is prescribed.
  
  
  OBJECTIVE
  This study aims to test the hypothesis that the implementation of educational and awareness strategies increases knowledge, and implementation of the evidence based use of nerve blocks NB's, as a mode of analgesia for elderly patients with a fractured neck of femur (#NOF) in the Emergency Department (ED).
  
  
  METHODS
  A retrospective clinical audit of medical records using explicit chart review pre and post implementation.
  
  
  RESULTS
  Implementation of educational and awareness strategies on pain management to clinical staff in the ED resulted in a significant increase in the administration of NBs, use of multimodal analgesia, and a reduction in average milligrams of morphine administrated to elderly patients with #NOF.
  
  
  CONCLUSIONS
  The number of older people with #NOF presenting to the ED in Australia is increasing and historically, pain management in this group of patients could be improved. This study demonstrated that an audit, intervention and re-audit design that focused on the implementation of educational and promotional strategies informed by evidence on current and best practice standards were successful in improving delivery of analgesia to elderly patients with #NOF in the ED.
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia. Electronic address: emmanb70@hotmail.com.
authors.forename: Emma
authors.initials: E
authors.lastname: Newton-Brown
authors.affiliation: La Trobe University, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
authors.forename: Les
authors.initials: L
authors.lastname: Fitzgerald
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000706:statistics & numerical data*; D000700:Analgesics / Q000008:administration & dosage; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008485:Medical Audit; D009407:Nerve Block / Q000706:statistics & numerical data*; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D012189:Retrospective Studies; D014218:Triage; D014739:Victoria
chemical_list: D000700:Analgesics
keywords: Analgesia; Elderly; Femoral neck fractures; Nerve block; Pain management