25IMPLEMENTATION OF AN ANALGESIA AND BOWELS PROTOCOL TO IMPROVE PATIENT CARE AFTER HIP FRACTURE

Abstract

Background: This improvement work was aimed at patients ≥65 years admitted with a fracture to the orthopaedic wards in Royal Alexandria Hospital, Paisley. The team included Orthogeriatricians, Elderly Care Orthopaedic Nurses and Pharmacists. Introduction: Anecdotally, it was believed hip fracture patients were receiving insufficient analgesia and laxatives. Optimal pain relief allows for earlier mobilisation, resulting in fewer complications. Pain and constipation can contribute to the development of delirium. The Scottish Standard of Care for Hip Fracture states that patients should have adequate provision of pain relief and should be mobilising by the end of the first postoperative day. This project aimed to improve analgesia and laxative prescribing. Methods: An audit was carried out in December 2017, which confirmed analgesia and laxative prescriptions were inconsistent (some instances of no analgesia). An Analgesia and Bowel protocol was produced by the local Orthogeriatric and Acute Pain teams and it was introduced in August 2018. An audit of the protocol's effectiveness was undertaken during November 2018. Data on patients' weights, protocol adherence, analgesia and laxatives prescriptions, prevalence of cognitive impairment and pain scores were collected. Interventions: The analgesia and bowels protocol was introduced to facilitate appropriate prescribing and reviews on orthopaedic wards. Results: In the 2018 audit, 47% of patients had prescriptions adhering to the protocol. 47% of patients had an Adult with Incapacity form. 92% of patients who could self-report had pain scores ≥5/10. 24% of patients had Abbey pain scores ranging from 3-9. Patients receiving analgesia as per protocol had a lower mean generic pain score (6.2 versus 7.7). Conclusions: The protocol resulted in considerable improvement in analgesia and laxative prescriptions. However there remains room for improvement. Adherence to the protocol needs to be increased through education of anaesthetic and orthopaedic ward staff. Analgesia and bowel health could be further optimised by encouraging more frequent assessments by all team members. Increased use of pain assessment tools (especially Abbey pain chart) achieved through nurse education may improve administration and titration of analgesia. (Table Presented) .