Translation of training to practice – ultrasound guided nerve block for analgesia in patients with hip fracture

Abstract

Aims: Ultrasound guided nerve blocks have been shown to be an effective analgesia option for patients with hip fracture. An education program was developed to train Emergency Department doctors and it received positive feedback from partici-pants who demonstrated competency after the training. We aimed to evaluate the education program at the behavioral level of the Kirkpatrick Model by determining the translation of training to practice of ultrasound guided nerve blocks in patients with a hip fracture at the Emergency Department. Materials and methods: A retrospective review of medical records was carried out from 18 August 2018 to 31 December 2020. Data on patient demographics, type of hip fracture, pain score, analgesia pro-vided and complications were collected using a standardized form and analyzed. Results: Among 634 patients, their median age was 79 years old (Interquartile range (IQR): 70 to 85) and 416 (65.6%) were female. The median pain score was 6 (IQR: 5 to 8) and analgesia was provided for 561 (88.5%) patients. Analgesia was administered most frequently via the intravenous route (n=407, 72.5%) and tramadol (n=293, 52.2%) was most commonly used. Ultrasound guided nerve block was performed in 26 (4.7%) patients – all were performed successfully without complications. The utilization increased from 1.0% before to 4.7% after the conduct of the training workshops (p=0.16). Conclusion: A significant gap still exists in the translation of training to practice. Barriers must be identified and overcome so that ultimately, the education program can bring about an organizational impact to benefit patients and improve their outcomes.