EP156 Auditing the pain and delirium in patients with hip fracture from admission to weight-bearing

Background and Aims Hip fragility fractures are associated with high morbidity, mortality, and risk of delirium. The British Orthopaedic Association Blue Book Guidelines (2007) and the AAGBI Guideline for the management of hip fractures (2020) emphasizes early, comprehensive assessment and management of both pain and delirium as core components of best practice. Delirium affects up to 50% of hip fracture patients and is associated with worse outcomes. Effective pain control is a modifiable risk factor for delirium. This audit evaluates use of screening tools such as the 4AT to assess for delirium and pain management of hip fracture including regional anaesthetic techniques. This audit aims to assess the documentation of delirium through the 4AT and the use of multimodal analgesia in the management of hip fracture and compare against standards set by the Blue Book Guidelines.Methods A clinical audit carried out in University Hospital Waterford over a two-month period in patients with hip fractures. We looked at presence of 4AT scores, pain scores, analgesia given in the preoperative, intraoperative and post-operative setting. Standards Compared To: BOA-BGS Blue Book (2007, updated 2020), AAGBI Guideline for the management of hip fractures (2020) recommendations. Approval was granted by Local Audit Committee University Hospital Waterford.Results 34 patients included. Fifty six percent were female, 44% male. Average age was 82 years. Most cases were carried out under spinal anaesthesia (75%). Common deficits identified included no 4AT admission, no peripheral nerve block pre-operatively (88%), use of regular opioids (71–82%) for the majority of patients.Abstract EP156 Table 1Multimodal pain management tableAbstract EP156 Figure 14AT scores pre-operatively and post-operativelyAbstract EP156 Figure 2Percentage of patients receiving peripheral nerve blocks on admission and pre-operativelyConclusions Findings highlight incomplete compliance with national standards for pain and delirium assessment. Improved documentation of 4AT scores, implementing regional anaesthesia techniques intra-operatively when appropriate, and staff training around use of regular versus as required opioids are needed to align with BOA-BGS Blue Book guidance.