A Community Hospital Implementation of a Mobile Preoperative Peripheral Nerve Block Service in Non-OR Environments for Hip Fracture Patients.

چکیده اصلی

BACKGROUND AND OBJECTIVE: Peripheral nerve blocks (PNB) are recognized as best practice for managing pain in older adults with fragility hip fractures. Despite strong evidence, the adoption of PNB pre-operation has been slow due to several implementation barriers. This study addresses this gap by describing the co-design and implementation of a preoperative Mobile PNB Service led by anesthesiology in a Canadian community hospital. We aim to: (1) provide a transferable, anesthesia focused implementation roadmap; (2) identify key implementation activities that enable the delivery of PNBs outside the operating room; and (3) report formative feasibility and evaluation outcomes (blocks delivered, pain levels, adverse events, and opioids administered before and after block delivery. METHODS: The mobile PNB service is comprehensively described to enable replicability following the Template for Intervention Description and Replication (TIDieR) checklist. Key design and implementation activities are identified by matching the activities with theory informed implementation functions from the Behavior Change Wheel (BCW). The formative outcomes were tracked alongside block delivery and abstracted from the patients' chart. RESULTS: The multidisciplinary team led implementation activities primarily targeted enablement, education, and environmental restructuring to support the capability, opportunity, and motivation to deliver nerve blocks. The Mobile PNB Service was implemented feasibly, 76 blocks were delivered (44% Emergency Department (ED) and 56% ward) and safely, no procedure-related adverse events were observed. Early implementation was associated with increased uptake of preoperative PNBs and substantial reductions in patient-reported mean (SD) pain scores following block delivery from 7.1 (2.6) pre-block to 1.0 (2.0) post-block, and reduction in mean (SD) opioid administration following block delivery from 0.64 (0.90 milligrams per hour of oral morphine equivalents pre-block to 0.22 (0.49) milligrams per hour post-block. DISCUSSION: This study provides a replicable, theory-informed roadmap for closing the gap between guideline-recommended PNB and their delivery in non-operating room settings. An anesthesiology-led Mobile PNB Service was successfully implemented by addressing known system- and provider-level barriers using implementation frameworks. These findings underscore the value of theory-guided service design to identify essential components that enable behavior change and expand access to evidence-based analgesia for hip fracture patients.

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