Themes of barriers - Fig. 1

3. From the staff interviews, four broad themes of barriers emerged: self, environment, patient and organisation (see Fig. 1)

Conclusions

This study’s findings found inequalities in hip fracture care exists among older adults (90+ years) compared to younger adults (<75 years).

y Older adults are 19% less likely to receive a nerve block compared to younger adults y Less than 50% of older adults received a pain assessment during their inpatient stay y Hospital stays were five days longer in older adults

The reasons for this inequality of care are multifaceted, but barriers such as low staffing, emergency department (ED) crowding, staff knowledge, and availability of staff to administer nerve blocks are likely to play a significant part.

Furthermore, staff unintentionally prioritised patients who vocalised their pain, often these were younger patients.

Key recommendations:

1. Update/re-circulate the hip fracture policy.

2. Regular pain education for staff.

3. Nerve block box/trolley to centralise equipment and appointed staff to maintain contents.

4. Increase volume of nurse prescribers and expand competence to administer nerve blocks.

5. Staff focus groups to support retention. There is already a recruitment and retention steering group and there are some retention initiatives currently being reviewed.

This study was funded by the NIHR and sponsored by PAHT. Special thanks to Dr Robert Ghosh, divisional director of medicine and urgent and emergency care; Katie Silk, head of therapies; and Chris Cook, head of research, development and innovation, for all their support and encouragement. For more information, please contact me at darryl.desouza@nhs. net,