HIP ALERT PROCESS

HiP Alert called

over vocera
Orange HIP Alert
Folder pulled by RN
ED RN gives pain
meds and then
calls xray 21773 or
call xray on
vocera
Prefer patient taken
to Medical Imaging
and have pelvis
taken first
Does Patient
have HIP
Fracture?
NO
Cancel
HIP
ALERT
YES
Does Patient have
EXCLUSION FOR
HIP BLOCK ?
YES
*6am to 9p (call
Anesthesia Scheduler
on vocera IN HOUSE HRS
*Afterhours/weekends
call answering service
480-478-6620 AZ
Heart Anesthesia
ED Provider orders
Setup Hip Blockorder
fromfavorites
1. Hip Block Cart
2. Hip Block Meds
3. Bring Ultrasound to
Bedside
Dispo Per
ED
Provider
ED RN Performs HIP
BLOCK Exclusion
Checklist
ED Provider to Call
Orthopedics and
Admitting Physician
RN/Tech Place Ultrasound Machine
& HIP Block Cart outside of patient
roomand HIP BLOCK meds pulled
fromPYXIS
Anesthesia Arrives within
1 hour of consult
ED Provider to order
labs, imaging,
analgesics
Patient Admitted to 4A
Ortho Med/Surg
(with REMOTE TELE if getting hip
block
Patient can be admitted
prior to all diagnostics
resulted. Need hip fx
confirmed, and exclusion
labs for HIP block
completed
Patient presents with
acute hip pain
ED Staff ED Provider
CONTRAINDICATIONS TO
HIP BLOCK
(absolute & relative)
Patient Enters ED
with
HIP Pain
Revised 9/8/2014 H. Patel MD
NO
NO
Is Anesthesia
IN HOUSE ?
Place physician consult for anesthesia
HUC will call AZ Heart answering service
Indicate following in your consult order
Reason: Notification for HIP BLOCK on
floor when available
1. Call anesthesia
scheduler on vocera
2. Confirm if they will be
available to come to ED
within 1hour or if they will
be going to Ortho floor
for HIP BLOCK
3. Place physician consult
for HUC to document call
Indicate following in your
consult order
Reason: HIP BLOCK
consult(do not call
already discussed)
Step 1
Step 2
Will Hip Block be
done in the ED?
YES
YES
Do Not Order HIP
BLOCK setup
NO
Do Not Call
Anesthesia
Step 3
ABSOLUTE CONTRAINDICATIONS:
1. known h/o allergic reaction to local anesthetics,
2. groin infection/cellulitis,( if able to performwithout going thru infected area may be relative contraindication)
3. cant get conset or pt refuses
RELATIVE CONTRAINDICATIONS:
1. inr>2, platelets less than 70, or on anticoagulants(xarelto,pradaxa,eliquis etc)
2. groin hematoma/swelling fromfx
3.prior surgery in the area (i.e CFA, FA bypass)
4.less than 6months h/o weakness, paralysis, significant parathesia of the affected limb
5. impaired cognitive fxn who are unable to understand/consent for the block(or MPOA)
6. Morbid Obesity
If not able to arrive within an hour
or if unexpected delay, HIP block
can be done on ortho floor. Do not
delay patient transfer.