A Quality Improvement approach to safer Zoledronate prescribing and improved communication with patients and primary care

Introduction

Intravenous zoledronate (IV Zol) is an established first‑line therapy after fragility hip fracture, and its use has risen markedly within our trauma service. The orthogeriatric team identified concerns regarding patients’ understanding of secondary fracture prevention and noted cases where patients were inappropriately prescribed oral alendronate in primary care despite already receiving IV Zol. 

Our project goals were to empower patients, ensure safer prescribing, and improve our communication with primary care colleagues.  

Methodology

We conducted a two-cycle quality improvement project (QIP) using plan-do-study-act methodology. Baseline surveys assessed resident orthopaedic doctors’ knowledge and confidence in osteoporosis management, including zoledronate use. Discharge letters were audited for documentation of secondary prevention, treatment, and follow-up plans. Following root cause analysis, we introduced enhanced induction, departmental teaching, standardised discharge templates, treatment flow charts, and posters, shared via teaching sessions, WhatsApp, and email.

Results

• 86% of resident doctors self-reported an improvement in their clinical practice. 
• Confidence in prescribing osteoporosis treatments rose from 3.8/5 to 4.2/5.
• Discharge summary documentation in both the patient and GP information sections significantly improved:
  • Documentation to the GP of bone health follow-up plans rose from 35% to 85%.
  • Information to the GP regarding specific treatments prescribed increased from 70% to 90%.
  • Patients receiving clear information regarding their follow-up rose from 60% to 100%.
  • Patients signposted to information from the Royal Osteoporosis Society rose from 0% to 55%.
  • Patients receiving specific information about their osteoporosis medication increased from 5% to 75%. 

Conclusion

Our QIP improved clinician confidence and ensured patients and GPs received clear information on osteoporosis management, treatment, and follow‑up. Resources are now embedded in rotating doctors’ induction, and regular teaching sessions are in place to sustain progress, with annual re‑audit planned.