Abstract
Introduction
Hip fractures are a leading cause of morbidity and mortality in frail older adults, with 70,000–75,000 cases annually in the UK. Osteoporosis is a major contributor, and those with one hip fracture face a 2–3 fold risk of recurrence. Intravenous (IV) zoledronic acid reduces future fractures and improves outcomes. Scottish standards recommend a loading dose of vitamin D within 7 days and IV zoledronic acid within 30 days unless contraindicated, along with referral to the local bone health pathway. Zoledronic acid is also cost-effective, costing under £1,000 compared to over £14,000 per hip fracture.
Methodology
Conducted at Forth Valley Royal Hospital from February–May 2025, this QI project focused on patients aged ≥65 with a Clinical Frailty Score ≥5, admitted with neck of femur fractures and eligible for IV zoledronic acid. Two audit cycles were performed on wards A21 and B23. Interventions included staff education and introducing a checklist in patient notes to ensure safe administration. The first cycle included 30 patients; the second, 21.
Results
In cycle one, 23% of records lacked the checklist, and many were incomplete. By cycle two, inclusion improved to 95%. Two safety incidents in the first cycle involved IV zoledronic acid given with suboptimal renal function and without prior vitamin D. Improvements were noted in documenting vitamin D loading and creatinine clearance. While some vitamin D doses were delayed beyond 24 hours, 86% received it within 72 hours. Notably, 95% received zoledronic acid within 30 days. Consent documentation remained at 80%, affected by inconsistent recording.
Conclusion
Introducing a checklist and targeted staff education improved compliance with IV zoledronic acid guidelines. Sustainability depends on embedding the checklist into routine documentation and regular training, particularly for rotating junior staff. Re-auditing every 4–6 months is recommended.