Call to Action - NWAFT’s response to the IV zoledronate administration issue

5467
R Forster (Advanced Clinical Pharmacist)1; E Clayton (Higher Specialty Trainee)2; F Hansell (Consultant Orthogeriatrician)2
1. Pharmacy (cross-site), North West Anglia Foundation Trust; 2. Hip Fracture Unit, Peterborough City Hospital, North West Anglia Foundation Trust
Clinical Quality Research
CQ - Improved Access to Service
Bone Health
View DOI

Abstract

  1. Introduction

Call to action: a five nations consensus on the use of intravenous zoledronate after hip fracture provides a compelling argument for the use of IV zoledronate as first line antiresorptive therapy for patients with neck of femur fracture. Historically, North West Anglia Foundation Trust’s zoledronate administration rate has lagged behind other trusts.

  1. Method

Between October 2025 and January 2026, we deployed the following strategies to embed change: 

  • IV zoledronate kept as stock drug on the ward.
  • Patient’s bone health status (zoledronate needed) highlighted every board round from day 3 post-op. 
  • Rotating resident doctors given robust bone health prescription protocol on-boarding and template for discharge letters. 
  • Rotating pharmacists and hip fracture specialist nurse prescribe IV zoledronate given as inpatient on the TTO section of discharge letters.

A retrospective audit of patient notes was carried out in April-May 2025 (152 case notes), October-November 2025 (121 case notes) and April-May 2026 (124 case notes). Exclusion criteria: non-operative management, death during admission, notes missing. 

  1. Results

The audit identified that in the pre-intervention period from April-May 2025 only 76 of 152 patients (50%) were identified as suitable for bone health treatment. Of these, 68 were recommended zoledronate with 47 receiving treatment (69%) but only 5 (11%) had this documented in discharge medications. From the post-intervention cohort of 124 patients in April-May 2026 92 (74%) were identified as suitable for treatment, with 81 recommended for zoledronate treatment of which 81 (100%) were administered and for 60 (74%) this was documented in discharge medications. 

  1. Conclusions

The zoledronate administration rate has improved by 111% from April-May 2025 to April-May 2026 and 100% of patients who have been recommended zoledronate as part of their Comprehensive Geriatric Assessment are receiving it. Our dissemination of this information on discharge is also improving. 

References: 

  1. Johansen A, Sahota O, Dockery F, Black AJ, MacLullich AMJ, Javaid MK, Ahern E, Gregson CL. Call to action: a five nations consensus on the use of intravenous zoledronate after hip fracture. Age Ageing. 2023 Sep 1;52(9):afad172. doi: 10.1093/ageing/afad172. Erratum in: Age Ageing. 2024 Jan 2;53(1):afae014. doi: 10.1093/ageing/afae014.

This is a poster presented at a BGS conference. It constitutes research undertaken by the authors  and queries should be addressed to them. The BGS do not endorse or recommend any of the content. BGS do not make any warranties or guarantees in relation to the content.  If you wish to comment on the poster you will need to create a website account, sign in and submit for the authors to respond.