Abstract
Introduction
Fragility fractures are associated with increased morbidity and mortality. Early identification of patients at risk is essential for prevention. Bone health assessment tools are recommended in current clinical guidelines for those at risk. Despite this, baseline audit data showed that only 3% of patients admitted to a geriatric ward following a fall had a bone health assessment completed within 72 hours of admission. This project aimed to increase the completion rate of bone health assessments to over 90%.
Methods
A series of targeted interventions were implemented over four consecutive quality improvement cycles to increase rates of bone health assessments among inpatients. The primary cohort was resident doctors, and the primary outcome was the presence of a documented bone health assessment. The initial intervention integrated a structured bone health assessment documentation tool. This included known osteoporosis, bone profile screening, use of antiresorptive therapy or supplementation, and need for referral to the fracture liaison service. The second intervention involved a bone health assessment prompt within ward round proformas. The third intervention involved educational posters about bone health assessment. The last intervention involved teaching sessions. Three weeks after each intervention, data was collected daily for one week.
Results
Results have shown an increase from 3% to 76% over the last four cycles. This has shown an improvement following interventions. However, improvements to aim >90% completed of bone health assessments could be achieved through further training and teaching sessions, and routinely embedding bone health assessments within electronic medical records.
Conclusion
Targeted interventions have improved the timely completion of bone health assessments in patients admitted following a fall. By raising awareness and integrating bone health assessments into routine care, a further increase from 76% can be increased. Continued emphasis on early assessment is essential to optimise fragility falls and reduce future fracture risk.
Comments
Future plans
Hello. Thank you for your poster. What do you plan to do to improve awareness / better integrate bone health assessments beyond the steps that you have already taken? What barriers were there to not achieving the goal of 90%?
Reply to Future Plans
Thanks for your comment. In our final cycle, we have plans to update our Senior Health Induction handbook with information about ward round templates and bone health assessment, and we are planning to integrate some further teaching into induction about expectations in terms of documentation (e.g. Completing 4-ats and bone health assessments). This way, we aim to sustain this change we have made and embed it into our common practice.