Enhancing Coordination of Bone Protection Plans in Ortho-Geriatric Patients: A Quality Improvement Project

Introduction

Bone health assessment forms a standard aspect of orthogeriatric care in line with NHFD* and NOGG**. Current recommendation is to administer first dose of bone protection medication during hospital stay due to high imminent fracture risk. We identified several cases where the first dose was delayed, including near misses and adverse events with potential for patient harm.

Methods

A process map of 20 patients was conducted to collect data on decision-making, documentation, and implementation of bone protection plans. A staff questionnaire identified key shortcomings and areas for improvement. A teaching session on the importance of bone protection was delivered to the ACM*** department. Trust guidelines were developed to support clinical decision making, and electronic system note redesigned for uniformity of documentation. This was included in the induction for incoming orthogeriatric team members. A re-audit was performed to assess whether patients received their first dose of bone protection prior to discharge.

Result

Of the sample initially collected 90% had a bone health plan made, however only 33% of these received their first dose before discharge. There were several barriers highlighted including lack of clarity/variation in documentation, inadequate replacement of vitamin D/Ca, not obtaining consent during the admission. This meant treatment was delayed in 56% and was not given in 10% of the cohort. Qualitative data collected from the questionnaire highlighted the causes in delays including requiring improvements in “clear communication and documentation”, prioritising “early consent”, and “clearer understanding of roles” of members of the team.

Following implementation of the interventions, 100% of the sample had a bone health plan made, of these 81.25% were given their first dose of iv bisphosphonate prior to discharge, thus showing a 48.25% improvement.

Conclusion

The improvements achieved reduction in imminent fracture risk and decreased delays in first dose of bone protective medication being administered.

*National Hip Fracture Database

**National Osteoporosis Guideline Group

***Ageing and Complex Medicine