Abstract
Background:
Zoledronic acid (Zol) is used in the prevention and treatment of osteoporotic fractures. Once IV Zol has been administered as an inpatient, discharge documentation and GP communication should be completed. However, this can be inconsistent and can compromise continuity of care. A checklist produced by the HCOP (Health Care of Older People) team aimed to standardise osteoporosis management. In addition to the metrics reviewed in the previous 4 audit cycles, this audit looked at vitamin D correction before Zol.
Methods:
Data was collected from 55 patients receiving their first dose of IV Zol between 01/03/2025 and 31/05/2025. Exclusions for data collection include patients outside of the HCOP speciality and indications other than osteoporosis. Data was collected from hospital systems, including digital health records.
Results:
The repeat audit showed that pre-infusion correction of vitamin D levels was given in 33% of patients, of which only 63% of patients received the correct dose. Renal function was checked before infusion in 100% (previous audit was 100%) of patients, and calcium/vitamin D levels in 96.4%(93%) of patients. Counselling was documented in 96.4%(85%). Zol was correctly prescribed in 91% (83%) of patients. Administration was documented on discharge paperwork in 87.3% (90.5%), but follow-up plans were documented in only 16.4% (25%). A standardised intended GP letter was sent in 25.5% of cases.
Discussion:
The checklist has been successfully embedded within practice despite resident doctors rotating out of the department. The checklist has improved patient safety by allowing for consistent prescribing, counselling and pre-infusion checks of IV Zol. Documentation and follow-up remain suboptimal. Limitations included understanding the ownership of who completes follow-up referrals to primary care, as this was previously completed by medical admin staff. These limitations will provide a basis for future interventions, including a re-audit.
Comments
Glad to see there is an…
Glad to see there is an improvement in proportion of patients receiving counselling and correct prescriptions, whilst there is a drop in letters sent to GPs, it would be interesting to see if there was a clerical cause or a new system in primary care or hospitals that may explain this drop. A statistical test such as chi-squared could help determine if there is statistical significance in the change of percentages.
We discussed with the…
We discussed with the administrative team why there was this drop. Another project related to this would be great to be certain, but there is two possibilities suggested to explain why.
One being that the admin staff have had an increased work burden and are unable to carry out this task of sending a letter to the GP. Another reason suggested was a lack of resident doctors emailing and alerting the admin staff of patients and their details. The checklist has clear details on how to alert the admin staff of the patients who have had the infusion but that section might not be getting done.
Meaningful improvement
A clear and well-structured audit that highlights meaningful improvements in patient safety and prescribing practice following implementation of a checklist. The authors demonstrate sustained gains across multiple cycles, particularly in renal and vitamin D monitoring, counselling, and correct prescribing of IV zoledronic acid, despite junior doctor turnover.