Improving Timely Bone Protection Therapy Following Neck of Femur Fracture: A Quality Improvement Project.

Introduction:
Timely administration of intravenous Zoledronic Acid (ZA) following Neck of femur (NOF) fracture reduces subsequent fracture risk by up to 35% and is recommended by national guidance. Local policy recommends ZA administration between Days 5-8 post-operatively, following a minimum of 4 days of Vitamin D loading. Delays occur due to late counselling, decision-making and treatment coordination.

Aim: To identify delays in ZA administration in eligible NOF patients and implement strategies to improve pathway efficiency.

Methods:
A quality improvement project was conducted at a district general hospital. Data were retrospectively collected from patients admitted to Elm Unit following NOF fracture between January and June 2026. Eligible patients were suitable for intravenous ZA with no contraindications or established alternative bone protection. Two sequential PDSA cycles were undertaken, with 16 eligible patients included in each cycle. Interventions included targeted clinician education and introduction of a bone health proforma within ward-round documentation. Outcome measures included time from first discussion to treatment decision, ZA administration and earliest eligibility.

Results:
Compliance with local policy for ZA administration on postoperative days 5-8 increased from 0/16 (0%) at baseline to 6/16 (38%) in cycle 2. Mean time from first discussion to treatment decision reduced from 7 to 2 days, while time from first discussion to ZA administration reduced from 8 to 5 days. Mean time from earliest eligibility for ZA (completion of 4 days of Vitamin D loading) to administration reduced from 10 to 7 days. Same day consent at first discussion increased from 3/16 (19%) to 10/16 (63%).

Conclusion:
Targeted interventions improved compliance with local policy and reduced delays in bone protection following NOF fracture. Earlier patient counselling and treatment decision-making represented the greatest improvements, highlighting these as important targets for optimising the pathway.