Abstract
Introduction
Fracture prevention is a key component in the care of frail patients who fall. Patients that have already fallen and suffered a fractured neck of femur are highly likely to fall again, and have proven themselves high risk for fracture. Bone protection is a priority, and recent guidelines recommend IV Bisphosphonates as an appropriate 1st line drug. Vitamin D level should be 50 or above before this is given.
Method: I audited the notes of 41 patients age 60 years or over who were admitted in 2022 with a fractured neck of femur. I reviewed their admission Vitamin D level, and whether they required loading with Vitamin D before IV Bisphosphonates could be given. I reviewed the loading regime used, and how many of the patients had received bone protection medication, either as an inpatient or post-discharge. I liaised with 3 other neighbouring trusts to find out their current Vitamin D loading regimens to compare to our own.
Results: The audit identified that 54% of those patients required Vitamin D loading before they could be given IV Bisphosphonates. 36% of those never had their loading regime prescribed, and of those that did all were prescribed a 7 week long regime. 1 patient was already receiving IV Bisphosphonates prior to admission, and continued on those. 4 Patients were prescribed PO Bisphosphonates. 4 patients were Fast-Track or EOL. 7 patients had low CrCl preventing use of bisphosphonates. Of those that remained, none got inpatient treatment. I identified that the long loading regime was proving a barrier, and so drafted a new rapid loading guideline, similar to the practice of nearby trusts. Re-audit to assess the impact of this will be performed in July & August 2023 with results presented at conference