Abstract
Introduction
Fragility fractures are associated with significant morbidity and mortality. The National Osteoporosis Guideline Group advise that a FRAX assessment should be completed in all patients with falls. Despite this only 3% of patients admitted to a geriatric ward following a fall had a bone health assessment completed within 72 hours of admission. Our aim is for a bone health assessment to be completed in >90% of these patients.
Method
Our intervention focused on promoting bone health assessment with a ‘FRAX proforma’. This was aimed at junior doctors as the main cohort expected to perform the assessment. The proforma incorporated documentation of the FRAX score including outcome, vitamin D and calcium results, prescribed supplementation and antiresorptives, and a prompt for referral to the fracture liaison service or osteoporosis clinic. The main outcome measure was the percentage of completed bone health assessments using FRAX or Qfracture. Awareness of the proforma was raised through a presentation at a senior health department teaching session and sending an email to all members of the senior health team. Data was collected daily for a week approximately 3 weeks later.
Results
Following our intervention, the percentage of completed bone health assessments increased from 3% to 12%, consistent with a modest improvement. This should translate to a decreased risk of fragility fracture. However, there is ongoing scope to improve. We are planning a further intervention integrating bone health assessment into the ward admission proforma.
Conclusions
Although our intervention has demonstrated a modest improvement, there is scope for further improvement embedding bone health assessment as routine practice for older patients presenting with falls. Future interventions will increase this further by integrating bone health assessment into the existing documentation tools, embedding this as regular practice in the inpatient setting.
Comments
Hello. Thank you for your…
Hello. Thank you for your work on improving bone health assessments on patients admitted with falls. What consideration has been made to administering regular vitamin D to all elderly patients admitted with a fall as opposed to checking their vitamin D levels? What plans are there to evaluate the impact of embedding the bone health assessment into current assessments?
Thank you for your comment…
Thank you for your comment.
In response to your first question, the proforma has a section to document the vitamin D and calcium levels, and if supplementation has been prescribed. This is to encourage doctors to check the levels and prescribe if appropriate, rather than to stipulate that vitamin D and calcium should be prescribed in all patients presenting with a fall. Of course, there will be patients where prescription is not appropriate, such as in those with primary hyperparathyroidism.
In response to your second question, we have gone on to do this with good results. We already had a 'ward admission proforma' which contains prompts such as TEP status and delirium screen. We have added a prompt for bone health assessment. We have seen an increase from 12% to 40% in the wards using the proforma.