Audit of usage of IV Zoledronate in patients with a NOF fracture in IRH/RAH and documentation on the IDL and ECS.

Background:

Use of bisphosphonates following NOF fracture in patients over the age of 60 has extensive evidence showing up at a 50% relative reduction in fracture risk. However this is variably recorded on the immediate discharge letter (IDL) and subsequently poorly communicated to Primary Care via the emergency care summary (ECS).

Aim:

To review how often IV Zoledronate is used in hospital, documented in the IDL and on ECS, leading to an improvement of documentation and communication between primary and secondary/tertiary care and therefore the safer management and usage of medicines. Method: Retrospective analysis of inpatient administration of IV Zolendronate and its documentation in the IDL text, medication script and ECS for all patients with hip fracture admitted to RAH in October, November and December 2023. Exclusion criteria were patients who died during admission and those without an IDL completed.

Results:

There were 114 patients who met inclusion criteria. Only 25.4% received IV Zoledronate, 72.4% of these patients had this documented in the IDL text however only 6.9% on the IDL medication script. Where IV Zoledronate was on the medication script there was 100% transfer to a patients ECS.

Conclusion and discussion:

The data highlights that when IV Zoledronate is put on their discharge script this is transferred to ECS by community pharmacists, identifying a key part of the documentation pathway to target. On further review of the data we also looked at reasons why patients were not given IV Zoledronate e.g. CrCl <30, previous bisphosphonate course or alternative drug, pathological fractures and patients referred for dental review, accounting for a large portion of the data set, which going forward are other areas to target to increase use of IV Zoledronate. We have implemented a change and aim to re audit and assess whether this has led to any improvement.