Use of an inpatient checklist to improve administration process and follow up communication of Zoledronic Acid for osteoporosis

Introduction

Zoledronic Acid has been shown to reduce the incidence of vertebral, non-vertebral and hip fractures[1]. Once Zoledronic Acid has been administered as an inpatient, follow-up communication to primary care teams should be completed however no formal process was in place. A checklist was developed to ensure consistency in administration processes on Care of the Elderly wards and to ensure adequate documentation and appropriate follow-up communicated to primary care teams.

Method

Baseline data was collected from 25 patients who received Zoledronic Acid as inpatients under Care of the Elderly at a large acute hospital trust between 01/08/21-30/09/21. Patients receiving routine repeat infusions or receiving Zoledronic Acid for indications other than osteoporosis were excluded. Data was collected from hospital systems including digital health records. A checklist was created in consultation with local osteoporosis specialists. Following implementation, post-intervention data was collected from 20 patients who received Zoledronic Acid between 01/03/22-30/04/22. Data was compared and presented locally.

Results

Following checklist implementation, Zoledronic Acid was prescribed correctly on the first attempt in 95% cases, compared to 52% at baseline. Documentation of patient counselling improved from 8% to 60% of cases and follow up plans were documented on the discharge letter to the GP in over 50% more cases. Using the checklist did not delay administration.

Conclusion

Use of a checklist improved patient safety by enhancing communication with patients prior to administration and by enabling accurate prescriptions of Zoledronic Acid by inpatient prescribers. Furthermore, communication with primary care teams improved. Limitations of the use of the checklist included rotation of junior doctors, and completion of discharge paperwork by clinicians outwith the original treating team. These limitations will provide foundations for future interventions, including further promotion of the checklist and re-assessment thereafter. 1. Black DM, Delmas PD, Eastell R. N Engl J Med 2007; 356:1809-1822