Abstract
An estimated 500,000 people present to UK hospitals with fragility fractures each year with an annual cost of approximately 4.4 billion pounds. NICE CG146 and NICE QS149 recommend that the risk of fracture be assessed in women over 65 years old and men over 75 years old, and in younger people if certain risk factors are identified. One of these risk factors includes the use of high-dose steroids which is defined by QS149 as the equivalent of 5mg prednisolone per day or greater for 3 months or more.
This project aimed to improve the frequency both of fragility fracture risk assessment and bone health intervention in a busy frailty admissions unit in a district general hospital.
Over a four week period we audited how often patients over the age of 65 admitted following a fall or taking high-dose steroids were offered bone health intervention. We subsequently delivered an education session during departmental teaching and created a proforma which we placed above each computer workstation as a visual prompt. We then re-audited for a further four weeks.
Prior to our teaching session and visual prompts only 12% of patients not already on appropriate treatment were offered bone health intervention. After implementation of our measures this increased to 41%.
Our project shows that updated education sessions alongside the use of proformas as prompts is effective in improving the frequency of bone health intervention offered to patients at risk of fragility fractures.
Comments
Thanks Charlotte for the poster and your talk around it.
A 30% improvement in the number of patients who undergo a bone health screen in a four-week period is great!
I was wondering if there were any audit standards that you were comparing against, and what proportion of people you are aiming to be screened in STH during admission as a marker of improved care? Also, why did you choose steroids as the only extra risk in younger patients, I understand the need for simplicity for the flow chart intervention, but why steroids and not other risk factors?
Thank you for your interest in my poster.
The NICE quality standard QS 149 under statement 1 says that only adults with history of falls or fragility fracture or use of steroids should be risk assessed which is why we’ve focussed on those risk factors more specifically in our intervention. The NICE clinical guidance CG146 then goes into more details on targeting risk assessment for a slightly wider patient group. We felt we should be addressing the risk factors in the quality standard as a minimum before expanding to include the other risk factors identified by CG146.
The long-term aim would be that 100% of patients admitted with fall, fragility fracture or on steroids would be risk assessed during their admission to meet the quality standard.
I hope that answers your questions, please let me know if I can clarify any further,
Charlotte