Introduction Over 500,000 fragility fractures occur in the UK each year (1). NICE guidelines state that all women aged ≥65 and all men aged ≥75 should be considered for a fracture risk assessment. It was recognised that locally these guidelines were not being met. The aim of this quality improvement project was to improve the number of patients being assessed for osteoporosis across two medical wards. Method This quality improvement project followed two ‘Plan Do Study Act’ (PDSA) cycles. The first cycle involved teaching sessions for junior doctors on using the FRAX tool—a tool recommended by NICE guidelines to estimate 10-year predicted absolute fracture risk. Posters and visual reminders were placed around the wards. The second cycle involved creating a sticker which was placed in patients’ medical records prompting doctors to calculate FRAX scores and document the results. Patients deemed inappropriate for bone protection and patients already receiving bone protection prior to admission were excluded. Results A baseline set of data showed that 0% of patients had undergone fracture risk assessment, therefore resulting in no patients being prescribed bone protection or being referred to osteoporosis clinic. Repeat assessment after the first intervention showed 29.7% of patients had undergone fracture risk assessment, 13.5% were prescribed bone protection and 16.2% referred to osteoporosis clinic. After the second intervention, 80% of patients had undergone fracture risk assessment, 10% were prescribed bone protection and 55% referred to osteoporosis clinic. Conclusion Use of the FRAX tool was moderately increased by the targeted training of junior doctors and markedly increased by using a visual memorandum in the patient records. This led to an increase in treatment for osteoporosis, reducing patients’ future risk of fragility fractures. References 1. National Osteoporosis Society. Susan’s story: Osteoporosis 2017. https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2017/02/rightcare-susans-story-full-narrative.pdf

中文翻译：

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2303 改进区级综合医院骨质疏松症的评估和管理


简介 英国每年发生超过 500,000 例脆性骨折 （1）。NICE 指南指出，应考虑对所有 ≥65 岁的女性和所有 ≥75 岁的男性进行骨折风险评估。人们认识到，当地没有满足这些准则。该质量改进项目的目的是提高两个内科病房接受骨质疏松症评估的患者数量。方法 该质量改进项目遵循两个“计划、执行研究法案”（PDSA） 周期。第一个周期涉及为初级医生提供使用 FRAX 工具的教学课程，该工具是 NICE 指南推荐的工具，用于估计 10 年预测的绝对骨折风险。病房周围张贴了海报和视觉提醒。第二个周期涉及制作一个贴纸，该贴纸贴在患者的病历中，提示医生计算 FRAX 分数并记录结果。被认为不适合骨保护的患者和入院前已经接受骨保护的患者被排除在外。结果 一组基线数据显示，0% 的患者接受了骨折风险评估，因此没有患者被开具骨骼保护处方或被转诊至骨质疏松症门诊。第一次干预后的重复评估显示，29.7% 的患者接受了骨折风险评估，13.5% 的患者接受了骨骼保护，16.2% 的患者转诊至骨质疏松症门诊。第二次干预后，80% 的患者接受了骨折风险评估，10% 的患者接受了骨骼保护，55% 的患者转诊至骨质疏松症门诊。结论 通过对初级医生的针对性培训，FRAX 工具的使用量适度增加，而在病历中使用视觉备忘录则显著增加。 这导致骨质疏松症治疗的增加，降低了患者未来发生脆性骨折的风险。参考资料 1.国家骨质疏松症协会。苏珊的故事：骨质疏松症 2017。https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2017/02/rightcare-susans-story-full-narrative。PDF格式