Introduction: Bone Health assessment should be a key component of a Falls assessment (NICE, 2004) but a local Falls Clinic audit showed the existing section of the falls proforma was rarely completed. We conducted a Quality Improvement Project focusing on improving osteoporosis assessment in the Falls Clinic.
Change strategies: We confidentially interviewed nursing and healthcare assistants about the reason why the form was often incompletely filled in. There was a perception medical staff did not read or act on the results. Some staff were unsure of certain terminology (e.g. glucocorticoids and malabsorption) so did not complete fields for fear of providing inaccurate information. A complicated flowchart was omitted and the form changed/simplified in line with this feedback. This was approved by all the staff before use. We introduced a routine discussion of osteoporosis at the post-clinic multi-disciplinary team meeting, thus raising the profile and becoming a regular source of education.
Change effects: Following intervention, the proportion of patients with all fields in the FRAX assessment completed improved from 44 to 75%. The percentage of patients already taking anti-osteoporotic agents assessed for compliance and tolerance improved from 0 to 67%. The percentage of patients started on new anti-osteoporotic medication increased from 17 to 25%.
Conclusion: Using an in-depth focussed approach to a specific problem, we have improved the quality of bone health assessment. The process has proved enlightening as many of the changes implemented would not have been considered without anonymously interviewing nursing staff. It is likely that a further factor connected to the improved results is that nursing staff felt a degree of ownership in the changes and felt their views were respected rather than changes instituted without any consultation. We would propose the approach of a Quality Improvement Project involving all relevant staff members to improve defined areas of clinical practice.