1043 FRAGILITY FRACTURE RISK ASSESSMENT IN THE OLDER PERSON’S RAPID ACCESS CLINIC (OPRAC): A QUALITY IMPROVEMENT PROJECT

Abstract

Abstract Background One-in-two women and one-in-five men >50 years are expected to have an osteoporotic fracture during their lifetime. However, despite this 1-in-5 women who have broken a bone, break 3 or more before being diagnosed, highlighting the importance of early diagnosis. Aim NICE recommends a fragility fracture risk assessment in all women aged >65 and men >75 years. However, during our review of patients attending OPRAC, we found that only 3% of patients had an assessment done. Therefore, the primary aim of this project was to improve risk assessment of fragility fractures in this setting. Method We analysed the data for patients attending OPRAC between 23.09.20–23.10.20 and 01.05.21–15.06.21. We captured 35 and 51 patients respectively and sought to identify what proportion of the population had an accurate height, weight and fragility fracture assessment. We carried out our QIP using the PDSA cycle. Our interventions consisted of departmental teaching, posters and inclusion of fracture risk assessment in our induction handbook. Results The risk assessment went up from 3% to 33% post-intervention and documentation of height and weight went up from 74% to 98%. We retrospectively calculated the FRAX score for every single patient to assess whether the patients were receiving the appropriate treatment according to their risk score. What was consistent across both cycles was that if a patient had a risk assessment done, they were far more likely to have the correct treatment—89% and 82% in cycles 1 and 2 vs. 54% and 30% in those who didn’t have an assessment. Conclusion The above highlights what we already know about the importance of early diagnosis and treatment of osteoporosis. The interventions we have implemented have made a difference however further incorporation of fragility fracture assessments in clinical protocols is needed to bring about sustained change.