191 Improving and Maintaining the Implementation of Local Guidance on Vitamin D Supplementation for Patients with Hip Fracture

Abstract

Abstract Introduction With the number of older persons presenting to hospital with neck of femur (NOF) fractures climbing annually, there is an emphasis on reducing the impact of environmental factors in at risk individuals. The link between vitamin D deficiency and osteoporotic fractures has long been recognised in older populations and is incorporated in Department of Health ‘Best Practice Tariffs’ for hip fracture management. Recommendations state that all patients admitted to hospital with a NOF fracture should be assessed for bone protection, and Wirral University Teaching Hospital has developed local guidance to aid appropriate prescription of vitamin D for patients with a deficiency. Concerns were raised by local Orthogeriatricians that this guidance was not being consistently implemented and a review of current practice was requested. Method A quality improvement project reviewed vitamin D supplementation for all NOF fracture patients over a 3-month period. Subsequently lanyard cards with a summary of local guidance and correct treatment were created and distributed to junior doctors. Compliance with the guidance on measurement and treatment of low vitamin D levels was reviewed after 3 months and a further 12 months. Results Initially the guidance was followed correctly in only 48% of patients. With the implementation of lanyard cards this rose to 78% after 3 months and more encouragingly further increased to 83% after a further 12 months. Conclusions Providing an easily accessible summarised version of local guidance improved measurement of vitamin D levels and appropriate treatment for at risk patients.