366 Vitamin D3 Assessment and Supplementation in Elderly Hip Fracture Patients: A Closed Loop Quality Improvement Project

Abstract

Abstract Aim to improve the assessment and supplementation of vitamin D3 in elderly hip fracture patients in a trauma unit. Method This is a single-centre quality improvement project utilising the PDSA cycle based in a trauma unit covering the black country within the West Midlands. Data was collected retrospectively using the National Hip Fracture Database and hospital electronic systems such as clinical web portal, ICE, GP records, edischarge and ePMA. Inclusion criteria consisted of patient age greater than 60 with a radiologically confirmed neck of femur fracture, treated operatively with an orthogeriatrics review within 72 hours of admission, and COVID-19 negative PCR. Pre-intervention data included 15 patients from July 2020. We assessed 3 parameters including pre-admission vitamin D3 supplementation, measurement of vitamin D3 during admission and vitamin D3 supplementation on discharge. Interventions placed in February 2021 comprised of a postoperative hip blood profile pathway on ICE and guidelines on how to order bloods were circulated with information posters. In addition, teaching sessions for doctors and nurses with twice weekly orthogeriatric reviews emphasising bone protection. Post-intervention data included 15 patients from April 2021. Results Improvement in vitamin D3 level assessment during admission; 20% to 93.3% however, decline in vitamin D3 supplement prescribed on discharge; 73.3% to 26.7%. Conclusions Interventions showed an improvement in quality of vitamin D3 assessment however, the decline in supplementation on discharge may be due to further planned intravenous bone protection bisphosphonate therapy and miscommunication due to ward doctors rotating every 4-6 months on how to appropriately assess and supplement vitamin D3 levels.