Breaking bones, breaking barriers to treatment

Victoria Western, Pharmacist Independent Prescriber With kind support from the Royal Osteoporosis Society


Cardiff and Vale University Health Board


This Bevan Exemplar project utilised a specialist prescribing pharmacist to initiate bone protection treatment following identification of osteoporotic vertebral fractures.


Background


Osteoporosis is a condition where your bones lose strength, making you more likely to fracture a bone. These fragility fractures can have a huge impact on a patient, their independence, their family, social care systems and the NHS.


Treating patients who have been diagnosed with an osteoporotic fracture helps to reduce the incidence of future fractures and their associated complications:

  • More fractures

  • Chronic pain

  • Loss of independence

  • Impaired physical function

  • Deformity

  • Immobility

  • Low self esteem

  • Depression


Patients diagnosed with osteoporotic vertebral fractures within the Trauma Directorate at Cardiff & Vale University Health Board (CVUHB) do not routinely receive information about their condition, nor are they offered treatment to lower their future fracture risk. This is in contrast to the robust assessments performed for all patients admitted with osteoporotic hip fractures.


Aims

  • Ensure all osteoporotic vertebral fracture patients admitted to the Trauma Directorate receive a bone health assessment.

  • Educate patients about their diagnosis of osteoporosis.

  • Initiate treatment at the point of diagnosis.

  • Improve access to timely, comprehensive treatment.

  • Perform meaningful interventions that positively impact health.

  • Empower patients by involving them in the decision making process and development of treatment plans.

  • Assess patients during their hospital admission to reduce the need for additional outpatient and GP appointments.

  • Enhance patient engagement, experience and outcomes.


Challenges

  • Balancing existing roles with providing additional services.

  • Establishing logistics and ensuring clinic capacity for any referred patients.

  • Generating engagement with other linked specialties.

  • Gaining IT support to ensure electronic treatment plans are accessible to other healthcare professionals.

  • Gaining support from Finance partners to fund the service.


Outcomes

  • All vertebral fracture patients received dietary and lifestyle advice and were signposted to additional information sources.

  • Improved patient experience through co-production.

  • No additional medical support was required.

  • No additional appointments were necessary.

  • Reduction in harm through improved access to treatment.

  • Effective use of resources and skilled personnel.

  • Financial savings through prevention of future fractures, in-patient admissions and follow up appointments.



Next steps

  • IT support needs to be maximised for clear communication.

  • Work collaboratively with Radiology to ensure clinical guidelines are followed for effective identification of fractures.

  • Demonstrate that the costs of a Pharmacist Independent Prescriber and subsequent treatments can be offset by the potential cost savings of preventing a future fragility fracture-related hospital admission.



Did you know?

Fragility fractures cost NHS Wales over £108m a year.
Each vertebral fracture accounts for 14 additional GP visits in the year after the fracture. That’s 392,000 GP visits a year.
Over 28,000 osteoporotic fractures are predicted in Wales during 2020, this is predicted to increase to over 35,000 by 2030.


Bevan Exemplar experience has been the most challenging of my career so far; but worth the effort to progress a valuable service for those who need it most.Victoria Western



Part of cohort Bevan Exemplar Projects 2018-19