Model of support for Fracture Liaison Development and Improvement
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Mayrine Fraser, National Development Manager/Specialist Nurse from the National Osteoporosis Society, Scotland presents at the #Rheum2016 Conference to raise awareness of Fracture Liaison Services.
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Model of support for Fracture Liaison Development and Improvement
- 1. Model of support for Fracture Liaison Development and Improvement Mayrine Fraser National Development Manager/Specialist Nurse National Osteoporosis Society Scotland
- 2. The National Osteoporosis Society • The only UK-wide charity dedicated to improving the prevention, diagnosis and treatment of osteoporosis • Vision: A future without fragility fractures • Mission: Working together for a brighter future for people with or at risk of osteoporosis and fragility fractures across the UK, putting an end to preventable broken bones and helping people to live without pain and disability
- 8. 8 • 300,000 fragility fractures a year • 85,000 unplanned hospital admissions for hip fractures alone • 1.8 million hospital bed days • 1 in 4 people die within a year of suffering a hip fracture • 33% become totally dependent • £1.9 billion in hospital costs What is the impact of fractures?
- 9. 9 What is the impact of fractures? OSTEOPOROSIS
- 10. 10 X
- 11. What is the solution?
- 12. 12 Fracture Liaison Service (FLS) • An FLS is a proven model for fragility fracture prevention • 50% of hip fracture patients have had a prior fragility fracture • All patients > 50 years who fracture are targeted • Where treatment is initiated • Up to 25% hip fractures avoided in future Find them Assess them Treat where appropriate Follow- up
- 13. National Osteoporosis Society Priorities and Plans for 2016 Aim 1: Every person aged over 50 who breaks a bone is assessed for osteoporosis and managed appropriately. Priority 1: Extend coverage of Fracture Liaison Services Priority 2: Improve quality of Fracture Liaison Services and osteoporosis services
- 14. Key recommendations • People with a history of fragility fractures over 50 years should be offered DXA scanning to evaluate the need for anti-osteoporosis therapy • Fracture-risk assessment should be carried out, preferably using QFracture, prior to DXA in patients with clinical risk factors and in whom treatment is to be considered • Measurement of BMD by DXA at hip and spine should be carried out following fracture risk assessment in patients in whom treatment is considered. • Repeat DXA after 3 years may be considered to assess response to treatment. • Patients over 50 with a fragility fracture should be managed within a formal integrated system of care that incorporates a fracture liaison service. SIGN 142 Management of osteoporosis and the prevention of fragility fractures
- 15. 15 Definition of a Fracture Liaison Service An FLS systematically identifies, treats and refers to appropriate services all eligible patients over 50 within a local population who have suffered fragility fractures, with the aim of reducing their risk of subsequent fractures.
- 16. 16 What are the benefits of an FLS? An FLS: • Improves patients’ quality of care • Provides targeted intervention • Enables appropriate prescribing • Prevents pain/suffering • Reduces hospital admissions • Reduces hospital and social costs FLS’s are proven to be cost effective.
- 17. 17 Further benefits • Timely assessment for bone health/falls • Appropriate referral to DXA • Long-term reduction in fragility fractures • Prevention of further falls and fractures • Improves adherence to prescribed medication • Improves quality of life, health & well-being • Potential reduction in mortality rate
- 18. What is the Impact of an FLS? • Reduction in hip fractures • Hip fractures cost £1.9 billion/year • For every 1000 FLS patients assessed in FLS • 18 fractures are prevented • 11 of those are hip fractures
- 19. • FLS Implementation Group • UK FLS Clinical Standards • FLS Implementation Toolkit • FLS Implementation Workshops • Fracture Prevention Practitioner (FPP) Training • Peer Review • Service Delivery Team A National Approach to FLS
- 20. • FLS Implementation Group • UK FLS Clinical Standards • FLS Implementation Toolkit • FLS Implementation Workshops • Fracture Prevention Practitioner (FPP) Training • Peer Review • Service Delivery Team A National Approach to FLS
- 21. Service Delivery Team Sonya Stephenson Service Development Project Manager Will Carr Service Development Project Manager Hilary Arden Head of Service Delivery Tim Jones Commissioning Advisor Mayrine Fraser Service Development Project Manager Debbie Stone Service Development Project Manager Fiona Gardner Operation Projects Officer Henry Mace Professional Development Lead Jo Sayer Service Development Project Manager
- 22. • Facilitate stakeholder engagement • Help establish patient/care pathway • Project manage commissioning/funding: o The economic and business case o Service specification o Resource and capacity planning • Work with commissioners to ensure services are sustained. How the Charity Supports Implementation
- 23. • Provide input to enable the development of an FLS meets the UK FLS Clinical Standards • Help establish data collection, analysis, evaluation and reporting • Identify gaps in service provision, put in place improvement plans and monitor against agreed actions • Peer review How the Charity Supports Implementation
- 24. 24 FLS Coverage England NI/IOM Scotland Wales UK 2015 FLS Coverage 47/141 (33%) 4/6 (80%) 7/14 (50%) 6/11 (55%) 64/171 (37%) Supporting New Service Development 44 0 2 4 50 Supporting Quality Improvement 48 6 12 6 72 Number of additional sites engaged 24 3 2 6 35 Total/Potential number of FLS 116/141 (82%) 9/9 (100%) 16/16 (100%) 16/16 (100%) 157/182 (86%) No. of services commissioned 7 0 0 0 7
- 25. How Good is the FLS?
- 26. 26 Clinical Standards for FLS
- 27. UK FLS Clinical Standards The 5IQ approach describes the key objectives of an FLS: • Identification • Investigation • Information • Intervention • Integration • Quality www.nos.org.uk/fls
- 28. 28 No. Standard Rationale 1 IDENTIFICATION All patients aged 50 years and over with a new fragility fracture or a newly reported vertebral fracture will be systematically and proactively identified. Patients who have sustained a fracture are at higher relative risk of fracture than those who have not. Targeted interventions in this population will have most impact on reducing the future fracture burden. 2 INVESTIGATION Patients will have a bone health assessment and their need for a comprehensive falls risk assessment will be evaluated within 3 months of the incident fracture. Assessments need to be conducted promptly as the risk of having a further fracture is increased in the first year. 3 INFORMATION All patients identified will be offered written information about bone health, lifestyle, nutrition and bone- protection treatments. Anyone aged over 50 years who has had a fracture needs to be aware of the steps they can take to maintain healthy bones and prevent further fractures. 4 INTERVENTION Patients at increased risk of further fracture will be offered appropriate bone-protection treatments. Appropriately targeted interventions reduce future risk of fracture. 5 INTERVENTION Patients at increased risk of further falls will be referred for appropriate assessment or interventions to reduce future falls. Evidence-based falls interventions are effective at reducing risk of falls. FLS Clinical Standards - summary
- 29. 29 No. Standard Rationale 6 INTEGRATION Management plans will be patient-centred and integrated between primary and secondary care. Effective communication is essential to ensure that long-term management is achieved and that patients are supported to engage with recommended interventions. 7 INTEGRATION Patients who are recommended drug therapy to reduce risk of fracture will be reviewed within 4 months of initiation to ensure appropriate treatment has been started, and every 12 months to monitor adherence with the treatment plan. Treatments must be taken consistently and appropriately over many years to be effective. Follow-up allows early identification of issues (side effects, compliance) with prescribed medications, reinforces need to take treatments and supports long-term concordance. 8 QUALITY Core clinical data from patients identified by the FLS will be recorded on a database. Regular audit and patient experience measures will be performed Data recorded will allow the FLS to audit and improve the service they provide ensuring that high standards are met and maintained. 9 QUALITY The FLS team will have appropriate competencies in secondary fracture prevention and will maintain relevant Continued Professional Development (CPD). All staff need appropriate knowledge, skills and experience to fulfil their role. Engagement with relevant CPD activities ensures that these are up to date. 10 QUALITY The FLS should engage in a regular peer-review process of quality assurance. Clinical peer review facilitates quality standard assurance, equitable access to services, and provides a means of benchmarking and sharing best practice. FLS Clinical Standards - summary
- 30. 30 Gap Analysis Gap Analysis establishes to what degree an existing service is ‘performing’ against the Standards • Informative • Detailed • Specific • Targeted • Constructive
- 31. Gap Analysis
- 32. The FLS model/pathway NEW CLINICAL FRACTURE NEW VERTEBRAL FRACTURE (RADIOLOGY REPORT) ORTHO IP Virtual/ # CLINIC ‘CASE-FINDING’ BY FLS‘CASE-FINDING’ BY COTE CARE OF THE ELDERLY
- 33. The FLS model/pathway NEW CLINICAL FRACTURE NEW VERTEBRAL FRACTURE (RADIOLOGY REPORT) PREVIOUS FRACTURE OR FRACTURE NOT PRESENTING TO ACUTE CARE ORTHO IP Virtual/ # CLINIC ‘CASE-FINDING’ BY FLS‘CASE-FINDING’ BY COTE ‘CASE-FINDING’ BY GP/SEC CARE/CH FLS RISK ASSESSMENT ONE-STOP CLINIC WITH DXA CARE OF THE ELDERLY
- 34. FLS Nurse Led Clinic • Patient brings completed self history questionnaire • Height & weight measurements • DXA scan - radiographer • Bloods as per protocols? • Patient meets with osteoporosis nurse specialist • Questionnaire • DXA scan result
- 35. FLS Nurse Led Clinic • Discuss risk factors for falls and fracture • Discuss results of DXA scan • Discuss treatment if required as per protocols & FRAX • Provide lifestyle advice/education • Provide literature Drug treatments Lifestyle Fall prevention NOS • Arrange follow up at 4& 12 months • Refer for physiotherapy? • Refer to Community Falls Prevention Programme? • Refer onto Bone Metabolism Clinic if required?
- 36. Hospital-based Exercise Classes • Assessed by a physiotherapist before starting the classes • 12 week introductory programme • Run by a physiotherapist Leisure centre exercise classes • Suitable for long term conditions • Continue long term
- 37. Stage 1 General education (1:1) Linking their fracture with need for assessment for osteoporosis Stage 2 Specific education (1:1) Personalising education, with interpretation of DXA, fracture risk & need for treatment Stage 3 Empowerment (Group) 2.5hr interactive education programme 6-12mo after starting Rx
- 38. 14.00 Welcome 14.05 Treatment options 14.30 Pharmacy review 14.50 Exercise classes/falls prevention 15.15 Pain management 15.30 National Osteoporosis Society 15.45 Q & As Newly diagnosed education meetings
- 39. 39 Community Falls Prevention Programme • Specialist Falls service • Over 65, live at home and had a fall in last year • Aim to prevent further falls • Falls screening, health education, exercise, rehab and onward referral • Home visit within 7 days
- 40. The FLS model/pathway FALLS RISK ASSESSMENT NEW CLINICAL FRACTURE NEW VERTEBRAL FRACTURE (RADIOLOGY REPORT) PREVIOUS FRACTURE OR FRACTURE NOT PRESENTING TO ACUTE CARE ORTHO IP Virtual/ # CLINIC ‘CASE-FINDING’ BY FLS‘CASE-FINDING’ BY COTE ‘CASE-FINDING’ BY GP/SEC CARE/CH FLS RISK ASSESSMENT ONE-STOP CLINIC WITH DXA EXERCISE CLASSES Rx FOR FRACTURE 2Y PREVENTION EDUCATION PROGRAMME CARE OF THE ELDERLY 4 & 12 MONTH FOLLOW UP CLINIC COMPLEX CLINIC (IF REQUIRED)
- 41. 41 Challenges • Different models suit different services • Who and to what age for DXA? • 75+ No DXA (NICE) • No age restriction for DXA (SIGN) • Pathway - explicit when/whom to refer falls • Responsibility of blood tests - FLS/GP/referrer? • Following up complex cases – who is responsible?
- 42. 42 Challenges • Inpatient hips • Other inpatients (k-wiring and plates) • Patients included who fall/fracture on other wards • Fracture/virtual clinic • Spinal fractures • Radiology – incidental spinal fractures Who may be missed? • Patients attending emergency department not having any follow up i.e. clavicle, ribs, pubic rami. • Patients admitted for other reason and fracture identified on an X-ray …….
- 43. 43 How can the NOS help in your area?
- 44. 44 FLS Mapping
- 45. Assist with Stakeholder Meetings • Lead clinician/local champion • Consultants: o Endocrinologist o Rheumatologist o Geriatrician o Radiologist o Orthopaedic surgeon • Osteoporosis nurse specialists • DXA radiographers • Service manager/s • Pharmacist • Prescribing advisors • Physiotherapist • GPs/Primary care • CCGs • Commissioners • Health & Wellbeing Board/s • Public Health • IT • Site services • Patient rep (NOS!)
- 46. 46 • Comprehensive service review- professional credibility • Assessment of Service • Clinical Governance Quality Assurance Peer Review
- 48. Fracture Prevention Practitioner (FPP) Training • Officially launched April 2015 • Web-based training at Foundation and Advanced levels • 478 healthcare professionals registered • 120 accredited FPPs • Accessed by over 130 different hospital trusts and GP practices • Accessed from across 15 different countries (US, AUS, NZ, SA, CA, ROI, FR)
- 50. 50 FLS Implementation Toolkit 1. Promotes commissioning of effective high-quality services that are integrated within a system-wide approach 2. Ensures services are in accord with the evidence base and able to demonstrate outcomes 3. Stimulates provision of services that are sustainable 4. Make implementation easier, cheaper and more effective for commissioners and providers.
- 51. Contents Name Description Format UK FLS Standards Clinical standards for FLS PDF The Case for FLS A summary of evidence for providers and commissioners PDF Service Specification A part populated service specification suitable for use with NHS Standard Contracts MS Word Benefits Calculator A financial model demonstrating potential cost savings Web Cost Calculator A financial model to calculate the service requirements MS Excel Service Improvement Guide A descriptive guide setting out step-by-step actions for providers to achieve a service improvement PDF Outcome and Performance Indicators Practical, evidence-based indicators to demonstrate service improvement MS Excel Improvement Project Plan A list of tasks and activities for a development project MS Excel Business Case Part populated case for investment in FLS MS Word
- 52. To secure funding / reimbursement you need to show… Benefits less Costs = Value
- 53. FLS Benefits Calculator & Cost Calculator • Offer help and support based on Gap Analysis Tool to develop or improve an FLS • Estimates the benefits in terms of reduced fragility fracture incidence and cost savings that can be realised as a result of implementing an effective FLS. • Calculates the cost of resources required (in progress) • Produce an ‘Output report’, ‘Case for FLS’, SBAR and business plan if requested that can be submitted to Management
- 54. 54 Two calculators • Have been designed by clinicians and payors • Have been used in more than 30 sites • Are regularly updated and revised • Are based on proven service models • Are based on empirical data (not clinical trials) • Use local age-stratified population
- 55. 55 The FLS Benefits Calculator There is an online version (UK only) at http://benefits.nos.org.uk
- 56. 56 Define population Step 2 - Select population cohort for analysis (by age/gender) Male Female Include within analysis? Yes Yes Age from 50 - 54 50 - 54 Age to 85 + 85 + Percent of population in hospital catchment Population for inclusion 97.0% 234,200 10.0% 7,560 Select one or more from list NHS Oxfordshire CCG NHS Aylesbury Vale CCG
- 57. 57 Estimate fracture incidence from population Hip fracture (inpatient) Other fracture site (inpatient) Other fracture site (outpatient) Clinical vertebral Number of fractures expected based on incidence data 324 371 1,292 297
- 58. 58 Estimate number to be treated Reference Hip fracture (inpatient) Other fracture site (inpatient) Other fracture site (outpatient) Clinical vertebral Number of fractures expected based on incidence data 1 765 876 3,047 702 677 463 1515 210 Hip fracture (inpatient) Other fracture site (inpatient) Other fracture site (outpatient) Clinical vertebral Proportion of patients to be seen in the FLS 2 88.48% 52.81% 49.72% 29.84% Hip fracture (inpatient) Other fracture site (inpatient) Other fracture site (outpatient) Clinical vertebral Predicted number of FLS patients by category 677 463 1,515 210 Svedbom et al, Epidemiology and Economic Burden of Osteoporosis in UK, Archives of Osteoporosis, 2013 8:137, P212 Incidence is calculated for age bands selected and applied to the input population. Parameters for 'Other site' in Calculator is calculated from 'forearm' and 'other' in source paper above.
- 59. 59 Apply rate of prevention Department of Health, Fracture prevention services: An economic evaluation, 2009 Hip fracture (inpatient) Other fracture site (inpatient) Other fracture site (outpatient) Clinical vertebral Expected proportion of fractures prevented 2.26% 1.13% 1.13% 0.75% Year Hip fracture (inpatient) Other fracture site (inpatient) Other fracture site (outpatient) Clinical vertebral 2016 31.42% 40.16% 40.16% 31.44% 2017 22.29% 19.69% 19.69% 25.71% 2018 22.86% 17.32% 17.32% 21.90% 2019 14.29% 14.17% 14.17% 13.33% 2020 9.14% 8.66% 8.66% 7.62% All years 100.00% 100.00% 100.00% 100.00%
- 60. 60 Calculate number of fractures prevented Number of fractures prevented in each of 5 years for patients treated all years Year Hip fracture (inpatient) Other fracture site (inpatient) Other fracture site (outpatient) Clinical vertebral 2015 6 4 4 2 2016 11 6 6 4 2017 16 8 8 5 2018 19 10 10 6 2019 21 11 11 7 All years 73 39 39 24
- 61. 61 Multiply by benefits per fracture References – various, available on request Estimated costs Hip fracture (inpatient) Other fracture site (inpatient) Other fracture site (outpatient) Clinical vertebral Acute care £7,791 £1,715 £314 £1,867 Community and primary care £448 £57 £57 £59 Social care £8,237 £150 £150 £2,908 All £16,476 £1,922 £521 £4,833
- 62. 62 Year Hip fracture (inpatient) Other fracture site (inpatient) Other fracture site (outpatient) Clinical vertebral Total Average benefit per year Acute care 2016 £162,580 £23,257 £4,264 £13,636 £203,737 2017 £284,515 £35,780 £6,560 £23,376 £350,231 2018 £414,579 £46,514 £8,528 £33,116 £502,737 2019 £495,869 £55,459 £10,168 £40,908 £602,404 2020 £552,772 £60,826 £11,152 £44,804 £669,554 All years £1,910,315 £221,836 £40,672 £155,840 £2,328,663 £465,733 Year Hip fracture (inpatient) Other fracture site (inpatient) Other fracture site (outpatient) Clinical vertebral Total Average benefit per year Community and 2016 £8,960 £741 £741 £413 £10,855 primary care 2017 £15,680 £1,140 £1,140 £708 £18,668 2018 £22,848 £1,482 £1,482 £1,003 £26,815 2019 £27,328 £1,767 £1,767 £1,239 £32,101 2020 £30,464 £1,938 £1,938 £1,357 £35,697 All years £105,280 £7,068 £7,068 £4,720 £124,136 £24,827 Year Hip fracture (inpatient) Other fracture site (inpatient) Other fracture site (outpatient) Clinical vertebral Total Average benefit per year Social care 2016 £164,740 £1,950 £1,950 £20,356 £188,996 2017 £288,295 £3,000 £3,000 £34,896 £329,191 2018 £420,087 £3,900 £3,900 £49,436 £477,323 2019 £502,457 £4,650 £4,650 £61,068 £572,825 2020 £560,116 £5,100 £5,100 £66,884 £637,2000 All years £1,935,695 £18,600 £18,600 £232,640 £2,205,535 £441,107
- 63. 63 The FLS Cost Calculator This is not available on line
- 64. 64 What investment is required? • Cost of staff required: • Manager? • Consultant – clinical supervision • Nurse specialist/fracture practitioner • Clerical/admin • Set up costs – FLS accommodation, IT, DXA scanner and other associated costs: • DXA scans/reporting • Other diagnostics • Drug costs
- 65. The financial case • Costs = 37% of benefits • Break even – 13 – 20 months from start of service
- 66. 66 FLS Benefits Area Population Cohort (50+) Hip fractures prevented* Total benefits (of hip fractures prevented)* Bradford 459,142 129,011 119 £1,960,644 East Sussex 374,801 167,905 188 £3,097,488 Epsom 405,456 119,974 115 £1,894,740 Rotherham 258,751 96,591 66 £1,111,902 Salisbury 144,835 59,786 59 £972,084 Stoke-on-Trent 214,991 88,334 88 £1,449,888 Vale of York 348,363 131,411 128 £2,108,928 Total 2,206,339 793,012 763 £12,595,674 *Over a 5 year period
- 67. Conclusion • Targeting people at the highest risk of further fracture • Transforms post fracture care – providing a holistic approach to care – thinking long term • Equal opportunity to all patients within catchment area - not postcode driven (not relying on GP’s or Orthopaedic surgeons to refer pts) • Drug treatments/lifestyle advice are recommended appropriately dependent on scan result • NOS are here to help!
- 68. 68 Abstract deadline: 3 June 2016 Early-bird registration deadline: 5 August 2016 www.nos.org.uk/conference
- 69. Thank you
- 70. 70 Mayrine Fraser National Osteoporosis Society Camerton Bath BA2 0PJ Tel: 07515 574789 Email: m.fraser@nos.org.uk Website: www.nos.org.uk Contact information
Editor's Notes
- Focus is provision of FLS. I want to share our story and
- What is the problem? And it’s a big problem- bigger than you think Can you quantify the problem in your country, region, locality? Do you know your population figures – for hip fracture & fragility fractures.
- More than breast cancer Men more than stroke and MI together
- Creating awareness – locally, regionally, nationally
- Powers of persuasion – create your argument/case for support
- This is more bed days than heart attack and stroke combined Currently rising to £2.2 billion by 2025
- So the first fracture does not lead to a hip or vertebral fracture.
- We are fairly confident we know the answer
- *Within 3 years of pharmacotherapy – reduction in incidence of re-fracture by 20-70%
- So when it came to developing our core aims as a charity – FLS fitted in rather well
- Hilary QIPP: Quality, Innovation, Productivity and Prevention – for making decisions and patient care and use of resources
- Alistair McClellan For every 1000 patients assessed 18 fractures are prevented (11 hips) Glasgow
- What have we done and how did we do it? Top down with FLS-IG – National Stakeholders & Government (both NHS England and Public Health England) Bottom up with Service Delivery Team through direct contact and support using the relevant resources developed
- Bottom up with Service Delivery Team through direct contact and support using the relevant resources developed
- SDT provides bespoke individualised support to services: Project management for commissioning of FLS Reports Development and Mentoring of services
- The NOS gets contacted for support… We then follow up by phone, email, face to face meeting, etc…
- Updated 03/2/16 Supporting New Service Development – assisting in the implementation of new services where no FLS exists Supporting Quality Improvement – providing peer support with regards efficiency of existing services; and quality improvement through commissioning of additional staff/resources for an existing service Additional sites in contact – contact made with potential FLS sites but no measurable service implementation or quality improvement work has yet taken place Number of services commissioned – sites/areas where new FLS have been successfully commissioned or existing services have been enhanced through successful commissioning. NB these are not in addition to the totals above; they represent a commissioning/business case success but sites will continue to require on-going support as the new services come ‘on-line’
- Some hospitals only have a part service (just a slice a cake ) Others have a very full service which covers all aspects of the NOS standards ( icing and cherries on top on their cake) Others somewhere in the middle Jo- Equity and Quality of FLS is essential in order to achieve the potential benefits of preventing up to ¼ of future Hip # Nos Priority 2016 1. extend coverage of FLS 2. Improve the quality of FL and Osteoporosis Services across UK. KEY to a successful service is Quaility
- In 2015 NOS published The clinical stanards for FLS – Contributions from of UK s specialist s and endorsements from the relevant National societies and professional colleges eg RCP /BOA. The forward was written by our National director for Trauma Chris Moran . The FLS clinical standards - the 5 IQ approach clearly defines an FLS Describe what ‘good’ looks like Underpin FLS-DB ( Launch Jan 2016 ) Alignment of variables Support clinicians Support commissioning Drive quality Ensure benchmarking Enhance patient care Each IQ has actions to provide clinical structure
- Identification - finding patients with new, low trauma #’s at the time of # who will benefit from investigation; (potential to extend scope to include identification of patients with prior #) Investigation – incorporating fracture risk FRAX with DXA to determine modifiable risk that merit intervention; also includes tests to identify underlying causes of secondary osteoporosis including bloods and assessment of falls Information – ensure the patient knows enough about the condition with leaflets etc. to maintain healthy and prevent fractures Intervention - written Information educating patients about falls and fracture risk Intervention – ensure patients are treated for bone health and referred for detailed falls assessment as appropriate
- Integration - effective communication sharing patient specific management plans with the patient and other health professionals to ensure long term treatment concordance Integration – FOLLOW UP AT 4/12 AND 12/12 so treatment is taken consistently and appropriately over given years. Quality - optimising the delivery and organisation of the service through data collection and audit Quality – ensuring nurse/coordinator has appropriate competencies to deliver the service FPP Peer review - by another team to ensure standards
- WC In UK Gap Analysis is structured questioning with key clinical staff to establish degree of existing service against the Standards Informative – information for the Charity; highlights the Standards to services unaware of them Detailed – precise questioning, into all aspects of sub-categories within main Standards Specific – to the site involved; inclusive of associated services Targeted – goals/actions following consultation in line with what service wants to achieve Constructive – never critical; suggestive
- In the Clinical Setting we provide GAP analysis against our Standards Compare the best practices with the processes currently in place in your organisation. Determine the “gaps” between your organization’s practices and the identified best practices. Select the best practices you will implement in your organisation. Reviewing Identification how and where and How Many ? /All over 50 years Investigations - What ? Assessments & Time Scales ? Information - What ? Intergration - Communication between Patient and other Healthcare professionals & follow up Quality – Data recording and Audits Professional training Peer review This is beneficial throughout the service development and future improvement Welcomed by all our professionals
- SS Secondary/primary models -decide Pathway when to refer falls ?ED in a week urgent medical review , or if 1 black out but was l2 months ago medical assessment but not today. If tripping at home send ot/pt/generic worker around to house , consider foot wear, eye test for vision and depth perception Balance or exercise classes for ongoing mobility. Who responsible for bloods? Coordinator, GP clarity as to who is dealing with deplete vit d or high urea Complex cases – in your pathway have an arm for complex patients , who is seeing them , who can refer on, or does this have to go back to the gp ? referring them following them up. Could be nurse/coordinator referral and copying in endocrinology but gp needs to do the referral form Polypharmacy – if identified who is going to address this, ortho geri clinic, gp , pharmacist etc etc be explicit
- SS Other patients – consultant walk past k wiring patient in next bed to a hip fracture Radiology – consider a weekly vertebral fracture search if radiologists are reporting in a similar way Incidental #’s where patient is admitted for a copd and found to have a spinal fracture on x ray needs including or referral made to FLS Which ever pathway , it needs to follow 5IQ and NOS 10 standards
- Updated 3/2/16 Green = new services being developed from scratch (nothing) Blue = contact only at this stage Purple = quality improvement of service through peer support Yellow = quality improvement of service through additional commissioning
- The NOS are committed to the standards and encourage the engagement of all the stakeholders to achieve the Standards. Some localities can include missing standards within their organisation straight away; however others may need to address service development more fully through a business case First step - Organise for a big meeting with interested parties
- NOS offers a Comprehensive Peer review of FL and Metabolic Bone services, This provides Quality assessment and assurance of clinical care to improve performance, based around professional credibility. It addresses areas Clinical Governance, Service development Professional Development / Revalidation
- WC Officially launched April 2015 @ BSR Accessed by hospitals and GP practices Endorsed by 10 leading educational and professional bodies Accessed from across 15 different countries including US, AUS, NZ, SA, CA, ROI, FR…….. Standard and Advanced modules
- We have developed an online training programme for fracture prevention practitioners (FPP) Easily accessible, accredited web-based training Will establish a knowledge quality standard and certification at basic and advanced level Clinical knowledge in secondary fracture prevention Multi-media resources Online training Formal accredited exam: Foundation and Advanced level Evidence of training & competence; quality Assurance Continuing professional development Re-validation Accredited by RCP & RCGP
- Toolkit developed to support providers and commissioners (Payors) to enable commissioning of services This tool – like a fishing rod
- Need to test the hyperlink TJ NOS developed benefits calculator to Estimate fracture incidence for specific UK CCG populations Estimate number of fractures prevented over 5 years Estimate financial benefit based on fractures prevented
- Need to test the hyperlink TJ NOS cost calculator to Work out costs of service
- TJ Choose 2 x 0.6 over 1.2 WTE to give continuity Consider lower grade if no experience Grow your own from ortho/rheum/medicine Mandatory training (+FPP as a minimum) Annual leave Study leave Term time contracts Other roles – senior nurse bleep holder Travel to clinics if on other sites Plan for succession planning/turnover of staff Maternity/Paternity leave Make the service attractive to work for!............
- Updated 13/1/16 (FLS Benefits Calculator v2.8) Bradford population includes Bradford City CCG and Bradford District CCG East Sussex population includes Hastings & Rother CCG, and Eastbourne Hailsham & Seaford CCG Epsom is based at St Helier Hospital, population includes Merton and Sutton CCGs combined Salisbury population is 30% that of Wiltshire CCG Stoke population shown here is that of N.Staffs CCG (since that was the CCG that was found through peer review not to be commissioning the service. As a result of peer review, N.Staffs CCG approved funding of the service too).
- TJ
- THANK YOU FROM WILL AND SONYA Acknowledgements – SDT - Hilary, Tim, Jo, Mayrine, Debbie, Henry, Fiona; and all at NOS