Evaluation of current practice: compliance with osteoporosis clinical guidelines in an outpatient fracture clinic

Abstract

Better detection and management of osteoporosis will reduce unnecessary health expenditure. A number of high quality guidelines are available to support early detection and best practice management of osteoporosis in hospital settings. However, sustainable implementation of guidelines poses practical issues in terms of structure and processes in hospitals. This paper describes an investigation into guideline compliance in one large tertiary metropolitan hospital and discusses practical elements of guideline implementation.Given the evidence of poor practice across the two audit periods, we recommend that a coordinated clinical pathway be implemented in the fracture clinic, supported by a targeted and disciplinespecific training program. Small steps towards improving awareness and management of osteoporosis in patients presenting for the first time with non-trauma wrist fracture may well produce

Multifaceted guideline implementation strategies improve early identification and management of osteoporosis

“…Thus, this level of sustained success in implementing a multidisciplinary guideline highlights how a planned approach to understanding stakeholder perspectives, philosophies and potential for change can be a powerful driver for change. Despite the disappointing baseline audit findings, 19 the follow-up audits demonstrated that targeted guideline implementation could have a dramatic effect on key indicators, including the identification of patients with likely osteoporosis, and referral by hospital staff to appropriate care, as indicated by the guidelines. This suggests that the immediate guideline implementation phase significantly influenced behaviours of staff, and that the sustained improvement, albeit at a slower rate, demonstrated continuous improvement in behaviours.…”

“…17,18,[20][21][22][23] Based on our knowledge of current performance in the hospital site, 19 we not only identified opportunities for improvement, but also ways in which improvement could occur. Then we made a concerted effort over 6 months from August 2006, to increase awareness of, and compliance with, the osteoporosis guideline recommendations.…”

“…In our earlier paper 19 we found in a retrospective clinical record audit how poorly guidelines for osteoporosis diagnosis and management were incorporated into routine outpatient clinic practice in one large metropolitan hospital in South Australia. As we suspected, there were low levels of identification of at-risk patients by the orthopaedic team, and low compliance with commencing patients who had been identified as at-risk on a coordinated clinical management pathway as per guideline recommendations.…”

“…Communication with the primary health providers or specialists was variable and there was little evidence that the organisational culture included best practice health strategies such as proactive health promotion and osteoporosis prevention. 19 In this paper we present the findings of followup prospective patient record audits which tested whether our efforts to implement best-practice management improved immediate compliance with the clinical pathway.…”

“…19 Four datasets are reported in this paper: the 62 patients (combined) from the two baseline audits, 19 and three post-implementation audits of 31 patients, consecutively identified from patient lists, over the three following 3-month periods. The repeat audit data were stored in Microsoft Excel format (Microsoft Corporation, Redmond, Wash, USA), and the performance indicators were reported as percentages calculated using appropriate denominators.…”