Authors (including presenting author) :
Chan KW, Tsang WY, Tse CPS, Yu CKE, Choi KL, Cheung YP, Chan TJ
Affiliation :
Department of Orthopaedics and Traumatology, Prince of Wales Hospital
Introduction :
Early identification, investigation, initiation of treatment and integration of follow-up are the key elements in managing fragility fracture to prevent secondary fragility fracture and promote patient’s bone health. Nurses are in the best position to coordinate the identification, coordinate investigation and integration of follow up. In view of increasing demand of vertebral compression fracture (VCF) patient, a Nurse-led Service was developed in the management of VCF in Prince of Wales Hospital since May 2017.
Objectives :
1) To relieve the doctor workload in caring patient with VCF
2) To prevent patient suffering from further fragility fracture
Methodology :
Patients with VCF were recruited to this Nurse-led service. Osteoporosis workup including densitometry, blood tests and X-ray were arranged by nurse. Health education on pain relief, risk factor of osteoporosis and the management were also carried out in the first visit. These patients would then be assessed by Medical Officer in the second visit and prescribed anti-osteoporosis treatment. Non-complex case would be followed-up in nurse clinic for osteoporosis treatment; which include monitoring the drug compliance, reinforcement of fall prevention and lifestyle modification. Patient would be arranged to repeat the osteoporosis workup and reviewed by medical officer in two-year interval.
Result & Outcome :
Total 112 patients were recruited into the Nurse-led service. Seventy percent of patient (n=78) was prescribed with anti-osteoporosis treatment and followed-up in nurse clinic, 24% of patient (n=27) was reviewed and discharge by medical officer, 4% (n=5) of patient was continuous followed-up by medical officer due to the complexity of disease and 2% of cases (n=2) was defaulted the subsequent follow-up.
Nurse clinic plays an important role in reducing the medical follow-up session from 376 times to 111 times, and greatly reduced the medical workload by 70%.
During the follow-up period, 91% (n=71) of patient reported no fall injury, 6% (n=5) has fall injury but didn’t sustained any fracture. Three percent (n=2) of patient found sustained atypical fracture (n=1) or sustained hip fracture after fall incident.
Nurse-led service is an effective way to relieve medical workload and effective in increase patient’s awareness of fall prevention hence to prevent them from secondary fragility fracture.
