OrgCode,FLS Name,Where is the FLS delivered from?,Which NHFD hospitals do you provide the FLS to?,What month and year did you start the current form of FLS? ,How would you describe the current contract?,How many Consultant PAs (per week) are allocated to the FLS?,How much time is spent working within the FLS as the whole time equivalent?,,,Estimated population size,Which patient groups does your FLS cover? Hip fracture (including inpatient fractures),What restrictions are there on the patients seen by your service? ,What restrictions are there on the patients seen by your service? Other response,"If fracture site is a restriction selected, please specify which fracture sites excluded ",How does your site identify hip fracture patients?,How does your site identify hip fracture patients? Other response,How does your site identify other non-hip non-vertebral fracture inpatients? ,How does your site identify other non-hip non-vertebral fracture inpatients? Other response,How does your site identify fracture outpatients? ,How does your site identify fracture outpatients? Other response,How does your site identify patients with vertebral fracture(s)?,How does your site identify patients with vertebral fracture(s)? Other response,"If applicable, what barriers have you experienced in finding patients with vertebral fractures? ","If applicable, what barriers have you experienced in finding patients with vertebral fractures? Other response",Does your site have a process for identifying potentially eligible fragility fracture patients who should have but did not receive assessment for secondary fracture prevention?,Does your site have a process for identifying potentially eligible fragility fracture patients who should have but did not receive assessment for secondary fracture prevention? Please give details,What tests do you routinely use for identifying underlying secondary causes of osteoporosis?,Do you have access to DXA scan or do you use an alternative provider or tool? ,Who assesses the need for treatment? ,Who assesses the need for treatment? Other response,What interventions can be recommended or initiated by the FLS? ,"How do patients obtain their first prescription of bone sparing treatment, if it is recommended? ",Do you routinely provide a falls assessment as part of your FLS?,Which of the following are covered by the falls risk assessment in the FLS? ,"If Assessment of gait, balance and mobility is selected in 6.2 which assessments are used?","If Assessment of gait, balance and mobility is selected in 6.2 which assessments are used? Other response",Who receives the report from your FLS that summarises the outcomes of assessing patient need for treatment to prevent secondary fractures?  ,What information is included in the report?  ,Who is responsible for monitoring patients seen in the FLS?  ,What does the re-evaluation include?  ,How is adherence assessed or re-evaluated? ,How often is there a formal survey seeking patient/carer views on the FLS? ,How many completed responses did you get from your FLS patient survey?,Did you use the ROS patient experience survey? ,Do you use the FLS-DB patient resources?,"Do you use the FLS-DB patient resources? (if no selected, please specify barriers to using them if any)",How often does your FLS have a minuted governance meeting? ,Please list the reporting structures for the governance minutes ,How are patients involved in the governance of the FLS?,How are patients involved in the governance of the FLS? Other response
ADD,Cambridge University Hospitals NHS Foundation Trust FLS,An acute hospital,ADD Addenbrooke's Hospital,Apr-17,Block payment,2,Nurse~band 6~3.6;Nurse~band 7~1,Yes,2 band6 9/12 vacancies,500000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department,,Fracture clinic lists;Emergency Department lists;Other,Opportunistic case finding by orthogeriatricians / medical consultants,Still developing pathway;Other,,Yes,Often identified in OPD TO clinic and FLS clinics,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),DXA available on site,FLS specialist practitioner;Other,Cases discussed at FLS MDT with consultants,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision;Assessment of home hazards,Ask about gait problems,,Patient;Primary care physician;Falls service,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls;Other,Telephone interview,Never,,No,Yes,,1,Rheumatology governance,Patients are represented in the governance meetings,
AHX,Ashford and St Peter's Hospitals NHS Foundation Trust,An acute hospital,SPH St Peter's Hospital,Nov-12,Block payment,0,Nurse~band 7~1,No,,410000,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site,,Scaphoid;Face/skull;Rib;Avulsion,Seen by Orthogeriatric service not FLS,,Not applicable,,FLS visits the orthopaedic/trauma clinic,,Visits spine clinic/reviews letters;Fracture clinic lists,,Still developing pathway,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Serum Electrophoresis;Serum free light chains,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Number of falls in the last 12 months;Assessment for fear of falling,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Current drug treatment recommendations (if applicable);Medication compliance review,Delegated to other healthcare provider,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,Never,,No,Yes,,0,No governance minutes,Patients are not involved in governance,
BAT,Royal United Hospital,An acute hospital,BAT Royal United Hospital Bath,Aug-16,Block payment,0.3,Nurse~band 6~1;Nurse~band 7~0.6,No,,500000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Metacarpal;Metatarsal;Face/skull,Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems,,Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Other,FLS tag included in radiology reports if vertebral fracture identified to allow for text search algo,Lack of standardised practise/language for radiology reporting;Other,Not all radiologists report FLS tag consistently,Yes,Coding send monthly inpatient lists who have had a fracture;Peripheral clinic referrals,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Recurrent fractures,Telephone interview;Postal questionnaire,at least every 3 years,50,Yes,Yes,,1,trust audit;Rheumatology governance,Patients are not involved in governance,
BED,Bedford Hospital,An acute hospital,BED Bedford Hospital,Apr-18,Fixed term then need to renew,1,Nurse~band 7~1;Administrator~band 3~0.2,Yes,"band7, 6months",387947,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site;Other,50 Plus,Ankle;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,NHFD lists;FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Emergency Department lists;Other,X-ray department,Screening general radiology reports;Re-reading radiology images;Fracture clinic lists;Emergency Department lists,,Unable to access radiology images;Other,Sometimes a lack of specification of exact place of vertebral fracture on the report,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Liver function;Thyroid function;Liver function tests;Renal function tests,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care;Falls service;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment;Other,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls;Other,Telephone interview;DXA,Never,,No,Yes,,2,CCG Quality Lead Governance;Escalate any issues for concern through the Commissioning directorate,Patients are not involved in governance,
BEM,Enfield Bone Health and Fracture Liaison,A community care based service,RFH Royal Free Hospital,Aug-13,Block payment,0,Nurse~band 7~3,No,,333794,Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range,,,Fracture clinic lists,,Other IT systems,,Other IT systems,,Other,spreadsheets from secondary care,Not funded;Unable to access radiology images;Lack of engagement with radiology department;Lack of training in identifying vertebral fractures;Other,DXA proviser does not do VFA,Yes,We screen all data from the fracture clinics including all fractures high/low impact/soft tissue,Serum Calcium;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Renal function tests;Coeliac disease screen,Refer to another DXA provider,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision;Assessment of home hazards,Ask about gait problems;Berg balance,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment;Other,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls;Other,Telephone interview,Continuous (every patient),50,No,Yes,,12,Trust audit meeting,Patients are not involved in governance,
BFH,Broomfield Hospital,An acute hospital,BFH Broomfield Chelmsford,Mar-21,Part of hospital general contract with no separate documentation for FLS,0,Nurse~band 7~0.7;Administrator~band 3~0.8,No,,400000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site,,Scaphoid;Metacarpal;Face/skull;Rib,Fracture clinic lists;Trauma lists,,Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems,,Fracture clinic lists,,Unable to access radiology images;Lack of engagement with radiology department;Lack of training in identifying vertebral fractures,,No,,Serum Calcium;Serum 25OH vitamin D,DXA available on site,Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice,FLS recommends therapy to orthogeriatrician and/or primary care physician,No,,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,longer than every 3 years,Do not know,No,Yes,,0,MSK,Patients are not involved in governance,
BLA,East Lancashire Hospitals NHS Trust,An acute hospital,BLA Royal Blackburn Hospital,Apr-13,Part of hospital general contract with no separate documentation for FLS,0,Administrator~band 4~1;Nurse~band 6~2,No,,350000,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site;Other,local area,Face/skull;Avulsion,Seen by Orthogeriatric service not FLS,,Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists,,Not applicable,,Still developing pathway;Lack of standardised practise/language for radiology reporting,,Yes,ICE REFERRALS/PAS CAPTURE LISTS,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk,,,Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,"Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse;Delegated to Primary Care physician",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Recurrent fractures,Prescription review;Telephone interview;Postal questionnaire;Clinic review face to face;DXA,at least once a year,72,No,Yes,,6,"DATIX, CPD, LEARNING HUB, TRAINING, MINUTES, CMT, SS AUDITS",Patients are not involved in governance,
BNT,Barnet Hospital,An acute hospital,BNT Barnet General Hospital,Mar-15,Part of hospital general contract with no separate documentation for FLS,1,Nurse~band 7~1,No,,400000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Other,Barnet postcode,,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service not FLS;Other,Monthly dataset of radiology reports from CT/ XR,Ward/emergency room admissions/discharge lists;Radiology;Other IT systems;Fracture clinic attended;Other,,Other IT systems;Emergency Department lists;Referral from Emergency Department;Other,Monthly dataset of radiology reports from CT/ XR,Screening general radiology reports;Emergency Department lists;Other,referral from emergency department,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting;Other,Not funded to see patients outside of Barnet postcode,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes,Yes,Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk,,,Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review remote,Never,,No,Yes,,0,N/A,Patients are not involved in governance,
BOL,Royal Bolton Hospital,An acute hospital,BOL Royal Bolton Hospital,Jun-18,Other,2,Administrator~band 3~1;Nurse~band 7~1;Nurse~band 6~0.6,No,,250000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Face/skull;Rib;Patella;Avulsion,Seen by Orthogeriatric service not FLS,,Ward/emergency room admissions/discharge lists;Radiology;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Emergency Department lists,,Screening general radiology reports,,Still developing pathway,,Yes,Data list of admissions/ attendances via a and e,Other,Refer to another DXA provider,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Trauma prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Secondary causes of osteoporosis (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,longer than every 3 years,Do not know,No,Yes,,1,orthopaedic governance which feeds into the divisional governance which then goes to board,Patients are not involved in governance,
BRD,Bradford Teaching Hospitals Foundation Trust,An acute hospital,BRD Bradford Royal Infirmary,Dec-16,Part of hospital general contract with no separate documentation for FLS;Other,1,Nurse~band 7~0.8;Nurse~band 6~0.5;Administrator~band 2~1,No,,532000,Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site;Other,Adult patients;ALL ages Paediatric patients referred to on call paediatrician,Metacarpal;Metatarsal;Face/skull,Seen by Orthogeriatric service not FLS;Other,Captured by Trauma Co-ordinators who are managed by lead FLS nurse,FLS visits the orthopaedic/trauma ward;Radiology;Fracture clinic attended;Other,Daily trauma meetings virtual fracture clinics via PACS weekly automated list with admin code,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Other,Daily trauma meetings via Consultant referral virtual trauma clinics direct referral PACS lists,Other,Daily trauma meeting by specialist admin code on PACS list with direct referral for DEXA,Lack of standardised practise/language for radiology reporting;Lack of training in identifying vertebral fractures;Other,Currently in discussion about incidental vertebral fracture research study,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function,DXA available on site,FLS specialist practitioner;Delegated to Primary Care physician;Other,complicated cases are discussed with Consultant Rheum Bradford DEXA reports very comprehensive,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;Other,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care;Service that referred to FLS,DXA – BMD;Current drug treatment recommendations (if applicable);Follow-up plan;Other,FLS coordinator;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls;Other,Telephone interview,Never,,No,Yes,,6,Orthopaedic Clinical Governance,Other,Have links to local ROS volunteers
BRH,Bromley Healthcare Falls and Fracture Prevention Service,A community care based service,BRO Princess Royal University Hospital Bromley,Aug-14,Fixed term then need to renew,0,Nurse~band 6~1,No,,300000,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range,,,Fracture clinic lists,,Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists,,Fracture clinic lists,,Not funded,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Testosterone/ Sex hormone binding globulin,Refer to another DXA provider,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable),FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,longer than every 3 years,0,No,No,Patients given ROS information,0,N/A,Patients are not involved in governance,
BRI,University Hospitals Bristol NHS Foundation Trust,An acute hospital,BRI Bristol Royal Infirmary,Nov-21,Block payment,0.5,Nurse~band 7~0.8;Radiographer~band 6~1;Administrator~band 4~1;Administrator~band 3~0.6,Yes,Admin band 3,500000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Metacarpal;Face/skull,IT systems;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems,,DXA imaging (VFA);Screening general radiology reports,,Not funded;Unable to access radiology images;Lack of standardised practise/language for radiology reporting,,Yes,By checking outpatient and inpatient lists and correlating with our FLS database,Serum Calcium;Serum 25OH vitamin D;Liver function;Thyroid function;Liver function tests;Renal function tests;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),DXA available on site,FLS specialist practitioner;Clinician speciality;Other,Rheumatology Consultant and Ortho-Geriatrics,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls;Other,Prescription review;Telephone interview;Postal questionnaire;Clinic review face to face;Clinic review remote;DXA;Other,at least once a year,Do not know,No,Yes,,3,Report back to medical director and Trust board through triumvirate meetings,Patients are not involved in governance,
CHE,Chesterfield Hospital NHS Foundation Trust,An acute hospital,CHE Chesterfield Royal,Aug-12,Block payment,0,Radiographer~band 6~0.4;Administrator~band 3~0.6;Nurse~band 7~0.6,No,,337042,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range,,,Fracture clinic lists;Trauma lists,,Ward/emergency room admissions/discharge lists;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists,,Fracture clinic lists;Emergency Department lists;Other,referrals,Not funded;Unable to access radiology images;Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department;Lack of training in identifying vertebral fractures,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Liver function;Liver function tests;Renal function tests,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No,,,,Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,Delegated to Primary Care physician,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,Never,,No,Yes,,0,there isn't a meeting,Patients are not involved in governance,
CHN,Nottingham FLS,An acute hospital,UHN University Hospital Queens Medical Centre,Feb-04,Part of hospital general contract with no separate documentation for FLS,5,Nurse~band 6~1.6;Nurse~band 7~0.8,No,,800000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists,,Using clinic lists,,Other,Referral,Not funded;Still developing pathway,,Yes,GP letter,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision;Assessment of home hazards,Ask about gait problems,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,"Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse;Delegated to Primary Care physician;Delegated to other healthcare provider",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face;Clinic review remote;DXA,Never,,No,No,0,0,0,Patients are not involved in governance,
CRY,Croydon University Hospital,An acute hospital,MAY Mayday University Hospital,Jul-19,Part of hospital general contract with no separate documentation for FLS;Block payment,0,Nurse~band 8a~0.2;Nurse~band 7~1;Physiotherapist~band 7~1.5,No,,388563,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,None,None,,Seen by Orthogeriatric service not FLS;Fracture clinic lists,,Fracture clinic attended;Other,,Using clinic lists,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists,,Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin;Other,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Other,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Assessment of home hazards,Ask about gait problems;Timed up and go;Chair rise,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Non-clinical specialist practitioner;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Recurrent fractures;Recurrent falls,Telephone interview,longer than every 3 years,50,Yes,Yes,,3,Falls Business Meeting,Patients are not involved in governance,
DAR,University Hospital North Durham Darlington Memorial Hospital,A community care based service,DAR Darlington Memorial HospitalDRY University Hospital of North Durham,Dec-19,Block payment,0,Nurse~band 7~1;Physiotherapist~band 6~1;Nurse~band 4~1,No,,633546,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Metacarpal;Face/skull,Ward/emergency room admissions lists;Fracture clinic lists;Trauma lists,,Ward/emergency room admissions/discharge lists;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department;Other,GP referal from falls in other areas eg spain,Screening general radiology reports;Fracture clinic lists;Emergency Department lists,,Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk,,,Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Non-clinical specialist practitioner;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Clinic review face to face,longer than every 3 years,Do not know,No,Yes,,1,Audit,Patients are represented in the governance meetings,
EAL,Ealing Hospital,An acute hospital,NPH Northwick Park Hospital,Apr-19,Part of hospital general contract with no separate documentation for FLS,0,Nurse~band 7~1,No,,300000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site,,Ankle;Pelvis;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,NHFD lists;FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;IT systems;Trauma lists,,FLS visits the orthopaedic/trauma ward;Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems,,Fracture clinic lists;Other,E trauma,Not funded;Other,Lack of staffing and lack of funding,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Renal function tests,No,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Trauma prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility,Ask about gait problems,,Patient;Primary care physician,Date and type of fracture;DXA – BMD;Current drug treatment recommendations (if applicable);Follow-up plan,"FLS coordinator;Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face,at least once a year,Do not know,No,Yes,,0,NA,Patients are not involved in governance,
ESH,East Sussex Healthcare,An acute hospital,CGH Conquest Hospital,Sep-17,Block payment,0.5,Nurse~band 7~2;Administrator~band 4~0.8;Administrator~band 2~0.4;Other~band 8a~0.2,No,,560000,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site,,Metacarpal;Metatarsal;Face/skull,Seen by Orthogeriatric service not FLS;IT systems;Other,Please note : FLS see NOF Under 75 only patients who require DXA >75 seen by Orthogeriatric service,Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists;Other,Consultant referrals,Fracture clinic lists;Other,Consultant referral,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting,,Yes,AE IT used as first review for fracture patients daily then a review of fracture clinic lists,Serum Calcium;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Testosterone/ Sex hormone binding globulin,Refer to another DXA provider,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Review of all medications and combinations of medications that increase falls risk;An evaluation of vision,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment;Other,Delegated to other healthcare provider,Medication adherence;Medication persistence;Medication adverse effects;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Postal questionnaire,Continuous (every patient),Do not know,No,Yes,,3,Departmental IPR,Patient advisory group who review FLS documentation and information,
ESU,East Surrey Hospital,An acute hospital,ESU East Surrey Hospital,Jan-19,Per patient tariff,0.5,Nurse~band 7~0.4;Administrator~band 4~0.5;Radiographer~band 7~0.5,No,,500000,Hip fracture (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range,,,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS,,Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems,,Screening general radiology reports;Fracture clinic lists,,Other,no problem with this,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of gait and balance and mobility,Chair rise,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects,Telephone interview,at least once a year,Do not know,No,Yes,,1,"Service manager, rheumatology",Patients are not involved in governance,
FRY,North Bristol NHS Trust,An acute hospital,FRY Southmead Hospital,Jul-14,Part of hospital general contract with no separate documentation for FLS,1,Nurse~band 7~1;Administrator~band 4~1,Yes,consultant 1.0 PA 12months,500000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging,Age range;Fracture site,,Metacarpal;Face/skull;Avulsion,Seen by Orthogeriatric service not FLS,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended;Other,direct referrals,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Other,direct referrals,Visits spine clinic/reviews letters;DXA imaging (VFA);Fracture clinic lists;Emergency Department lists,,Not funded;Lack of standardised practise/language for radiology reporting;Other,time,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician,Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Current drug treatment recommendations (if applicable);Follow-up plan,FLS coordinator;Specialist nurse;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Postal questionnaire,longer than every 3 years,0,No,No,printing; content doesn't match up to way our service is delivered,0,Divisional clinical governance meeting,Patients are not involved in governance,
GEO,St George's Hospital,An acute hospital,GEO St George's Hospital,May-11,Block payment,1,Nurse~band 7~1,Yes,administration staff,4000000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Emergency Department lists;Referral from Emergency Department,,Visits spine clinic/reviews letters;DXA imaging (VFA);Screening general radiology reports;Re-reading radiology images;Fracture clinic lists,,Other,shortage of staff,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility,Ask about gait problems;Timed up and go;Chair rise,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,"Secondary care consultant (e.g. orthogeriatrician, rheumatology)",N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,at least once a year,Do not know,No,Yes,,1,To Rheumatology governance,Patients are not involved in governance,
GGH,Diana Princess of Wales Hospital,An acute hospital,GGH Diana Princess of Wales Hospital,Nov-16,Block payment,1,Nurse~band 6~1,No,,170000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,None,None,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Fracture clinic lists;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists,,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,No,,Serum Calcium;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Thyroid function;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate,Ask about gait problems,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,"FLS coordinator;Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse;Delegated to Primary Care physician",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face,longer than every 3 years,Do not know,No,No,not used,12,Medicine Governance;Surgery Governance;Quality Governance Group,Patients are not involved in governance,
GWH,Queen Elizabeth Hospital Lewisham,An acute hospital,GWH Queen Elizabeth Hospital Woolwich,Dec-11,Other,1,Nurse~band 7~0.1;Administrator~band 2~0.2,No,,4972.58,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range,,,Ward/emergency room admissions lists;Fracture clinic lists,,Ward/emergency room admissions/discharge lists;Radiology;Fracture clinic attended,,Using clinic lists,,DXA imaging (VFA);Fracture clinic lists;Emergency Department lists,,Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,No,,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Renal function tests,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,No,,,,Primary care physician,Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Follow-up plan,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects,Telephone interview;DXA,longer than every 3 years,Do not know,No,No,lack of time and current work pressures as one nurse team,3,Rheumatology governance,Patients are not involved in governance,
HAY,The Haywood Hospital Burslem Stoke on Trent,A community care based service,STO University Hospital of North Staffordshire,Feb-16,Block payment,0.5,Nurse~band 3~0.6;Nurse~band 5~0.6;Nurse~band 6~1.4;Nurse~band 7~1.6;Administrator~band 3~0.8;Radiographer~band 5~0.4;Radiographer~band 6~0.5,No,,500,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Fracture site,,Metacarpal;Face/skull;Avulsion,Seen by Orthogeriatric service not FLS;IT systems;Trauma lists,,Other IT systems,,FLS visits the orthopaedic/trauma clinic,,DXA imaging (VFA);Screening general radiology reports,,Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Review of all medications and combinations of medications that increase falls risk;An evaluation of vision,,,Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Recurrent fractures;Recurrent falls,Telephone interview;Postal questionnaire,Never,,No,Yes,,3,They feed into the Rheumatology governance meeting,Patients are not involved in governance,
HCH,Wye Valley NHS Trust,An acute hospital,HCH County Hospital Hereford,May-12,Part of hospital general contract with no separate documentation for FLS,0,Nurse~band 7~0.8;Nurse~band 6~0.5;Nurse~band 5~0.8;Administrator~band 3~1.2000000000000002;Radiographer~band 4~0.3;Radiographer~band 3~0.3,No,,324214,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems;Referral from Emergency Department,,Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Other,electronic ward round and GP refs,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,Yes,Chasing up of fracture pts who DNA a clinic appointment,Serum Calcium;Serum phosphate;Serum 25OH vitamin D;Full blood count;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision;Assessment of home hazards,Ask about gait problems;Timed up and go;Berg balance;Chair rise;Short physical performance battery;Other,,Patient;Primary care physician;Falls service;Service that referred to FLS,Date and type of fracture;Fracture risk score;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Medication compliance review;Lifestyle/health risk-factor assessment,"Secondary care consultant (e.g. orthogeriatrician, rheumatology);Delegated to Primary Care physician",N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,at least every 3 years,Do not know,No,Yes,,0,No governance meeting takes place. At present the future of the service is looking uncertain due to,Patients are not involved in governance,
HIL,The Hillingdon Hospitals NHS Foundation Trust,An acute hospital,HIL Hillingdon Hospital,Jan-21,Part of hospital general contract with no separate documentation for FLS,0.5,Nurse~band 7~1,No,,350000,Hip fracture (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Opportunistic radiological vertebral fractures,None,None,,NHFD lists,,Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic,,Not applicable,,Not funded,,Yes,We have an internal referal pathway for inpatients admitted who can be referred to the FLS,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen,Refer to another DXA provider,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope,,,Primary care physician,Fracture risk score;DXA – BMD;Current drug treatment recommendations (if applicable);Follow-up plan,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects;Started a programme of strength and balance exercise,Telephone interview,Never,,No,Yes,,0,0,Patients are not involved in governance,
IPS,The Ipswich Hospital NHS Trust,An acute hospital,IPS The Ipswich Hospital,Sep-20,Block payment,0.5,Physiotherapist~band 6~1;Nurse~band 7~1;Nurse~band 6~0.6;Nurse~band 2~0.3,No,,390000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Fracture site,,Scaphoid;Face/skull;Rib;Avulsion,Seen by Orthogeriatric service not FLS,,Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Emergency Department lists,,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Review of all medications and combinations of medications that increase falls risk;An evaluation of vision;Assessment of home hazards,,,Patient;Primary care physician;Falls service;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,at least every 3 years,Do not know,No,Yes,,1,RHEUMATOLOGY GOVERNANCE MEETING,Patients are not involved in governance,
KCC,East Kent Hospitals University NHS Foundation Trust,An acute hospital,WHH William Harvey HospitalQEQ Queen Elizabeth the Queen Mother Hospital,Jan-21,Part of hospital general contract with no separate documentation for FLS,0,Nurse~band 7~0.6;Nurse~band 6~0.8;Administrator~band 4~1;Nurse~band 8a~0.5,No,,695000,Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Patella,Seen by Orthogeriatric service not FLS,,Other IT systems,,Other IT systems,,Other,GP referrals,Not funded,,No,,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Thyroid function;Liver function tests;Renal function tests;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;An evaluation of vision,Ask about gait problems,,Patient;Primary care physician;Falls service,Date and type of fracture;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,Delegated to Primary Care physician,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,Never,,No,Yes,,3,Falls steering Committee meetings,Patients are not involved in governance,
KCH,King's College Hospital - Denmark Hill Site,An acute hospital,KCH King's College Hospital,Mar-20,Part of hospital general contract with no separate documentation for FLS,0,Nurse~band 7~1,No,,1000000,Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella,Fracture clinic lists,,Other IT systems;Fracture clinic attended;Other,Referral from the wards,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems,,Fracture clinic lists;Other,Referral from Radiology or Speciality,Not funded;Unable to access radiology images;Lack of training in identifying vertebral fractures;Other,Lack of time and resources,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate,Ask about gait problems,,Patient;Primary care physician;Service that referred to FLS;Other,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment;Other,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face,Continuous (every patient),30,Yes,Yes,,0,0,Patients are not involved in governance,
KMH,Sherwood Forest Hospitals,An acute hospital,KMH Kings Mill Hospital,Oct-21,Block payment,0,Nurse~band 7~1,Yes,Band 6 7 months,450000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),None,None,,NHFD lists;FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Fracture clinic lists;Trauma lists,,FLS visits the orthopaedic/trauma ward;Fracture clinic attended,,Using clinic lists,,Not applicable,,Still developing pathway,,No,,Serum Calcium;Serum 25OH vitamin D;Full blood count;C-reactive protein;Urine electrophoresis (for Bence Jones protein),Refer to another DXA provider,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice,Metabolic bone disease / osteoporosis specialist prescribes,No,,,,Primary care physician,Date and type of fracture;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead,FLS coordinator;Specialist nurse,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,Never,,No,Yes,,0,Trust audit meeting,Patients are not involved in governance,
LEW,University Hospital Lewisham,An acute hospital,LEW University Hospital Lewisham,Oct-14,Block payment,0,Nurse~band 1~0.1,No,,330000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range,,,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS,,Ward/emergency room admissions/discharge lists;Other,Direct referrals,Emergency Department lists;Other,Direct Referrals,Emergency Department lists;Other,Direct referrals,Still developing pathway,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Liver function;Thyroid function;Renal function tests;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality,,Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate,Ask about gait problems;Timed up and go;Berg balance,,Primary care physician;Falls service,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Never,,No,No,lack of admin support,6,Divisional governance meetings,Patients are not involved in governance,
LLD,University Hospital Llandough,An acute hospital,UHW University Hospital of Wales,Jan-11,Other,1,Nurse~band 6~0.8;Administrator~band 4~0.2,No,,500000,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Face/skull,Not applicable,,Ward/emergency room admissions/discharge lists;Other,Physiotherapy,Emergency Department lists,,DXA imaging (VFA);Emergency Department lists;Other,Incidental via CT MRI X Ray,Still developing pathway,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility,Ask about gait problems;Chair rise,,Primary care physician,Date and type of fracture;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,"Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse;Delegated to Primary Care physician",Medication adherence;Medication persistence;Medication adverse effects;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Clinic review remote;DXA,at least every 3 years,0,No,Yes,,0,N/A,Patients are not involved in governance,
MDW,Medway NHS Foundation Trust,An acute hospital,MDW Medway Maritime Hospital,Dec-12,Other,0,Nurse~band 5~0.5;Nurse~band 8a~0.1,Yes,Band 6 > 12 months,500000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Fracture site,,Scaphoid;Metacarpal;Face/skull;Avulsion,Fracture clinic lists;Trauma lists,,Other,trauma list only,Using clinic lists,,Fracture clinic lists,,Not funded;Still developing pathway;Lack of engagement with radiology department,,No,,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis,DXA available on site,Delegated to Primary Care physician,,None,Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No,,,,Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Current drug treatment recommendations (if applicable);Follow-up plan,Delegated to Primary Care physician,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,Never,,No,No,not currently running face to face appointments,1,FLS is on Governance agenda;Due to no contract/service highlights updates on plans for commissioning,Patients are not involved in governance,
MKH,Milton Keynes University Hospital Foundation Trust,An acute hospital,MKH Milton Keynes General Hospital,Oct-15,Part of hospital general contract with no separate documentation for FLS,0,Nurse~band 7~1;Nurse~band 6~1;Nurse~band 2~0.8,No,,540,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Gender;Fracture site,,Face/skull;Rib;Patella;Avulsion,Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Other IT systems;Emergency Department lists;Referral from Emergency Department;Other,Consultant referral,Fracture clinic lists;Emergency Department lists;Other,referred via radiology,Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,at least once a year,11,No,Yes,,0,We have MDT discussions via the email with the rheumatology consultant,Patients are not involved in governance,
MOR,Morriston Hospital ABMHU,An acute hospital,MOR Morriston Hospital,Jan-16,Other,0,Nurse~band 7~1;Administrator~band 2~0.2,No,,300000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards,Age range;Gender;Fracture site,,Ankle;Pelvis;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS,,Not applicable,,Not applicable,,Not applicable,,Not funded;Still developing pathway,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Thyroid function;C-reactive protein;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes,No - we refer patients on for a falls assessment,,,,Primary care physician;Other,Date and type of fracture;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment;Other,Delegated to Primary Care physician,Medication adherence;Medication persistence;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures,Postal questionnaire,Never,,No,Yes,,0,none,Patients are not involved in governance,
MPH,Musgrove Park Hospital,An acute hospital,MPH Musgrove Park Hospital,Jan-16,Block payment,2,Radiographer~band 7~0.4;Nurse~band 7~0.6;Administrator~band 3~1,Yes,Jan-Jul 2021 0.6 hours FLS Practitioner not filled.,340000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Patella;Avulsion,Seen by Orthogeriatric service not FLS;Trauma lists,,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service;Other IT systems,,Using clinic lists;Other IT systems;Emergency Department lists,,DXA imaging (VFA);Screening general radiology reports;Emergency Department lists,,Not funded;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Postal questionnaire,at least every 3 years,27,No,No,This was a specific telephone clinic survey,0,0,Patients are not involved in governance,
NCA,Northern Care Alliance - Bury Community Services,Another healthcare provider (Bury CCG),NMG North Manchester General HospitalOHM Royal Oldham Hospital,Jun-19,Block payment,0,Nurse~band 6~1,No,,190700,Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site;Other,50,Metacarpal;Metatarsal;Face/skull;Rib,Not applicable,,Radiology,,Not applicable,,Screening general radiology reports;Re-reading radiology images,,Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,No,,Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests,Refer to another DXA provider,Delegated to Primary Care physician;Other,Rheumatologist,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Intravenous bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision;Assessment of home hazards,Ask about gait problems,,Primary care physician,Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment;Other,FLS coordinator;Specialist nurse;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Postal questionnaire,Continuous (every patient),10,No,Yes,,0,monthly meeting with Falls team,Patients are not involved in governance,
NCR,Royal Wolverhampton Hospital NHS Trust,An acute hospital,NCR New Cross Hospital,Dec-21,Part of hospital general contract with no separate documentation for FLS,0.25,Nurse~band 7~0.5;Nurse~band 6~2;Administrator~band 3~0.8;Nurse~band 5~0.4;Other~band 4~1,No,,900000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range,,,Seen by Orthogeriatric service not FLS;Fracture clinic lists,,Other IT systems,,Emergency Department lists,,Other,Radiology specifically mention if fracture identified and ask the requester to refer patient to FLS,Not funded,,No,,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates,FLS recommends therapy to orthogeriatrician and/or primary care physician,No - we refer patients on for a falls assessment,,,,Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Lifestyle/health risk-factor assessment,Specialist nurse;Delegated to Primary Care physician,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,longer than every 3 years,Do not know,No,Yes,,0,none,Patients are not involved in governance,
NEV,Aneurin Bevan University Health Board,An acute hospital,NEV Nevill Hall Hospital,Dec-21,Other,2,Nurse~band 6~3,No,,560500,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Fracture site,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS,,Radiology;Fracture clinic attended,,Using clinic lists;Referral from Emergency Department,,Screening general radiology reports,,Other,need to access more incidental finding fractures,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk,,,Primary care physician;Service that referred to FLS,Date and type of fracture;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Lifestyle/health risk-factor assessment,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,longer than every 3 years,Do not know,No,Yes,,0,0,Patients are not involved in governance,
NPH,Northwick Park Hospital,An acute hospital,NPH Northwick Park Hospital,Apr-19,Part of hospital general contract with no separate documentation for FLS,0,Nurse~band 7~1,No,,850000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site,,Ankle;Pelvis;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,NHFD lists;FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;IT systems;Trauma lists,,Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems,,Fracture clinic lists;Other,etrauma,Not funded;Other,lack of staffing and lack of funding,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Renal function tests,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Trauma prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility,Ask about gait problems,,Patient;Primary care physician,Date and type of fracture;DXA – BMD;Current drug treatment recommendations (if applicable);Follow-up plan,"FLS coordinator;Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face,at least once a year,Do not know,No,Yes,,0,n/a,Patients are not involved in governance,
NTG,North Tees and Hartlepool NHS Foundation Trust,An acute hospital,NTG University Hospital of North Tees,Mar-11,Part of hospital general contract with no separate documentation for FLS,0.5,Nurse~band 5~1;Administrator~band 3~0.2;Radiographer~band 6~0.5,No,,400000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site;Other,Dexa scans performed on 50 - 75's,Scaphoid;Metacarpal;Metatarsal;Face/skull;Avulsion,NHFD lists;Seen by Orthogeriatric service not FLS;Trauma lists,,Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems,,Fracture clinic lists;Other,Referral from spinal nurses,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum 25OH vitamin D;Thyroid function;C-reactive protein;Renal function tests;Coeliac disease screen,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Delegated to Primary Care physician,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,longer than every 3 years,0.3,No,No,Nil,3,The FLS is part of the Falls Prevention Group which is minuted and actioned,Patients are not involved in governance,
OIC,Pennine Musculoskeletal Partnership Ltd,A community care based service,OHM Royal Oldham Hospital,Sep-21,Block payment;Per patient tariff,0.1,Nurse~band 8a~0.1;Other~band 8a~0.1;Nurse~band 5~0.1;Administrator~band 4~0.2;Administrator~band 2~0.2,No,,237600,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Opportunistic radiological vertebral fractures,Age range;Fracture site,,Metacarpal;Face/skull;Avulsion,Seen by Orthogeriatric service not FLS;IT systems;Other,Direct referrals from orthopaedic referrals,Radiology;Seen by Orthogeriatric service;Other IT systems;Other,Direct referrals from orthopaedic wards,Other IT systems,,Screening general radiology reports,,Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin,Refer to another DXA provider,Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Number of falls in the last 12 months;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility,Ask about gait problems,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Lifestyle/health risk-factor assessment,Delegated to Primary Care physician,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,Never,,No,Yes,,3,"Reported to SLT, CCG, Rheumatology MDT, Orthogeriatrician",Patients are not involved in governance,
PET,North West Anglia NHS Foundation Trust,An acute hospital,PET Peterborough City HospitalHIN Hinchingbrooke Hospital,Apr-18,Part of hospital general contract with no separate documentation for FLS;Block payment,8.5,Nurse~band 7~0.9,No,,700000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Fracture clinic lists;Other,email referral some are also seen by geriatricians,Other IT systems;Fracture clinic attended;Other,email referral from clinician,Using clinic lists;Other IT systems;Other,email referral from clinician,Fracture clinic lists;Other,macro statements on reports ask requester to refer to FLS via email if applicable clinician referra,Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Serum Electrophoresis,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face;Clinic review remote,Never,,No,No,No use other resources,2,trust audit meeting,Patients are not involved in governance,
PGH,Poole Hospital NHS Foundation Trust,An acute hospital,PGH Poole General HospitalBOU Royal Bournemouth General Hospital,Apr-13,Block payment,0.25,Nurse~band 7~1;Nurse~band 6~0.6;Administrator~band 3~0.8,No,,800000,Hip fracture (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site,,Scaphoid;Metacarpal;Face/skull;Rib;Avulsion,IT systems;Trauma lists,,Seen by Orthogeriatric service,,Other IT systems;Other,Trauma lists,Emergency Department lists,,Not funded;Lack of standardised practise/language for radiology reporting;Other,unable to take almost 1000 vertebral fracture patients into our service yearly in addition to other,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;ESR;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains;Testosterone/ Sex hormone binding globulin;Other,Refer to another DXA provider,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Service that referred to FLS;Other,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Postal questionnaire;Other,Never,,No,No,We use ROS patient resources or our local Osteoporosis Dorset and do not like to duplicate,0,N/A,Other,No minuted governance meeting
QAP,Portsmouth Southeast Hampshire,An acute hospital,QAP Queen Alexandra Hospital,Apr-14,Block payment,0.5,Nurse~band 6~6;Administrator~band 3~1,No,,67000,Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Avulsion,Seen by Orthogeriatric service not FLS,,Ward/emergency room admissions/discharge lists;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Referral from Emergency Department,,DXA imaging (VFA);Fracture clinic lists,,Not funded;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;ESR;Renal function tests,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Non-clinical specialist practitioner;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Postal questionnaire,Continuous (every patient),Do not know,No,Yes,,1,"Emailed to the entire team, feeds into MSK governance",Patients are not involved in governance,
QEB,University Hospitals Birmingham NHS Foundation Trust,An acute hospital,QEB Queen Elizabeth Hospital Edgbaston,Nov-20,Fixed term then need to renew;Part of hospital general contract with no separate documentation for FLS,0.25,Other~band 3~0.5;Nurse~band 6~3,No,,7900,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Vertebral Fracture Assessment using DXA spine imaging,Age range;Fracture site,,Metacarpal;Metatarsal;Face/skull;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;Trauma lists,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Fracture clinic attended;Other,referrals,Using clinic lists;Emergency Department lists;Referral from Emergency Department,,Fracture clinic lists;Emergency Department lists;Other,referrals from other speciality,Not funded;Still developing pathway,,Yes,Quoru report,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Thyroid function;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Non-clinical specialist practitioner;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Postal questionnaire;Clinic review remote,longer than every 3 years,Do not know,No,Yes,,1,Endocrine nurses monthly meeting,Patients are not involved in governance,
RAD,Oxfordshire Fracture Prevention Service,An acute hospital,RAD John Radcliffe HospitalHOR Horton General Hospital,Oct-11,Block payment,1,Nurse~band 7~1.5;Nurse~band 6~3.7;Administrator~band 4~1.7,No,,800000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range,,,Ward/emergency room admissions lists;Fracture clinic lists;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department,,Visits spine clinic/reviews letters;Re-reading radiology images;Fracture clinic lists;Emergency Department lists;Other,referrals from GP spine team,Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,Yes,NHFD team highlight any missed NOF,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin;24 hour urinary calcium,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Trauma prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Falls service;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview,at least once a year,74,No,Yes,,1.5,Trust,Patient advisory group who review FLS documentation and information;Patients are represented in the governance meetings,
RBE,Royal Berkshire FLS,An acute hospital,RBE Royal Berkshire Hospital,Jan-16,Block payment,0.5,Nurse~band 7~1;Nurse~band 6~1;Administrator~band 4~1,No,,500000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Face/skull;Rib;Patella;Avulsion,NHFD lists;FLS visits the orthopaedic/trauma ward;Fracture clinic lists,,FLS visits the orthopaedic/trauma ward;Radiology;Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Referral from Emergency Department,,Visits spine clinic/reviews letters;Screening general radiology reports;Fracture clinic lists;Other,'incidental findings' folder which Radiology place patients in,Lack of standardised practise/language for radiology reporting;Lack of training in identifying vertebral fractures,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis,Refer to another DXA provider,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,at least once a year,15,No,Yes,,1,To Rhuematology governance,Patient advisory group who review FLS documentation and information,
RCF,Airedale NHS Foundation Trust,An acute hospital,AIR Airedale General Hospital,Oct-19,Part of hospital general contract with no separate documentation for FLS,0.1,Nurse~band 6~1.6,Yes,Admin assistant,200000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib,FLS visits the orthopaedic/trauma ward;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Fracture clinic attended;Other,List of patients discharged from all wards with a fracture code,Using clinic lists;Emergency Department lists;Other,Referral from consultants,Re-reading radiology images;Fracture clinic lists;Emergency Department lists,,Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,Yes,We get a list of patients with a fracture code that have been discharged from all inpatient areas,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Trauma prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Current drug treatment recommendations (if applicable);Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview,Never,,No,Yes,,2,FLS + DXA governance;Surgical services and Diagnostics quality and safety meeting,Patients are not involved in governance,
ROT,The Rotherham NHS Foundation Trust,An acute hospital,ROT Rotherham General Hospital,Aug-15,Block payment,0,Nurse~band 7~1;Administrator~band 3~0.1;Radiographer~band 5~0.2;Radiographer~band 7~0.2,No,,265000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Fracture site;Other,digits/sternum/skull 50-75 years seen by FLS CNS and over 75 years seen by Falls CNS,Face/skull,NHFD lists;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;IT systems;Trauma lists;Other,Please note orthogeriatrician is par of FLS/Bone Health Service,Ward/emergency room admissions/discharge lists;Radiology;Other IT systems;Other,Trauma meeting sheets,Using clinic lists;Other IT systems;Emergency Department lists;Other,Trauma meeting sheets,Fracture clinic lists;Emergency Department lists;Other,Trauma meeting sheets; IT-radiology referrals,Lack of standardised practise/language for radiology reporting,,Yes,All systems checked monthly for appropriate patients,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Trauma prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;An evaluation of vision;Assessment of home hazards,Ask about gait problems;Chair rise;Other,Where appropriate referrals are made to a team who can assess as follow on support,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Never,,No,No,Not known,1,Division of Medicine escalated to Trust.,Patients are not involved in governance,
RSS,Shrewsbury and Telford Hospital NHS Trust,An acute hospital,RSS Royal Shrewsbury Hospital,Jan-20,Block payment,1,Nurse~band 6~2;Administrator~band 3~1,No,,306100,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Fracture site,,Scaphoid;Face/skull;Rib;Avulsion,FLS visits the orthopaedic/trauma ward;Fracture clinic lists;Other,Trauma Nurse Practitioner,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Fracture clinic attended;Other,Frailty team in AE refer patients to us,Using clinic lists;Other IT systems;Other,orthopaedic secretaries occasional referrals from dictated clinic letters,Fracture clinic lists;Other,radiology still developing pathway,Still developing pathway,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis,Refer to another DXA provider,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;An evaluation of vision,,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,"FLS coordinator;Secondary care consultant (e.g. orthogeriatrician, rheumatology)",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Postal questionnaire,longer than every 3 years,Do not know,No,Yes,,1,trauma orthopaedic educational governance,Patients are not involved in governance,
RSU,Royal Surrey County Hospital,An acute hospital,RSU Royal Surrey County Hospital,Dec-14,Part of hospital general contract with no separate documentation for FLS,1.56,Nurse~band 7~1;Nurse~band 6~1,No,,300000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Fracture site,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service not FLS;Fracture clinic lists;Trauma lists,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Fracture clinic attended;Other,referrals from ward doctors,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Referral from Emergency Department;Other,referral from community hospitals,Fracture clinic lists;Emergency Department lists;Other,ward doctor referrals,Still developing pathway;Lack of standardised practise/language for radiology reporting;Other,disconnection with vertebral fracture identification and referral to FLS,Yes,referral from ward doctors and fracture triage,Serum Calcium;Serum 25OH vitamin D;Serum Parathyroid hormone;ESR;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Testosterone/ Sex hormone binding globulin;24 hour urinary calcium,Refer to another DXA provider,FLS specialist practitioner;Clinician speciality;Other,rheumatologist and orthogeriatrician,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;A requirement to check lying and standing BP;Pulse check for rhythm and rate;Assessment of home hazards,,,Patient;Primary care physician;Falls service;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,"FLS coordinator;Secondary care consultant (e.g. orthogeriatrician, rheumatology);Delegated to Primary Care physician",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Clinic review remote,at least once a year,30,No,Yes,,1,In house reporting;Annual submission to Trust audit committee,Other,Feedback at follow up calls
SCM,James Cook University Hospital,A community care based service,SCM James Cook University Hospital,Sep-10,Block payment,0,Nurse~band 7~1;Other~band 3~1;Administrator~band 2~0.3,No,,273000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site;Other,Patients residing out side Middlesbrough / redcar and cleveland,Scaphoid;Metacarpal;Metatarsal;Face/skull;Avulsion,IT systems;Trauma lists;Other,Over 75 care continued by Ortho - geri consultant,Radiology;Other IT systems;Fracture clinic attended,,Other IT systems,,Screening general radiology reports;Re-reading radiology images;Other,Code inserted by reporter into report which is sent automatically to the FLS,Lack of standardised practise/language for radiology reporting,,Yes,Staff are asked to email the FLS for patients who may not have been identified in the above ways,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision;Assessment of home hazards,Ask about gait problems,,Patient;Primary care physician;Other,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Continuous (every patient),Do not know,No,Yes,,1,Senior management. Direcrtorate meeting. Rheumatology governance meeting,Patients are not involved in governance,
SEH,Southend Hospital,An acute hospital,SEH Southend Hospital,Mar-12,Part of hospital general contract with no separate documentation for FLS,0,Nurse~band 6~0.7;Nurse~band 7~0.5;Administrator~band 4~0.1,No,,363000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib,Seen by Orthogeriatric service not FLS;IT systems;Trauma lists,,Seen by Orthogeriatric service;Other IT systems,,Other IT systems,,Other,email from radiology,Not funded;Still developing pathway,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),DXA available on site,FLS specialist practitioner;Clinician speciality;Other,Oncology,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS prescribes;Orthogeriatrician prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Post fracture mobility;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face,longer than every 3 years,Do not know,No,No,Use ROS patient information,0,To Rheumatology Governance,Patients are not involved in governance,
SGH,University Hospitals Southampton NHS Foundation Trust,Another healthcare provider (Silent Medical Services),SGH Southampton General Hospital,Oct-21,Block payment,0,Nurse~band 6~1.6;Physiotherapist~band 7~0.9;Administrator~band 2~0.6,Yes,"band 7, 3 months",1900000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site;Other,CCG,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;IT systems,,Ward/emergency room admissions/discharge lists;Other IT systems,,Other IT systems;Emergency Department lists;Other,referrals into service,Emergency Department lists;Other,referrals,Still developing pathway,,Yes,referrals in from MSK outpatients etc,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Trauma prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk,,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,Delegated to other healthcare provider,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Clinic review face to face;Clinic review remote,Never,,No,Yes,,3,suspended during covid,Patients are not involved in governance,
SRH,Salford Royal NHS Foundation Trust,An acute hospital,SLF Salford Royal,Feb-19,Fixed term then need to renew,1,Nurse~band 6~0.2;Administrator~band 3~0.6,No,,230000,Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site,,Metacarpal;Metatarsal;Face/skull,Seen by Orthogeriatric service not FLS,,Ward/emergency room admissions/discharge lists;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists,,Visits spine clinic/reviews letters;Emergency Department lists,,Not funded;Unable to access radiology images,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Serum Electrophoresis,DXA available on site,Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Recurrent fractures;Recurrent falls,Telephone interview,Never,,No,No,we use Better Bone Health for Everyone ROS,0,N/A,Other,N/A
STH,Guys and St Thomas' NHS Foundation Trust,An acute hospital,STH St Thomas Hospital,Feb-17,Block payment,1,Nurse~band 7~2;Administrator~band 3~1,Yes,Band 3 - 3 months,635000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Face/skull,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems,,Visits spine clinic/reviews letters;Screening general radiology reports;Re-reading radiology images;Fracture clinic lists;Other,Dedicate AI and radiology detected direct referrals following QI project,Other,No current barriers - working well,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes,Yes,A formal assessment of cognition;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate,Ask about gait problems;Timed up and go;Berg balance,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Delegated to Primary Care physician,N/A monitoring is not carried out by the FLS,Prescription review;Telephone interview,Never,,No,No,We use the ROS - 'have you broken a bone' as cheaper to send out and more concise for our patients,0,None,Patients are not involved in governance,
STM,Imperial College Healthcare NHS Trust,An acute hospital,STM St Marys Hospital Paddington,Dec-19,Part of hospital general contract with no separate documentation for FLS,1,Nurse~band 7~1;Administrator~band 2~0.3,No,,2000000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Metacarpal;Face/skull;Rib,IT systems;Trauma lists;Other,Etrauma,Other IT systems;Other,Etrauma,Using clinic lists,,DXA imaging (VFA);Screening general radiology reports,,Other,None,Yes,daily admissions to elderly care wards,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains;Testosterone/ Sex hormone binding globulin;24 hour urinary calcium,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Clinic review remote,at least once a year,Do not know,Yes,Yes,,3,Quality and safety board,Patients are not involved in governance,
SUN,Sunderland Royal Hospital,An acute hospital,SUN Sunderland Royal Hospital,Jan-14,Block payment,0,Nurse~band 6~1;Administrator~band 3~0.5,Yes,Administrator 6 months,350000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range,,,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service not FLS;Fracture clinic lists;Trauma lists;Other,Ward Referrals,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service;Fracture clinic attended;Other,Ward Referrals,FLS visits the orthopaedic/trauma clinic;Using clinic lists,,Visits spine clinic/reviews letters;Fracture clinic lists;Other,Ward Referrals,Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,Yes,Clinic Letters,Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes;Other,Yes,A formal assessment of cognition;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;An evaluation of vision;Assessment of home hazards,,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care;Falls service;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,"FLS coordinator;Secondary care consultant (e.g. orthogeriatrician, rheumatology)",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face;DXA,longer than every 3 years,0,No,Yes,,2,Trauma and Orthopaedics Clinical Governance;Hip Fracture Forum Meetings;Trust Audit Review,Patients are not involved in governance,
WDH,Dorset County Hospital,An acute hospital,WDH Dorset County Hospital,Jan-14,Block payment,0.5,Radiographer~band 6~0.1;Administrator~band 3~0.6,No,,220000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull,NHFD lists;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Other,All Fracture Clinic lists,Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department;Other,All fracture clinic lists,DXA imaging (VFA);Screening general radiology reports;Re-reading radiology images;Fracture clinic lists;Emergency Department lists,,Not funded;Still developing pathway;Other,Lack of staff,Yes,We can audit - but ALL patients attending fracture clinic are captured All spinal xrays are checked,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin,DXA available on site,Clinician speciality;Delegated to Primary Care physician;Other,Recommended via DXA report and protocol driven,Written material;Calcium and vitamin D supplementation advice;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes;Other,No - we refer patients on for a falls assessment,,,,Primary care physician;Falls service,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Postal questionnaire;DXA,at least once a year,55,Yes,Yes,,2,Part of Rheumatology governance and business meetings with Service Team Management,Patients are not involved in governance,
WES,Chelsea and Westminster Hospital NHS Foundation Trust,An acute hospital,WES Chelsea Westminster Hospital,Aug-19,Block payment,0,Administrator~band 4~1;Nurse~band 7~1;Other~band 8a~0.5,Yes,FLS admin maternity cover took seven months due to delayed in paper works,300000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Fracture clinic lists,,Radiology;Other IT systems;Fracture clinic attended,,Other IT systems,,Other,through Xray,Not funded,,Yes,Those patients over the age of 75 with fragility fracture and those with history numerous fragility,Serum Calcium;Serum 25OH vitamin D;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Serum Electrophoresis,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of gait and balance and mobility,Ask about gait problems,,Patient;Primary care physician;Falls service,Date and type of fracture;Fracture risk score;DXA – BMD;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Never,,No,Yes,,1,Monthly Rheumatology management meeting,Patients are not involved in governance,
WMH,Walsall Healthcare,A community care based service,WMH Manor Hospital,Jan-20,Block payment,0,Nurse~band 6~1;Nurse~band 7~1;Administrator~band 3~1.5,No,,285,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging,Age range;Fracture site;Other,Location,Scaphoid;Face/skull,Fracture clinic lists;IT systems,,Other IT systems,,Other IT systems,,Fracture clinic lists,,Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,Yes,list received each week for patients 50 attending AE or fracture clinic,Serum Calcium;Serum phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Other,Refer to another DXA provider,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Clinic review face to face;Clinic review remote;DXA,Continuous (every patient),240,No,No,used National FFT,1,"Trust governance, care Group, divisional board",Patients are not involved in governance,
WMU,West Middlesex hospital,An acute hospital,WMU West Middlesex University Hospital,Nov-19,Part of hospital general contract with no separate documentation for FLS,1,Administrator~band 4~1,Yes,"Band 4, Maternity Cover",425000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Fracture clinic lists;IT systems,,Radiology;Other IT systems;Fracture clinic attended,,Other IT systems,,Other,A short code has been set up by IT Any VF identified on imaging filters through to FLS,Not funded,,Yes,An effective referral system has been set up for incidental VF identified in imaging to be referred,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of gait and balance and mobility,Ask about gait problems,,Falls service,Date and type of fracture;DXA – BMD;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable),Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Never,,No,Yes,,3,Rheumatology Governance;GIRFT,Patients are not involved in governance,
WSH,West Suffolk NHS Foundation Trust,A community care based service,WSH West Suffolk Hospital,May-11,Block payment,0,Nurse~band 7~1.2999999999999998;Nurse~band 5~0.6,No,,275000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,IT systems,,Radiology;Other IT systems,,Other IT systems,,Screening general radiology reports,,Still developing pathway,,Yes,Acute hospital fractured codes for patients over the age of 50yrs;Direct referrals from GP's other,Serum Calcium;Serum 25OH vitamin D;Serum Parathyroid hormone;Renal function tests;Coeliac disease screen,Refer to another DXA provider,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision;Assessment of home hazards,Ask about gait problems,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Postal questionnaire;Clinic review face to face;DXA,at least once a year,Do not know,No,Yes,,3,Suffolk GP Fed Governance,Patients are not involved in governance,
WWL,Wrightington Wigan and Leigh NHS Foundation Trust,A community care based service,WRI Wrightington Hospital,Apr-15,Part of hospital general contract with no separate documentation for FLS,1,Physiotherapist~band 6~0.9;Nurse~band 6~0.3,No,,320000,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range,,,Seen by Orthogeriatric service not FLS,,Radiology;Fracture clinic attended,,Using clinic lists;Other,radiology lists,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists,,Other,ongoing development,Yes,audit admission all fractures from x-ray to FLS,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),DXA available on site,FLS specialist practitioner;Clinician speciality;Other,Consultant Nurse if spinal complex OP,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision;Assessment of home hazards,Ask about gait problems;Timed up and go;Chair rise;Other,If Physio FLS sees patient assesses gait,Patient;Primary care physician,Date and type of fracture;DXA – BMD;Fall risk factors;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects,Telephone interview,longer than every 3 years,0,No,Yes,,0,none,Other,WE ask the local OP patient forum for feedback yearly
YEO,Yeovil Hospital,An acute hospital,YEO Yeovil District Hospital,Dec-21,Block payment,0,Nurse~band 8a~0.5;Nurse~band 6~0.8;Administrator~band 3~1.2;Administrator~band 2~0.5,No,,180000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Fracture site;Other,NH residents;Periprosthetic and fibula lateral malleolus fractures,Scaphoid;Face/skull,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;IT systems;Trauma lists;Other,Daily TO handover,Ward/emergency room admissions/discharge lists;Other IT systems;Fracture clinic attended;Other,Daily TO handover,Using clinic lists;Other IT systems;Emergency Department lists,,Re-reading radiology images;Emergency Department lists;Other,IT systems daily TO handover DXA requests GP AG,Not funded,,Yes,Multiple ways of checking for fractures Look into why any fracture missed when found later,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician;Other,Orthogeriatrician for femur fractures,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS prescribes;Orthogeriatrician prescribes;Trauma prescribes;Metabolic bone disease / osteoporosis specialist prescribes;Other,No,,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Postal questionnaire;DXA,Never,,No,Yes,,0,N/A,Patient advisory group who review FLS documentation and information,
Z10,Belfast Health and Social Care Trust,An acute hospital,RVB Royal Victoria Hospital,Mar-03,Other,0.25,Nurse~band 7~1;Nurse~band 6~1;Nurse~band 5~3.2;Administrator~band 2~0.5;Radiographer~band 7~0.3;Radiographer~band 6~0.3,No,,359230,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Face/skull;Rib,Ward/emergency room admissions lists;Fracture clinic lists;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Fracture clinic attended,,Using clinic lists;Emergency Department lists;Referral from Emergency Department,,Fracture clinic lists;Emergency Department lists;Other,vertebral signpost for FLS,Lack of standardised practise/language for radiology reporting;Lack of training in identifying vertebral fractures,,Yes,vertebral signpost within radiology in BHSCT for FLS,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Post fracture mobility;Recurrent fractures;Recurrent falls,Telephone interview,longer than every 3 years,0,No,Yes,,1,Written minutes circulated to all members of the Osteoporosis team and Service managers,Patients are not involved in governance,
Z14,Southern Health and Social Care Trust,A community care based service,CRG Craigavon Area Hospital,Apr-16,Other,0.5,Nurse~band 7~1;Nurse~band 6~1;Administrator~band 4~0.6,No,,388688,Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Fracture site;Other,Age 50 years;excluding fracture sites below,Scaphoid;Metacarpal;Metatarsal;Face/skull;Patella;Avulsion,Seen by Orthogeriatric service not FLS;Other,Hip fracture patients requiring DXA referred to FLS from Orthogeriatric service,Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists,,Screening general radiology reports;Fracture clinic lists;Emergency Department lists,,Lack of standardised practise/language for radiology reporting;Other,Difficulty identifying new fractures if no previous imaging or levels not specified,Yes,ED UDDA coding;In-patient ICD10 codes;Fracture Clinic list;Referral from orthogeriatric-service,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility,Ask about gait problems;Other,Timed up go by FLS stopped since COVID Falls service assess,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,Delegated to Primary Care physician,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,at least every 3 years,0,No,No,Patients are given ROS medication specific information,0,Falls service,Patients are not involved in governance,
Z18,Western Health Social Care Trust,An acute hospital,ALT Altnagelvin Hospital,Nov-20,Other,1,Nurse~band 7~2.8;Administrator~band 3~1,No,,444000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib,Other,TO management spreadsheet,Other,TO management spreadsheet Trauma list,Using clinic lists;Emergency Department lists,,Fracture clinic lists;Emergency Department lists,,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Thyroid function;Renal function tests;Testosterone/ Sex hormone binding globulin,DXA available on site,Clinician speciality;Other,Rheumatology,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Number of falls in the last 12 months;Assessment of gait and balance and mobility,Ask about gait problems;Chair rise,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,"FLS coordinator;Secondary care consultant (e.g. orthogeriatrician, rheumatology);Delegated to Primary Care physician",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face;Clinic review remote;DXA,longer than every 3 years,Do not know,No,No,Use ROS resources,12,Nurse Manager,Patients are not involved in governance,
GWY,,A community care based service,CLW Glan Clwyd HospitalGWY Ysbyty Gwynedd Hospital,Nov-06,Other,1,Nurse~band 8a~1;Nurse~band 7~0.4,Yes,maternity leave for 2021,660000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,None,None,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Fracture clinic attended;Other,Referrals from GP/IP,Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department,,Visits spine clinic/reviews letters;DXA imaging (VFA);Fracture clinic lists;Emergency Department lists;Other,Referrals from other clinicians radiologists,Still developing pathway,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Thyroid function;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin;24 hour urinary calcium,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Primary care physician;Falls service;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,"Secondary care consultant (e.g. orthogeriatrician, rheumatology);Delegated to Primary Care physician",N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,longer than every 3 years,0,No,Yes,,0,Trust audit meeting,Patients are not involved in governance,