FLS code,Name of FLS,FLS site or service,Where is the FLS delivered from?,Where is the FLS delivered from? Other responses,Which NHFD hospitals do you provide the FLS to?,Which ICS are you part of?,What month and year did you start the current form of FLS,Which of the following best describes the current contract?,Which of the following best describes the current contract : Other response,How many Consultant PAs (per week) are allocated to the FLS?,"For each type of staff, please enter how much time is spent working within the FLS as the whole time equivalent","For each type of staff, please enter how much time is spent working within the FLS as the whole time equivalent. Other responses. ",Did you have any staff vacancies that lasted longer than 6 months in 2024?,"If yes, please describe the type of staff member and the duration of the vacancy ",If yes are there any current vacancies?,Estimated population size,Which patient groups does your FLS cover? ,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? (Select all that apply),How does your site identify hip fracture patients? (Select all that apply) Other responses.,How does your site identify hip fracture patients? (Select all that apply) Other responses.,How does your site identify other non-hip non-vertebral fracture inpatients? ,How does your site identify fracture outpatients? ,How does your site identify fracture outpatients? Other responses,How does your site identify patients with vertebral fracture(s)?,How does your site identify patients with vertebral fracture(s)? Other response,How does your site identify patients with vertebral fracture(s)? 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? (select all that apply) other responses ",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? Other responses,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? 
(select all that apply) ",Who counsels the patient for bone strengthening medicine?,Who assesses the need for treatment?  Other,What interventions can be recommended or initiated by the FLS? ,"How do patients obtain their first prescription of anti-resorptive 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? ,Which of the following are covered by the falls risk assessment in the FLS? Other responses,"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 responses","Once FLS assessment is complete, who is informed of the outcome? ",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 at 16 and 52 weeks evaluated? ,How often is there a formal survey seeking patient/carer experience or satisfaction on the FLS? ,How often is there a formal survey seeking patient reported outcomes (PROMs)?,How many completed responses did you get from your FLS patient survey in 2024?,Did you use the Royal Osteoporosis Society patient experience survey?,Which patient resources do you use? ,"Do you use the FLS-DB patient resources? (if no selected, please specify barriers to using them if any)",Which patient resources do you use? Other responses,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
GWY,Betsi Cadwaladr UHB,GWY. Ysbyty Gwynedd Hospital,A community care based service,,"GWY. Ysbyty Gwynedd Hospital,CLW. Glan Clwyd Hospital",Betsi Cadwaladr University Health Board,Apr-15,Part of hospital general contract with no separate documentation for FLS,,0.5,Nurse~band 5~0.4;Nurse~band 6~0.4;Nurse~band 8a~0.2,,No,,,700000,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,,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,symphony;WPAS,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,WPAS,,Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department;Referral from primary/community services;Radiology report,"Symphony, WPAS",,Fracture clinic lists;Referral from primary/community services,,Still developing pathway;Lack of standardised practise/language for radiology reporting,,Yes,All fragility fractures >50 yrs screened as per the above systems,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin,DXA available within organisation,FLS specialist nurse practitioner;FLS nurse prescriber;Consultant linked to FLS,,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 primary care physician;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;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,Longer than every 3 years,Never,Do not know,No,ROS resources,,,0,Do not have a meeting,Patients are not involved in governance,
AHX,Ashford and St. Peter's Hospitals NHS Foundation Trust,AHX. Ashford Hospital,An acute hospital,,SPH. St Peter's Hospital,NHS Surrey Heartlands,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 within organisation,FLS specialist nurse 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 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 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,Never,Do not know,No,ROS resources,,,0,No government minutes,Patients are not involved in governance,
7A2T,Hywel Dda UHB,7A2T. Hywel Dda University LHB,An acute hospital,,"WYB. Withybush General Hospital,BRG. Bronglais General Hospital,WWG. West Wales General",Hywel Dda University Health BOard,Sep-24,Fixed term then need to completely re-bid,,5,Nurse~band 7~3.4;Nurse~band 8a~1;Physiotherapist~band 7~0.8;Administrator~band 3~2,,No,,,380000,Hip fracture (including inpatient fractures);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,See patients age 50 and over.,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,Welsh PAS / WCP / Teams (for Orthopaedic admission lists),,Ward/emergency room admissions/discharge lists;Radiology;Other IT systems;Fracture clinic attended;Referral from primary/community services,Welsh PAS / WCP / Teams (for Orthopaedic admission lists),,Using clinic lists;Other IT systems;Referral from Emergency Department;Referral from primary/community services;Radiology report;Radiology images,Welsh PAS / WCP / Teams (for Orthopaedic admission lists),,Screening general radiology reports;Re-reading radiology images;Fracture clinic lists;Referral from primary/community services,,Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,No,,Serum Calcium;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,DXA available within organisation;Refer to another DXA provider,FLS specialist nurse practitioner;FLS nurse prescriber,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to primary care physician;FLS prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No,,,,,Patient;Primary care physician;Service that referred to FLS,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;Other,Continuous (every patient),Continuous (every patient),Do not know,No,Strong bones after 50: Fracture liaison services explained;ROS resources;men and FLS leaflet,,,1,Service Delivery Manager part of minuted governance meetings.,Patients are not involved in governance,
GGH,Diana Princess of Wales Hospital,"GGH. Diana, Princess of Wales Hospital",An acute hospital,,"GGH. Diana, Princess of Wales Hospital",Humber Coast and Vale,Oct-16,Block payment,,3,Nurse~band 6~1,,No,,,160000,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,,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Other,,Orthopaedic trauma coordinator,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Fracture clinic attended;Other,,Orthopaedic trauma coordinator,FLS visits the orthopaedic/trauma clinic;Using clinic lists,,,DXA imaging (VFA);Referral from primary/community services;Other,Emails from Admin teams in Accident & Emergency,Still developing pathway,,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 within organisation,FLS specialist nurse practitioner;Consultant linked to FLS;Other,Trauma Coordinator,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to primary care physician;FLS prescribes;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 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,,,,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",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;Review face to face,Never,Never,,No,Strong bones after 50: staying on treatment;Strong bones after 50: Fracture liaison services explained,,,0,n/a,Patients are not involved in governance,
BFH,Broomfield Hospital,BFH. Broomfield Chelmsford,An acute hospital,,BFH. Broomfield Chelmsford,mid and south essex,Apr-15,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 7~0.7;Administrator~band 3~0.4,,No,,,405000,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,,Metacarpal;Metatarsal;Face/skull;Rib,Fracture clinic lists;Trauma lists,,,Fracture clinic attended;Other,,trauma lists,Using clinic lists,,,Visits spine clinic/reviews letters;Fracture clinic lists,,Unable to access radiology images;Lack of engagement with radiology department,,No,,Other,DXA available within organisation,Primary care physician,,None,Orthogeriatrician prescribes,No,,,,,Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD,N/A monitoring is not carried out by the FLS,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,Longer than every 3 years,Do not know,No,ROS resources,,,3,Rheumatology / Trauma Orthopaedics,Other,Patients Not Involved
QEB,University Hospitals Birmingham NHS Foundation Trust,"QEB. Queen Elizabeth Hospital, Edgbaston",An acute hospital,,"QEB. Queen Elizabeth Hospital, Edgbaston",Solihull and Birmingham,Jan-23,Part of hospital general contract with no separate documentation for FLS,,0.25,Nurse~band 6~3;Administrator~band 3~0.5,,No,,,1200000,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;Geographic,,,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;Trauma lists,,,Referral from primary/community services;Other,,"Referral from Orthogeriatric Consultant, ED minor list, trauma take admission list",Using clinic lists;Emergency Department lists,,,DXA imaging (VFA);Fracture clinic lists;Referral from primary/community services;Other,Radiology has automated text to refer to FLS then requesting doctor will refer to FLS,Still developing pathway,,Yes,"Clinical portal fracture clinic list, trauma take admission list.",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 within organisation,FLS specialist nurse practitioner;FLS nurse prescriber;Consultant linked to FLS;other clinical speciality;Primary care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician;FLS recommends therapy to primary care physician;FLS prescribes;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,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,Never,Never,,No,Bone health card;ROS resources,,,6,Metabolic bone service meeting,Patients are not involved in governance,
DAR,University Hospital North Durham & Darlington Memorial Hospital,DAR. Darlington Memorial Hospital,A community care based service,,DAR. Darlington Memorial Hospital,"Our atchement would span over 2: Durham, Darlington, Teesside, Hableton, Richmondshire and Whitby STP aswell asNorthumberland, Tyne & Wear, and North Durham",Jan-17,Block payment,,0,Physiotherapist~band 6~1;Nurse~band 6~0.4;Other~band 4~0.6,Associate Pratitioner,Yes,B6 Nurse 1WTE;0.5 WTE of band 4 Associate Practitioner,Yes,522100,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;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site;Geographic,,Scaphoid;Metacarpal;Face/skull;Other,IT systems;Trauma lists,Electronic Patient Records EPR,,Ward/emergency room admissions/discharge lists;Other IT systems;Fracture clinic attended;Referral from primary/community services,Electronic Patient Records,,Using clinic lists;Emergency Department lists;Referral from primary/community services,,,Emergency Department lists;Referral from primary/community services,,Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Other,DXA available within organisation,FLS specialist nurse practitioner,,Written material;Calcium and vitamin D supplementation advice;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to primary care physician;Trauma 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;Review of all medications and combinations of medications that increase falls risk;Other,"We would refer on for a Full Falls Assesment by the Falls service if indicated, covering other boxes",,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Fall risk factors;Current drug treatment recommendations (if applicable);Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse,Medication adherence;Medication adverse effects;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Never,Never,,No,Strong bones after 50: Fracture liaison services explained,,,1,Community Governance.,Patients are not involved in governance,
WMU,West Middlesex hospital,WMU. West Middlesex University Hospital,An acute hospital,,WMU. West Middlesex University Hospital,NWL - Hounslow,Sep-19,Block payment,,1,Nurse~band 7~0.1;Administrator~band 4~0.2,,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,Fracture site;Geographic;Other,Age range: Overs 50s;Geographic: Hand over to GP,Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Seen by Orthogeriatric service not FLS;Trauma lists,,,Radiology;Other IT systems;Fracture clinic attended,,,Using clinic lists;Other IT systems,,,Fracture clinic lists;Other,short code from radiology to FLS,Other,Need funding for more nurses to assess all patients,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;Testosterone/ Sex hormone binding globulin,DXA available within organisation,FLS specialist nurse practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician;FLS recommends therapy to 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;Other,FRAT assessment,,,Patient;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);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,Prescription review;Telephone interview,Never,Never,,No,ROS resources;Other,,Calcium diet sheet,3,Rheumatology Governance,Patients are not involved in governance,
BEM,Enfield Bone Health and Fracture Liaison,BEM. Barnet Enfield And Haringey Mental Health NHS Trust,A community care based service,,"NMH. North Middlesex Hospital,BNT. Barnet General Hospital",North London ICB,Jan-15,Block payment,,0,Nurse~band 7~2,,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);Opportunistic radiological vertebral fractures,Age range,,,Fracture clinic lists,,,Radiology;Referral from primary/community services,,,Other IT systems,Lists from FIP Teams in Secondary care,,Fracture clinic lists;Referral from primary/community services,,Unable to access radiology images;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,No,,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,Refer to another DXA provider,FLS specialist nurse practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Other interventions,FLS recommends therapy to 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;An evaluation of vision;Assessment of home hazards,,,,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;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),Continuous (every patient),Do not know,No,ROS resources;Other,,"AGE UK, Enfield Carer's centre, Safe and Connected material",0,0,Patients are not involved in governance,
SRH,Salford Royal NHS Foundation Trust,SRH. Salford Royal Hospital,An acute hospital,,SLF. Salford Royal,Greater Manchester,Feb-20,Fixed term then need to renew,,0.2,Nurse~band 6~0.3;Administrator~band 3~0.7;Radiographer~band 7~0.2,,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;Opportunistic radiological vertebral fractures,Age range;Fracture site;Geographic,,Scaphoid;Face/skull;Other,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;IT systems,A&E dashboard,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems,A&E dashboard,,Other IT systems;Referral from Emergency Department;Referral from primary/community services,A&E dashboard,,Visits spine clinic/reviews letters;Emergency Department lists;Referral from primary/community services,,Not funded,,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 within organisation,FLS specialist nurse practitioner;Primary care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to 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;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;Post fracture mobility;Recurrent fractures;Recurrent falls,Telephone interview;Review face to face,Never,Never,,No,ROS resources,,,4,Rheumatology Governance,Patients are not involved in governance,
STM,Imperial College Healthcare NHS Trust,"STM. St Marys Hospital, Paddington",An acute hospital,,"STM. St Marys Hospital, Paddington",North West London,Nov-19,Part of hospital general contract with no separate documentation for FLS,,0.5,Nurse~band 7~2,,No,,,2400000,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;Geographic,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems,E-trauma,,Radiology;Other IT systems,Fracture clinic online,,Other IT systems;Radiology report,Fracture clinic online,,Re-reading radiology images;Other,Radiology sends pacs reports from a system called soliton,Other,None,Yes,"radiology, e-trauma, referrals from other HCP's, GP,s",Serum Calcium;Serum alkaline phosphate;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 within organisation,FLS specialist nurse practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician;FLS recommends therapy to 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,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,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),Continuous (every patient),50,No,Bone health card;Strong bones after 50: staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources;men and FLS leaflet,,,1,FLS clinical lead in Endocrine,Other,"Not currently involved, still needs setting up"
BAT,Royal United Hospital,BAT. Royal United Hospital Bath,An acute hospital,,BAT. Royal United Hospital Bath,Bath Swindon and Wiltshire,Aug-16,Block payment,,0.3,Nurse~band 7~0.2;Administrator~band 4~1;Other~band 8a~0.2,Clinical Scientist,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;Geographic,,Metacarpal;Metatarsal;Face/skull,Seen by Orthogeriatric service not FLS;Fracture clinic lists,,,Other IT systems;Fracture clinic attended,Coding list of fractures including inpatients,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Emergency Department lists,Coding list of fractures including inpatients,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Other,FLS tag to reports when Vertebral # identified. FLS runs reports to search for the TAG,Lack of standardised practise/language for radiology reporting,,Yes,"Coding lists used to pick up patients from ED, and inpatients with #, EPR reviewed.",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 within organisation,Primary care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician;FLS recommends therapy to primary care physician;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Number of falls in the last 12 months,,,,Primary care physician,Date and type of fracture;DXA – BMD;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Medication compliance review;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;Recurrent fractures,Postal questionnaire,Longer than every 3 years,Longer than every 3 years,,No,ROS resources,,,1,rheumatology governance,Patients are not involved in governance,
WES,Chelsea and Westminster Hospital NHS Foundation Trust,WES. Chelsea and Westminster Hospital,An acute hospital,,WES. Chelsea & Westminster Hospital,North West London,Sep-19,Block payment,,1,Nurse~band 7~1;Administrator~band 4~1,,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;Opportunistic radiological vertebral fractures,Age range;Fracture site;Geographic,,Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Seen by Orthogeriatric service not FLS;Trauma lists,,,Radiology;Other IT systems;Fracture clinic attended;Other,,Hand Therapy team referrals,Using clinic lists;Other IT systems,,,Other,Care of the elderly and Acute Frailty Service e-mail referrals and Auto-referrals (e-mail) from Radi,Other,Funding for additional Nurses to screen general radiology reports and identify those cases missed wi,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 within organisation,FLS specialist nurse practitioner;Consultant linked to FLS,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician;FLS recommends therapy to 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,,,,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);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,Prescription review;Telephone interview,Never,Never,,No,ROS resources;men and FLS leaflet;Other,,– Calcium Diet information leaflet,3,Rheumatology Governance,Patients are not involved in governance,
Z10,Belfast Health and Social Care Trust,Z10. Belfast Health and Social Care Trust,An acute hospital,,RVB. Royal Victoria Hospital,N/A,Sep-20,Fixed term then need to renew,,0.25,Radiographer~band 7~0.3;Radiographer~band 6~0.3;Nurse~band 7~0.5;Nurse~band 6~0.5;Administrator~band 3~0.5;Nurse~band 5~3,,Yes,BAND 3 Administrator 6 months,Yes,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;Opportunistic radiological vertebral fractures,Age range;Fracture site;Geographic,,Scaphoid;Metacarpal;Face/skull;Rib;Avulsion,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;Fracture clinic attended;Referral from primary/community services,,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Emergency Department lists;Referral from Emergency Department;Referral from primary/community services;Radiology report;Radiology images,,,Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Referral from primary/community services,,Still developing pathway;Lack of training in identifying vertebral fractures;Other,Radiologists often not using correct standardised language required 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);Serum free light chains;Testosterone/ Sex hormone binding globulin;24 hour urinary calcium,DXA available within organisation,FLS specialist nurse 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 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,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,At least once a year,Never,55,Yes,What should happen if you or someone you know experiences a fragility fracture?;Six golden rules video resource;Bone health card;Strong bones after 50: staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources;men and FLS leaflet,,,1,Service manager partakes in governance meeting with Osteoporosis Clinical lead and FLS team,Patients are not involved in governance,
RCF,Airedale NHS Foundation Trust,RCF. Airedale NHS Foundation Trust,An acute hospital,,AIR. Airedale General Hospital,West Yorkshire,Oct-19,Part of hospital general contract with no separate documentation for FLS,,1,Nurse~band 6~1.6;Administrator~band 2~0.4,,No,,,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,Fracture site,,Face/skull;Rib,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists,,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Fracture clinic attended;Other,,referrals directly from consultants/doctors on wards other than T+O,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Emergency Department lists;Referral from primary/community services;Radiology report,,,Screening general radiology reports,,Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,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);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available within organisation,Consultant linked to FLS;Primary care physician,,Written material,FLS recommends therapy to orthogeriatrician;FLS recommends therapy to 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,,,,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;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;DXA;Other,Never,Never,,No,ROS resources,,,3,Surgical services and diagnostics quality and safety group,Patients are not involved in governance,
RBE,Royal Berkshire FLS,RBE. Royal Berkshire Hospital,An acute hospital,,RBE. Royal Berkshire Hospital,"BOB- Buckinghamshire, Oxfordshire and Berkshire",Jan-16,Block payment,,4,Other~band 7~1;Nurse~band 7~1;Nurse~band 6~1;Administrator~band 4~1.8,,No,,,560000,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;Geographic,,Scaphoid;Face/skull;Patella;Avulsion,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service not FLS;Fracture clinic lists,,,FLS visits the orthopaedic/trauma ward;Radiology;Seen by Orthogeriatric service;Fracture clinic attended;Referral from primary/community services,,,Using clinic lists;Other IT systems;Referral from Emergency Department;Referral from primary/community services;Radiology report,"EPR, INSIGHT",,Fracture clinic lists;Referral from primary/community services;Other,Radiology place in a 'fragility fracture' folder when identifying vertebra fractures,Lack of engagement with radiology department,,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,Refer to another DXA provider,FLS specialist nurse practitioner;FLS nurse prescriber,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to primary care physician;FLS prescribes;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;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;Recurrent fractures,Prescription review,Continuous (every patient),At least every 3 years,Do not know,No,Bone health card;ROS resources;men and FLS leaflet;Other,,trust leaflets,1,Rheum governance,Patients are not involved in governance,
ESU,East Surrey Hospital,ESU. East Surrey Hospital,An acute hospital,,ESU. East Surrey Hospital,Surrey Heartlands Integrated Care System,Feb-20,Part of hospital general contract with no separate documentation for FLS,,0.5,Nurse~band 7~0.3;Radiographer~band 8a~0.3;Administrator~band 4~0.6,,No,,,744000,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,Seen by Orthogeriatric service not FLS,,,Fracture clinic attended,,,Other IT systems,Pathpoint,,DXA imaging (VFA);Screening general radiology reports,,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;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 within organisation,FLS specialist nurse practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests;Other interventions,FLS recommends therapy to primary care physician,Yes,Assessment of a history of falls;Number of falls in the last 12 months,,,,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;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Longer than every 3 years,Never,,No,Strong bones after 50: Fracture liaison services explained;ROS resources,,,1,Rheumatology governance,Patients are not involved in governance,
NCA,Northern Care Alliance - Bury Community Services,NCA. Northern Care Alliance - Bury Community Services,A community care based service,,OHM. Royal Oldham Hospital,GREATER MANCHESTER,Jun-19,Block payment,,0,Nurse~band 1~1,,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;Opportunistic radiological vertebral fractures,Fracture site;Geographic;Other,Cover BURY POSTCODE ONLY;BURY GPs,Metacarpal;Metatarsal;Face/skull;Rib;Other,Not applicable,,,Radiology;Referral from primary/community services,,,Other,,radiology reports,Screening general radiology reports;Referral from primary/community services,,Still developing pathway,,No,,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests,DXA available within organisation,Primary care physician,,Written material;Calcium and vitamin D supplementation advice;Further education programmes/resources,FLS recommends therapy to primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of a history of falls;Review of all medications and combinations of medications that increase falls risk;Other,,,,Patient;Primary care physician,Fracture risk score;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Residential status;Recurrent fractures;Recurrent falls,Prescription review;Other,Continuous (every patient),Longer than every 3 years,5,Yes,Strong bones after 50: staying on treatment;men and FLS leaflet,,,3,Trust audit meeting;FLS steering group,Patients are not involved in governance,
HAY,"The Haywood Hospital, Burslem, Stoke on Trent",HAY. Haywood Hospital,A community care based service,,STO. University Hospital of North Staffordshire,Staffordshire and Stoke on Trent,Feb-16,Block payment,,0.5,Nurse~band 3~1.6;Nurse~band 6~3.6;Nurse~band 7~1;Administrator~band 3~0.6;Other~band 7~0.5;Other~band 6~0.5;Other~band 5~0.3;Other~band 3~1,"AHP 0.5 Band 7, the rest are DXA tech",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,Fracture site,,Metacarpal;Face/skull;Avulsion;Other,Ward/emergency room admissions lists;IT systems;Trauma lists,iPortal,,Ward/emergency room admissions/discharge lists;Other IT systems;Fracture clinic attended;Referral from primary/community services,iPortal,,Using clinic lists;Other IT systems;Emergency Department lists,iPortal,,DXA imaging (VFA);Screening general radiology reports;Emergency Department lists;Referral from primary/community services,,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 within organisation,FLS specialist nurse practitioner;Other,Allied Health Professionals,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests;Other interventions,FLS recommends therapy to primary care physician;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);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;Postal questionnaire,At least every 3 years,Never,Do not know,No,ROS resources;Other,,Drug company resources,3,They feed into the Rheumatology governance meeting,Patients are not involved in governance,
YEO,Yeovil Hospital,YEO. Yeovil District Hospital,An acute hospital,,YEO. Yeovil District Hospital,Somerset ICS,Jan-16,Block payment,,0,Nurse~band 7~0.8;Nurse~band 6~0.6;Administrator~band 3~1.1;Administrator~band 2~0.8,,No,,,185000,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;Geographic,,Ankle;Face/skull;Other,NHFD lists;FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,T&O handover list,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended;Referral from primary/community services;Other,"Ben's report, Data warehouse, Incident reports, Inpatient fallers list, Trauma board, VFC list","DXA requests, T&O reports, TARN",Using clinic lists;Other IT systems;Emergency Department lists;Referral from primary/community services;Radiology report;Radiology images;Other,"Ben's report, Data warehouse, Incident reports, Inpatient fallers list, Trauma board, VFC list","DXA requests, T&O reports, TARN",DXA imaging (VFA);Fracture clinic lists;Emergency Department lists;Referral from primary/community services;Other,"Ben's report, Data warehouse, Incident reports, Inpatient fallers list, Trauma board, VFC list",Not funded;Lack of training in identifying vertebral fractures;Other,Staffing capacity,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;Serum free light chains,DXA available within organisation,FLS specialist nurse practitioner;FLS nurse prescriber;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 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;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;Post fracture mobility;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Postal questionnaire;Review face to face,Never,Never,,No,Strong bones after 50: staying on treatment;ROS resources;men and FLS leaflet,,,2,FLS team meetings,Patients are not involved in governance,
RSS,Shrewsbury and Telford Hospital NHS Trust,RSS. Royal Shrewsbury Hospital,An acute hospital,,RSS. Royal Shrewsbury Hospital,"Shropshire, Telford and Wrekin",Jan-20,Block payment,,1,Nurse~band 6~2;Administrator~band 3~0.8,,No,,,324700,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;Geographic,,Scaphoid;Face/skull;Rib;Avulsion,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;Referral from primary/community services,,,Using clinic lists;Referral from Emergency Department,,,Fracture clinic lists,,Not funded,,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,Refer to another DXA provider,FLS specialist nurse practitioner;Consultant linked to FLS;Primary care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to primary care physician;Orthogeriatrician prescribes;Trauma prescribes;Metabolic bone disease / osteoporosis specialist prescribes;Other,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;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,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,Never,,No,Strong bones after 50: staying on treatment;ROS resources;men and FLS leaflet,,,3,Trauma and Orthopaedic educational governance meetings,Patients are not involved in governance,
WWL,"Wrightington, Wigan and Leigh NHS Foundation Trust","WWL. Wrightington, Wigan and Leigh NHS Foundation Trust",Another healthcare provider,Acute & Community Trust,"WRI. Wrightington Hospital,AEI. Royal Albert Edward Infirmary",Greater Manchester,Apr-15,Part of hospital general contract with no separate documentation for FLS,,0.5,Physiotherapist~band 6~0.9;Nurse~band 6~0.6,,No,,,310000,Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site,,Other,Not applicable,,,Radiology,,,Radiology report,,,Screening general radiology reports,,Other,N/A,No,,Other,DXA available within organisation,FLS specialist nurse 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 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,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects;Recurrent fractures;Recurrent falls,Telephone interview,At least once a year,Never,Do not know,Yes,Strong bones after 50: staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources;men and FLS leaflet,,,0,"Q10.1 - None, is covered in the falls policy and Harm Free Care and Community governance",Patients are not involved in governance,
DER,Royal Derby Hospital,DER. Royal Derby Hospital,An acute hospital,,DER. Royal Derby Hospital,Derby and Derbyshire,Oct-16,Block payment,,0,Nurse~band 6~1.5,,No,,,600000,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),Fracture site;Geographic,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Patella;Avulsion;Other,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service not FLS;Trauma lists,,,Seen by Orthogeriatric service,,,Using clinic lists;Referral from Emergency Department,,,Not applicable,,Not funded;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;Serum Electrophoresis;Testosterone/ Sex hormone binding globulin;24 hour urinary calcium,DXA available within organisation,FLS specialist nurse practitioner;FLS nurse prescriber;Consultant linked to FLS,,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;FLS recommends therapy to primary care physician;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;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 adverse effects;Recurrent fractures;Recurrent falls,Telephone interview,Longer than every 3 years,Longer than every 3 years,Do not know,No,Strong bones after 50: staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources,,,1,FLS part of monthly Osteoporosis/FLS MDT and also included in management meetings,Patients are not involved in governance,
ADD,Cambridge University Hospitals NHS Foundation Trust FLS,ADD. Addenbrooke's Hospital,An acute hospital,,ADD. Addenbrooke's Hospital,Cambridgeshire and Peterborough,Apr-17,Block payment,,2,Nurse~band 6~3.6;Nurse~band 7~1;Administrator~band 3~0.4;Physiotherapist~band 6~0.2,,Yes,7 months parental leave for 0.8wte band 6 FLS nurse,No,578264,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;Geographic,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Avulsion,Ward/emergency room admissions lists;Fracture clinic lists;Trauma lists;Other,,T&O post take ward round lists;Orthogeriatrics in patient lists,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,Epic ED track board;Multi-professional virtual fracture clinic,,Using clinic lists;Emergency Department lists,,,Visits spine clinic/reviews letters;Fracture clinic lists;Emergency Department lists;Other,Vertebral fracture pathway - referrals from neurosurgery teams,Other,FLS is primarily involved in identifying acute symptomatic vertebral fractures grade 2 and above,Yes,Review of fracture clinic lists,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Other,DXA available within organisation,FLS specialist nurse practitioner;Consultant linked to FLS;other clinical speciality;Primary care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests;Other interventions,FLS recommends therapy to primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes;Other,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,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;Review face to face,Longer than every 3 years,Longer than every 3 years,Do not know,No,What should happen if you or someone you know experiences a fragility fracture?;Strong bones after 50: Fracture liaison services explained;ROS resources;men and FLS leaflet;Other,,Stronger for longer (C&P leaflet);Super 6 strength and balance (C&P leaflet),3,Rheumatology governance meeting,Patients are not involved in governance,
WGH,Weston General Hospital,WGH. Weston General Hospital,An acute hospital,,WGH. Weston General Hospital,BNSSG,Apr-25,Block payment,,0.5,Nurse~band 7~0.8;Nurse~band 6~1;Administrator~band 3~1.8,,Yes,We have yet to fully recruit to the band 6 role and are 16 hours short,Yes,216735,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;Metacarpal;Face/skull;Avulsion,NHFD lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists,,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Fracture clinic attended,,,Using clinic lists;Referral from Emergency Department;Radiology report,,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Other,Referrals from T&O consultants,Still developing pathway,,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;Coeliac disease screen;Serum Electrophoresis;Serum free light chains,Refer to another DXA provider,FLS specialist nurse practitioner;FLS nurse prescriber;Consultant linked to FLS;other clinical speciality;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 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,At least every 3 years,At least every 3 years,Do not know,No,What should happen if you or someone you know experiences a fragility fracture?;Bone health card;Strong bones after 50: staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources;men and FLS leaflet,,,3,to Care of the Elderly governance,Other,We have just started the service and hope to recruit a patient representative ASAP
PET,North West Anglia NHS Foundation Trust,PET. Peterborough City Hospital,An acute hospital,,"PET. Peterborough City Hospital,HIN. Hinchingbrooke Hospital",Cambridgeshire & peterborough,Jan-25,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 7~1.5,,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;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Pelvis;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Fracture clinic lists;Trauma lists,,,Fracture clinic attended;Other,,referral from clinician,Using clinic lists,,,Fracture clinic lists;Referral from primary/community services;Other,direct clinician referral,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,DXA available within organisation,FLS nurse prescriber,,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 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,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;Review face to face,Never,Never,,No,ROS resources,,,0,if required/any issues FLS is included within the MSK governance meeting,Patients are not involved in governance,
7A5T,,7A5T. Cwm Taf University LHB,A community care based service,,"RGH. Royal Glamorgan,PCH. Prince Charles Hospital,POW. Princess Of Wales Hospital",NA,Nov-24,Other,SERVICE HAS STARTED,1,Other~band 7~2;Administrator~band 3~2;Administrator~band 4~1,,No,,,450000,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range,,,Not applicable,,,Not applicable,,,Radiology report,,,Screening general radiology reports,,Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum 25OH vitamin D;C-reactive protein;Renal function tests,DXA available within organisation,FLS specialist nurse practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab,FLS recommends therapy to primary care physician,No - we refer patients on for a falls assessment,,,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;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;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Postal questionnaire,At least once a year,At least once a year,Do not know,No,ROS resources,,,4,Mediicine Governance,Patients are not involved in governance,
ESH,East Sussex Healthcare,ESH. East Sussex Healthcare,An acute hospital,,CGH. Conquest Hospital,Sussex Health and Care integrated care system,Sep-17,Block payment,,0.5,Nurse~band 7~2;Administrator~band 5~0.8;Administrator~band 2~0.3,,No,,,309700,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site,,Ankle;Pelvis;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Other,,<75yrs Hip fracture seen that require DXA;>75yrs Hip fracture seen by Orthogeriatric service,Ward/emergency room admissions/discharge lists;Other IT systems;Referral from primary/community services,Nervecentre A&E system,,Other IT systems;Emergency Department lists;Referral from primary/community services,Nervecentre A&E system,,Referral from primary/community services,,Not funded;Lack of standardised practise/language for radiology reporting,,Yes,Referral,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Testosterone/ Sex hormone binding globulin,Refer to another DXA provider,FLS specialist nurse practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests;Other interventions,FLS recommends therapy to 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;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;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;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;Postal questionnaire,Continuous (every patient),Never,Do not know,No,Strong bones after 50: staying on treatment;ROS resources;men and FLS leaflet;Other,,Trust Leaflets on How to take Bisphosphonates.;Medications management CCG information for Denosumab,6,Trust governance meetings,Other,Patient outcomes and case studies
SCM,James Cook University Hospital,SCM. James Cook University Hospital,A community care based service,,SCM. James Cook University Hospital,north east and cumbria,Jan-15,Block payment,,0,Nurse~band 7~1;Nurse~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;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site;Geographic,,Scaphoid;Metacarpal;Metatarsal;Face/skull,IT systems,BIU,,Other IT systems,BIU,,Other IT systems,BIU,,Referral from primary/community services;Other,It system - reported by radiologist and coded,Other,no barriers,Yes,refresh of reports;GP referral,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 within organisation,FLS specialist nurse practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Other interventions,FLS recommends therapy to 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;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,,Patient;Primary care physician,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;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;Review face to face,Continuous (every patient),At least once a year,56,No,ROS resources,,,6,Trust Falls Improvement Group;Clinical Improvement Group,Other,Link with ROS support group
HHC,Hull and East Riding FLS,HHC. Hull and East Riding FLS,A community care based service,,HRI. Hull Royal Infirmary,Humber and North Yorkshire integrated Care Board,Jun-21,Fixed term then need to completely re-bid,,0,Nurse~band 7~0.6;Nurse~band 6~1;Nurse~band 5~0.4;Other~band 3~0.6,,No,,,615000,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;Patella;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems,Hospital generate list of patients that have coded as fracture,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended;Referral from primary/community services,Hospital generate list of patients that have coded as fracture,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department;Referral from primary/community services;Radiology report,Hospital generate list of patients that have coded as fracture,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Referral from primary/community services;Other,Hospital generate list of patients that have coded as fracture,Lack of standardised practise/language for radiology reporting,,No,,Other,Refer to another DXA provider,FLS specialist nurse practitioner;Consultant linked to FLS;Primary care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources,FLS recommends therapy to primary care physician;Orthogeriatrician prescribes,No - we refer patients on for a falls assessment,,,,,Patient,Other,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Postal questionnaire;Review face to face,Never,Never,,No,ROS resources;Other,,evenity information leaflets,0,N/A,Patients are not involved in governance,
CRY,Croydon University Hospital,CRY. Croydon University Hospital,An acute hospital,,MAY. Mayday University Hospital,Integrated Falls Service,May-17,Block payment,,1,Nurse~band 7~0.1;Physiotherapist~band 7~0.2;Nurse~band 8a~0.1,,No,,,400000,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;Geographic,,,Seen by Orthogeriatric service not FLS,,,Radiology;Other IT systems;Fracture clinic attended;Referral from primary/community services,referral form on CERNA,,Other IT systems;Referral from primary/community services;Radiology report,referral form CERNA,,DXA imaging (VFA);Screening general radiology reports;Referral from primary/community services;Other,Community phisiotherapist,Other,Internal project completed. Referral received from Radiology automatically.,Yes,Liaise with Fracture Clinic.,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 within organisation,FLS specialist nurse practitioner;Consultant linked to FLS,,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 primary care physician;FLS 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;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,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;Review face to face,Never,Never,,No,What should happen if you or someone you know experiences a fragility fracture?;Strong bones after 50: staying on treatment;ROS resources;Other,,Calcium and Vitamin D information leaflet,6,"orthopaedic governance, rheumatology meeting.",Other,Patient feedback is taken into account when changes are made.
NTG,North Tees and Hartlepool NHS Foundation Trust,NTG. University Hospital of North Tees,An acute hospital,,NTG. University Hospital of North Tees,HAST,Mar-11,Part of hospital general contract with no separate documentation for FLS,,0.5,Nurse~band 5~1.4;Administrator~band 2~0.2;Radiographer~band 6~0.2,,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;Geographic,,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,"CRIS, Trackcare",,Visits spine clinic/reviews letters;Fracture clinic lists;Other,Daily trauma lists,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 within organisation,FLS specialist nurse practitioner;Primary care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources,FLS recommends therapy to 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 a history of blackouts or syncope;Assessment of home hazards,,,,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,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,Never,0,No,ROS resources,,,3,The FLS is part of the falls prevention group which is minuted and actioned,Patients are not involved in governance,
WSH,West Suffolk NHS Foundation Trust,WSH. West Suffolk Hospital,A community care based service,,WSH. West Suffolk Hospital,West Suffolk ICB,May-15,Block payment,,0,Nurse~band 7~1.1;Nurse~band 6~0.6;Administrator~band 2~0.2,,No,,,177300,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;Geographic,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,IT systems,Hospital Coding,,Other IT systems,Hospital coding,,Other IT systems,Hospital coding,,DXA imaging (VFA);Referral from primary/community services;Other,Hospital Coding,Unable to access radiology images;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;Renal function tests;Coeliac disease screen;Testosterone/ Sex hormone binding globulin,DXA available within organisation,FLS specialist nurse practitioner;FLS nurse prescriber;other clinical speciality;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;Other interventions,FLS recommends therapy to orthogeriatrician;FLS recommends therapy to primary care physician;FLS prescribes;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;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;Chair rise,,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,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;Review face to face,Continuous (every patient),Never,Do not know,No,Six golden rules video resource;Strong bones after 50: staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources;men and FLS leaflet;Other,,Bisphosphonate leaflet,1,Risk assessments updated monthly. Minutes stored on shared drive.,Patients are not involved in governance,
Z18,Western Health & Social Care Trust,Z18. Western Health and Social Care Trust,An acute hospital,,ALT. Altnagelvin Hospital,Western Health &Social Care Trust,Mar-22,Other,Recurrently funded service,1,Nurse~band 7~2.8;Administrator~band 4~1.8,,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,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion;Other,Other,,T&0 Management sheets,Other,,T&0 Management sheets,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 25OH vitamin D;Thyroid function;Renal function tests;Testosterone/ Sex hormone binding globulin,DXA available within organisation,FLS specialist nurse practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to primary care physician;Orthogeriatrician prescribes,Yes,Assessment of a history of falls;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;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);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,Longer than every 3 years,Longer than every 3 years,Do not know,No,ROS resources,,,12,Nurse Manager,Patients are not involved in governance,
PGH,Poole Hospital NHS Foundation Trust,PGH. Poole General Hospital,An acute hospital,,PGH. Poole General Hospital,Dorset,Apr-13,Block payment,,0.25,Nurse~band 7~1;Nurse~band 6~0.5;Administrator~band 4~0.8,,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);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site;Other,"Restricted to major fracture sites Pelvis, Hip, Prox Humerus , wrist & Hip<age 85",Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion;Other,Ward/emergency room admissions lists;Trauma lists;Other,,"Hips> 85 Orthogeriatrics;Hips< 75 FLS;Hips 75-85 frailty score less than 6, FLS",Radiology;Other IT systems;Referral from primary/community services;Other,Business Intelligence report daily all fractures age 50 and over attending ED,Trauma list,Emergency Department lists;Referral from primary/community services;Other,,Business Intelligence report daily all fractures age 50 and over attending ED,Emergency Department lists;Referral from primary/community services;Other,Referral from inpatient departments if incidental finding,Not funded;Still developing pathway,,No,,Serum Calcium;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;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 within organisation,FLS specialist nurse practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to 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,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Current drug treatment recommendations (if applicable);Follow-up plan,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,Postal questionnaire,Never,Never,,No,ROS resources;Other,,All patient letters include links to ROS,2,Rheumatology Governance,Patients are not involved in governance,
MDW,Medway NHS Foundation Trust,MDW. Medway Maritime Hospital,An acute hospital,,MDW. Medway Maritime Hospital,Medway,Mar-16,Other,non commissioned service,0,Nurse~band 8a~0.1;Nurse~band 6~0.1;Nurse~band 5~0.1,,Yes,Band 5,Yes,427000,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,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS,,,Fracture clinic attended,,,Using clinic lists,,,Fracture clinic lists,,Not funded;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;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis,DXA available within organisation,Primary care physician,,None,Orthogeriatrician prescribes,No,,,,,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,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,Never,Never,,No,ROS resources,,,1,Rheumatology governance and business meeting,Patients are not involved in governance,
SGH,University Hospitals Southampton NHS Foundation Trust,SGH. Southampton General Hospital,An acute hospital,,SGH. Southampton General Hospital,Hampshire and Isle of Wight ICS,Feb-25,Block payment;Per patient tariff,,0,Physiotherapist~band 8a~0.8;Administrator~band 4~2;Nurse~band 6~2.3,,Yes,band 4 admin 1WTE - recruitment freeze;band 4 admin 0.5 WTE - recruitment freeze,Yes,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;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;IT systems;Trauma lists,eTrauma;ED admissions (PowerBI report),,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Other IT systems;Fracture clinic attended,PowerBI report run through ED admissions,,Using clinic lists;Other IT systems;Emergency Department lists,PowerBI report run through ED admissions,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Emergency Department lists,,Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department;Lack of training in identifying vertebral fractures,,Yes,PowerBI report of rolling ED admissions list,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;Urine electrophoresis (for Bence Jones protein);Serum free light chains,DXA available within organisation;Refer to another DXA provider,FLS specialist nurse practitioner;Consultant linked to FLS,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to primary care physician;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;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;Specialist nurse;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,Longer than every 3 years,Longer than every 3 years,Do not know,No,Strong bones after 50: staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources,,,1,T&O governance,Patients are not involved in governance,
ROT,The Rotherham NHS Foundation Trust,ROT. Rotherham General Hospital,An acute hospital,,ROT. Rotherham General Hospital,South Yorkshire,Aug-17,Per patient tariff,,0,Administrator~band 2~0.1;Administrator~band 3~0.1;Radiographer~band 5~0.2;Radiographer~band 6~0.1;Nurse~band 7~1.6,,Yes,"Band 7, nurse, 12 months",No,268000,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,,Face/skull;Other,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists;Other,"Radiology, Trauma meeting sheets. Please note orthogeriatrician is part of bone health",Meditech/PACs/A&E IT system,Ward/emergency room admissions/discharge lists;Radiology;Other IT systems;Fracture clinic attended;Other,Trauma meeting sheets,Meditech/PACs/A&E IT system,Using clinic lists;Other IT systems;Emergency Department lists;Radiology report;Other,Meditech/PACs/A&E IT system,Trauma meeting sheets,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Other,"Radiology, A&E, Trauma meeting sheets, fracture clinic",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;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 within organisation,FLS specialist nurse practitioner;FLS nurse prescriber;Consultant linked to FLS;Primary care physician;Other,Bone health clinic,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to primary care physician;FLS prescribes;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 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;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);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,Never,,No,ROS resources;Other,,Trust FLS leaflet,1,"Reported to specialist medicine, escalated to Trust",Patients are not involved in governance,
HIL,The Hillingdon Hospitals NHS Foundation Trust,HIL. Hillingdon Hospital,An acute hospital,,HIL. Hillingdon Hospital,Hillingdon,Jul-18,Part of hospital general contract with no separate documentation for FLS,,0.5,Nurse~band 7~1.6,,No,,,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;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,NHFD lists,,,Seen by Orthogeriatric service,,,FLS visits the orthopaedic/trauma clinic,,,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),Refer to another DXA provider,FLS specialist nurse practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Intravenous bisphosphonates,FLS recommends therapy to 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 a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk,,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Started a programme of strength and balance exercise;Recurrent fractures,Telephone interview,Never,Never,,No,What should happen if you or someone you know experiences a fragility fracture?;Six golden rules video resource;Bone health card;Strong bones after 50: staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources,,,0,nil,Patients are not involved in governance,
SUN,Sunderland Royal Hospital,SUN. Sunderland Royal Hospital,An acute hospital,,SUN. Sunderland Royal Hospital,North East and North Cumbria,Jan-15,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 6~2;Nurse~band 7~0.2;Administrator~band 4~0.9,,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,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Avulsion,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service not FLS;Trauma lists,,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Fracture clinic attended;Other,,other specialty referrals,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Referral from Emergency Department,,,Visits spine clinic/reviews letters;Fracture clinic lists;Other,referrals from the Targeted Lunch Healthcare Project;Inpatient referrals,Still developing pathway,,No,,Other,DXA available within organisation,FLS specialist nurse practitioner;Consultant linked to FLS,,Written material;Further education programmes/resources;Other interventions,FLS recommends therapy to 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,,,,Patient;Primary care physician;Service that referred to FLS,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;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Started a programme of strength and balance exercise;Recurrent fractures,Telephone interview,Longer than every 3 years,Never,Do not know,No,ROS resources;men and FLS leaflet;Other,,Trust's own bone health passport,2,Presented at orthopedic CG,Patients are not involved in governance,
WDH,Dorset County Hospital,WDH. Dorset County Hospital,An acute hospital,,WDH. Dorset County Hospital,NHS Dorset,Jan-15,Other,Part of University Hospitals Dorset Rheumatology department,0.25,Nurse~band 6~1;Administrator~band 4~0.8,,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;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site;Geographic,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;Trauma lists,,,Ward/emergency room admissions/discharge lists,,,Using clinic lists;Other IT systems;Other,Business intelligence report populated from fracture clinic patients,Orthopaedic trauma list,DXA imaging (VFA);Re-reading radiology images;Fracture clinic lists;Other,Orthopaedic trauma list,Other,not applicable,Yes,not applicable,Other,DXA available within organisation,FLS specialist nurse practitioner;Other,GP,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests;Other interventions,FLS recommends therapy to 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,,,,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;Specialist nurse,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,At least every 3 years,At least every 3 years,,No,ROS resources,,,3,Lead consultant and lead nurse practitioner,Other,patients have occasionally attended meetings
CHN,Nottingham FLS,CHN. Nottingham City Hospital,An acute hospital,,UHN. University Hospital Queens Medical Centre,NHS nottingham and nottinghamshire,Feb-04,Part of hospital general contract with no separate documentation for FLS,,5,Nurse~band 7~0.6;Nurse~band 6~1.2,,Yes,0.4 wte B7 nurse,Yes,2500000,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;Metatarsal;Face/skull;Rib;Patella;Avulsion,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Trauma lists,,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Fracture clinic attended,,,Using clinic lists,,,Visits spine clinic/reviews letters;Referral from primary/community services,,Not funded;Lack of engagement with radiology department,,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);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available within organisation,FLS specialist nurse practitioner;FLS nurse prescriber;Consultant linked to FLS;Primary care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician;FLS recommends therapy to 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;Timed up and go;Chair rise,,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);Follow-up plan;Lifestyle/health risk-factor assessment,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,Never,Never,,No,Strong bones after 50: staying on treatment;Other,,Trust developed patient leaflet,0,N/A,Patients are not involved in governance,
EAL,Ealing Hospital,EAL. Ealing Hospital,An acute hospital,,EAL. Ealing Hospital,North West London Integrated Care System,Feb-18,Part of hospital general contract with no separate documentation for FLS,,0.5,Nurse~band 7~2,,No,,,300000,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,Age range;Fracture site;Geographic,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service not FLS;IT systems;Trauma lists,Pathpoint/Etrauma,,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,Pathpoint/Etrauma,,Using clinic lists;Other IT systems,Pathpoint/Etrauma,,DXA imaging (VFA);Other,Reading patient record to see if previous fracture is documented.,Not funded;Still developing pathway;Other,insufficient staff,No,,Serum Calcium;Serum 25OH vitamin D;Renal function tests,DXA available within organisation,FLS specialist nurse practitioner;Primary care physician,,Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests;Other interventions,FLS recommends therapy to orthogeriatrician;FLS recommends therapy to 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 of gait and balance and mobility,,Other,mobility status assessed - use of aids.,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);Medication compliance review;Follow-up plan,"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 falls,Telephone interview;Other,Never,Never,,No,ROS resources,,,18,FLSDB audit and pathpoint digital system were presented at the Rheumatology governance meeting.,Patients are not involved in governance,
KCC,East Kent Hospitals University NHS Foundation Trust,KCC. Kent and Canterbury Hospital,An acute hospital,,"WHH. William Harvey Hospital,QEQ. Queen Elizabeth the Queen Mother Hospital",Kent and Medway,Jan-24,Other,"No funding, screening is opportunistic by referral from GP's and specialists. Hip fracture referrals",0,Nurse~band 6~0.5;Nurse~band 8a~0.5,,No,,,65000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards,Fracture site;Other,"Please note, the FLS was suspended in January 2024 due to long waiting times, lack of resources",Scaphoid;Face/skull;Patella,Other,,Referral from orthogeriatric team,Not applicable,,,Not applicable,,,Not applicable,,Not funded,,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;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin,DXA available within organisation,Other,"Osteoporosis nurse, osteoporosis nurse consultant",Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests;Other interventions,FLS recommends therapy to primary care physician;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 gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision,,Ask about gait problems,,Patient;Primary care physician;Service that referred to FLS,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);Lifestyle/health risk-factor assessment,Specialist nurse;Delegated to Primary Care physician,Medication adverse effects,Other,Never,Never,,No,ROS resources;Other,,Falls information,0,N/A,Patients are not involved in governance,
NPH,Northwick Park Hospital,NPH. Northwick Park Hospital,An acute hospital,,NPH. Northwick Park Hospital,North West London Integrated Care System,Feb-18,Part of hospital general contract with no separate documentation for FLS,,0.5,Nurse~band 7~2,,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,Age range;Fracture site;Geographic,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service not FLS;IT systems;Trauma lists,Pathpoint/Etrauma,,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,Pathpoint/Etrauma,,Using clinic lists;Other IT systems,Pathpoint/Etrauma,,DXA imaging (VFA);Other,Reading patient record to see if previous fracture is documented.,Not funded;Still developing pathway;Other,Insufficient staff,No,,Serum Calcium;Serum 25OH vitamin D;Renal function tests,DXA available within organisation,FLS specialist nurse practitioner;Primary care physician,,Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests;Other interventions,FLS recommends therapy to orthogeriatrician;FLS recommends therapy to 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 of gait and balance and mobility,,Other,Mobility status assessed - use of aids.,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);Medication compliance review;Follow-up plan,"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 falls,Telephone interview;Other,Never,Never,,No,ROS resources,,,18,FLSDB audit and pathpoint digital system were presented at the Rheumatology governance meeting.,Patients are not involved in governance,
LEW,University Hospital Lewisham,LEW. University Hospital Lewisham,An acute hospital,,LEW. University Hospital Lewisham,South East London,Oct-13,Block payment,,0,Nurse~band 8a~0.3,,No,,,305853,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,Age range = 50+ years,Scaphoid;Metacarpal;Metatarsal;Face/skull,Ward/emergency room admissions lists;IT systems;Trauma lists,,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems;Referral from primary/community services;Other,,GP direct referral,Other IT systems;Emergency Department lists;Referral from primary/community services;Other,,Ward referrals,Emergency Department lists;Other,Incidental finds,Not funded;Still developing pathway,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Renal function tests;Testosterone/ Sex hormone binding globulin,DXA available within organisation,FLS specialist nurse practitioner;Primary care physician;Other,Care of Older Adult Consultants,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Intravenous bisphosphonates;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests;Other interventions,FLS recommends therapy to orthogeriatrician;FLS recommends therapy to 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 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);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,Never,Never,,No,None of the above,Lack of resources in FLS,,2,N/A as meetings are not formally minuted. (Meetings held every 6/8 weeks),Patients are not involved in governance,
FRY,North Bristol NHS Trust,FRY. Southmead Hospital,An acute hospital,,FRY. Southmead Hospital,BNSSG,Apr-12,Part of hospital general contract with no separate documentation for FLS,,1,Nurse~band 7~1;Administrator~band 4~1,,No,,,500000,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;Geographic,,Metacarpal;Face/skull;Avulsion,Seen by Orthogeriatric service not FLS,,,Other IT systems;Other,PAS/ electronic searches of ortho ward round letters,direct referral from ward HCPs,Using clinic lists;Other IT systems;Referral from Emergency Department;Referral from primary/community services;Other,electronic searches of ortho clinic letters,direct referral from clinic HCPs,Referral from primary/community services;Other,direct referrals from other colleagues; very ad-hoc,Not funded;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department;Other,lack of time/resources/staff,No,,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),DXA available within organisation,FLS specialist nurse practitioner;FLS nurse prescriber;Consultant linked to FLS;Primary care physician;Other,Orthogeri nurses adn frailty trauma practitioner on wards.,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources,FLS recommends therapy to primary care physician;Orthogeriatrician prescribes,No - we refer patients on for a falls assessment,,,,,Patient;Primary care physician,Current drug treatment recommendations (if applicable),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 falls,Prescription review;Postal questionnaire,Never,Never,,No,Strong bones after 50: staying on treatment;ROS resources;Other,,NICE: Bisphosphonates for treating osteoporosis: Patient decision aid,0,n/a,Patients are not involved in governance,
OIC,Pennine Musculoskeletal Partnership Ltd,OIC. Oldham Integrated Care Centre,A community care based service,,OHM. Royal Oldham Hospital,Manchester,Jun-23,Fixed term then need to renew;Per patient tariff,,0.5,Administrator~band 3~0.1;Administrator~band 4~0.6;Nurse~band 8a~0.5;Other~band 8a~0.5,pharmacist,No,,,246130,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;Geographic,,Face/skull;Avulsion;Other,Seen by Orthogeriatric service not FLS;IT systems;Other,radiology spreadsheet of all potential fractures sent weekly,referrals from GP and orthogeriatrician,Radiology;Seen by Orthogeriatric service;Referral from primary/community services;Other,,internal physiotherapy referrals,Other IT systems,radiology spreadsheet of all potential fractures sent weekly,,Screening general radiology reports;Referral from primary/community services;Other,radiology spreadsheet of all potential fractures sent weekly,Other,none,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,Refer to another DXA provider,FLS nurse prescriber;other clinical speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to primary care physician,Yes,Assessment of a history of falls;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;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;Started a programme of strength and balance exercise;Recurrent fractures,Prescription review;Review face to face,Never,Never,,No,Strong bones after 50: staying on treatment;Strong bones after 50: Fracture liaison services explained;Other,,ROS website;ROS medication information leaflets;ROS bonemed online,6,"team meetings, senior management team, ICB",Patients are not involved in governance,
MPH,Musgrove Park Hospital,MPH. Musgrove Park Hospital,An acute hospital,,MPH. Musgrove Park Hospital,somerset,May-16,Block payment,,0.5,Radiographer~band 7~0.4;Nurse~band 7~0.6,,Yes,Not technically a vacancy but band 7 Nurse has been absent for 7 months and no cover provided,No,340000,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,Fracture site;Geographic,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Patella;Avulsion,Seen by Orthogeriatric service not FLS,,,Ward/emergency room admissions/discharge lists;Other IT systems;Fracture clinic attended,Maxims;EPRO;Discharge summaries,,Using clinic lists;Other IT systems;Emergency Department lists;Radiology report,Maxims;EPRO;PACS/WIM audit,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Other,Agreed Radiology audit using a code 'FLS',Not funded,,No,,Serum Calcium;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,DXA available within organisation,Consultant linked to FLS;other clinical 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 primary care physician;Orthogeriatrician prescribes,Yes,Assessment of continence and toileting;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;An evaluation of vision,,,,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;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise,Prescription review,Never,Never,,No,ROS resources,,,0,N/A,Patients are not involved in governance,
LLD,University Hospital Llandough,LLD. Llandough Hospital,An acute hospital,,UHW. University Hospital of Wales,Cardiff and vale UHB,Aug-24,Fixed term then need to renew,,1,Nurse~band 7~1;Nurse~band 6~1.3,,No,,,500000,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;Geographic,,Scaphoid;Metacarpal;Face/skull,Seen by Orthogeriatric service not FLS,,,Ward/emergency room admissions/discharge lists;Radiology;Fracture clinic attended;Referral from primary/community services;Other,,"Breast team, early menopause patient, other members of MDT",Other IT systems;Emergency Department lists;Referral from primary/community services;Radiology report;Other,BIS,referral from T+O Consultants letter requests.,DXA imaging (VFA);Screening general radiology reports;Re-reading radiology images;Emergency Department lists;Referral from primary/community services,,Still developing pathway,,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;Serum Electrophoresis;Serum free light chains,DXA available within organisation,FLS specialist nurse practitioner;Consultant linked to FLS;Primary care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests;Other interventions,FLS recommends therapy to primary care physician;Metabolic bone disease / osteoporosis specialist prescribes;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;An evaluation of vision,,,,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);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;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Other,At least every 3 years,Never,,No,What should happen if you or someone you know experiences a fragility fracture?;ROS resources;men and FLS leaflet;Other,,healthy living for strong bones.;Individual drug written information.,0,Work in progress.,Patients are not involved in governance,
STH,Guys and St Thomas' NHS Foundation Trust,STH. St Thomas Hospital,An acute hospital,,STH. St Thomas Hospital,Southwark and Lambeth,Sep-24,Block payment,,1,Nurse~band 7~1.6;Administrator~band 3~1,,No,,,13000000,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;Gender;Fracture site;Geographic,,Scaphoid;Metacarpal;Face/skull;Patella;Avulsion,Seen by Orthogeriatric service not FLS,,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Fracture clinic attended;Referral from primary/community services,,,FLS visits the orthopaedic/trauma clinic;Using clinic lists,,,Fracture clinic lists;Other,Radiology set up search function within Epic for finding incidental spine fractures,Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department;Lack of training in identifying vertebral fractures;Other,other services do not flag spine fractures to us.,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,DXA available within organisation,FLS specialist nurse practitioner;FLS nurse prescriber;Consultant linked to FLS;other clinical speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to 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;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,,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,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,Never,,No,ROS resources,,,3,Consultant to SDM,Patients are not involved in governance,
RAD,Oxfordshire Fracture Prevention Service,RAD. John Radcliffe Hospital,An acute hospital,,"RAD. John Radcliffe Hospital,HOR. Horton General Hospital",BOB,May-15,Block payment,,0.5,Nurse~band 7~1.8;Nurse~band 6~4.8;Administrator~band 4~1.7,,No,,,655000,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;Geographic,,Pelvis,Ward/emergency room admissions lists;Fracture clinic lists;IT systems;Trauma lists,Query set up using coding to indentify diganosis of fracture in ED documentation,,Ward/emergency room admissions/discharge lists;Other IT systems;Fracture clinic attended;Referral from primary/community services,Query set up using coding to indentify diganosis of fracture in ED documentation,,Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department;Referral from primary/community services,Query set up using coding to indentify diganosis of fracture in ED documentation,,DXA imaging (VFA);Re-reading radiology images;Emergency Department lists;Referral from primary/community services,,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;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin;Spot urinary calcium;24 hour urinary calcium,DXA available within organisation,FLS specialist nurse practitioner;Other,specialist pharmacist on occasion,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests;Other interventions,FLS recommends therapy to primary care physician;FLS prescribes;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,,,,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,Medication adherence;Medication persistence;Recurrent fractures,Prescription review;Telemed review,At least once a year,Never,Do not know,Yes,ROS resources,,,2,Metabolic Bone team present;Minutes recorded and made available for trust review,Patient advisory group who review FLS documentation and information;Patients are represented in the governance meetings,
MKH,Milton Keynes University Hospital Foundation Trust,MKH. Milton Keynes General Hospital,An acute hospital,,MKH. Milton Keynes General Hospital,Bedford Luton And Milton Keynes,Jun-16,Part of hospital general contract with no separate documentation for FLS,,2,Nurse~band 7~0.1;Nurse~band 6~0.1;Administrator~band 3~0.8,,No,,,250,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,Fracture site;Geographic,,Ankle;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Seen by Orthogeriatric service not FLS;Other,,FLS is ortho-geri led service,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended;Referral from primary/community services,,,Using clinic lists;Referral from Emergency Department;Referral from primary/community services;Radiology report,,,Visits spine clinic/reviews letters;DXA imaging (VFA);Fracture clinic lists;Emergency Department lists,,Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;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 within organisation,FLS specialist nurse practitioner;FLS nurse prescriber,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates,FLS recommends therapy to primary care physician;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;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,Medication adherence;Medication persistence;Medication adverse effects;Post fracture mobility;Recurrent fractures;Recurrent falls,Telephone interview,Continuous (every patient),Continuous (every patient),Do not know,No,What should happen if you or someone you know experiences a fragility fracture?;Strong bones after 50: staying on treatment;Strong bones after 50: Fracture liaison services explained;men and FLS leaflet,,,1,Hip Fracture meeting and annual clinical governance,Patients are not involved in governance,