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The Fracture Liaison Service Database (FLS-DB) Jan to December 2021
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Download this fileOrgCode | FLS Name | Where is the FLS delivered from? | Which NHFD hospitals do you provide the FLS to? | What month and year did you start the current form of FLS? | How would you describe the current contract? | How many Consultant PAs (per week) are allocated to the FLS? | How much time is spent working within the FLS as the whole time equivalent? | Estimated population size | Which patient groups does your FLS cover? Hip fracture (including inpatient fractures) | What restrictions are there on the patients seen by your service? | What restrictions are there on the patients seen by your service? Other response | If fracture site is a restriction selected, please specify which fracture sites excluded | How does your site identify hip fracture patients? | How does your site identify hip fracture patients? Other response | How does your site identify other non-hip non-vertebral fracture inpatients? | How does your site identify other non-hip non-vertebral fracture inpatients? Other response | How does your site identify fracture outpatients? | How does your site identify fracture outpatients? Other response | How does your site identify patients with vertebral fracture(s)? | How does your site identify patients with vertebral fracture(s)? Other response | If applicable, what barriers have you experienced in finding patients with vertebral fractures? | If applicable, what barriers have you experienced in finding patients with vertebral fractures? Other response | Does your site have a process for identifying potentially eligible fragility fracture patients who should have but did not receive assessment for secondary fracture prevention? | Does your site have a process for identifying potentially eligible fragility fracture patients who should have but did not receive assessment for secondary fracture prevention? Please give details | What tests do you routinely use for identifying underlying secondary causes of osteoporosis? | Do you have access to DXA scan or do you use an alternative provider or tool? | Who assesses the need for treatment? | Who assesses the need for treatment? Other response | What interventions can be recommended or initiated by the FLS? | How do patients obtain their first prescription of bone sparing treatment, if it is recommended? | Do you routinely provide a falls assessment as part of your FLS? | Which of the following are covered by the falls risk assessment in the FLS? | If Assessment of gait, balance and mobility is selected in 6.2 which assessments are used? | If Assessment of gait, balance and mobility is selected in 6.2 which assessments are used? Other response | Who receives the report from your FLS that summarises the outcomes of assessing patient need for treatment to prevent secondary fractures? | What information is included in the report? | Who is responsible for monitoring patients seen in the FLS? | What does the re-evaluation include? | How is adherence assessed or re-evaluated? | How often is there a formal survey seeking patient/carer views on the FLS? | How many completed responses did you get from your FLS patient survey? | Did you use the ROS patient experience survey? | Do you use the FLS-DB patient resources? | Do you use the FLS-DB patient resources? (if no selected, please specify barriers to using them if any) | How often does your FLS have a minuted governance meeting? | Please list the reporting structures for the governance minutes | How are patients involved in the governance of the FLS? | How are patients involved in the governance of the FLS? Other response | ||
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ADD | Cambridge University Hospitals NHS Foundation Trust FLS | An acute hospital | ADD Addenbrooke's Hospital | Apr-17 | Block payment | 2 | Nurse~band 6~3.6;Nurse~band 7~1 | Yes | 2 band6 9/12 vacancies | 500000 | Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures | Age range;Fracture site | Not set | Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib | Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists | Not set | Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended | Not set | Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department | Not set | Fracture clinic lists;Emergency Department lists;Other | Opportunistic case finding by orthogeriatricians / medical consultants | Still developing pathway;Other | Not set | Yes | Often identified in OPD TO clinic and FLS clinics | Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein) | DXA available on site | FLS specialist practitioner;Other | Cases discussed at FLS MDT with consultants | Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests | FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes | Yes | A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision;Assessment of home hazards | Ask about gait problems | Not set | Patient;Primary care physician;Falls service | Date and type of fracture;Fracture risk score;DXA BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment | Specialist nurse;Delegated to Primary Care physician | Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls;Other | Telephone interview | Never | Not set | No | Yes | Not set | 1 | Rheumatology governance | Patients are represented in the governance meetings | Not set |
AHX | Ashford and St Peter's Hospitals NHS Foundation Trust | An acute hospital | SPH St Peter's Hospital | Nov-12 | Block payment | 0 | Nurse~band 7~1 | No | Not set | 410000 | Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures) | Age range;Fracture site | Not set | Scaphoid;Face/skull;Rib;Avulsion | Seen by Orthogeriatric service not FLS | Not set | Not applicable | Not set | FLS visits the orthopaedic/trauma clinic | Not set | Visits spine clinic/reviews letters;Fracture clinic lists | Not set | Still developing pathway | Not set | No | Not set | Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Serum Electrophoresis;Serum free light chains | DXA available on site | FLS specialist practitioner | Not set | Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests | FLS recommends therapy to orthogeriatrician and/or primary care physician | Yes | Number of falls in the last 12 months;Assessment for fear of falling | Not set | Not set | Patient;Primary care physician | Date and type of fracture;Fracture risk score;DXA BMD;Current drug treatment recommendations (if applicable);Medication compliance review | Delegated to other healthcare provider | N/A monitoring is not carried out by the FLS | N/A monitoring is not carried out by the FLS | Never | Not set | No | Yes | Not set | 0 | No governance minutes | Patients are not involved in governance | Not set |
BAT | Royal United Hospital | An acute hospital | BAT Royal United Hospital Bath | Aug-16 | Block payment | 0.3 | Nurse~band 6~1;Nurse~band 7~0.6 | No | Not set | 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 | Not set | Metacarpal;Metatarsal;Face/skull | Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems | Not set | Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended | Not set | Using clinic lists;Other IT systems;Emergency Department lists | Not set | DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Other | FLS tag included in radiology reports if vertebral fracture identified to allow for text search algo | Lack of standardised practise/language for radiology reporting;Other | Not all radiologists report FLS tag consistently | Yes | Coding send monthly inpatient lists who have had a fracture;Peripheral clinic referrals | Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin | DXA available on site | FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician | Not set | Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests | FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes | No - we refer patients on for a falls assessment | Not set | Not set | Not set | Primary care physician;Service that referred to FLS | Date and type of fracture;Fracture risk score;DXA BMD;DXA vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment | FLS coordinator;Specialist nurse;Delegated to Primary Care physician | Medication adherence;Medication persistence;Medication adverse effects;Residential status;Recurrent fractures | Telephone interview;Postal questionnaire | at least every 3 years | 50 | Yes | Yes | Not set | 1 | trust audit;Rheumatology governance | Patients are not involved in governance | Not set |
BED | Bedford Hospital | An acute hospital | BED Bedford Hospital | Apr-18 | Fixed term then need to renew | 1 | Nurse~band 7~1;Administrator~band 3~0.2 | Yes | band7, 6months | 387947 | Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures | Age range;Fracture site;Other | 50 Plus | Ankle;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion | NHFD lists;FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;Trauma lists | Not set | FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Fracture clinic attended | Not set | FLS visits the orthopaedic/trauma clinic;Using clinic lists;Emergency Department lists;Other | X-ray department | Screening general radiology reports;Re-reading radiology images;Fracture clinic lists;Emergency Department lists | Not set | Unable to access radiology images;Other | Sometimes a lack of specification of exact place of vertebral fracture on the report | No | Not set | Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Liver function;Thyroid function;Liver function tests;Renal function tests | DXA available on site | FLS specialist practitioner;Clinician speciality | Not set | Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests | FLS recommends therapy to orthogeriatrician and/or primary care physician | No - we refer patients on for a falls assessment | Not set | Not set | Not set | Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care;Falls service;Service that referred to FLS | Date and type of fracture;Fracture risk score;DXA BMD;DXA vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment;Other | Specialist nurse | Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls;Other | Telephone interview;DXA | Never | Not set | No | Yes | Not set | 2 | CCG Quality Lead Governance;Escalate any issues for concern through the Commissioning directorate | Patients are not involved in governance | Not set |