Fracture Liaison Service or site ,Complete,FLS Name,,,Which NHFD hospitals do you provide the FLS to,Which ICS are you part of,What month & 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,How many Consultant PAs (per week) are allocated to the FLS,1.7 staff,Staff other,1.8 Vacancies,1.8a what vacancies,1.8.1 Current vacancies,2.1 Population size,2.2 patient groups does your FLS cover,2.3 restrictions are there on patients,2.3 OtherRestrictions,2.3.1 fracture sites are excluded,3.1 identify hip fractures,3.1 other,3.2 dentify other non-hip non-vertebral fracture,3.2 Other,3.3 Identify outpatients,3.3 Other,3.4 identify vertebral fracture,3.4 Other,3.5 barriers have you experienced,3.5 Other,3.6  identifying potentially eligible,3.6 Other,4.1 identifying underlying secondary causes,4.2 Access to DXA scan,5.1 Assess need,5.1 Other,5.2 Interventions,5.3 Obtain perscription,6.1 Falls assessment,6.2 Risk assessment,6.2.1 gait balance and mobility assessment,6.2.1 Other,7.1 Who receives the report,7.2  Included in the report,8.1 Who monitors patients,8.2 Re-evaluation include,8.3 Adherence assessed,9.1 Formal survey,9.2 How many completed responses,9.3 Did you use the ROS,9.4 Use of FLSDB resources,9.4 other,10.1 How often minuted gov meeting,10.2 Reporting structures,10.3 patients involved in governance,10.3 Other
NCA. Northern Care Alliance - Bury Community Services,yes,Northern Care Alliance - Bury Community Services,,,"NMG. North Manchester General Hospital,OHM. Royal Oldham Hospital",NCA bury,Jul-19,Block payment,,0,,1,No,,,194148,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,Fracture site,,Metacarpal;Metatarsal;Face/skull,Not applicable,,Radiology,,Not applicable,,Screening general radiology reports,,Lack of engagement with radiology department,,No,,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests,Refer to another DXA provider,FLS specialist practitioner;Delegated to Primary Care physician,,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 orthogeriatrician and/or primary care physician;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Falls service,Date and type of fracture;Fracture risk score;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan,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;Other,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;ROS resources,,3,KPI monitoring;Pathway monitoring,Patients are not involved in governance,
BEM. Barnet Enfield And Haringey Mental Health NHS Trust,yes,Enfield Bone Health and Fracture Liaison,,,"NMH. North Middlesex Hospital,RFH. Royal Free Hospital",North Central London Integrated Care Board,Jun-22,Block payment,,0,Nurse~band 7~2,,No,,,329600,Hip fracture (including inpatient fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Ankle;Scaphoid;Metatarsal;Face/skull;Patella;Avulsion,Fracture clinic lists;IT systems,,Radiology;Fracture clinic attended,,Other IT systems,,Fracture clinic lists,,Not funded;Unable to access radiology images;Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department;Lack of training in identifying vertebral fractures,,No,,Serum phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Thyroid function;C-reactive protein;Renal function tests;Other,Refer to another DXA provider,FLS specialist 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 and/or primary care physician,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision;Assessment of home hazards,Ask about gait problems;Berg balance,,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),Do not know,No,ROS resources,,2,Trust Audit,Patients are not involved in governance,
ACE. Anglian Community Enterprise FLS,,Anglian Community Enterprise FLS,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
KCH. King's College Hospital,yes,King's College Hospital - Denmark Hill Site,,,KCH. King's College Hospital,Southwark & Lambeth,May-20,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 7~1,,No,,,1000000,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,,,Ward/emergency room admissions lists;Fracture clinic lists,,Ward/emergency room admissions/discharge lists;Fracture clinic attended,,Using clinic lists,,Fracture clinic lists,,Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department;Other,Lack of manpower to identify all fractures,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate,Ask about gait problems,,Patient;Primary care physician,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;DXA,Continuous (every patient),50,Yes,ROS resources,,0,n/a,Other,No governance meetings take place.
BRH. Bromley Healthcare,yes,Bromley Healthcare Falls and Fracture Prevention Service,,,BRO. Princess Royal University Hospital (Bromley),South East London,Feb-14,Fixed term then need to renew,,0,Nurse~band 6~0.4,,No,,,300000,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range,,,Fracture clinic lists,,Fracture clinic attended,,Using clinic lists,,Fracture clinic lists,,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;Thyroid function;Liver function tests;Renal function tests;Testosterone/ Sex hormone binding globulin,Refer to another DXA provider,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Current drug treatment recommendations (if applicable),FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects,Telephone interview,Never,,No,ROS resources,,0,Not known,Patients are not involved in governance,
RBE. Royal Berkshire Hospital,yes,Royal Berkshire FLS,,,RBE. Royal Berkshire Hospital,"Berks, Ox, Bucks",Jan-16,Block payment,,2,Nurse~band 6~1;Nurse~band 7~1;Administrator~band 4~1,,No,,,500000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site;Other,GP surgery postcode,Scaphoid;Face/skull;Rib;Patella;Avulsion,NHFD lists;Fracture clinic lists;IT systems;Other,Referrals from Orthogeri team,Radiology;Other IT systems;Fracture clinic attended;Other,Referral from inpatient teams,Using clinic lists,,Fracture clinic lists;Other,Referral from Radiology teams,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;Other,Refer to another DXA provider,FLS specialist 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 and/or primary care physician;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician,Date and type of fracture;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,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;Telephone interview,At least once a year,30,No,Bone health card;ROS resources,,1,FLS governance;Rheumatology governance,Patients are not involved in governance,
Z10. Belfast Health and Social Care Trust,yes,Belfast Health and Social Care Trust,,,RVB. Royal Victoria Hospital,N/A,Jun-03,Other,Northern Ireland,0.25,Radiographer~band 7~0.3;Radiographer~band 6~0.3;Administrator~band 3~0.5;Nurse~band 5~2;Nurse~band 7~0.5;Nurse~band 6~0.3,,No,,,348000,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,50-80;Male ankle,Scaphoid;Metacarpal;Face/skull;Rib,Ward/emergency room admissions lists;Fracture clinic lists;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Fracture clinic attended,,Using clinic lists;Emergency Department lists;Referral from Emergency Department,,Fracture clinic lists;Emergency Department lists;Other,Vertebral fracture voice recognition,Lack of training in identifying vertebral fractures,,Yes,Vertebral fracture voice recognition signpost within radiology in BHSCT,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;Liver function;Thyroid function;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,At least once a year,50,Yes,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,,3,To all FLS staff;To Trauma/Orthopaedic service manager,Patients are not involved in governance,
RAD. John Radcliffe Hospital,yes,Oxfordshire Fracture Prevention Service,,,"NOC. Nuffield Orthopaedic Centre,RAD. John Radcliffe Hospital,HOR. Horton General Hospital",BoB,Jan-11,Block payment,,1,Nurse~band 6~3.2;Administrator~band 4~1.8;Nurse~band 7~1.8,,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,Age range;Fracture site,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Patella;Avulsion,IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Other IT systems;Other,Medical team referrals,Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department;Other,GP referrals,DXA imaging (VFA);Re-reading radiology images;Emergency Department lists,,Still developing pathway;Other,Time,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site;Peripheral DXA,FLS specialist 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 and/or primary care physician;Orthogeriatrician prescribes;Trauma prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No,,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview,At least once a year,100,Yes,ROS resources,,1.5,Trust board level review,Patient advisory group who review FLS documentation and information;Patients are represented in the governance meetings,
BNT. Barnet General Hospital,yes,Barnet Hospital,,,BNT. Barnet General Hospital,north central London,Jan-16,Block payment,,1,Nurse~band 7~1,,No,,,247000,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,,Ankle;Metacarpal;Metatarsal;Face/skull;Rib,FLS visits the orthopaedic/trauma ward;IT systems;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Other IT systems;Other,Referral from inpatient services,Using clinic lists;Other IT systems;Emergency Department lists;Other,Referral from physio therapists/ fracture clinic /referral from geriatric hot clinic,Screening general radiology reports;Emergency Department lists;Other,Referral from inpatient services/ referral from geriatric hot 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;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;Other,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,A formal assessment of cognition;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope,,,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,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Continuous (every patient),Do not know,No,Bone health card;Strong bones after 50 - staying on treatment;ROS resources,,0,Service is audit yearly by governance team according to FLSDB data,Patients are not involved in governance,
"QEB. Queen Elizabeth Hospital, Edgbaston",yes,University Hospitals Birmingham NHS Foundation Trust,,,"QEB. Queen Elizabeth Hospital, Edgbaston",Solihull and Birmingham,Jan-23,Fixed term then need to renew,,0.25,Other~band 3~0.5;Nurse~band 6~3,,No,,,1300000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging,Age range;Fracture site,,Metacarpal;Metatarsal;Face/skull;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;Trauma lists,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Fracture clinic attended,,Using clinic lists;Emergency Department lists;Other,Referral from PT/OT,DXA imaging (VFA);Fracture clinic lists;Emergency Department lists;Other,Referral from other specialty/radiology,Other,Staffing level recently provided. Engagement with radiology just started.,Yes,Usually we received a list from QUORU (informatics),Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Thyroid function;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician 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 orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Trauma prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,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;Clinic review remote,Longer than every 3 years,Do not know,No,Bone health card;ROS resources,,1,Endocrinology and metabolic bone,Patients are not involved in governance,
ESH. East Sussex Healthcare,yes,East Sussex Healthcare,,,CGH. Conquest Hospital,Hastings and Rother and Eastbourne Seaford and Hailsham,Sep-17,Block payment,,0.5,Nurse~band 7~2;Administrator~band 5~0.8;Administrator~band 2~0.4,,No,,,360000,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site;Other,Hip fracture patients under age 75 that require DEXA scan.,Pelvis;Metacarpal;Metatarsal;Face/skull;Rib,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Other,"FLS only identifies <75yrs Hip fractures that require a DEXA scan, >75 seen by orthogeriatric team.",Ward/emergency room admissions/discharge lists;Other IT systems;Other,Referrals from consultants for VF#.,Other IT systems;Emergency Department lists,,Other,Referral only from spinal consultants.;Not funded for case finding of VF#.,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Testosterone/ Sex hormone binding globulin,Refer to another DXA provider,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;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,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Postal questionnaire,Continuous (every patient),Do not know,No,Strong bones after 50 - staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources,,6,Trust review,Patient advisory group who review FLS documentation and information,
MDW. Medway Maritime Hospital,,Medway NHS Foundation Trust,,,MDW. Medway Maritime Hospital,,Jan-16,Other,non-commissioned,,Nurse~band 5~0.30000000000000004;Nurse~band 6~0.1;Nurse~band 8a~0.2,,Yes,x1 wte band 6,Yes,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,Fracture site,,Scaphoid;Metacarpal;Face/skull;Avulsion,Trauma lists,,Other,trauma list,Using clinic lists,,Fracture clinic lists,,Not funded;Unable to access radiology images;Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department;Lack of training in identifying vertebral fractures,,No,,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;ESR;Liver function;Thyroid function;Renal function tests;Coeliac disease screen;Serum Electrophoresis,DXA available on site,Clinician speciality,,None,FLS recommends therapy to orthogeriatrician and/or primary care physician;Metabolic bone disease / osteoporosis specialist prescribes,No,,,,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;Current drug treatment recommendations (if applicable);Follow-up plan,Delegated to Primary Care physician,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,Never,,No,ROS resources,,0,,Patients are not involved in governance,
Z18. Western Health and Social Care Trust,yes,Western Health & Social Care Trust,,,ALT. Altnagelvin Hospital,Western Health & Social Care Trust,Mar-22,Other,Recurrently funded service,1,Nurse~band 7~2.8;Administrator~band 4~0.8;Administrator~band 3~1,,No,,,444000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib,Other,T&O management spreadsheet,Other,T&O management spreadsheet,Using clinic lists;Emergency Department lists,,Fracture clinic lists;Emergency Department lists,,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Thyroid function;Renal function tests;Testosterone/ Sex hormone binding globulin,DXA available on site,Clinician speciality,,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 and/or primary care physician,Yes,Number of falls in the last 12 months;Assessment of gait and balance and mobility,Ask about gait problems;Chair rise,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,"FLS coordinator;Secondary care consultant (e.g. orthogeriatrician, rheumatology);Delegated to Primary Care physician",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face;Clinic review remote;DXA,Longer than every 3 years,Do not know,No,ROS resources,,12,Nurse Manager,Patients are not involved in governance,
WMH. Manor Hospital,yes,Walsall Healthcare,,,WMH. Manor Hospital,Black Country,Jan-20,Block payment,,0,Nurse~band 6~1;Nurse~band 7~1;Administrator~band 3~0.8,,No,,,225000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib,Fracture clinic lists;IT systems,,Other IT systems,,Using clinic lists;Other IT systems,,Fracture clinic lists,,Unable to access radiology images;Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,Yes,fracture list received daily for aged 50+ patients attending A&E / # clinic,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Renal function tests;Coeliac disease screen,Refer to another DXA provider,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes,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;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;Post fracture mobility;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Clinic review face to face;Clinic review remote;DXA,At least once a year,100,No,ROS resources,,6,"divisional board, care group , Governance board",Patients are not involved in governance,
BFH. Broomfield Chelmsford,yes,Broomfield Hospital,,,BFH. Broomfield Chelmsford,MSE,Apr-16,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 7~1.6;Administrator~band 3~0.8,,No,,,4000000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site,,Metacarpal;Face/skull;Rib,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Fracture clinic lists;IT systems;Trauma lists,,Not applicable,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems,,Not applicable,,Unable to access radiology images;Lack of engagement with radiology department;Lack of training in identifying vertebral fractures,,No,,Serum Calcium;Serum 25OH vitamin D,DXA available on site,Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab,FLS recommends therapy to orthogeriatrician and/or primary care physician,No,,,,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;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,Do not know,No,None of the above,ROS no longer provide publications We direct patient to the website,0,Trauma and orthopaedic,Patients are not involved in governance,
IPS. The Ipswich Hospital,yes,The Ipswich Hospital NHS Trust,,,IPS. The Ipswich Hospital,Suffolk and North Essex Integrated Care System,Sep-20,Block payment,,0.375,Nurse~band 7~1;Physiotherapist~band 6~1;Nurse~band 6~1.3,,Yes,Band 6 nurse 10 hours per week,No,385000,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;Rib;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,Using clinic lists;Emergency Department lists;Referral from Emergency Department,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Emergency Department lists,,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,Yes,if they are admitted we still get information and pick up from community hospitals,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;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;Other,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;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;An evaluation of vision;Assessment of home hazards,Ask about gait problems;Berg balance,,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;Clinic review face to face;Other,At least every 3 years,66,No,Strong bones after 50 - staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources,,1,Rheumatology governance;orthogeriatrician governance;monthly team meeting in community,Patients are not involved in governance,
ADD. Addenbrooke's Hospital,yes,Cambridge University Hospitals NHS Foundation Trust FLS,,,ADD. Addenbrooke's Hospital,Cambridge and Peterborough,Apr-17,Per patient tariff,,1.25,Nurse~band 6~3.6;Nurse~band 7~1;Physiotherapist~band 6~0.4,,Yes,Band 6 vacancy intermittent throughout the year.,Yes,400000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Emergency Department lists;Other,FLS are integrated within the Orthopaedic / fracture clinic,Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Other,"Referral from medical, vertebral fracture clinic and surgical teams and AI as part of R&D",Still developing pathway;Other,New member of staff in post to review opportunistic vertebral fracture pathway,Yes,"FLS identifies all fragility fracture patients over age of 50, assess, investigate and treat.",Serum Calcium;Serum phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),DXA available on site,FLS specialist practitioner;Other,Orthogeriatricians,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;An evaluation of vision,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,"Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse",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,At least every 3 years,Do not know,No,Strong bones after 50 - staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources,,3,Rheumatology governance;Divisional board for escalations,Patients are not involved in governance,
"STM. St Marys Hospital, Paddington",yes,Imperial College Healthcare NHS Trust,,,"STM. St Marys Hospital, Paddington",North west London,Dec-19,Part of hospital general contract with no separate documentation for FLS,,1,Nurse~band 7~2;Administrator~band 2~0.3,,No,,,2000000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Ward/emergency room admissions lists;Fracture clinic lists;IT systems;Trauma lists,,Radiology;Other IT systems,,Using clinic lists;Other IT systems;Referral from Emergency Department,,DXA imaging (VFA);Screening general radiology reports,,Other,n/a,Yes,"referrals from other professionals, Gp,s, other clinics",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;24 hour urinary calcium,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Trauma prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care;Falls service;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Clinic review remote;DXA,Continuous (every patient),Do not know,Yes,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;ROS resources,,12,Trust audit,Patients are not involved in governance,
PGH. Poole General Hospital,yes,Poole Hospital NHS Foundation Trust,,,PGH. Poole General Hospital,Dorset,Apr-13,Block payment,,0,Nurse~band 7~1;Nurse~band 6~0.6;Administrator~band 4~0.8,,No,,,800000,Hip fracture (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site;Other,Patients aged 50-90 routinely seen. Over 90's considered if frailty score<6. Under 50's by referral,Scaphoid;Metacarpal;Face/skull;Rib;Avulsion,Other,Mainly seen by Orthogeriatrics. Under 75 NOF's identified and seen by FLS via emergency lists,Other,Over 85 years seen by Orthogeriatrics Under 85 identified by IT Systems report,Other IT systems;Emergency Department lists,,Emergency Department lists;Other,Not systematically identified at present except via trauma lists,Not funded;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;Testosterone/ Sex hormone binding globulin,Refer to another DXA provider,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Falls service;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;Secondary causes of osteoporosis (if applicable);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,,No,ROS resources,,0,No minuted meetings but issues are raised via Rheumatology Governance /Medical Specialties Managers,Patients are not involved in governance,
SRH. Salford Royal Hospital,yes,Salford Royal NHS Foundation Trust,,,SLF. Salford Royal,Greater Manchester,Jan-18,Fixed term then need to renew,,1,Nurse~band 6~0.2;Administrator~band 3~0.6,,No,,,230000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site,,Scaphoid;Face/skull,Seen by Orthogeriatric service not FLS;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems,,FLS visits the orthopaedic/trauma clinic;Other IT systems;Emergency Department lists,,Emergency Department lists;Other,referral from spine clinic,Not funded,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),DXA available on site,Clinician 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 orthogeriatrician and/or primary care physician,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Recurrent fractures;Recurrent falls,Telephone interview,Longer than every 3 years,0,No,ROS resources,,3,Rheumatology Governance,Patients are not involved in governance,
BED. Bedford Hospital,yes,Bedford Hospital,,,BED. Bedford Hospital,Bedford,Apr-18,Fixed term then need to renew,,1,Nurse~band 7~1;Administrator~band 3~1,,Yes,"Full time administrative, band 3, 9months",No,493,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;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Fracture site,,Ankle;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,NHFD lists;FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Fracture clinic attended,,Using clinic lists;Emergency Department lists,,Screening general radiology reports;Re-reading radiology images;Fracture clinic lists;Emergency Department lists,,Other,Sometimes a lack of specification of exact fracture placed on the report,Yes,Every admin on A&E with fractures will be sent for x-ray and report will send referral to FLS,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Liver function;Thyroid function;Liver function tests;Renal function tests,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;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;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;Assessment of home hazards,Ask about gait problems,,Patient;Primary care physician;Other,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,Clinic review remote,Never,,No,Strong bones after 50 - staying on treatment;ROS resources,,2,- CCG Quality Lead about governance;- Escalate any concern/issue through the commission directory,Patients are not involved in governance,
CHN. Nottingham City Hospital,yes,Nottingham FLS,,,UHN. University Hospital Queens Medical Centre,Nottingham & Nottinghamshire,Feb-04,Part of hospital general contract with no separate documentation for FLS,,2,Nurse~band 1~1;Nurse~band 6~1.3,,No,,,25000000,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;Fracture clinic lists;IT systems;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Emergency Department lists,,Visits spine clinic/reviews letters,,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 on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;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,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;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;Clinic review face to face;Clinic review remote;DXA,Never,,No,None of the above,Local alternatives,0,Not governance,Patients are not involved in governance,
SGH. Southampton General Hospital,yes,University Hospitals Southampton NHS Foundation Trust,,,SGH. Southampton General Hospital,Hampshire and Isle of Wight,Apr-17,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 7~1;Nurse~band 6~1.4;Radiographer~band 6~1;Administrator~band 3~0.5,,No,,,500000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Pelvis;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Trauma lists;Other,Hip fracture ward patients managed by orthogeriatric service in conjunction with FLS,Ward/emergency room admissions/discharge lists;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department,,Fracture clinic lists;Emergency Department lists,,Still developing pathway;Lack of training in identifying vertebral fractures,,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,DXA available on site,FLS specialist 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 and/or primary care physician;Orthogeriatrician prescribes;Trauma prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care,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 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;Other,Telephone interview;Telemed/video consultation;Other,Continuous (every patient),Do not know,No,Strong bones after 50 - staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources,,3,through trauma and orthopaedic governance,Patients are not involved in governance,
BAT. Royal United Hospital Bath,yes,Royal United Hospital,,,BAT. Royal United Hospital Bath,BSW,Aug-16,Block payment,,0.3,Nurse~band 7~0.2;Administrator~band 4~1;Radiographer~band 5~0.3;Other~band 8a~0.2,,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;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site;Other,Our FLS only identifies patients aged >50,Metacarpal;Metatarsal;Face/skull,Seen by Orthogeriatric service not FLS;Fracture clinic lists;Other,Coding lists for in-patients and A+E attendances.,Other IT systems;Fracture clinic attended;Other,"Monthly coding list of fractures, including inpatients",FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Emergency Department lists;Other,"Monthly coding list of fractures, including fracture clinic and emergency department",DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Other,Radiologists add FLS tag to reports when they have identified vert #. FLS searches for these tags,Lack of standardised practise/language for radiology reporting;Other,Not all radiologists use standard tag FLS for 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;Full blood count;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin;Other,DXA available on site,Clinician speciality;Delegated to Primary Care physician;Other,"Osteoporosis clinicians, orthogeriatrician",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 and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Number of falls in the last 12 months,,,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);Specialist nurse;Delegated to Primary Care physician",Medication adherence;Medication persistence;Medication adverse effects;Recurrent fractures,Telephone interview;Postal questionnaire;DXA,Longer than every 3 years,0,No,ROS resources,,1,n/a,Patients are not involved in governance,
LLD. Llandough Hospital,yes,University Hospital Llandough,,,UHW. University Hospital of Wales,Cardiff and Vale UHB,Jan-13,Other,UHB ongoing funding,5,Nurse~band 6~1;Administrator~band 3~0.2,,No,,,500000,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Face/skull,Seen by Orthogeriatric service not FLS,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other,Physiotherapy,Emergency Department lists,,Visits spine clinic/reviews letters;DXA imaging (VFA);Emergency Department lists;Other,Radiology forward incidental vert#'s seen on CT and MRI scans,Not funded;Lack of standardised practise/language for radiology reporting,,Yes,Via Dexa reporting service,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,DXA available on site,FLS specialist practitioner;Clinician 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 orthogeriatrician and/or primary care physician;FLS prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility,Ask about gait problems;Chair rise,,Primary care physician;Falls service,Date and type of fracture;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,"Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse;Delegated to Primary Care physician",Medication adherence;Medication persistence;Medication adverse effects;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Clinic review face to face;Clinic review remote;DXA,At least every 3 years,Do not know,No,ROS resources,,0,N/A,Patients are not involved in governance,
HIL. Hillingdon Hospital,yes,The Hillingdon Hospitals NHS Foundation Trust,,,HIL. Hillingdon Hospital,Hillingdon,Apr-22,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);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Opportunistic radiological vertebral fractures,Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,NHFD lists;Seen by Orthogeriatric service not FLS;IT systems;Other,NHFD Audit forms,Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended;Other,Seen by geriatrician if on COTE ward,Using clinic lists;Other IT systems,,Other,Vertebral fracture pathway set up via radiology so we receive reports of these patients who we asses,Other,not applicable,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),No,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling,,,Primary care physician;Service that referred to FLS,Date and type of fracture;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Recurrent fractures;Recurrent falls,Telephone interview,Never,,No,Strong bones after 50 - staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources,,0,not applicable,Patients are not involved in governance,
OIC. Oldham Integrated Care Centre,yes,Pennine Musculoskeletal Partnership Ltd,,,OHM. Royal Oldham Hospital,Manchester ICB,May-18,Fixed term then need to renew;Per patient tariff;Other,Combination per pt tariff and part of community contract,0.1,Nurse~band 8a~0.2;Other~band 8a~0.2;Nurse~band 5~0.1;Administrator~band 4~0.2,Pharmacist,No,,,235000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Metacarpal;Face/skull;Avulsion,Seen by Orthogeriatric service not FLS;IT systems;Other,Radiology spreadsheet,Radiology;Seen by Orthogeriatric service;Other IT systems,,Other IT systems;Other,Radiology lists,Screening general radiology reports;Other,Radiology lists,Lack of standardised practise/language for radiology reporting;Other,Only screen xray reports not other imaging modalities,Yes,"GP referral, MSK referrals",Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin,Refer to another DXA provider,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Number of falls in the last 12 months;Assessment of gait and balance and mobility,Ask about gait problems;Chair rise,,Patient;Primary care physician;Service that referred to FLS,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,"Secondary care consultant (e.g. orthogeriatrician, rheumatology);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,Never,,No,Strong bones after 50: Fracture liaison services explained;ROS resources,,3,"Senior leadership team, team meetings and ICB",Patients are not involved in governance,
DER. Royal Derby Hospital,yes,Royal Derby Hospital,,,DER. Royal Derby Hospital,South Derbyshire,Oct-16,Block payment,,0,Nurse~band 6~1.5;Administrator~band 2~0.1,,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);Presenting with a clinical vertebral fracture,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Patella;Avulsion,FLS visits the orthopaedic/trauma ward;Seen by Orthogeriatric service not FLS;Trauma lists,,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;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Delegated to 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 and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;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;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Clinic review remote,Longer than every 3 years,Do not know,No,ROS resources,,2,Governance,Patients are not involved in governance,
BWA. Bridgewater Commnity Healthcare NHS Foundation Trust,,Bridgewater Commnity Healthcare NHS Foundation Trust,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
CHE. Chesterfield Royal,yes,Chesterfield Hospital NHS Foundation Trust,,,CHE. Chesterfield Royal,Derby and Derbyshire,Jan-23,Part of hospital general contract with no separate documentation for FLS,,1,Nurse~band 7~0.6;Administrator~band 3~0.6;Radiographer~band 5~0.6,,No,,,139399,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,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Patella;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;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists,,Not applicable,,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department;Lack of training in identifying vertebral fractures,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes,No,,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Current drug treatment recommendations (if applicable);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,Never,,No,ROS resources,,0,dosent happen,Patients are not involved in governance,
"GWH. Queen Elizabeth Hospital, Woolwich",,Queen Elizabeth Hospital Lewisham,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
HCH. County Hospital Hereford,,Wye Valley NHS Trust,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
DVH. Darent Valley Hospital,,Dartford and Gravesham Community FLS,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
GEO. St George's Hospital,yes,St George's Hospital,,,GEO. St George's Hospital,SW ICS,Aug-05,Per patient tariff,,8,Nurse~band 8a~1,,No,,,1700000,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,,,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,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department,,Visits spine clinic/reviews letters;Screening general radiology reports;Fracture clinic lists;Emergency Department lists,,Other,short of staff,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin;Spot urinary calcium;24 hour urinary calcium,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;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;Timed up and go;Berg balance;Chair rise;Short physical performance battery,,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;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;Telemed/video consultation;Postal questionnaire;Clinic review face to face;Clinic review remote;DXA,Longer than every 3 years,0,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,,3,Rheumatology governance meeting,Patients are not involved in governance,
BLA. Royal Blackburn Hospital,yes,East Lancashire Hospitals NHS Trust,,,BLA. Royal Blackburn Hospital,ELHT,Apr-13,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 6~2;Administrator~band 4~1;Administrator~band 3~0.5,,No,,,350000,Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures),Age range;Fracture site;Other,local area,Face/skull;Avulsion,Seen by Orthogeriatric service not FLS,,Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists,,Not applicable,,Still developing pathway;Lack of standardised practise/language for radiology reporting,,Yes,PAS lists and ICE referrals,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk,,,Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,"Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse;Delegated to Primary Care physician",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Recurrent fractures,Prescription review;Telephone interview;Postal questionnaire;Clinic review remote;DXA,At least once a year,38,No,ROS resources,,3,CIC Governance,Patients are not involved in governance,
BAS. Basildon Hospital,,Basildon and Thurrock Hospital,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
LEW. University Hospital Lewisham,,University Hospital Lewisham,,,LEW. University Hospital Lewisham,South East London Integrated Care System,Jan-13,Block payment,,0,Nurse~band 8a~0.1,,No,,,330000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Other,GP address,,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists;Other,"Physio, Falls service, OT, Orthopaedic Dr's, Rheumatology, GPs",Emergency Department lists;Other,as above and ward referrals,Not funded;Still developing pathway,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Renal function tests,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Intravenous bisphosphonates,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk,,,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,Never,,No,None of the above,cost/ funding,2,"Trust falls group, elderly care governance,",Patients are not involved in governance,
BOL. Royal Bolton Hospital,,Royal Bolton Hospital,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
BNG. Brighton General Hospital,,"Briggs Unit, Brighton General Hospital",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SFL. Regent House,,Stockport FLS,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SAL. Salisbury District Hospital,,Salisbury NHS Foundation Trust,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
NCP. Nottingham City Care Partnership CIC,,Nottingham City Care Partnership CIC,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
KMH. Kings Mill Hospital,,Sherwood Forest Hospitals,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
LIN. Lincoln County Hospital,,United Lincolnshire Trust,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
MOR. Morriston Hospital,yes,"Morriston Hospital, ABMHU",,,MOR. Morriston Hospital,unclear,Jun-16,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 7~0.1;Administrator~band 2~0.2,,No,,,390000,Hip fracture (including inpatient fractures),Age range,,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists,,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;Thyroid function;Renal function tests,Refer to another DXA provider,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes,Yes,A formal assessment of cognition;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;A requirement to check lying and standing BP;Pulse check for rhythm and rate,,,Primary care physician,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,Other,Never,,No,None of the above,Inhouse documentation,0,Does not have governance meeting,Patients are not involved in governance,
NTG. University Hospital of North Tees,yes,North Tees and Hartlepool NHS Foundation Trust,,,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;Administrator~band 2~0.2;Radiographer~band 6~0.5,,No,,,400000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Avulsion,NHFD lists;Seen by Orthogeriatric service not FLS;Trauma lists,,Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems,,Fracture clinic lists;Other,Referral from spinal nurses,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum 25OH vitamin D;Thyroid function;C-reactive protein;Renal function tests;Coeliac disease screen,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician;Other,Orthopaedic Geriatrician,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope,,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Delegated to Primary Care physician,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,At least every 3 years,14,No,ROS resources,,3,The FLS is part of the Falls prevention group which is minuted and actioned,Patients are not involved in governance,
QAP. Queen Alexandra Hospital,yes,Portsmouth & Southeast Hampshire,,,QAP. Queen Alexandra Hospital,Portsmouth and Southeast Hants,Apr-14,Block payment,,1,Nurse~band 7~0.5;Nurse~band 6~3;Administrator~band 3~1;Administrator~band 2~1,,No,,,670000,Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site;Other,50 AND OVER,Scaphoid;Metacarpal;Face/skull;Avulsion,Seen by Orthogeriatric service not FLS,,Ward/emergency room admissions/discharge lists;Fracture clinic attended;Other,OTHER TREATMENT CENTRES,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Referral from Emergency Department,,DXA imaging (VFA);Fracture clinic lists,,Not funded,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;ESR;Renal function tests,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Non-clinical specialist practitioner;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Postal questionnaire,Continuous (every patient),Do not know,No,Strong bones after 50 - staying on treatment;ROS resources,,1,Governance,Patients are not involved in governance,
OLD. Queens Hospital Romford,,Barking Havering and Redbridge University Hospital Hospitals Trust,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
NPH. Northwick Park Hospital,yes,Northwick Park Hospital,,,NPH. Northwick Park Hospital,North West London,Apr-19,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 7~1,,No,,,1000000,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;Pelvis;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,NHFD lists;FLS visits the orthopaedic/trauma ward;Fracture clinic lists;IT systems,,FLS visits the orthopaedic/trauma ward;Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Other,Virtual Fracture Clinic meetings,Fracture clinic lists,,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department;Lack of training in identifying vertebral fractures;Other,lack of staff,No,,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Renal function tests,DXA available on site,FLS specialist practitioner;Clinician speciality;Other,Rhuematology Consultant and via DXA report,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Trauma prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No,,,,Patient;Primary care physician,DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Never,,No,ROS resources,,0,Post Covid restructuring for next year- will be done via Rheumatology governance every 3 months,Patients are not involved in governance,
NMH. North Middlesex Hospital,,North Middlesex University Hospitals NHS Trust,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
RAD. John Radcliffe Hospital,,Oxfordshire Fracture Prevention Service,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
NSE. Northumbria Specialist Emergency Care Hospital,,The Northumbria Hospital (NSECH),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SMV. Stoke Mandeville Hospital,,Buckinghamshire Healthcare NHS Trust,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
"TLF. Princess Royal Hospital, Telford",,"Princess Royal Hospital, Telford",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
STH. St Thomas Hospital,yes,Guys and St Thomas' NHS Foundation Trust,,,STH. St Thomas Hospital,South East London,Jan-23,Part of hospital general contract with no separate documentation for FLS,,1.5,Nurse~band 6~1;Nurse~band 7~0.7;Administrator~band 3~1,,Yes,Band 3 administrator - 12 months;Band 7 CNS - 5 months;Band 7 CNS 3 months,No,625300,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,,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Referral from Emergency Department,,DXA imaging (VFA);Fracture clinic lists,,Still developing pathway,,No,,Serum Calcium;Serum 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 on site,FLS specialist 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 prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate,Ask about gait problems;Timed up and go,,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;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face,Never,,No,ROS resources,,6,As per of wider department,Patients are not involved in governance,
SEH. Southend Hospital,yes,Southend Hospital,,,SEH. Southend Hospital,Mid and South Essex ICS,Mar-12,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 6~0.1;Nurse~band 7~0.1,,No,,,363000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Seen by Orthogeriatric service not FLS,,Other,referrals from wards,Using clinic lists;Other,referrals from orthopaedic clinic,Fracture clinic lists;Other,email from radiology,Not funded;Still developing pathway;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),DXA available on site,FLS specialist practitioner;Clinician 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 orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Other,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;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,"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;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face,Never,,No,ROS resources,,0,to rheumatology governance,Patients are not involved in governance,
SHC. St Helier Hospital,,Epsom & St Helier University Hospitals NHS Trust,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
RSS. Royal Shrewsbury Hospital,yes,Shrewsbury and Telford Hospital NHS Trust,,,RSS. Royal Shrewsbury Hospital,"NHS Shropshire,Telford and Wrekin ICS",Jan-20,Block payment,,1,Nurse~band 6~2;Administrator~band 3~0.8,,No,,,324716,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site;Other,age 50 and over,Scaphoid;Face/skull;Rib;Avulsion,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Fracture clinic lists;IT systems,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,Using clinic lists;Other,frailty team phone through referrals if appropriate,Fracture clinic lists;Other,ward in-patients,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,Refer to another DXA provider,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of 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;Primary osteoporosis risk factors;Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Lifestyle/health risk-factor assessment,"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;Postal questionnaire,Never,,No,ROS resources,,1,Trauma and Orthopaedic clinical governance,Patients are not involved in governance,
Z14. Southern Health and Social Care Trust,,Southern Health and Social Care Trust,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
WGH. Weston General Hospital,yes,Weston General Hospital,,,WGH. Weston General Hospital,BNSSG,Jan-23,Other,Non commissioned- no funded service for our main ICS. Small amount of funding for Somerset ICS,0,Nurse~band 1~0.1;Administrator~band 1~0.2,,Yes,CNS osteoporosis for most of 2022 and part of 2021;Current moderate term leave for co-ordinator role,No,180000,Opportunistic radiological vertebral fractures,Other,All due to lack of staff/funding,,Not applicable,,Radiology,,Not applicable,,DXA imaging (VFA);Screening general radiology reports,,Not funded,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,Delegated to Primary Care physician,,None,FLS recommends therapy to orthogeriatrician and/or primary care physician,No,,,,Other,Other,Delegated to Primary Care physician,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,Longer than every 3 years,Do not know,No,None of the above,No service,0,No currently commissioned service.,Patients are not involved in governance,
WDH. Dorset County Hospital,yes,Dorset County Hospital,,,WDH. Dorset County Hospital,NHS Dorset,Jan-16,Block payment,,0.5,Administrator~band 2~0.4,,Yes,Band 6 lead and band 3 administrator vacancy,Yes,102750,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;Other,over 90 not picked up routinely,,NHFD lists;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department,,DXA imaging (VFA);Screening general radiology reports;Re-reading radiology images;Fracture clinic lists;Emergency Department lists,,Not funded;Other,"The service has absorbed this - time and manpower do have an effect, it is hard to sustain.",Yes,The trauma list indicates admissions that may miss bypass fracture clinic,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Thyroid function;Renal function tests;Coeliac disease screen,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;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,"Non-clinical specialist practitioner;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;Postal questionnaire,At least every 3 years,75,No,Bone health card;Strong bones after 50 - staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources,,2,Rheumatology Governance,Other,Patients may be involved in Rheumatology MDT
WES. Chelsea and Westminster Hospital,yes,Chelsea and Westminster Hospital NHS Foundation Trust,,,WES. Chelsea & Westminster Hospital,North West London,Aug-19,Block payment,,0,Nurse~band 7~0.1,,No,,,300000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;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;Fracture clinic lists;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Radiology;Other IT systems;Fracture clinic attended,,Other IT systems,,Emergency Department lists;Other,Radiology Department referral xray,Not funded,,Yes,Those patients over the age of 75 with fragility fracture and those with history numerous fragility,Serum Calcium;Serum 25OH vitamin D;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Serum Electrophoresis,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician;Other,Rheumatology/Osteoporosis Specialist,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;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 gait and balance and mobility,Ask about gait problems,,Patient;Primary care physician;Falls service,Date and type of fracture;Fracture risk score;DXA – BMD;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment;Other,FLS coordinator;Specialist nurse;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Never,,No,ROS resources,,3,Rheumatology Clinical Governance meeting,Patients are not involved in governance,
MPH. Musgrove Park Hospital,yes,Musgrove Park Hospital,,,MPH. Musgrove Park Hospital,Somerset,Jan-16,Block payment,,1,Nurse~band 7~0.6;Radiographer~band 7~0.4;Administrator~band 3~1,,No,,,340000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Ankle;Scaphoid;Metacarpal;Metatarsal;Face/skull;Patella;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Other IT systems;Fracture clinic attended,,Using clinic lists;Other IT systems;Emergency Department lists,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Other,Radiology referral via coded monthly audit ('FLS audit' code on any positive scans).,Other,We have a great working relationship with Radiology & have made great improvements,No,,Serum Calcium;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 on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;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;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);Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Postal questionnaire,At least every 3 years,Do not know,No,ROS resources,,12,Care of the older person team;Report national audit to audit team annually,Patients are not involved in governance,
ESU. East Surrey Hospital,yes,East Surrey Hospital,,,ESU. East Surrey Hospital,NHS Surrey Heartlands,Jan-22,Part of hospital general contract with no separate documentation for FLS,,0.5,Radiographer~band 7~0.3;Nurse~band 7~0.3;Administrator~band 3~0.5,,No,,,540000,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;Patella;Avulsion,Not applicable,,Not applicable,,Other IT systems,,DXA imaging (VFA);Screening general radiology reports,,Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Serum Electrophoresis;Serum free light chains,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Falls service,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment,"FLS coordinator;Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse",Medication adherence;Medication persistence;Recurrent fractures,Telephone interview,At least every 3 years,50,No,Strong bones after 50: Fracture liaison services explained,,0,to rheumatology governance,Patients are not involved in governance,
"GGH. Diana, Princess of Wales Hospital",yes,Diana Princess of Wales Hospital,,,"GGH. Diana, Princess of Wales Hospital",Humber Coast and Vale,Nov-16,Block payment,,1,Nurse~band 6~1,,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;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,None,,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Trauma lists,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Referral from Emergency Department,,DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists,,Unable to access radiology images;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 on site,FLS specialist practitioner;Clinician 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 orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Trauma prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;A requirement to check lying and standing BP;Pulse check for rhythm and rate,,,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;Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse;Delegated to Primary Care physician",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face;DXA,Never,,No,None of the above,no barriers,12,Medicine Audit;Medicine Governance;Quality Governance Group,Patients are not involved in governance,
SCM. James Cook University Hospital,yes,James Cook University Hospital,,,SCM. James Cook University Hospital,North East and Cumbria,Jun-10,Block payment,,0,Nurse~band 7~1;Other~band 3~1;Administrator~band 2~0.3,,No,,,279100,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,FLS only covers Middlesbrough and Redcar & Cleveland. Over 50 only.,Scaphoid;Metacarpal;Metatarsal;Face/skull,IT systems;Other,Over 75 HIPS reviewed by orthogeriatric service not the FLS. Also receive adhov fracture list.,Ward/emergency room admissions/discharge lists;Other IT systems;Other,Referrals from any other teams.,Other IT systems;Other,Referrals from any other teams.,Screening general radiology reports;Re-reading radiology images;Other,Insert of code to radiology reports which automatically get sent to the FLS,Lack of standardised practise/language for radiology reporting,,Yes,Email to FLS,Serum Calcium;Serum 25OH vitamin D;Serum Parathyroid hormone;Renal function tests,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;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;Service that referred to FLS;Other,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment;Other,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;Clinic review face to face;Clinic review remote,Continuous (every patient),Do not know,No,ROS resources,,1,Meeting with staff members in the department. Waiting list and waiting times discussed.,Patients are not involved in governance,
RCF. Airedale NHS Foundation Trust,yes,Airedale NHS Foundation Trust,,,AIR. Airedale General Hospital,West Yorkshire ICB,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,Age range;Fracture site,,Metacarpal;Metatarsal;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;Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Emergency Department lists;Other,referrals directly from doctors within the hospital or from primary care,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 on site,Clinician speciality;Delegated to Primary Care physician,,Written material,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling,,,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,,No,ROS resources,,6,Surgical services and diagnostics learning group,Patients are not involved in governance,
BRI. Bristol Royal Infirmary,yes,University Hospitals Bristol NHS Foundation Trust,,,BRI. Bristol Royal Infirmary,"NHS Bristol, North Somerset and South Gloucestershire",Apr-12,Block payment,,0.5,Nurse~band 7~0.8;Radiographer~band 6~1;Administrator~band 4~1;Administrator~band 3~0.6,,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,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Avulsion,IT systems,,FLS visits the orthopaedic/trauma ward;Radiology;Seen by Orthogeriatric service,,Using clinic lists;Other IT systems;Other,self completed patient questionnaire,DXA imaging (VFA);Other,Inpatient referrals,Not funded;Unable to access radiology images;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,Yes,"If a self-completed questionnaire does not arrive, we will post a form, twice if necessary",Serum Calcium;Serum 25OH vitamin D;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;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;Other,FLS coordinator;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls;Other,Prescription review;Telephone interview;Postal questionnaire;Clinic review face to face;Clinic review remote;DXA,At least every 3 years,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;ROS resources,,3,Care of the Elderly Dept via Medical directorate Governance;Trust Audit Dept,Patients are not involved in governance,
DAR. Darlington Memorial Hospital,yes,University Hospital North Durham & Darlington Memorial Hospital,,,"DRY. University Hospital of North Durham,DAR. Darlington Memorial Hospital","Darlington, Durham Dales, Easington and Sedgefield, North Durham, Central and Tees Valley.",Jun-17,Block payment,,0,Nurse~band 6~1.4;Physiotherapist~band 6~1;Other~band 4~0.6,Assistant Practitioner,No,,,629900,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,Over 50 years of age.,Metacarpal;Face/skull,Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Fracture clinic attended,,Using clinic lists,,Fracture clinic lists,,Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department,,No,,Serum Calcium;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;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;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;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review remote;DXA,Longer than every 3 years,Do not know,No,ROS resources,,0,N/A,Other,No governance meeting.
MKH. Milton Keynes General Hospital,yes,Milton Keynes University Hospital Foundation Trust,,,MKH. Milton Keynes General Hospital,BLMK,Sep-15,Fixed term then need to renew,,0.25,Nurse~band 7~1;Nurse~band 6~1;Nurse~band 2~1,,No,,,400,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,None,,,FLS visits the orthopaedic/trauma ward,,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology,,FLS visits the orthopaedic/trauma clinic;Other IT systems;Referral from Emergency Department,,Screening general radiology reports;Fracture clinic lists;Emergency Department lists,,Lack of standardised practise/language for radiology reporting;Other,We do not have a dedicated vertebral fracture pathway.,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,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,FLS coordinator;Non-clinical specialist practitioner,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Recurrent fractures;Recurrent falls,Telephone interview,Never,,Yes,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;ROS resources,,6,We present annual finding and bench a marking in the Orthopaedic governance meeting.,Patients are not involved in governance,
SUN. Sunderland Royal Hospital,yes,Sunderland Royal Hospital,,,SUN. Sunderland Royal Hospital,North East and North Cumbria,Jan-14,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 6~2,,No,,,430000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging,Age range;Fracture site,,Scaphoid;Face/skull;Rib,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;Other,Referrals from medical wards with fractures.,FLS visits the orthopaedic/trauma clinic,,Visits spine clinic/reviews letters;Fracture clinic lists;Other,Inpatient referral system for asymptomatic spinal fractures,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;Full blood count;Liver function;Thyroid function,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope,,,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 adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Longer than every 3 years,Do not know,Yes,Strong bones after 50 - staying on treatment;Strong bones after 50: Fracture liaison services explained;ROS resources,,2,Aim to present at the T&O CG meetings.,Other,Annual patient education day prior to Covid-19 pandemic;Aim to restart annually.
WMU. West Middlesex University Hospital,yes,West Middlesex hospital,,,WMU. West Middlesex University Hospital,Hounslow NWL,Sep-19,Block payment,,1,Nurse~band 7~1;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;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,Seen by Orthogeriatric service not FLS;IT systems;Trauma lists,,Other IT systems,,Using clinic lists;Other IT systems,,Other,"Referral from radiology, using a short code IT system",Lack of engagement with radiology department,,Yes,This is a single person service. The number of fragility fractures exceeds the staff capacity,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources,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;An evaluation of vision,Ask about gait problems;Other,If inpatient patient will receive inpatient 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,"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,Longer than every 3 years,Do not know,No,Strong bones after 50 - staying on treatment;ROS resources,,3,Rheumatology governance,Patients are not involved in governance,
AHX. Ashford Hospital,yes,Ashford and St. Peter's Hospitals NHS Foundation Trust,,,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 on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Number of falls in the last 12 months;Assessment for fear of falling,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Current drug treatment recommendations (if applicable);Medication compliance review,Delegated to other healthcare provider,N/A monitoring is not carried out by the FLS,N/A monitoring is not carried out by the FLS,Longer than every 3 years,Do not know,No,ROS resources,,0,No governance minutes,Patients are not involved in governance,
EAL. Ealing Hospital,yes,Ealing Hospital,,,EAL. Ealing Hospital,North West London,Apr-19,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 7~0.3,,Yes,FLS Nurse transferred to Orthopaedics to cover staff shortages,No,850000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture,Age range;Fracture site,,Ankle;Pelvis;Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,NHFD lists;FLS visits the orthopaedic/trauma ward;Fracture clinic lists;IT systems,,FLS visits the orthopaedic/trauma ward;Other IT systems;Fracture clinic attended,,FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Other,Virtual Fracture Clinic Meetings,Fracture clinic lists,,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of engagement with radiology department;Lack of training in identifying vertebral fractures;Other,Lack of staff/ insufficient funding,No,,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;Renal function tests,DXA available on site,FLS specialist practitioner;Clinician speciality,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Trauma prescribes;Metabolic bone disease / osteoporosis specialist prescribes,No,,,,Patient;Primary care physician,DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Never,,No,ROS resources,,0,Post Covid restructuring - means will be part of Rheumatology governance next year,Patients are not involved in governance,
NCR. New Cross Hospital,yes,Royal Wolverhampton Hospital NHS Trust,,,NCR. New Cross Hospital,Black country,Jan-22,Other,non commissioned service . non funding provides wider trust saving,0.5,Administrator~band 4~0.5;Nurse~band 6~1.5,,No,,,450000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site;Other,patients live i.e nursing homes.,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Other,on line referral for other ward areas,Other,internal referral from other medical wards. gp,Emergency Department lists;Other,orthopedic letter referrals.,Screening general radiology reports;Other,internal referral,Not funded;Still developing pathway;Lack of training in identifying vertebral fractures,,No,,Serum Calcium;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis,DXA available on site,FLS specialist practitioner,,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 and/or primary care physician;Orthogeriatrician prescribes;Trauma prescribes;Other,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;Post fracture mobility,Telephone interview,Never,,No,ROS resources,,0,rheumatology governance,Patients are not involved in governance,
NEV. Nevill Hall Hospital,yes,Aneurin Bevan University Health Board,,,"NEV. Nevill Hall Hospital,GWE. The Grange University Hospital","ABUHB, Wales",Nov-21,Fixed term then need to renew;Other,Joint working with Medical and Rheumatology Division,1,Administrator~band 4~0.2;Nurse~band 7~2.2,,No,,,242325,Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Other,All patients with above 50,,Seen by Orthogeriatric service not FLS,,Ward/emergency room admissions/discharge lists;Radiology;Other IT systems,,Other,We are working on referral systems so far but we will be identifying fractures by FLS team,Screening general radiology reports,,Still developing pathway,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein),Peripheral DXA,FLS specialist 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 and/or primary care physician;FLS prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of home hazards,,,Patient;Primary care physician;Falls service;Service that referred to FLS,Date and type of fracture;Fracture risk score;Fall risk factors;Follow-up plan;Lifestyle/health risk-factor assessment,"Secondary care consultant (e.g. orthogeriatrician, rheumatology);Specialist nurse",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Clinic review face to face,At least once a year,30,No,ROS resources,,6,To Trust audit meeting - yearly and Medical Directorate - 6 months,Patients are not involved in governance,
KCC. Kent and Canterbury Hospital,yes,East Kent Hospitals University NHS Foundation Trust,,,"WHH. William Harvey Hospital,QEQ. Queen Elizabeth the Queen Mother Hospital",NHS Kent and Medway,Jan-23,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 8a~0.2;Nurse~band 6~1.5,,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,Age range;Fracture site,,Metacarpal;Metatarsal;Face/skull;Patella,Seen by Orthogeriatric service not FLS;IT systems,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems,,Other IT systems;Referral from Emergency Department,,Emergency Department lists,,Not funded,,No,,Serum Calcium;Serum alkaline phosphate;Serum 25OH vitamin D;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 on site,FLS specialist 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 and/or primary care physician;FLS prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;An evaluation of vision;Assessment of home hazards,Ask about gait problems,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Recurrent fractures,Prescription review;Telephone interview;Clinic review face to face,Never,,No,ROS resources,,0,None,Patients are not involved in governance,
RCP. ΜπΠΔΦ±²₯,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Continuous (every patient),,No,None of the above,,,,,
"WWL. Wrightington, Wigan and Leigh NHS Foundation Trust",yes,"Wrightington, Wigan and Leigh NHS Foundation Trust",,,"WRI. Wrightington Hospital,AEI. Royal Albert Edward Infirmary",GM ICB / Wigan PCN,Apr-15,Other,now permanent,0,Nurse~band 6~0.6;Physiotherapist~band 6~0.9;Other~band 8a~0.1,Nurse Consultant,No,,,205000,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;Other,under 50 years of age,,Trauma lists,,Radiology;Seen by Orthogeriatric service;Other,Community Based Teams,Using clinic lists,,DXA imaging (VFA);Re-reading radiology images,,Still developing pathway;Other,Pathway agreed but waiting for CCG funding.;Need to be directed to Specialist OP Clinics,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;Other,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;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;Chair rise;Other,Tinetti balance assessment tool,Patient;Primary care physician;Falls service,Date and type of fracture;Fracture risk score;DXA – BMD;Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator;Delegated to other healthcare provider,Medication adherence;Medication persistence;Medication adverse effects,Telephone interview,Never,,No,None of the above,Trust leaflets,0,Falls & Bone Health Strategy meetings - quarterly;Divisional Quality Executive Group - monthly,Patients are not involved in governance,
YEO. Yeovil District Hospital,yes,Yeovil Hospital,,,YEO. Yeovil District Hospital,Somerset,Jan-23,Part of hospital general contract with no separate documentation for FLS,,0,Administrator~band 3~1.2;Administrator~band 2~0.6;Nurse~band 6~0.6;Nurse~band 8a~0.2,,No,,,188000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Fracture site;Other,"Clavicle, elbow, digit fractures excluded",Ankle;Scaphoid;Face/skull,NHFD lists;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;IT systems;Trauma lists;Other,Daily orthopaedic handover list,Ward/emergency room admissions/discharge lists;Other IT systems;Other,Daily orthopaedic handover & silver trauma list;Discharge coding search;Referrals,Other IT systems;Other,GP referral;Frailty clinic referral,DXA imaging (VFA);Re-reading radiology images;Emergency Department lists;Other,Discharge coding;Daily orthopaedic handover list;GP DXA requests or A&G requests,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting,,Yes,Multiple different ways of finding fractures.,Serum Calcium;Serum phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Trauma prescribes;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,Prescription review;Telephone interview;Postal questionnaire;DXA,Longer than every 3 years,0,No,What should happen if you or someone you know experiences a fragility fracture?;Strong bones after 50 - staying on treatment;ROS resources,,0,None,Other,Have informal patient advisors who are consulted as needed
ROT. Rotherham General Hospital,yes,The Rotherham NHS Foundation Trust,,,ROT. Rotherham General Hospital,South Yorkshire ICB,Aug-17,Block payment,,0,Nurse~band 7~1.4;Nurse~band 6~0.4;Administrator~band 3~0.1;Radiographer~band 5~0.2;Radiographer~band 6~0.2,,No,,,266000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Face/skull,NHFD lists;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists;Other,Trauma meeting sheets;Please note orthogeriatrician is part of Bone health and FLS,Ward/emergency room admissions/discharge lists;Radiology;Other IT systems;Fracture clinic attended;Other,Trauma meeting sheets,Using clinic lists;Other IT systems;Emergency Department lists;Other,Trauma meeting sheets,Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Other,"Radiology, A&E, trauma 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 on site,FLS specialist practitioner;Clinician 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 orthogeriatrician and/or 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;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);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;Recurrent fractures,Clinic review face to face;DXA,Never,,Yes,ROS resources,,1,"To specialist medicine, escalated to trust",Patients are not involved in governance,
FRY. Frenchay Hospital;FRY. Southmead Hospital,yes,North Bristol NHS Trust,,,FRY. Southmead Hospital,BNSSG,Jul-14,Block payment,,0,Nurse~band 7~1;Administrator~band 4~1,,Yes,Clinical Lead (1PA per week),Yes,500000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging,Age range;Fracture site;Other,age >50,Metacarpal;Face/skull;Avulsion,Seen by Orthogeriatric service not FLS,,Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems;Other,direct referral from frailty team,Using clinic lists;Other IT systems;Emergency Department lists,,Visits spine clinic/reviews letters;Fracture clinic lists;Emergency Department lists,,Not funded;Still developing pathway;Lack of standardised practise/language for radiology reporting;Other,capacity within service,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Falls service,Date and type of fracture;Fracture risk score;Secondary causes of osteoporosis (if applicable);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;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Postal questionnaire;Other,Never,,No,Strong bones after 50 - staying on treatment;ROS resources,,0,T&O clinical governance /audit meeting,Patients are not involved in governance,
BRD. Bradford Royal Infirmary,yes,Bradford Teaching Hospitals Foundation Trust,,,BRD. Bradford Royal Infirmary,NHS West Yorkshire,Dec-16,Part of hospital general contract with no separate documentation for FLS,,0.5,Nurse~band 7~0.8;Nurse~band 6~0.5;Administrator~band 2~1,,No,,,537000,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,"Fractures of fingers and toes excluded, rather than metacarpal or metatarsal.",Metacarpal;Metatarsal;Face/skull,Seen by Orthogeriatric service not FLS;Other,"Captured by trauma co-ordinator team, which FLS lead nurse manages.",FLS visits the orthopaedic/trauma ward;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended;Other,"Daily trauma meetings; Consultant referral, other HCP referral.",FLS visits the orthopaedic/trauma clinic;Using clinic lists;Other IT systems;Other,Daily trauma meetings; VTC; face to face; Consultant referral; direct referral.,Other,Daily trauma meetings; radiology admin code lists; Consultant referral.,Lack of standardised practise/language for radiology reporting;Lack of training in identifying vertebral fractures;Other,ADOPT study delay in starting,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;Other,DXA available on site,FLS specialist practitioner;Delegated to Primary Care physician;Other,Complicated cases discussed with Clinical Lead or with Rheumatology.,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;Other,No,,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;DXA – BMD;Current drug treatment recommendations (if applicable);Follow-up plan;Other,FLS coordinator;Delegated to Primary Care physician,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls;Other,Telephone interview,Never,,No,ROS resources,,12,Mentioned in Orthopaedic Clinical Governance meetings.,Patients are represented in the governance meetings,
RSU. Royal Surrey County Hospital,yes,Royal Surrey County Hospital,,,RSU. Royal Surrey County Hospital,Surrey Heartlands,Jan-17,Per patient tariff,,1.56,Nurse~band 7~1;Nurse~band 6~1,,No,,,330000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site;Other,Younger patients referred on clinical picture,Scaphoid;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;Other,if operated on out of area,FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Fracture clinic attended,,Using clinic lists;Emergency Department lists;Referral from Emergency Department;Other,referred in by GPs with fractures sustained out of area,Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Other,referred in by GPs,Still developing pathway;Lack of standardised practise/language for radiology reporting;Lack of training in identifying vertebral fractures,,Yes,referred by GPs or ward doctors;Patient self referral,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;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 practitioner;Clinician speciality;Delegated to Primary Care physician,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;FLS prescribes;Orthogeriatrician prescribes;Trauma 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;Assessment of home hazards,,,Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care;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,"FLS coordinator;Secondary care consultant (e.g. orthogeriatrician, rheumatology);Delegated to Primary Care physician",Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview,Never,,No,ROS resources,,1,Significant issues forwarded to Trust,Patients are not involved in governance,
SAN. Sandwell District Hospital,yes,Sandwell and West Birmingham Hospitals NHS Trust,,,SAN. Sandwell District Hospital,Black Country and West Birmingham ICS,Jan-17,Block payment;Other,First started as a block payment (13 years ago) not informed of contract changes since then,0.125,Nurse~band 6~1,,No,,,530000,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,Seen by Orthogeriatric service not FLS;IT systems;Other,X-ray data,Other IT systems;Other,X-ray data,Other IT systems;Other,X-ray data,Other,X-ray data,Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of gait and balance and mobility,Ask about gait problems,,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);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,Do not know,No,ROS resources,,0,N/A,Patients are not involved in governance,
PET. Peterborough City Hospital,,North West Anglia NHS Foundation Trust,,,"PET. Peterborough City Hospital,HIN. Hinchingbrooke Hospital",,Jan-18,,,0,Nurse~band 7~0.9,,No,,,800000,Hip fracture (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;Other,email referral from orthopaedic ward junior doctor,Fracture clinic attended;Other,As required email referral from treating clinician,Other IT systems,,Other,"clinician referral, incidental findings on imaging have a statement suggesting FLS if appropriate",Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Serum free light chains;Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Never,,No,ROS resources,,2,,Patients are not involved in governance,
CRY. Croydon University Hospital,yes,Croydon University Hospital,,,MAY. Mayday University Hospital,South West London,Jul-19,Part of hospital general contract with no separate documentation for FLS,,0,Nurse~band 8a~0.2;Nurse~band 7~1;Physiotherapist~band 7~2,,No,,,391000,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Metacarpal;Metatarsal;Face/skull,Seen by Orthogeriatric service not FLS,,Seen by Orthogeriatric service;Fracture clinic attended;Other,Driect referrals from ward/dept consultants/staff to the FLS,FLS visits the orthopaedic/trauma clinic;Using clinic lists,,Screening general radiology reports;Re-reading radiology images;Other,Referral from Radiology generated from reports when vertebral fractures are identified,Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;C-reactive protein;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Testosterone/ Sex hormone binding globulin,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;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;Chair rise;Other,Grip strength,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;Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Longer than every 3 years,Do not know,Yes,ROS resources,,1,Falls Business Meetings;SWL Bone Sub-committee meetings;Bone Health Steering Group,Patients are not involved in governance,
WSH. West Suffolk Hospital,yes,West Suffolk NHS Foundation Trust,,,WSH. West Suffolk Hospital,Suffolk and North East Essex,Aug-13,Part of hospital general contract with no separate documentation for FLS,,2,Nurse~band 7~1.4;Nurse~band 5~0.6;Nurse~band 2~0.4,,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;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Age range;Fracture site,,Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion,IT systems,,Radiology;Other IT systems,,Other IT systems,,DXA imaging (VFA);Other,IT Systems,Other,We have worked with radiology to improve language used on reports so we receive the referrals.,Yes,Triage system in place for all patients with a fracture code.,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 specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources,FLS recommends therapy to orthogeriatrician and/or primary care physician;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;Timed up and go,,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;Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,Specialist nurse,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Prescription review;Telephone interview;Postal questionnaire,Never,,No,What should happen if you or someone you know experiences a fragility fracture?;Strong bones after 50: Fracture liaison services explained;ROS resources,,3,Meeting with Governance team.,Patients are not involved in governance,
HAY. Haywood Hospital,yes,"The Haywood Hospital, Burslem, Stoke on Trent",,,STO. University Hospital of North Staffordshire,Staffordshire and Stoke on Trent,Feb-16,Block payment,,0.5,Nurse~band 3~0.6;Nurse~band 6~2.8;Nurse~band 7~1.5;Administrator~band 3~0.8;Radiographer~band 5~1;Radiographer~band 6~0.5,,No,,,500,Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures,Fracture site,,Metacarpal;Face/skull;Avulsion,Seen by Orthogeriatric service not FLS;IT systems;Trauma lists,,Ward/emergency room admissions/discharge lists;Other IT systems,,FLS visits the orthopaedic/trauma clinic;Using clinic lists,,DXA imaging (VFA);Screening general radiology reports,,Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;ESR;Liver function;Thyroid function;Liver function tests;Renal function tests;Serum Electrophoresis;Serum free light chains,DXA available on site,FLS specialist practitioner,,Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Romosozumab;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests,FLS recommends therapy to orthogeriatrician and/or primary care physician;Metabolic bone disease / osteoporosis specialist prescribes,No - we refer patients on for a falls assessment,,,,Patient;Primary care physician;Service that referred to FLS,Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment,FLS coordinator,Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview;Postal questionnaire,Never,,No,ROS resources,,3,They feed into the rheumatology governance meeting,Patients are not involved in governance,
JPH. James Paget Hospital,yes,James Paget Hospital,,,JPH. James Paget Hospital,Norfolk and Waveney,Sep-22,Part of hospital general contract with no separate documentation for FLS,,1,Nurse~band 7~1;Nurse~band 6~1;Administrator~band 4~1;Administrator~band 3~0.8;Radiographer~band 5~0.2;Radiographer~band 6~0.4;Radiographer~band 7~0.8,,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;Opportunistic radiological vertebral fractures,Age range;Fracture site;Other,FLS clinic age range 50 - 80 yrs. A letter is sent to GP to assess 81yrs+ and out of area pts.,Scaphoid;Face/skull;Avulsion,Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;IT systems,,Ward/emergency room admissions/discharge lists;Other IT systems;Other,referral from other hospitals from out of area attendance.,Other IT systems;Emergency Department lists;Other,"other hospitals - out of area attendance, incidental finding on lung screenings outsourced reporting",Screening general radiology reports;Emergency Department lists;Other,incidental findings from lung screening service - outsourced reporting.,Still developing pathway;Lack of standardised practise/language for radiology reporting,,No,,Serum Calcium;Serum 25OH vitamin D;Renal function tests,DXA available on site,Delegated to Primary Care physician;Other,fracture Liaison ( support) Nurses in discussion with Consultant for complex patients,Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide,FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes,Yes,Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Assessment of a history of blackouts or syncope;An evaluation of vision,,,Patient;Primary care physician,Date and type of fracture;Fracture risk score;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;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls,Telephone interview,Never,,No,ROS resources,,2,Rheumatology (Specialty);Divisional;Divisional Board;Caldicott Guardian Approval;Exec Chair Committ,Patients are not involved in governance,