title: The impact of a standardized order set for the management of non-hip fragility fractures in a Fracture Liaison Service.
abstract: We analysed the impact of a standardized order set empowering staff nurses to independently manage a Fracture Liaison Service over a 9-month period. Nurses identified between 30 and 70 % of non-hip fragility fractures to the unit in charge of management over time. The latter managed 58 % of referred patients.
  
  
  
  The main goal of this study was to evaluate the impact of a standardized order set empowering nurses to independently manage a fracture liaison service (FLS).
  
  
  
  Since November 2014, an order set allowed nurses of a Montreal hospital, Quebec, Canada to entirely manage an FLS on their own. Nurses followed an 6-h training program on-site. Emergency department (ED) and orthopaedic outpatient clinic (OC) nurses identified non-hip fragility fractures. Medical day treatment unit (MDTU) nurses were in charge of the management (investigation and treatment initiation). The list of patients, 50 years and older, with a fracture were retrieved for the period of November 2014 to July 2015. Performance was assessed with the rate of identification over time and the rate of management of non-hip fragility fractures.
  
  
  
  Over the 9-month period, 346 patients of ≥50 years old were seen for a fracture, of which 190 met fragility criteria (excluding hip fractures). A sinusoid pattern of rates of identification between 30-70 % was observed over time. An average proportion of 58.1 % of fracture patients were managed by MDTU nurses.
  
  
  
  A standardized order set legally allowing nurses to manage an FLS led to identification rates varying from 30-70 % and a management rate close to 60 % for referred patients over a 9-month period, which largely exceeds that of standard care. Identification was mostly compromised by difficulty integrating the order set into routine practice. Enforcement of the hospital policy on fragility fractures could help yield efficiency of identification of osteoporosis-related fractures by the staff.
authors.affiliation: Université de Montréal, 2900 bl. Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada.|Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada.|Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Senay
authors.affiliation: Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada.|Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Delisle
authors.affiliation: Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Giroux
authors.affiliation: Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada.|Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada.
authors.forename: G Y
authors.initials: GY
authors.lastname: Laflamme
authors.affiliation: Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada.|Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Leduc
authors.affiliation: Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada.|Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Malo
authors.affiliation: Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Nguyen
authors.affiliation: Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada.|Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Ranger
authors.affiliation: Université de Montréal, 2900 bl. Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada. julio.c.fernandes@umontreal.ca.|Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada. julio.c.fernandes@umontreal.ca.|Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada. julio.c.fernandes@umontreal.ca.
authors.forename: J C
authors.initials: JC
authors.lastname: Fernandes
mesh_terms: D006801:Humans; D009741:Nursing Staff, Hospital; D010024:Osteoporosis; D058866:Osteoporotic Fractures / Q000451:nursing* / Q000628:therapy*; D017064:Process Assessment, Health Care; D011792:Quebec
keywords: Fracture liaison service; Fragility fracture; Identification; Management; Order set; Osteoporosis