Wolfson Medical Center
The orthopedic department in Wolfson Medical Center has a nursing practitioner trained in geriatrics. She has undergone training by the endocrinology team to identify subjects with hip fracture aged >65 years and with fracture following minimal or no trauma (minimal trauma defined as a fall from standing height or lower). She places patient information in an excel file for further use.
The nurse practitioner has roles in patient education and in treatment recommendations.
Regarding education, the nurse practitioner describes to patients the meaning of the new diagnosis of osteoporosis. She distributes a pamphlet prepared by the endocrinology team communicating the meaning of osteoporosis, its ramifications, recommended lifestyle interventions and the importance of therapy to prevent further fractures.
Regarding treatment recommendations, the nurse practitioner questions patients regarding prior use of osteoporosis therapies and documents this in the patient file. Treatment recommendations are written in the discharge summary. For patients who are naïve to osteoporosis treatment and have eGFR >35, the nurse practitioner fills in a consult in which she recommends treatment with IV Aclasta (Zolendronic Acid, ZA) 5mg. For patients who are not naïve, or whose GFR is <35, a virtual in-hospital endocrinology consult is requested by the nurse practitioner and performed by the endocrinology team.
Patients who do not take vitamin d chronically and do not have hypercalcemia are given vitamin D supplementation, as a once-off 100,000 Units dose (1 bottle of drops containing 200UI/drop).
Following hospital discharge, treatment recommendations are sent to the treating health fund, enabling rapid authorization of the recommended treatment.
The treatment coordinator is a receptionist who has been trained in FLS protocol by the endocrinology team. She receives the excel file from the nurse practitioner, telephones the patient or their close relative to explain to them about the requirement for treatment, assists with difficulties they may have in acquiring treatment and documents treatment rates. She also offers patients a virtual or physical appointment in the Bone and Calcium Health clinic.
This program has received a stipend from the Israeli Foundation for Osteoporosis and Bone Diseases which funds the work of the receptionist in coordinating patient therapy.
