Improving Bone Density Screening Rates in Patients at Risk for Falls Using Chart Screening and Protocol Orders

PURPOSE: This quality improvement project’s purpose was to identify those at risk for low bone density from a clinic’s population of positive fall risk screenings, to encourage bone density screening and identify those who would benefit from bone health optimization. BACKGROUND: Spine fractures result in serious morbidity and mortality. The type of treatment options available for spine fractures and the timing of intervention is affected by the patient’s bone density. METHODOLOGY: The aim was for patients diagnosed with spine fractures and degenerative spine conditions to be screened for osteoporosis/osteopenia according to screening recommendation standards. The goals were to maintain a minimum 90% fall risk screening rate, increase bone density screening rate by 20%, and add an electronic health record (EHR) check for bone density screening. Using the DMAIC framework, implementation of technology controls created a hard stop in the EHR for electronic screening for bone density documentation. Enhanced provider communication provided a fall risk warning on the encounter signing screen with an alert to address the positive fall risk screening and a best practice advisory to address the missing bone density with DEXA order. RESULTS: The fall risk screening rate was maintained at 95% mean during the intervention. The bone density screening rate was increased by 117% from a mean of 12 prior to the interventions to a mean of 26 during the interventions. IMPLICATIONS FOR PRACTICE: Improved bone density screening rates can guide treatment for those who would benefit from bone health optimization.