Page 20 - MRS Abstracts March 2023

Methods:
Data from 1 April to 30 September 2022, sourced from the local NHS database, was analysed. Twelve VOC sessions were audited to identify causes of delay, and a focus group was formed for root cause analysis and recommendation development.
Results:
The analysis included 176 patients, revealing the average total wait times from treatment referral in the clinic until administration were 82.04 days for zoledronic acid, 88.09 days for denosumab, and 97.43 days for teriparatide. The audit identified a significant delay in the initiation of injectable bone-sparing agents.
184 patients were reviewed over 12 VOC sessions, with 93 receiving approval and 91 requiring further investigation. The most frequent reasons for treatment delays were the lack of blood test results and dental health issues.
Followed by the focus group discussion, the following recommendation were made: proactively contact patient in VOC to confirm dental health, contact patient to arrange blood tests, issue Vitamin D loading prescription directly from VOC, liaised with Black Country Pathology service to remove the minimal Vit D testing interval, additional CNS led follow-up clinic, osteoporosis consultant direct referrals, and streamlined homecare prescriptions. A provisional audit of 35 zoledronic acid cases after practice changes showed a significant reduction in wait times (from 82.04 to 60.4 days).
Initial post-implementation results indicate shorter waiting times, however highlighting the need for further process improvements. Future initiatives include integrating VOC referrals into the electronic referral system, enhancing collaboration with the Fracture Liaison Service, and establishing pharmacist-led osteoporosis follow-up clinics.
Conclusions:
In conclusion, the pharmacist and nurse-led VOC approach can be a viable alternative to the traditional model. The new approach has effectively reduced patient wait times and freed up doctors' time for more complex cases.
Key points:
• The VOC was set up to centralise safety and suitability assessments for injectable bone- sparing agents.
• An evaluation of the VOC was conducted, which identified causes of delay in the approval process.
• The implementation of recommended changes led to a reduction in wait times.