Date of Conferral

2017

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Mattie Burton

Abstract

Vertebral fragility fractures are common, affecting approximately 50% of all postmenopausal women and 33% of men over the age of 50, and are the most common type of fracture seen in osteoporosis. The management of vertebral fragility fractures in the acute care setting is lacking in standardization, in the use of evidence-based practice, and in addressing the underlying cause of osteoporosis. The purpose of this project was to develop an evidence-based protocol to standardize the care of the vertebral fragility fracture in the acute care setting. This protocol included patient education, fall risk assessment, screening for osteoporosis, and follow up with an osteoporosis clinic for comprehensive management once discharged. This project used the Donabedian model to provide a conceptual framework for evaluating the structure, process, and outcomes related to the practice problem. This quantitative study involved 10 participants that were selected using purposive sampling and used process control charting to show compliance with elements of the guideline, and descriptive data to depict process change. Guideline compliance was measured over an 8-week period and indicated successful implementation of fall risk assessment with a 100% compliance rate and osteoporosis screening with an 80% compliance rate. Compliance with fracture education and securement of follow up were difficult to ascertain in the 8-week period and non-compliance evident. In conclusion, two elements of the guideline showed to be an unstable process and further work is necessary to improve. Positive social change may result from empowering nurses by education and giving them autonomy to use evidence-based practice to decrease the risk for secondary vertebral fragility fractures.

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