Trust blog

“I genuinely love my job, I love what I can deliver for my patients.” Meet Donna Rowe, clinical nurse specialist in our Fracture Liaison Service 20 Aug 2024

To mark the third series of Channel 4’s Emergency documentary, we’re highlighting the work of some of the people who work in or alongside our major trauma centre.

Donna Rowe is a clinical nurse specialist at Imperial College Healthcare NHS Trust and set up our Fracture Liaison Service. The service screens for (and supports people with) a frequently under-diagnosed condition called osteoporosis, working closely with teams across our hospitals including A&E, radiology and major trauma. Donna tells us why the service is like a ‘helicopter’ hovering over our hospitals and how it’s built around patients.  

Tell us about your role and the Fracture Liaison Service. 

I’m a clinical nurse specialist in the Trust’s Fracture Liaison Service (FLS). We’re a small nurse-led service which screens patients for potential osteoporosis, a frequently under-diagnosed condition which progressively reduces your bone strength and so increases your risk of fractures. For example, if you have a vertebral (spinal) fracture, you are at a 40 per cent risk of further vertebral fracture. Without treatment, osteoporosis can have a debilitating long-term effect on patients’ lives and wellbeing. It’s really important to identify the condition and start treatment early.  

The first presentation of osteoporosis is generally a broken bone, so we set up our service to proactively seek out all patients presenting in our hospitals with actual or potential fragility fractures. We utilise various electronic platforms to identify patients and we also accept direct referrals into the service. 

We review each patient and assess the mechanism of injury which led to the fracture, alongside other factors, to ensure we capture the correct patients. 

Once we have identified potential patients, we contact the ward (if they are an inpatient with us) or the patient directly (if they are an outpatient). For inpatients, we work with our clinical colleagues to assess for bone health and, if indicated, start treatment prior to discharge. We follow-up with these patients in the community, in conjunction with community health providers, for 12 months post-fracture. It is an individualised service and we encourage patients to contact us if they have queries in relation to their post-fracture journey.  

I often use a helicopter metaphor to explain how we work. We’re based in specialist medicine (Endocrine Bone Unit), but we’re not restricted to a specific part of the Trust. Instead, we hover remotely over all our sites to ensure we identify all potential fragility fracture patients.  

When did the service launch? 

I joined Imperial College Healthcare in 2019, specifically to set up the FLS. This is a gold standard model for identifying, assessing and treating anyone who sustains a potential fragility fracture (a fracture resulting from a fall from standing height or less) after age 50. I have significant experience working in fracture liaison, which proved very helpful when it came to establishing a service here, especially given the size and complexity of the Trust’s work across multiple sites. The key thing was working with colleagues from lots of different teams and specialisms to develop processes and embed our service across our hospitals. We launched in January 2020 and today we are one of 76 services across the country, which is about half of the NHS Trusts in England. 

We’re a small multidisciplinary team – there’s myself and my nursing colleague Liz and we run the service day-to-day. We also have excellent administrative support from Olima and work closely with Jacques, a clinic nurse who is part of the endocrine bone team. Professor Alex Comninos, head of the Endocrine Bone Unit, provides clinical supervision and direction for the service which continues to expand with demand! 

How common is osteoporosis? 

Around 3.5 million people in the UK are estimated to have osteoporosis. We reach peak bone health at the age of 30 and it begins to naturally decline as we get older, especially for women experiencing the menopause. There are lots of ways to help prevent this and to maintain good bone health throughout our lives by trying to maintain a healthy lifestyle – things like exercising regularly, eating a balanced diet with good amounts of calcium, and ensuring you’re getting enough vitamin D, not smoking and reducing or avoiding alcohol consumption. 

You can be at risk without being aware. Sometimes lifestyle could be a factor but there are also other causes. For example, a family history of hip fracture will increase your risk of fragility fractures, as will a history of low-trauma fractures (fractures resulting from simple slips/trips etc). Part of our FLS role is to narrow down and address any potential risks. 

For anyone who thinks they could be at risk or are just looking for further information, the Royal Osteoporosis Society have a fantastic website with lots of resources and a nurse helpline for specific advice. 

Do you have a typical working day? 

My role is focused on identifying patients who may be at risk of osteoporosis and supporting them through their journey with us. The first thing I do each day is look through our lists of patients who have come into our hospitals with a broken bone in the preceding 24 hours – and then review each patient’s details so we can follow up with those who have a potential fragility fracture.   

The remainder of my day is primarily clinic-based. We operate remote clinics, which work really well for our patients and allow us to support a higher number of people than we’d be able to if it was face-to-face. On average, I will see 40 – 50 patients per week in my remote clinics. This model also delivers flexibility for our patients, as we are able to structure calls around their needs and any additional requirements such as the availability of family members or carers who support them. 

Which departments do you work most closely with? 

We work with teams across our hospitals but we probably have most contact with our emergency department, including our urgent treatment centres. We also work with the admitting wards, including orthopaedic and orthogeriatric. For patients who do not require admission into our hospitals, we work with both the patient and community healthcare providers. We also work closely with the radiology department, via a Quality Improvement Project, to ensure we capture all fragility fractures, including vertebral fractures (the often ‘silent’ precursor to further fragility fracture).  

What treatments are there for osteoporosis? 

There are various treatment options for osteoporosis, including oral and injectable medications. There are also modifications which patients may make to their lifestyle, which can support the development of stronger bones and reduce the risk of further fracture. We generally make decisions about treatment following a range of diagnostic tests and risk assessment calculations. We discuss all options with each patient, and their GP, and then provide support over the next 12 months. This last point is really important for helping patients remain in treatment and ultimately helps reduce their risk of further fragility fracture. 

Our Fracture Liaison Service is the top-performing service in the country. What makes our service unique? 

We are immensely proud that our service has achieved the best overall statistics on national audits for two years running. This shows the consistency and effectiveness of the service we provide for our patients. And it also helps us identify areas we can improve! 

One of our key strengths is our identification of vertebral (spinal) fractures, which has enabled us to help many more patients who may have previously remained undiagnosed and at further risk of fragility fractures. Statistically around 70 per cent of vertebral fractures remain undiagnosed but, at Imperial, we are identifying the vast majority that come through our doors. 

What do you love most about your role? 

I know it sounds really cheesy, but I genuinely love my job. I've been specialising in fracture liaison and osteoporosis for over 10 years across two trusts, as well as a period working with the Royal Osteoporosis Society as service delivery lead. 

I love that my patients receive their care from a named nurse throughout their post-fracture journey. Patients know my name, how to reach me, and are comfortable contacting me with any queries or questions. Delivering the service in the very unique ‘FLS’ way is a fantastic model of care and, as a clinician, it is very satisfying. 

Communication with my patients is really important to me, throughout their entire 12-month journey with us. We consistently achieve 98 - 100 per cent in our patient satisfaction survey results, which is a real testimony to the patient-centric care provided by our small nurse-led service. 

Find out how to join Imperial College Healthcare NHS Trust.

Stream all episodes of Emergency series 3 on All4.