I. Primary osteoporosis clinical pathway standard inpatient procedure
(A) Applicable objects.
The first diagnosis of primary osteoporosis (ICDC10: M80CM81).
(B) Diagnostic basis.
1, clinical manifestations: bone pain and/or history of fragility fracture.
2, bone density (dual-energy X-ray bone densitometry of the lumbar spine and hip): a decrease of more than 2.5 standard deviations was considered osteoporosis (T value ≤ -2.5).
3.Imaging suggests osteoporosis.
4.Secondary osteoporosis or other skeletal diseases should be excluded.
(C) The basis for selecting the treatment plan.
According to the Concordia Endocrinology and Metabolism (Shi Yiyan, ed., Science Press, 1999, first edition), the Primary Osteoporosis Treatment Guide (Chinese Medical Association, Osteoporosis and Bone Mineral Disorders Branch), and the Clinical Treatment Guide C, Endocrinology Branch (Chinese Medical Association, People’s Health Press).
1.Basic measures.
(1) Lifestyle modification.
(2) Basic bone nutrition supplements (calcium, vitamin D type).
2.Pharmaceutical treatment.
(1) Inhibit bone resorption drugs.
(2) Promote bone formation drugs.
(3) Drugs with dual effects of inhibiting bone resorption and promoting bone formation.
(D) The standard hospitalization day is 10C14 days.
(E) Entry pathway criteria.
1. The first diagnosis must meet the ICD-10: M80-M81 primary osteoporosis disease code.
2. . Patients can enter the pathway when they also have other disease diagnoses but do not require special treatment during hospitalization and do not affect the implementation of the clinical pathway process for the first diagnosis.
(F) Examination items during hospitalization.
1. Required examination items.
(1) Routine blood, routine urine, and routine stool.
(2) liver and kidney function, blood glucose, electrolytes, blood calcium, phosphorus, alkaline phosphatase, blood sedimentation, 24-hour urine calcium, phosphorus, blood gas analysis.
(3) chest X-ray, electrocardiogram, abdominal ultrasound.
(4) X-ray of thoracic, lumbar spine, pelvis and suspected fracture bones.
(5) Dual-energy X-ray bone densitometry to determine the bone density of the lumbar spine and hip.
2.Checkup items that can be selected according to the patient’s condition.
(1) Blood parathyroid hormone (PTH), 25(OH)D3, 1,25(OH)2D3, osteocalcin, bone-specific alkaline phosphatase, anti-tartrate acid phosphatase and other bone biochemical indicators.
(2) Gonadal hormones.
(3) For suspected secondary osteoporosis or other skeletal diseases: bone scan, blood immunofixation electrophoresis, urine immunofixation electrophoresis, bone marrow morphology, thyroid function, blood total cortisol, 24-hour urine free cortisol measurement, etc.
(vii) Treatment plan and drug selection.
1.Basic measures.
(1) Lifestyle modification.
(2) Basic bone nutritional supplements.
A, calcium: the average daily calcium supplementation is 800C1000mg.
B, vitamin D: the recommended dose is 40OC800IU (10C20μg)/d, and active vitamin D (alfa osteopontinol, osteopontin triol) is recommended for the elderly or those with liver and kidney dysfunction.
2.Drug selection.
(1) Inhibit bone resorption drugs.
A, bisphosphonates (alendronate sodium, zoledronic acid, etc.).
B, calcitonin class (salmon calcitonin, eel calcitonin).
C, selective estrogen receptor modulators (SERMs) (raloxifene).
D. Estrogen class.
(2) Drugs that promote bone formation (human PTH1C34, etc.).
(3) Drugs with dual effects of inhibiting bone resorption and promoting bone formation (strontium ranelate).
(H) Discharge criteria.
Clear diagnosis and no serious adverse reactions to treatment.
(ix) Variation and cause analysis.
The pathway is withdrawn if the etiology of secondary osteoporosis or other skeletal diseases are detected after examination.
II. Clinical pathway form for primary osteoporosis
□ Ask for medical history and physical examination
□ Complete medical record writing
□ Complete auxiliary examinations
□ Physician visit to determine the preliminary diagnosis
□ Inform patients and their families of the disease and treatment plan, and sign the relevant informed consent form
□ Complete the medical record, such as the first medical history
□ If necessary, higher-level physician visits to clarify the diagnosis and guide treatment
□ Complete records of physician visits
□ Inform patients and families of changes in condition and relevant test results when necessary
□ Provide symptomatic treatment
□ Visits by higher-level physicians
□ Improve admission examination items
□ Continue symptomatic treatment
□ Complete the medical records including the records of the higher-level physician’s visit
□ Consultations with relevant departments as necessary
Long-term medical advice.
□ Endocrinopathy nursing routine
□ Primary/secondary/tertiary care
□ Diet
□ Notification of serious illness depending on condition
□ Other medical advice
Temporary medical advice.
□ routine blood, routine urine, routine stool
□ liver and kidney function, blood sugar, electrolytes, blood calcium, phosphorus, alkaline phosphatase, blood sedimentation, 24-hour urine calcium, phosphorus, blood gas analysis, etc.
□ Chest X-ray, electrocardiogram, abdominal ultrasound
X-ray examination of bones of thoracic, lumbar spine, pelvis and suspected fracture
□ Bone density (measured by dual-energy X-ray bone densitometer)
□ Other medical prescriptions
Long-term medical advice.
□ Endocrinopathy nursing routine
□ Primary/secondary/tertiary care
□ Diet
□ Medication based on condition
□ Patient’s previous basic medication
□ Other medical orders
Temporary medical orders.
□ Additional necessary tests
□ Other orders
Major nursing tasks
□ Introduction to ward environment, facilities and equipment
□ Admission nursing assessment
□ Precautionary education (fall prevention precautions)
□ Preaching (knowledge of endocrinopathies)
□ Observe changes in patient’s condition
□ Timely assessment of condition and corresponding care in place
Disease variation record
□ None □ Yes, reasons.
1.
2.
□ No □ Yes, reasons.
1.
Main consultation work
□ Third-level physician check-up
□ Review blood routine, liver and kidney function
□ Differential diagnosis and determination of diagnosis based on physical examination, laboratory test results and previous data
□ Conduct corresponding examination if secondary osteoporosis or other bone diseases are suspected
□ Consultation with relevant departments as necessary
□ Develop a treatment plan based on the examination results
□ Observe the adverse effects of treatment and treat them as appropriate
□ Complete documentation of the course of the disease
□ Check in with the supervising physician, evaluate, determine if there are any adverse effects of treatment, and clarify whether to discharge
□ Complete discharge records, medical case home page, discharge certificate, etc.
□ Provide patients with post-discharge precautions, such as the time and place to return to the hospital for follow-up, and the treatment in case of emergencies, etc.
Key medical advice
Long-term medical advice.
□ Primary/secondary/tertiary care
□ Diet
□ Treatment plan according to different conditions
□ Other medical advice
Temporary medical advice.
□ Additional and complete relevant tests
□ Symptomatic support
□ Other medical advice
Discharge instructions.
□ Discharge with medication
□ Regular outpatient follow-up
Major nursing tasks
□ Observation of changes in the patient’s condition
□ Psychological and life care
□ Discharge medication instruction
□ Special nursing guidance
□ Explain common adverse drug reactions and ask for regular outpatient follow-up
Disease variation record
□ None □ Yes, reasons.
1.
2.
□ No □ Yes, reasons
1.
2.