Interactive PDSA workbook Pilot version

Aclasta infusions in general practice

Fill this in as your practice works through a Plan-Do-Study-Act cycle on introducing zoledronic acid (Aclasta) infusion as a practice service: mapping suitable patients, building and approving a written clinical protocol, and running the infusions safely. Your answers save automatically on this computer. Come back over the months and pick up where you left off. Written so the practice manager can drive it.

AuthorDr Chris Mitchell AM, FAICD

CPD hoursUp to 9 (EA 3 + RP 3 + MO 3)

Timeline3 to 6 months

Last savednot yet

Before you start: how this workbook saves

Type into the dashed magenta boxes. Each one shows an example answer above it. If you are not sure what to write, say the same kind of thing about your own practice.
Your answers save by themselves as you type, on this computer, in this browser. Close the tab, come back next week, everything will still be here. Check the 'Last saved' date on the cover.
Use one computer for the whole cycle, usually the practice manager's. If someone else needs to add their part, click Save to file, email them the file, and they click Load from file on their computer. Then they save to file and send it back.
Click Save to file at the end of every session. It downloads a small file. Keep it in your practice records folder. It is your backup if this computer is cleaned, replaced or reset.
When the cycle is finished, click Print / Save as PDF and choose 'Save as PDF'. That PDF is what the GPs upload as evidence to the RACGP CPD portal, and what you keep for accreditation.

One caution: clearing the browser's history or cache can delete your saved answers. The Save to file backup protects you.

This workbook is a pilot. If something is confusing or does not work on your computer, tell us via the contact page so we can fix it.

Your progress

0 of 0 fields completed. This is a long activity. Do a section, close the tab, come back next week.

The four stages

PlanPick the problem. Decide what you will count and who does what.

DoRun the change. Hold the meetings. Record the numbers as you go.

StudyCompare the numbers across the weeks. Write down what you noticed.

ActKeep what worked. Drop what did not. Make the good changes permanent.

The shaded boxes show you what to write

Every question carries the answer from Dr Chris Mitchell's own Aclasta cycle, run in his practice across 2025 and 2026. You do not need to invent anything: read the example, then write the same kind of answer about your practice. The dashed magenta boxes are yours.

The learning: where your educational hours come from

Three of the nine hours are educational activities (EA). Your team earns them by reading and discussing the zoledronic acid evidence, then applying it during the cycle. Chris wants this background on hand in every practice that runs the cycle.

The full background sits in the guide: osteoporosis and fracture risk, the place of zoledronic acid against oral bisphosphonates and denosumab, the HORIZON fracture-prevention evidence, osteonecrosis of the jaw risk at osteoporosis doses, PBS eligibility, pre-infusion pathology and creatinine clearance, consent and the nursing infusion checklist. Read it as a team at a clinical meeting and log the time as EA. A written clinical protocol must be developed and approved under your own medical governance; do not adopt the worked-example protocol as-is.

Read the background for this cycle

Resources you can share with the team

The HORIZON Pivotal Fracture Trial (yearly zoledronic acid over 3 years)
Therapeutic Guidelines: Endocrinology, on osteoporosis management
PBS Schedule: current zoledronic acid authority and eligibility criteria
RACGP guidelines for preventive activities in general practice (the red book)
MBS Online: confirm current consultation descriptors before billing
Your own approved clinical protocol and nursing infusion checklist

For the practice manager

Email the guide page to every GP and nurse before the clinical meeting, so the reading is done by the time everyone sits down. The hours they spend reading and discussing it count toward EA, and this workbook records the rest.

Plan

Topic, idea and plan

Topic: what is this PDSA about?

Example

Introducing Aclasta (zoledronic acid) infusion as a practice service, governed by an approved written clinical protocol.

The idea you are testing

Example

Introduce Aclasta infusions as a practice service. Review the current evidence base. Develop, pilot and approve a written clinical protocol that supports safe care, identifies suitable patients, manages pathology work-up and governs the infusion itself. Osteoporosis is underdiagnosed and under-treated, and an annual infusion fits the general practice recall workflow.

Plan: what you will do and what you will count

Example

Map the current state: how many active patients have a diagnosis of osteoporosis, how many are on oral bisphosphonates, how many are on denosumab (Prolia), and how many are on no therapy. Identify the subgroup most likely to benefit from switching to annual zoledronic acid, which is patients on no therapy and those on denosumab. Draft a clinical protocol and consent form. Agree the doctor-led recall process. Train the nursing team on the infusion procedure and observations.

Aims: what does success look like?

Example

Aclasta is offered as a clinically appropriate option to identified suitable patients. A written clinical protocol governs patient selection, pathology, consent and administration. Pre-infusion bloods (U&E, calcium, magnesium, phosphate, 25-OH vitamin D) are completed and reviewed. Creatinine clearance (Cockcroft-Gault) is calculated before every infusion. Nursing staff follow a documented infusion checklist. Consent is informed, documented and signed. A recall system is in place for the annual dose.

Meeting and action schedule

Chris's practice worked from a planning meeting through to a final protocol sign-off over several months. Type your dates in as each one happens. These dates become part of the CPD evidence, so keep them accurate.

Milestone	Date
Planning meeting: agree the approach with GPs and nurses
Clinical meeting (first): evidence and draft protocol
Review of draft protocol and consent form
Nursing training and checklist walk-through
First patient infusion
Mid-cycle review of experience
Final protocol sign-off
RACGP portal upload (GPs log their hours)

Study

Data collection

Audit the cohort at three points across the cycle: as you identify candidates, as patients proceed, and once the service is running. Enter the totals here. Numbers only in the audit boxes (12, not '12 patients'). The change column works itself out.

Example

The active patient list was searched on Best Practice for a diagnosis of osteoporosis, and doctors reviewed each record for suitability. The practical subgroup for switching was patients on no therapy and those on denosumab, since patients already on oral bisphosphonates had little cause for change. Progress was audited across the cycle as candidates had their decision conversation, consented, completed pre-infusion bloods and proceeded to infusion.

What you are counting	Audit 1	Audit 2	Audit 3	Change

What we learned

Example

A clear written protocol is essential: without it, each infusion becomes a one-off negotiation between doctor, nurse and patient; with it, the nurse runs the infusion with confidence and the doctor retains clinical governance. Patients are more concerned about osteonecrosis of the jaw than about fracture risk, even though fractures are more common and more serious, so evidence-based reassurance on ONJ risk at osteoporosis doses is central to consent. The evidence base is more contested than expected: reasonable doctors in the same practice reached different positions, and the protocol held space for that. Targeting is harder than expected, because patients on oral bisphosphonates have little cause for change. What worked best was a recall appointment with the patient's usual GP to arrange investigations and confirm suitability, then a separate nurse infusion date.

Act

What to keep and make permanent

Example

Aclasta is now available for infusion at our clinics. The approved clinical protocol and nursing checklist govern every infusion. A Best Practice shortcut (ACLASTADR) documents the decision conversation and pre-infusion checklist in one place. Recalls are booked at the time of infusion for the next annual dose.

CPD hours

Count the hours each GP spent. Reviewing the zoledronic acid evidence and the clinical meetings count as EA. Auditing the cohort and reviewing the draft protocol against the evidence counts as RP. Running the cycle itself, including the infusions and recall system, counts as MO. The total adds up automatically. When in doubt, the GP lead decides what to claim.

Activity type	Hours	Evidence you already have
Educational activities (EA)		Clinical meeting attendance, reviewing the zoledronic acid evidence
Reviewing performance (RP)		The cohort audit and the draft protocol review against the evidence
Measuring outcomes (MO)		This completed workbook, meeting dates, the infusion and recall figures
Total	0	GPs submit as a GP-led activity via RACGP myCPD Home

In-house education is the easiest EA time to claim, and the easiest to forget

Reviewing the zoledronic acid evidence in the guide as a team, at a clinical meeting, is the most direct source of EA hours in this cycle. Log the time while you are there, because it is the part practices most often forget to claim.

Reflections (the GPs write these)

The RACGP asks each GP to reflect on three areas. Hand the computer to the GP lead for this bit, or collect a sentence or two from each GP at the follow-up meeting and type them in. There is no worked example here: these have to be your own.

Culturally safe practice Professional and health inequities Ethical practice

Participating doctors

One per line. This is for your records so nobody has to reconstruct it at portal-upload time.