Title : Assessment of compliance with BOAST Guidelines on weightbearing following lower limb trauma surgery at Arrowe Park Hospital
Abstract:
Background: The British Orthopaedic Association Standards for Trauma (BOAST) provide national guidance on postoperative weightbearing instructions following lower limb trauma surgery. Clear, standardised terminology and rehabilitation planning are essential to ensure safe and effective mobilisation, reduce complications, and improve multidisciplinary communication.
Aims: To assess compliance with BOAST guidelines on weightbearing documentation at Arrowe Park Hospital, identify deviations in terminology, and implement improvements in postoperative care planning and documentation.
Methods: A retrospective review of lower limb trauma cases was conducted between 5th August and 29th September 2024. Data were collected on weightbearing status as documented in theatre notes and the time to physiotherapy-led mobilisation post-surgery. Compliance was measured against BOAST standards, which mandate the use of specific terms ("Non-weightbearing," "Limited weightbearing," and "Unrestricted weightbearing") and require a documented rehabilitation plan with review at least every 72 hours.
Results: Although most patients were mobilised appropriately post-surgery, only 17% of cases used BOAST- compliant terminology. Commonly used non-standard terms included "WBAT" (Weightbearing as tolerated), "FWB" (Full weightbearing), and hybrid terms such as "FWBAT." Documentation also included vague or percentage-based instructions, which are discouraged by BOAST. These findings highlight a gap in standardisation, which could affect clarity and patient outcomes.
Interventions and Progress: In response, educational posters were disseminated in theatre, and the postoperative proforma on Cerner was updated to align with BOAST terminology. A second audit cycle is now underway, with data collection due to complete in September 2025. Preliminary results are looking promising, suggesting an improvement in compliance and greater use of standardised terminology.
Conclusion: Initial findings demonstrate the need for improved adherence to BOAST guidelines, particularly regarding consistent and accurate weightbearing terminology. The implemented changes aim to standardise practice and enhance multidisciplinary communication, with ongoing evaluation expected to confirm sustained improvements.
