Title : Improving Weight Bearing Status (WBS) documentation compliance as per British Orthopaedic Association (BOA) guidelines in a North West London District General Hospital (DGH): A 2-cycle closed-loop audit
Abstract:
Background: Weight bearing status (WBS) is a core pillar in orthopaedic practice, crucial for patient recovery. Despite updated British Orthopaedic Association (BOA) guidelines, WBS documentation has been historically poor, impacting patient care and timely discharges.
Aim: This audit aimed to improve the recording rate and documentation compliance of WBS at a District General Hospital (DGH) in North West London.
Methods: We carried out a 2-cycle closed-loop prospective audit on the WBS documentation within our Trauma & Orthopaedic (T&O) department. The electronic notes of T&O inpatients were collected in the first cycle (September – December 2024) and analysed against the BOA guidelines, including WBS recording rates, documentation timing and BOA-recommended term utilisation. These findings were shared at our daily Trauma Meeting over a 2-week period as part of the intervention. Subsequently, a second data collection cycle was conducted (May – July 2025) to re-review for compliance, and the subsequent interventions for Cycle 2 included: posters in doctors’ office, regular Occupational Therapy (OT) and Physiotherapy (PT) involvement, ongoing reinforcement in trauma meetings and the introduction of a dedicated WBS documentation proforma.
Results: 50 patients with both upper and lower limb fractures were included in both cycles. Cycle 1: although 66% (n=33) had a WBS recorded, only 36% (n=12) used the BOA-recommended terms. Post- intervention, the former increased to 74% (n=37), with just under half using the recommended WBS terms (46%). However, documentation often occurred late in admission (e.g., post-operatively). In Cycle 2, we initially found the WBS documentation compliance slightly dipped (60%) pre-intervention, compared to December. However, following the second cycle intervention, significant improvement was demonstrated: WBS was recorded for 90% (n=45) of patients, and crucially, adherence to BOA-recommended terms also dramatically increased to 93% (n=42; overall adherence 84%), with documentation starting to be recorded from admission clerking. This highlights a substantial positive change in compliance over the two cycles.
Conclusion: Both cycles showed progressive improvement in WBS documentation compliance and BOA-recommended term adherence. Cycle 2, with its multi-faceted interventions, yielded significantly enhanced rates. While challenges with earlier documentation may persist, this audit demonstrates the positive impact of targeted efforts. Given the initial slight decline in compliance between both cycles however, our next step is to embed the WBS proforma and relevant information into resident doctors' induction workbooks for new rotations, aiming to further improve adherence and early documentation across the Trust.
