Title : Improving weight-bearing status documentation after orthopaedic surgery: A closed-loop audit against BOAST 2024
Abstract:
Introduction: Clear postoperative weight-bearing status (WBS) instructions are essential for safe rehabilitation. In August 2024, the british orthopaedic association standard for trauma (BOAST) on mobilisation and weightbearing revised the accepted lexicon, permitting only three terms – non-weightbearing (NWB), limited weight bearing (LWB) and unrestricted weightbearing (UWB) – attributed to the affected limb, and retiring ambiguous descriptors such as touch, partial and percentage- or weight-based limits. We audited WBS documentation against this standard and implemented a targeted intervention.
Methods: A prospective single-centre closed-loop audit was undertaken at a major trauma unit. Operatively managed limbs on the trauma list over a consecutive seven-day window were assessed from the operation note and postoperative plan, one record per affected limb, using a standardised proforma. Core compliance was defined as a documented status that was attributed to the affected limb and used an approved BOAST term; full compliance additionally required, for restricted plans, clinical justification, a functional description, an intended duration and any walking aids. Following cycle 1, a two-component intervention (departmental teaching and a point-of-documentation prompt with a BOAST lexicon poster and writing-station cards) was delivered, and the audit was repeated.
Results: In cycle 1, 42 limbs were analysed. A weight-bearing status was documented in 90.5% of cases, but only 21.4% met core compliance and 14.3% full compliance. A retired term was used in 52.4%, and the status was attributed to the affected limb in only 28.6%. Compliance was lowest in hip fragility and femoral fixation cases (5.6%). The predominant failure was continued use of legacy terminology rather than absence of documentation.
Conclusion: Baseline WBS documentation was frequent but rarely met the BOAST 2024 standard, with terminology and limb attribution the principal deficits. A low-cost educational and point-of-documentation intervention was introduced to address these, targeting the highest-risk hip fracture group, with re-audit undertaken to close the loop.
