The Weight Of Words: Documenting Post-operative Mobilisation And Weight Bearing Status For Orthopaedic Patients

The Weight Of Words: Documenting Post-operative Mobilisation And Weight Bearing Status For Orthopaedic Patients

Tenzin Dorji
Betsi Cadwaladr University Health Board, United Kingdom

Introduction: Inconsistent terminology for postoperative weight-bearing (WB) creates confusion and patient harm. The British Orthopaedic Association Standards for Trauma (BOAST) defined three terms—non-weight-bearing (NWB), limited WB and unrestricted WB with mandated limb-specific rehabilitation plans and recommended reviewing WB status during routine follow up (BOA 2024).

Aim: Audit post-operative WB documentation and review against BOAST guidelines, followed by the implementation of a novel standardised change to improve compliance.

Methods: Single-centre audit of all operated trauma and lower-limb elective cases over a one month period. Data collected from theatre lists, operation notes and electronic health records. Exclusions: non-operative cases and incomplete records.
Results: Trauma (n=72): WB documented in 62.5% (45/72); BOAST-compliant terminology in 24.4% of documented cases with limb-specific attribution 0%. Among NWB/limited WB cases (n=18): clinical justification 11.1%, quantification 11.1% and duration 66.7% were documented. WB reviewed at clinic 31.8% of those followed up. For elective lower limb (n=45): WB documented in 95.6% (43/45). Compliant terminology used in 2.3% and limb-specific attribution 0%. Among NWB/limited (15/43): justification 0%, quantification 20.0%, duration 66.7% were documented. WB reviewed at follow-up 18.2%.

Conclusion: WB is often recorded but seldom BOAST-compliant. To improve compliance, our department has looked at introducing a standardised operation-note template with a mandatory WB field alongside clinician education. Local orthopaedic departments should be encouraged and find creative solutions to use standardised terminology with regards to patient mobilisation post-surgery.

Keywords: Orthopaedics, Post-operative, Weight-bearing, Unrestricted, Limited, Non