DOI: 10.1093/bjs/znad258.656 ISSN:

295 Education and Training to Improve Compliance to the BOAST Guidelines on Assessing and Documenting Peripheral Nerve Status and Injury

O Khirsheh, K Yusuf, A Dutta, C Serino, I Rafiq
  • Surgery



Peripheral nerve injuries affect 2-3% of trauma patients, with potentially high morbidity, and associations with litigation. BOAST guidelines were introduced in December 2021 outlining standards in assessing and documenting neurovascular status in trauma patients. Key elements included nerve-specific documentation and assessments pre- and post-interventions such as manipulation.


This project assessed departmental performance against the BOAST standards, then presented the results to both orthopaedic and emergency departments, as well as setting up teaching sessions to orthopaedic junior doctors in the assessment of neurovascular status and updating awareness on the guidelines.


50 patient records were analysed retrospectively for the first arm, and 50 records prospectively for the second arm. Acute trauma presentations with a risk of peripheral nerve injury met the inclusion criteria. Intervention included practical senior-led teaching on clinically assessing neurovascular status, and the importance of detailed documentation, as well as when to repeat the examination.


Results were improved drastically from initial audit against standards to post-intervention audit; documentation improved from 70% to 95% (n = 50 for both arms), with appropriate detail in documentation improving from 11% to 49%.


Neurovascular status is critical to be documented in detail, both pre and post-interventions. By using BOAST guidance as a standard, the initial inadequacies of the departmental practice were highlighted, and significantly improved through active teaching, distribution of the guidelines, raising the standards, clinical assessment, and documentation, thus improving patient care, and robustness of legal documentation.

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