Total Hip Replacement: An Audit of the Provision and Use of Equipment

Abstract

Historically, Perth and Kinross Social Services supplied every total hip replacement patient with a ‘hip pack’ containing a raised toilet seat, a helping hand, a long-handled shoe horn and a sock/tights aid. This pack was issued by the hospital occupational therapist prior to discharge. In January 1996 the funding for this equipment was withdrawn. This move obstructed the hospital-based occupational therapists from achieving the standard practice that ‘all patients will be provided with a hip pack prior to discharge’. The hip pack should be used for 6–12 weeks postoperatively to reduce the risk of dislocation. These standards are in agreement with guidelines in James (1992). The occupational therapy department was concerned that patients would be at greater risk of dislocation if this equipment was not provided. A variety of options were considered to overcome this, including patients purchasing their own equipment or the hospital trust funding a loan service.

In order to support these proposals an audit was carried out with three main aims: (i) to assess whether the hospital occupational therapists were meeting the standards by providing every total hip replacement patient with equipment from a hip pack; (ii) to assess whether the standard statement that the hip pack equipment should be used for 6–12 weeks was an appropriate time scale for patients; and (iii) to obtain the patient's perspective on the proposals being explored to continue to meet the standards.

There was an 85% (63/74) response rate and the results of the audit highlighted how important the equipment was to the patient. The time each item was used for varied, but many were still in use 6 months postoperatively. Due to budget constraints, patients were also asked if they would purchase some of the equipment; 51 (93%) of the 55 respondents stated that they would have purchased at least one item in the hip pack. The standards were nearly but not fully met. This was due to the lack of flexibility in the standards not acknowledging that some patients would not need equipment.