Clinicians’ experiences of discontinuing routine hip precautions following total hip replacement surgery: a qualitative analysis

Abstract

Purpose

Hip precautions are routinely provided in the UK, despite evidence suggesting that they are no longer needed. A change in practice was introduced into an orthopaedic service whereby the provision of routine hip precautions was discontinued for selected individuals receiving a primary total hip replacement. The change involved implementing a new regime of “no precautions” which was facilitated using a number of key strategies. The aim of this study was to explore the experiences of clinicians associated with the change in practice.

Material and methods

Individual semi-structured interviews were conducted with clinicians who had experience of delivering both hip precautions and no hip precaution regimes. Data were analysed thematically.

Results

Ten orthopaedic staff (two senior occupational therapists, one occupational therapy support worker, three senior physiotherapists, two surgeons, and two senior nurses) were interviewed. Three main themes were identified: changes experienced, perceptions of the new regime, and challenges experienced.

Conclusion

Several barriers and facilitators to the successful changeover were identified. Successful strategies in changing practice included assigning “Hip Champions”, staff education and targeted training. It is proposed that holding multidisciplinary education and training would be the ideal model.

Implications for rehabilitation

• Key strategies for changing practice were educating staff and providing targeted training.

• Multidisciplinary training might prevent discrepancies in the advice given to patients.

• Appointing “Hip Champions” provided clear role models and enabled new clinical behaviours to be enforced.

Keywords:

• Hip precautions
• total hip replacement
• implementation
• rehabilitation
• change in practice

Acknowledgements

The authors wish to acknowledge all staff of Nottingham Elective Orthopaedic Services (NEOS) who participated and assisted with the study and the wider HippityHop research group. They would also like to particularly thank Prof Brigitte Scammell, Gary Drury, and Laura Garratt for their assistance and support with the study, and the “Hip champions” who implemented the new regime (Karen Hawkins, Lauren Hutchinson, Sarah Hopkins, Sarah Roworth, Chantel Moir, Nova Charles, Gillian Kruszewski, Glenda Cope, Dawn Menzies, Claire Ashby, Bridget Greengrass, and Claire McElhorne).

Consent

All participants provided written informed consent prior to taking part in interviews. Written informed consent was obtained prior to the telephone interview, and verbal consent was audio recorded at the start of each interview.

What the study has added

This study has identified key issues in implementing a successful change in an orthopaedic service, which could be used to support changing practice in other areas.

Disclosure statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Funding

CJL was funded by School of Health Sciences, University of Nottingham for her PhD.