ISPO UK ASM 2023 - Poster Exhibition
IRPAG+ Liner Algorithm Update and Audit
Presenter: Gayle Arthur, Prosthetist, NHS Tayside, Scotland, UK
As a profession we have a duty to ensure we are prescribing appropriately to ensure best practice for our patients as well as cost effectiveness for the NHS. Liners take up a significant proportion of our budgets, we need to be able to justify why we prescribe them. The Inter Regional Prosthetics Audit Group+ (IRPAG+) are a collaboration of centres around London and the south that meets 3-4 times a year to encourage inter centre learning and improve standards of care through ongoing practice review and audit, within the field of prosthetics. As a group they have produced several guidelines to help inform prosthetic practice over the years including a Liner Algorithm produced in 2009. In 2019 it was agreed that this algorithm should be reviewed and updated due to the vast increase of variety, availability, and prescribing of these high-cost items in recent years.
A survey was completed by the IRPAG+ centres informing what guidance is used locally to justify liner prescriptions, including whether the Liner Algorithm 2009 was still relevant, and the 2009 algorithm was reformatted at this time for ease of access. Further to this, an audit was carried out in order to determine clinical justification for prescribing liners in order to inform a new updated IRPAG+ Liner Algorithm in order for this to be used objectively across all centres.
To find out how IRPAG+ centres justify the prescription of liners for their patients and how relevant the Liner Algorithm 2009 is. To find out whether the guidelines need updated and generalised to indicate specific material types, suspension methods and inform clinical reasoning for liner prescription, whilst ensuring the decision process is objective and unbiased. Methods:
An audit was devised and sent to each centre requesting they complete a spreadsheet for 20 new liner prescriptions in July/August 2019, the information gathered included level of amputation, suspension type, clinical reasoning if any.
In total, 8 centres participated, with 165 separate entries and 35 different types of liners being prescribed. The clinical justification for prescribing a liner fell into 1 of 3 categories: suspension only, residual limb protection only, or both suspension and residual limb protection. Most frequently prescribed material is silicone for ‘suspension only’ and gel is more popular for ‘residual limb protection only’. Most frequently prescribed suspension method for silicone liners are pin locks followed by seal-in, and these tend to be for K3 transtibial patients who are the cohort most likely to be prescribed a liner.
The information gathered allowed a new IRPAG+ Liner Algorithm to be created to include clinical reasoning, suspension considerations, and general liner types to be identified, therefore helping to justify the prescription of every liner and informing our best practice going forward.
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