Creating and Implementing a Protocol for the Management of Patients in Skeletal Traction: A Quality Improvement Project


  • Justin A. Cline, M.D. University of Kansas School of Medicine - Wichita
  • Jack A. Bolte, B.S.
  • Gregory M. Mendez, M.D.
  • Jordan T. Willis, M.D.
  • Andrew J. Bachinskas, M.D.
  • Clint L. Benge, M.D.
  • Bradley R. Dart, M.D.



Traction, Skeletal traction, patient care, policy, protocol


Introduction.Skeletal traction use generally has decreased over generations and is used most often for temporary fracture stabilization. Proper nursing management of patients in skeletal traction is crucial. A hospital protocol was created and implemented to educate and direct registered nurses (RNs) in the care of patients requiring skeletal traction.

Method.A skeletal traction management protocol was drafted and implemented as hospital policy. Twenty-nine RNs from an orthopaedic unit at a level 1 trauma center attended a financially compensated, 45-minute, in-person, off-shift educational session. An anonymous pre-test utilizing a 5-point Likert scale was completed to assess RN knowledge and comfort regarding the following topics of traction care: pin care, manual traction, frame assembly, weight application and removal, skin evaluation, neurovascular checks, and reporting issues. The RNs were provided with a copy of the new hospital policy and key points were highlighted and demonstrated. After the demonstration, the RNs were given a post-test to assess their perceived knowledge and comfort with traction care.

Results.Statistically significant improvements in RN knowledge and comfort were seen in six of the seven evaluated topics. The greatest increase was seen in the manual traction topic. No significant change regarding neurovascular checks was observed with this topic having the highest pre-test scores.

Conclusion. A hospital protocol was created successfully and implemented that significantly improved the level of RN knowledge and comfort with the management of patients requiring skeletal traction. Future studies should assess the effectiveness of annual education regarding the traction policy.






Original Research