by Dr Nesem Al-Ali

Quality Improvement Poster Download

Background & Problem

When performing a neurological assessment for a patient the testing of reflexes is an essential task to complete. This however is often performed poorly as the right equipment (a tendon hammer) is rarely available. For this problem we focused on inpatient wards where preliminary tests had shown difficulty in obtaining tendon hammers. The ward managers were involved in the implementation of the intervention.


Reducing length of time for finding tendon hammers to <30s within a month.


Preliminary data was collected from all the wards that contained inpatients on the Cheltenham and Gloucester sites. The time taken to locate tendon hammers on each ward was measured.

The most poorly performing wards were selected for the intervention. This was a poster that would act as a signpost. Timings were taken again to identify whether the intervention had any impact.


Results show a decrease in the time taken to locate the tendon hammer on the selected wards however the impact of the intervention is negligible. This is because on many occasions the poster was not up.


From this intervention I have learnt the importance of co-operation with other members of staff to get buy in. I think that having more staff involved in the project especially junior doctors would have helped to improve awareness. Better results may have also been obtained. Future improvements could be focused on the junior doctor population and getting them to monitor the availability of tendon hammers with a champion for each ward.

Quality Improvement Presenter(s)
Dr Nesem Al-Ali, Postgraduate Medical Education Fellow
Quality Improvement Team
Dr K Benstead
Sarah Pearce, Ward Manager 2B
Helen Russell, Ward Manager 5B
Diana Moorse, Ward Manager 7B