Ann-Marie Riley praises the #endPJparalysis campaign, stressing how quickly loss of muscle strength can happen in hospital and how important it is to keep patients mobile
The #EndPJparalysis campaign, which started with a few tweets in November 2016, has now been shared both nationally and internationally, and impressions on Twitter have reached almost 170 million.
Some argue that getting patients up, dressed and moving is just what nurses have done for years and I agree to some degree. However, evidence suggests that many patients spend up to 83% of their time in bed, with even those who are more than able to walk in hospital hardly doing any steps.
Loss of muscle strength can begin frighteningly quickly – within hours in some cases. For a person who, before admission, was just managing to stand from a chair or get on and off the toilet, even a small amount of muscle strength loss can be life-changing. I wonder how many nursing staff receive training on preventing deconditioning either pre- or post-registration?
Evidence suggests that, compared with those who are not admitted to hospital, hospitalised older adults are significantly more likely to develop some disability in terms of activities of daily living (ADLs). We have to ask: why? Are we satisfied that we collate the right information about how patients managed these activities at home so we can plan to maintain as much of that ability as possible? Do we investigate loss of ability and the root cause of why it happens in hospital?
At Nottingham University Hospital (NUH) we will soon be capturing loss of ADLs via incident reporting and new electronic nursing documentation. Although our data capture and evaluation methods are likely to require refinement over time, we will at least be formally acknowledging deconditioning as harm and striving to determine root causes. Fear of patients falling, inadequate staffing levels and lack of time to focus on mobilising patients are common themes that have arisen from the many presentations we have done across the country. I believe a formal process to recognise deconditioning harm is needed across all care settings so we can begin to have honest conversations about why deconditioning happens.
A national challenge to capture one million patient days of getting patients up, dressed and moving is running until 26 June. An app will support data capture. Even if you are not able to submit data, what you can do is ask a simple question – why? Immobility can be lifechanging so why is this person not getting out of bed and moving? Changes to continence function can be lifechanging so why is this person not going to the toilet instead of using aids?
I’m proud of our team at NUH who are asking these types of questions and developing local solutions to improve care delivery and prevent harm from deconditioning. For example, one of our trauma and orthopaedic wards has seen reductions of 37% in falls, 80% in complaints and 86% in pressure ulcers through the implementation of a simple bundle of initiatives (see next month’s issue).
Imagine the potential reduction in harm if we could replicate even a fraction of this nurse-led improvement across multiple healthcare settings.
Ann-Marie Riley is deputy chief nurse (strategy) at Nottingham University Hospitals Trust.
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