An MDT Approach to Reducing Clinical Deconditioning: Sitting Out

Introduction

A Quality Improvement Project on UHCW’s largest Care of the Elderly ward, aiming to reduce deconditioning, by using intra-MDT education to improve the proportion of patients sitting out in a chair.

Method

We measured the proportion of patients who sat out in a chair across five weekdays.  We did this by: 1) Observing the number of patients sat out, 2) Discussing with nursing/HCA staff whether patients had sat out and if not, the reason why and 3) Reviewing medical/nursing/physio documentation. We also reviewed baseline mobility, to understand what proportion of our patients we might expect to sit out.

We then implemented an education programme, with different parts of the MDT teaching and learning from each other.  The aim was to improve deconditioning awareness and to support the MDT in increasing the proportion of patients sat out. Doctors taught their peers and nursing staff on the clinical importance of sitting out and how to optimise documentation to make it a priority.  Physios ran sessions, for resident doctors, on manual handling.  Feedback was sought, from nursing and HCA colleagues, on the barriers they face in sitting patients out.  Following the education programme, we repeated the study.

Results

We found an increase in the proportion of patients sitting out, from 60% in Cycle-1 to 69% in Cycle-2.  This was in the context of a maximum ‘expected to achieve’ (calculated on baseline mobility) of 86-87%.  We also identified modifiable and non-modifiable barriers, including: clinical deterioration, patient refusal and resource shortages (staff and equipment availability).

Conclusion

Core to our project was an intra-MDT approach to education around deconditioning.  We found that by teaching each other, medical, nursing, HCA and physio staff were able to together improve the proportion of patients sitting out in a chair.  We have since implemented a rotational education programme.