Abstract
Introduction:
Deconditioning remains a significant challenge for hospital inpatients, particularly the older patients. National campaigns such as “End PJ Paralysis” and “Sit Up, Get Dressed, Keep Moving” endorsed by the British Geriatrics Society, highlight the importance of maintaining mobility during hospital stays. We designed a QIP to raise awareness of deconditioning among nursing staff and resident doctors and to identify barriers preventing mobilization.
Method:
We conducted a QIP on a geriatric ward at Lincoln County Hospital, collecting quantitative data on the frequency of patients sitting out of bed, sitting up for meals, wearing appropriate footwear, and wearing their own clothes. Qualitative feedback was obtained through short interviews with nurses and healthcare assistants(HCAs) to explore reasons patients remained in bed. Patients receiving end-of-life care, those medically unwell(NEWS>5),or those with baseline immobility (i.e bed bound) were excluded. Following an initial cycle, teaching sessions were delivered to staff and resident doctors over two weeks before repeating data collection.
Results:
In the first cycle, 69% of patients sat out of bed daily, 50% sat up for meals, 42% wore appropriate footwear, and 26% wore their own clothes. After staff education, the second cycle showed no significant improvement: 64% sat out of bed, 48% sat up for meals, 40% wore appropriate footwear, and 36%wore their own clothes. Barriers identified included patient factors (fatigue, lack of motivation and awareness), equipment shortages (e.g.recliner chairs), staffing pressures, and difficulty accessing personal clothing. Notably, some patients who could mobilize independently remained in bed. This showed that the risk of prolonged bedrest is even greater for those needs support.
Conclusion:
Despite increased staff awareness, this QIP showed a neutral impact on outcomes, highlighting that education alone is insufficient. Multifactorial barriers, including patient factors, limited equipment, and staffing constraints, been identified and have to be addressed collectively to improve outcome.
Comments
Important Topic
Really important topic for all ward doctors and nurses to be aware of. Early mobilisation would improve the overall health of patients and help them return to their baseline sooner, rather than requiring a period of rehabilitation. Do you think educating patients about factors contributing to deconditioning on the first day of admission would make a difference?
Many thanks for your comment…
Many thanks for your comment. In our QIP, we identified that patients’ factor and motivation is the key in getting them out of bed, so managing the challenges such as pain is crucial. I agree with you that preventing deconditioning should always start from day 1.
System factors
Sounds like an interesting piece of work. Have you considered presenting it at a managers' meeting within your organisation? I wonder if there is scope for a re-think of any of the system factors you mention (equipment, access to personal clothing) such that some of the barriers can be overcome?
Thank you for your comment…
Thank you for your comment. I believe in the past, the lack of recliner chair has been flagged up however not sure what was the outcome. It’s a good idea as you suggested to present the finding in the management.