Staff blog posts

Making small changes to improve patient outcomes

Nicola Herraghty
Clinical Matron

My name is Nicola Herraghty and I’m currently the Clinical Matron for two older people’s wards – Wards 11 and 12 – at The James Cook University Hospital.

We know that for every 10 days of bed rest in hospital, the equivalent of 10 years of muscle aging occurs in people over 80 years old.

Within Older People’s Care we have embarked on the national #EndPJparalysis 70 Day Challenge. This is something that as a nurse that I’m passionate about. The campaign is about making small changes to improve patient outcomes.

On Wards 11 and 12 we have developed a dignity wardrobe for those patients who do not have any relatives or carers to bring them appropriate clothing into hospital. The dignity wardrobe provides our patients with appropriate clothing while in hospital.

Already we have seen a huge reduction in our falls over the past few weeks and I’m really excited to see other improvements in patient outcomes, patient experience and length of stay. If you had 1,000 days left to live, how many would you choose to spend in hospital?

When I visit the wards I now often see patients mobilising around the ward, dressed appropriately and enjoying their meals while sat out of bed.

I encourage everyone caring for our older patients in hospital to help #EndPJparalysis and get involved in the campaign to improve outcomes for our most vulnerable patients.

Keep up the good work!

Sarah Clifford
Community therapy team lead

“48% of people over 85 die within one year of hospital admission”

“10 days in a hospital bed (acute or community) leads to the equivalent of 10 years of ageing in the muscles of people over 80”

I was really concerned when I originally saw the above data showing what happens to patients when they stay in bed longer than necessary.

As an Occupational Therapist and Therapy Lead I am passionate about increasing staff awareness and understanding of deconditioning to ensure that all patients in our care are given opportunities to promote their independence as much as possible, improve their quality of life and be discharged to their preferred location.

This can be as simple as getting out of bed for as long as possible each day and getting dressed to promote a more positive approach to their recovery and rehabilitation.

It is also important to support our patients to actively participate in meaningful occupations as much as they can, walking to the toilet where possible, and teaching them ways of managing their condition more effectively.

Therapists are key to the multidisciplinary team in communicating how the above can be safely achieved but this is everybody’s business.

The current #EndPJparalysis campaign to encourage our patients to get up, get dressed and keep moving will help to reduce the risk of infection and their length of stay in hospital.

It will improve mobility, independence and recovery, skin integrity, posture, digestion and breathing; reducing their risk of falls and dependency on others. Ultimately our patients are more likely to be able to return home.

By supporting the above we can all make such a positive contribution to the health and wellbeing of our patients, so please keep up the good work!

Heart procedures in your own clothes

Neil Swanson
Consultant cardiologist

I work as a doctor in the heart department and often deal with people who are having complex heart procedures.

Mostly this means threading equipment from the pulse in the wrist, round the body to the heart.

It’s quite a scary thing for people, especially as it’s all done while they are awake. I think a lot of them feel pretty vulnerable. The high tech environment can take away people’s feeling of independence and of being in control.

There are a few heart centres around the UK and abroad that have started doing these procedures while people are wearing their own clothes. It’s something we’ve started to do here too, if people want.

There’s a small chance of clothing getting damaged or of getting stained with the disinfectant we use, but it doesn’t really affect how we do the procedure. We just have to make sure patients aren’t wearing clothes with metal bits in them because they show up on the x-ray scans we do during the procedures.

The good thing about it is it allows people to feel more normal while a stressful procedure is done. They can walk to and from the operating area if they wish.

Before they go for the test and as soon as they come back, they can sit in a lounge or TV room, with their family if they wish. They don’t need to be looked after in a bed at all.

I feel this is an important psychological stage in helping people cope with the shock of a heart problem. It shows them that they can get back to their normal lives and get home quickly.

We hardly ever prescribe bed rest in hospitals anymore

I remember visiting my father in hospital. I was 10 years old, and he was 38. He had been admitted for ‘bed rest’ due to a bad back. I recollect being struck at how this proud man, my father, looked so old and so small, lying there in his hospital gown. He came home soon and, back in his own clothes, in his own home he looked the man I normally recognised.

Thirty years on we hardly ever prescribe bed rest in hospitals anymore. We admit to provide complex medical care and to actively mobilise with the aid of specialist therapists.

Bed rest is now known to cause harm – Dr David Oliver, a specialist in Elderly Care wrote about this recently in the BMJ ‘a few days’ bed rest can cause rapid decline in muscle strength, higher risk of thrombosis or delirium, pressure sores, infection, loss of confidence, and greater dependence.  It can also cause incontinence by too often resorting to catheters, pads, or bedpans or by causing constipation, instead of assisting and encouraging patients to toilet as they usually would’. These risks are greatest in our older frailer patients.

Thirty years on my father is older. I worry that he would come out of hospital an even older man. I worry about his loss of dignity whilst in hospital and how that would impact on his will to live and get better.

We need to encourage patients, especially those that are older or frail, to stay as independent as possible whilst in hospital. I wholeheartedly support the End PJ paralysis campaign in the hope that it will change knowledge and attitudes of healthcare teams, carers and patients. I encourage all involved to help those in our care get up and get dressed, and get moving.

Thrown a curve ball

Debi McKeown
Nursing sister in therapeutic care
Posted on 23 April 2018

Day 2 of #Endpjparalyis and we have been thrown a curve ball!

One of the team spent time with a lady who has been in hospital for a few weeks now, she asked to get her hair washed and “tonged” – old school styling at its best.

A soak in the bath, hair done but alas no fresh pyjamas to wear.

This lady had no family locally so that wasn’t an option so we gave her the option of having some pyjamas supplied by us. The lady was thrilled, her words to us “new do, clean pyjamas and clean sheets, what a treat”.

This for me demonstrates the importance of this campaign. At the heart of it, patient choice is paramount, it’s never about forcing people to get up and get dressed against their will, it’s about encouraging patients and giving them a choice.

The campaign has really got hold of staff and patients here, there was lots of banter to be had with five chaps on one of our wards, not one of them wore pyjamas anyway so they were all about promoting this. They all said they felt better in mood when they got up and ready . It’s great to see such positivity!