The #endPJparalysis was recently started by Ann-Marie Riley from Nottingham University Hospital, following research that implies PJ’s have a lot to answer for when considering hospital admissions. They found that 65% of older patients experience a functional decline between admission and discharge (BGS, 2018), and this is replicated throughout the world, not just the country! This combined with the knowledge that it only takes 10 bed rest days to lose 1kg of lean leg mass from healthy older adults (Kortebein et al, 2007), has created a revolution to prevent deconditioning.
Deconditioning is described as "a complex process of physiological change following a period of inactivity, bedrest or sedentary lifestyle. It results in functional losses in such areas as mental status, degree of continence and ability to accomplish activities of daily living” (Gillis & Macdonald, 2005). Moral of the story, deconditioning can happen to anyone!
As an occupational therapist at the Royal National Orthopaedic Hospital (RNOH) I see people potentially deconditioning on a daily basis. Working as part of a multidisciplinary team (MDT) we do all we can to prevent this, however if the person this is happening to is unaware it is happening, then their motivation to assist in their deconditioning prevention is very low. As a result, a small #ontheMEND committee was started to discuss the dissemination of information to patients and staff alike and increase patients getting up, dressed and moving.
RNOH chose the #ontheMEND to compliment the #endPJparalysis # already created. The letters of MEND stand for Medicines, Exercise, Nutrition and Daily living. This emphasises that in order to prevent deconditioning, the whole MDT needs to become involved.
Disseminating information to patients can be quite tricky. Therefore, the hospital had a pyjama day where staff were encouraged to dress in their PJ’s for the day whilst treating patients. The staff had some amazing pj’s ranging from Harry Potter pj’s to my very fabulous elf onesie (well it was just after Christmas)! This lead to discussion with patients and a realisation from staff that patients often think they are “not allowed” to get dressed, and they haven’t brought any/suitable clothes with them. Other hospitals have also had pj days and have combatted the lack of clothing, particularly for those without family or friends, by having donated clothes in a cupboard ready to provide to those who need it. A radio broadcast on Radio Brockley (https://youtu.be/ftaLo-WQ4s0) was also aired for RNOH patients to listen to, where four members of the #ontheMEND committee spoke about their role in this initiative.
On a personal level I have created posters and tweeted about the initiative, written this blog and I plan to complete an interactive newsletter based off the “Getting patients up, dressed and moving” conference I attended with others from the #ontheMEND committee. I received very positive comments from the MDT when I created one for occupational therapy week, and it’s a fun way of providing information to everyone through research, video links and movies that might touch on the subject being discussed.
Getting involved in this initiative is super easy, partly because there are posters already created ready for distribution and there is an upcoming challenge for the whole country being organised by Ciara Moore from Cambridge. The challenge if you chose to accept it, is to get one million patients up, dressed and moving within 70 days! It starts on 17th April 2018.
As a final thought, the reason I chose the title “PJ’s = lazy days!” was to get everyone thinking about when they have PJ days and how this makes you feel physically and mentally. I know on my PJ days I become lethargic, unmotivated and generally lazy. Baring this in mind then, as hospital staff we are expecting patients to be motivated and active when they are in their PJ’s all day. So, get talking to patients and explaining why getting dressed will help them with their recovery, and generally you’ll receive a great response.
Written by Deborah Abson Occupational Therapist
For further information regarding accessing posters, viewing the reference list or any questions email firstname.lastname@example.org.
Bgs.org.uk. (2018). Deconditioning Awareness - British Geriatrics Society. [online] Available at: http://www.bgs.org.uk/ethicslaw-2/deconditioning-awareness/deconditioning-into [Accessed 17 Feb. 2018].
Gillis, A. and MacDonald, B. (2005). Deconditioning in the hospitalized elderly. Can Nurse, 101(6), pp.16-20.
Kortebein, P., Ferrando, A., Lombeida, J., Wolfe, R. and Evans, W. (2007). Effect of 10 Days of Bed Rest on Skeletal Muscle in Healthy Older Adults. JAMA, 297(16), p.1769.