33
#endPJparalysis Eleanor Sawyer: Project Lead, Care of Older People Clinical Network, Safer Care Victoria @EleanorSawyer20 7 February 2020
#endPJparalysis
Eleanor Sawyer: Project Lead, Care of Older
People Clinical Network, Safer Care Victoria
@EleanorSawyer20
7 February 2020
Welcome
● Why #endPJparalysis?
● The project structure
● Victorian #endPJparalysis interventions
● Results
● Sustainability
● Questions
Session Outline
n. the lack of movement that occurs when people remain in their
pyjamas.
PJ paralysis?
Why #endPJparalysis?
Musculoskeletal impact
• 1.5kg of muscle lost per week
• Contractures and reduced ROM
around joints
• Disuse osteoporosis
• Impaired balance mechanism1,2
Crabtree (2019)
Cardiovascular impact
• 3 weeks in bed = 40 years of aging
on the cardiovascular system
• Decreased V02 max
• Reduced cardiac output
• Decreased circulating volume
• Increased heart rate3,4
Crabtree (2019)
Respiratory impact
• Lying causes atelectasis
and pooling of secretions
• Reduced functional
residual capacity
• Altered chest mechanics3
Crabtree (2019)
Skin impact
Pressure
Skin necrosis after 2 hours
Crabtree (2019)
Other system impact
Multiple other systems
Gastrointestinal
Genitourinary
Cognitive
…Pain
Crabtree (2019)
#endPJparalysis Victoria:
The project structure
Outcome measures:
- Number of patients who mobilised per day
- Number of patients who were dressed in every day clothes per day
- Number of patients who sat out of bed for lunch per day
Balancing measures:
- Median length of stay
- Number of falls per month
- Number of pressure injuries per month
- Discharge location
Measures
- November 2018- September 2019
- 35 participating wards across the state
- General Medical: 9 (+1 RAPU)
- Surgical: 4
- Geriatric Evaluation and Management: 3
- Rehabilitation: 3
- Acute Neurological: 2
- Renal: 2
- Oncology: 1
- Rural Health Services: 10
#endPJparalysis Victoria
1. Recruit project team
2. Collaborate online and at workshops
3. Action periods using Plan Do Study Act cycles to implement changes
Project steps
IHI Improvement Coach Program (2019)
Interventions
Launch
Visual management
boards
Environmental modifications- Race tracks
- Kingston kilometre
- Declutter visitor rooms
- Cognition boards
- Adequate equipment?
Education
Education
Education
- Calling friends and family
- Preadmission pamphlets
- Clothes banks
- Op shop support
Where are my clothes?
Crabtree (2019)
Consumer impact
Promotion
Results
Results
- 19% increase in the median number of patients getting dressed and
mobilising per day
- 16% increase in the median number of patients sitting out of bed for
lunch per day
- Decrease in length of stay, falls and pressure injuries in high performing
sites
- Significant increase in quality improvement knowledge and capability in
participants
Sustainability
Sustainability tips and tricks
- Measure over time
- Report to an executive sponsor
- Engage a multidisciplinary team with dedicated responsibilities
- Communicate and educate in numerous formats
- Hardwire the changes into ward processes
- Stagger interventions over time
- Have fun!
Questions?
• www.bettersafercare.vic.gov.au
• @safercarevic or @EleanorSawyer20
• Safer Care Victoria
Contact Us
1. Bodilsen AC, Pedersen MM, Petersen J, et al. . Acute
hospitalization of the older patient: changes in muscle strength
and functional performance during hospitalization and 30 days
after discharge. Am J Phys Med Rehabil . 2013;92:789–796.
2. English KL, Paddon-Jones D. Protecting muscle mass and
function in older adults during bed rest. Curr Opin Clin Nutr
Metab Care . 2010;13:34–39
3. Gill TM, Gahbauer EA, Han L, Allore HG. Functional trajectories
in older persons admitted to a nursing home with disability after
an acute hospitalization. J Am Geriatr Soc . 2009;57:195–201.
4. Stuempfle, K, Drury, D. The physiological consequences of bed
rest. J Exercise physiology, 2007;10 (3):32-41
References
