Campaign to End 'Pyjama Paralysis': More than half a million patients mobilised

Nicky Broyd

Disclosures

July 09, 2018

A 70-day nationwide mission to get people up, dressed, and mobilised whilst in hospital has not hit its million patient target but 'End PJ Paralysis' has resulted in hundreds of thousands more patients encouraged to get out of bed and out of their pyjamas.

Medscape UK spoke to Professor Jean White, chief nursing officer for Wales, on the day before the challenge ended, when she said the final numbers weren't in but the campaign had so far led to more than half a million mobilised patients:

  • 55,999 in Wales

  • 13,401 in Scotland

  • 491,091 patients in England

  • 9876 in Northern Ireland and

  • 10,106 in the Republic of Ireland, which also took part

Q&A

Medscape UK: What is the benefit of getting patients up, out of their pyjamas and moving?

Professor Jean White: The evidence is very clear that for older people, particularly the very aged person, if they stay in bed all day long, they can lose up to 5% of their muscle strength every day they spend in bed. And so, getting people up and into their own clothes not only is a dignified thing to do, it helps them return to a sense of normality, but it also encourages movement and so we see that they tend to stay in hospital a shorter length of time. They have less loss of mobility, there's less risk of falling, there's less food wastage, because they actually have a bit of an appetite, and the consequence of it might mean they go home rather than going into institutionalised care.

So, from the evidence it's very, very clear that this is a good thing for older patients particularly to do, to get up, be normalised, move around, and plan for going home. 

Medscape UK: Is there a group of patients that is resistant to change?

Prof White: Of course, we're not going to force anybody to get into their own clothes if they don't want to do it. You are allowed to stay in your own clothes, pyjamas, if those are what you want. But I think it's important for people to be told why it is that it's good for them so they understand some of the benefits of becoming normalised in preparing for going home. But for a lot of patients they won't have been even offered the opportunity.

The campaign has really raised awareness among staff. In Wales, we've had over 100 different care settings sign up to this … and I'm really impressed with the enthusiasm, it's really got the nurses, the therapists all working together to talk to patients about 'do you fancy this?' 'It's good for you.' 'Think about getting up and getting dressed.'

Medscape UK: Do you think it makes the job easier for nurses, occupational therapists, physiotherapists?

Prof White: I'm not sure easy is the right word. But it's certainly more satisfying for them if they can see their patients taking a bit more interest in their day, encouraged to think about going home and just having the opportunity to see their patient make a faster recovery to get out of hospital sooner. That's hugely satisfying to nurses and therapists.

Medscape UK: Is this something you're going to keep going across the nation, not just for 70 days?

Prof White: Yes, I will certainly continue to find ways to encourage engagement and to be fair some hospitals had similar schemes already in place before this kicked off because the evidence behind this has been around for a little while. Brian Dolan  [visiting professor of nursing, Oxford Institute of Nursing, Midwifery & Allied Health Research], who's the originator of this research, has been promoting it for a couple of years. So for example where I went in April to kick the campaign off in Wales, I went up to Morriston Hospital [in Swansea] and they had this Get Up and Go! scheme and it had been running since early in 2017. It was run mostly by the therapists but the nurses were also involved and they were great, they were just getting them [patients] up out of bed, getting them a positive change in their recovery path. I think having enthused people by the campaign, places will continue with it.

I think there are some challenges, for example, in areas where you don't have a day room you may find it difficult for some patients. Where do they mobilise in the ward? What some of the wards do is offer to take patients to the coffee shop, which might be out on the concourse, so you have to think what might be the impact of taking a nurse or a nursing assistant and a patient off the ward. So, there are practical things you've got to think of about how you do this.

Medscape UK: It appears a very simple thing but it seems to be having a health effect.

Prof White: Absolutely right. I've got lots of stats to share with you. The one that struck me when I came to look at this, it says that research has shown that 60% of immobile patients have no clinical reason that requires bed rest, and that for people over 80, spending 10 days in bed ages their muscles by 10 years, and that older adults living at home will take 900 steps a day compared to only 250 steps in hospital.

Healthy patients in a bed begin to weaken immediately. After one day of admission and after just 24 hours of bed rest you can lose between 2% and 5% of your muscle power.  This is something that happens almost immediately. It's not surprising then when you have patients that often end up in care homes instead of going home. And if you stay in bed any length of time you are more prone to things like thrombosis, delirium, infectious diseases like pneumonias, depression, loss of confidence, constipation, and incontinence. It's undignified as well, all of that, so it's really compelling when you start looking at what the statistics and the evidence tell you.

Medscape UK: What would require bed rest?

Prof White: If you've broken your leg and you're tied to traction or some physical thing like that, or if you're likely to faint, or your risk of falling is very great, you might need somebody with you before you mobilise. There is a safety element to it, but there are actually very few reasons why you have to stay in bed. It's more to do with your physical restrictions. If you're paralyzed from the waist down you're not going to be able to stand up, your muscle wastage is such that you physically can't do that obviously … but even then you could be sat out in a chair quite often or sat up. You don't have to lie down in the bed.

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