end pj paralysis: preventing functional decline in inpatients€¦ · eleanor sawyer: project lead,...
TRANSCRIPT
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#endPJparalysis
Eleanor Sawyer: Project Lead, Care of Older
People Clinical Network, Safer Care Victoria
@EleanorSawyer20
7 February 2020
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Welcome
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● Why #endPJparalysis?
● The project structure
● Victorian #endPJparalysis interventions
● Results
● Sustainability
● Questions
Session Outline
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n. the lack of movement that occurs when people remain in their
pyjamas.
PJ paralysis?
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Why #endPJparalysis?
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Musculoskeletal impact
• 1.5kg of muscle lost per week
• Contractures and reduced ROM
around joints
• Disuse osteoporosis
• Impaired balance mechanism1,2
Crabtree (2019)
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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)
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Respiratory impact
• Lying causes atelectasis
and pooling of secretions
• Reduced functional
residual capacity
• Altered chest mechanics3
Crabtree (2019)
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Skin impact
Pressure
Skin necrosis after 2 hours
Crabtree (2019)
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Other system impact
Multiple other systems
Gastrointestinal
Genitourinary
Cognitive
…Pain
Crabtree (2019)
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#endPJparalysis Victoria:
The project structure
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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
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- 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
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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)
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Interventions
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Launch
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Visual management
boards
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Environmental modifications- Race tracks
- Kingston kilometre
- Declutter visitor rooms
- Cognition boards
- Adequate equipment?
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Education
Education
Education
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- Calling friends and family
- Preadmission pamphlets
- Clothes banks
- Op shop support
Where are my clothes?
Crabtree (2019)
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Consumer impact
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Promotion
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Results
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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
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Sustainability
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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!
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Questions?
• www.bettersafercare.vic.gov.au
• @safercarevic or @EleanorSawyer20
• Safer Care Victoria
Contact Us
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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