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‘Does this person need to be in bed?’: How #EndPJparalysis is changing mindsets in patient care

1st May 2018

Rosie Skrypak, Clinical Lead Occupational Therapist at London’s Royal Free Hospital, explains how Ward 10N colleagues have been working to end PJ paralysis and how the current 70-day challenge has encouraged more wards across the Royal Free London NHS Foundation Trust to take on the campaign too.

A 70-day End PJ Paralysis Challenge is currently taking the NHS by storm. The national campaign aims to end ‘pyjama paralysis’ by helping people to not spend any longer than is clinically necessary in hospital.  Focusing on the importance of patients’ time, health and care professionals across the NHS have been swapping their uniforms for pyjamas to encourage patients to get people up, dressed in their own clothes, and moving to boost their recovery.

Staff from Ward 10N in their PJs

“We launched an #EndPJparalysis campaign as a small quality improvement (QI) project last summer on Ward 10N at the Royal Free Hospital, London, which is one of our elderly care wards.  We have been engaging with the campaign for some time now and we are really beginning to see the positive long term impact it is having on patients, their families and all staff.

The QI project aimed to increase the number of patients out of bed and dressed at lunchtime by 25%.  I am delighted to report that we have achieved our target, although this has been difficult to maintain during winter with more patients requiring extra care.  However, what has been the biggest change is the mind-set and approach of colleagues, with the project embedding an ethos that it is everyone’s responsibility to encourage and assist patients to sit out of bed, get dressed and preparing to go home.

The campaign has also created joy in work for the team by building strong relationships between healthcare assistant (HCA), therapy and nursing staff.

As part of our planning, we mapped out how we were going to communicate the project to patients, their families and staff.  We worked with our communications team to produce posters and patient information leaflets which explain the impact of deconditioning and encourage patients to bring in their own clothes.  All patients should now receive the leaflet on admission to the ward and are informed that on 10N, we expect patients to be up and dressed wherever possible.  For staff, we ran drop-in sessions to discuss the impact of deconditioning and what they can do to counter this.  As part of our staff engagement, everyone was asked to keep the following question in mind when they are with a patient: ‘does this person need to be in bed?’

We had a launch day where all staff came in to work in their pyjamas – like many wards and hospitals are doing towards the current national end PJ paralysis 70-day challenge.  This was hugely successful and lots of fun and the patients on the ward responded really well to staff in their pyjamas.  One patient in particular stated she didn’t understand why everyone was in nighties because she would never wear her nightie during the day at home.

From the outset, we were fortunate to have HCA champion, Pedro, who owned the project and encouraged peers to engage with it.  Pedro would go to all bays at lunchtime to make sure all patients that could be up were.  He was brilliant at encouraging family members to bring in clothes when they were often reluctant.

This has been a perfect project to bring colleagues together to improve patient care.  We had great success in getting HCAs and therapists to buddy up.  This meant that HCAs were able to easily ask for advice and support to use moving and handling equipment so they can assist more patients.  Nursing and therapy colleagues have also come together so positively towards the project.  For example, on one ward there were uncertainties over who could help patients return to their beds and it was considered a predominantly a therapy-related activity to mobilise patients. Now teams have been empowered to take more responsibility to engage patients in their recovery.

The importance of our hospital volunteers helping towards the project can’t be understated either.  We had a lady who was awaiting a care home placement. She was able to mobilise unaided but due to her very poor short-term memory this was a safety issue as she could become quite distressed.  However, one of the hospital’s young volunteers spent time with her after a session with our physio, walking with her and talking to her.  She enjoyed it so much that she asked for her every day. This meant that she was much more settled and maintained her mobility whilst in our care.

We have been fortunate to have had executive-level and communications support towards the project, alongside senior leaders understanding how this has been hugely positive for patients and their families.  The power of the data has been important in terms of motivating staff and bringing colleagues together.

It is important to remember that wards need to volunteer to engage with their own #endPJparalysis campaign, as each ward will have different needs or considerations depending on their patients.  However, by the end of the 70-day challenge we hope to have all wards engaged and look forward to continuing the principles of ending PJ paralysis as business as usual.”

Rosie SkrypakAbout the author

Rosie Skrypak is clinical lead occupational therapist and therapy service lead for the health services for elderly people and rapid response therapy team at the Royal Free Hospital in London. Rosie qualified as an occupational therapist 14 years ago, starting her career at the Royal Free Hospital before working elsewhere in palliative care and returning to take up her current role in 2012. Rosie’s interests are frailty and patient flow and the role that quality improvement can play in these areas.

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