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Who would have known that a visit from Brian Dolan to Nottingham University Hospitals NHS Trust (NUH) late in 2016 would lead to an international call to action?
Brian had visited NUH to talk about his #last1000days work, and following his talk I asked staff what we could do to value patient time and they suggested we get more patients dressed. This created a good amount of discussion at the time and later that evening Brian, via Twitter, discussed pyjamas as a uniform for patients. He sent this tweet to myself and Tim Gillatt on November 6 2016.
Nursing was born in the church and raised in the army, so leaving patients in pyjamas is their 'uniform' #Letsfixthat
Within a few days #Letsfixthat became #endPJparalysis and a movement was born.
Call to action
The premise of #endPJparalysis is about enabling hospitalised patients to get up, dressed and moving in order to prevent deconditioning. The evidence of harm from deconditioning has been known for decades and yet we still allow patients to be immobile for up to 90% each day. This immobility will have a negative impact, not only to the patient, but potentially to the wider healthcare system as older patients will often need increased support on discharge.
The start of our #endPJparalysis journey at NUH began with a call to action for our staff to consider ways they
could support patients to maintain some normality in their routine and get up,
dressed and active. Our work has involved a close collaboration between nursing
and allied health professionals (AHPs) who have that rehabilitative focus at the core of their work.
Encouraging different views
We have also involved our patient and public involvement groups and patient representatives in our work so that communications to families and patients is clear and ward staff are able to incorporate their perspective on #endPJparalysis. This approach enables family members to contribute to the care of their loved ones by bringing in items such as day clothes, well fitting shoes and toiletries.
We have purposely not made #endPJparalysis into a project – there are no targets, KPIs or project plans – we are trusting staff to use their professional judgement and do the right thing for their patients. Brian Dolan and I have been clear that this is the best approach and, certainly from our experience at NUH, is key to its success.
Additionally, a series of tweets highlighting the risks of deconditioning have encouraged staff to think about how they would feel as an immobile patient, what decisions they would make if they were in their patients position and what simple things they could do to support their patients to be more empowered.
Message spreading far and wide
The essence of #endPJparalysis is that it forces us to hold a mirror to our practice and reflect against the evidence. It drives us to put the patient at the centre of our actions and it empowers patients and their families to challenge some our current practice. It has united like-minded people who are selflessly sharing their work for the wider benefits of patients.
The #endPJparalysis message is spreading fast and already has over 23 million Twitter impressions across many countries. Most of this spread is in acute hospital provision and the next obvious spread would be to those areas outside the hospital – for example, GPs highlighting the risk of deconditioning so patients keep active in their home, ambulance services bringing clothes if able when transferring patients to hospital.
I am incredibly proud that NUH has been a driving force in spreading the #endPJparalysis message and that the fantastic work of our teams has been recognised by Jane Cummings, the Chief Nursing Officer for England.