Ending Pyjama Paralysis; Physical Steps In The Right Direction For An Irish University Hospital

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Abstract Background The risk of hospital-associated deconditioning for frail older adults (i.e. reduced functional performance after acute hospitalisation, due to low activity levels during an admission) is well recognised, yet continues to occur commonly. This quality improvement project aimed to promote a cultural change within two acute medical wards, in line with the principles of “End PJ Paralysis”, which aims to “get patients out of bed, dressed in their own clothes and when possible, moving rather than lying in bed”. Methods A multidisciplinary committee was formed to oversee this project. An initial audit on observed levels of patient activity was performed, along with a root cause analysis to identify points of action. A multicomponent intervention was designed and implemented over an 8-week period (Oct to Nov 2023), with weekly re-audit of activity levels. Data on the monthly incidence of falls & pressure areas, as well as average length-of-stay, was also collected, with the results for the intervention period (Q4) compared with the monthly averages for the nine months prior (Q1-3). Results A total of 570 Patients were included. Improvements were observed in all outcomes. The proportion of patients dressed in their own clothes increased from 28.5% (18/63) to 51.8% (263/507), those sitting out in a chair increased from 50% (32/63) to 64% (326/507), and those mobilising at the time of audit increased from 60% (38/63) to 71% (360/507). Average falls (Q1-3 vs Q4) fell from 14.8 to 12.6 per month, average pressure sores from 5.5 to 5 per month, and average length of stay from 11.20 to 10 days. Conclusion This project demonstrates that a ward-based multidisciplinary initiative can lead to an increase in the proportion of patients on an acute medical ward being dressed in their own clothes, sitting out, and mobilising, without an increase in the incidence of falls.