National Deconditioning Awareness and Prevention Campaign: ‘Sit Up Get Dressed Keep Moving’

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Case Study Summary
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Overview summary:
Dr Amit Arora is a consultant geriatrician at the University Hospital of North Midlands and has served as Chairman of England Council of the British Geriatrics Society. He and his team developed the “National Deconditioning Awareness and Prevention Campaign” that encouraged elderly patients to “Sit up, Get Dressed, Keep Moving”. The campaign aims to stop older patients becoming deconditioned whilst in hospital or care homes. The campaign was initially used locally and then launched nationally on Older People’s Day, 1st October 2016.
Challenge identified and actions taken :
During hospitalisation, older people can spend up to 83% of their time sitting in bed and often a further 12% in a chair, therefore becoming deconditioned. Deconditioning can start as early as the first 24 hours where patients could lose up to 2-5% of muscle mass. It is often said that ten days of bed rest can be considered to be equivalent to ten years of muscle ageing in people over 80 years. Up to 65% of older people can experience decline in functionality during hospitalisation. Moreover, patients may experience:
  • Reduced mobility and functional ability
  • Increased dependence
  • Confusion, loss of self-confidence, depression, and demotivation
  • Further complications such as falls, delayed recovery, pneumonias and associated complications
These factors can lead to what he describes as ‘Deconditioning Syndrome’. Deconditioning is preventable but requires a strategic approach and awareness. Recovery from deconditioning can take twice as long.

Dr Arora: “Deconditioning is common but it is under-recognized and under-reported. There are many people who may have experienced deconditioning... Across our hospitals and care homes, we need to make healthcare staff and families aware of deconditioning to minimise and prevent it. To create awareness, we’ve developed the ‘National Deconditioning Awareness and Prevention Campaign’.
Impacts / outcomes:

Within the deconditioning campaign there are resources such as banners, posters, screen savers, information leaflets, exercise programs, videos and practical demonstrations to raise awareness.

As older people are the core users of the NHS, they benefit most from this campaign.

Dr Arora says “An appropriate level of exercise, activity and mobility in older people is easily do-able with in the usual surroundings. We are not talking about going to gymnasiums here. It is about doing simple activities of daily living, exercises in bed or chair, walking to toilet, sitting out in chair, standing, walking etc...” Some of the information available includes advice on how people could be supported and encouraged to stay active and independent by performing activities of daily living and movement when in hospitals and care homes. For example staff could ensure that:
  • Glasses, hearing aids, calendars and clocks are readily available and visible to promote awareness.
  • Patients are sat up in chairs, rather than remaining stationary in beds.
  • They should be dressed properly in their own clothes rather than in hospital gowns as it can make people feel better and more able.
  • Meals are eaten whilst sitting in chairs and not spoon fed in bed unless circumstances dictate so.
  • Patients should be encouraged to wash and dress independently, walk to the toilet where possible.
    • Appropriate mobility aids should be provided earlier on if needed.
    • We should ask if the mobility aids are of the right height.
    • We should check if the height of the chair for example is not so low that the patient can’t get up.
    • Patients should be encouraged to keep their arms and legs moving in their beds or chairs especially if they are unable to mobilize themselves.
  • Restrictions on visiting hours should be adjusted to encourage normal social interactions, which will also help to maintain functionality, regain independence and reduce loneliness.
  • Patients should be supported and encouraged to move as quickly as possible, where possible.
All of this support and encouragement movements could help to:
  • Reduce the risk of harm from falls, infection, thrombosis and delirium.
  • Reduce length of stay in hospital.
  • Reduce the likelihood of having an increase in their future care needs.
In addition there are many benefits of staying active in hospital:
  • Better able to fight infections
  • Better appetite
  • Better sleep
  • Better mood
  • Better able to cope at home
  • Lower risk of pressure sores
  • Less weakness and fatigue
  • Less dizziness
  • Lower risk of falls
  • Less pain
  • Less confusion
Moreover, this project noted that the biggest change was the individual’s behaviour and organisational culture generated through awareness.

The initial intended outcome was to achieve a 25% increase in the number of patients sat out, dressed and engaging in meaningful activity during their acute illness. However, there was an increase in the number of patients sat out, dressed in their own attire and mobilized by 60%. There was also an increase in therapy review and therapy led plan setting within 24 hours of admission. However, these can be fluctuant and dips were commonly noted so it is important to keep the momentum going.

There was also an enhancement in patient experience and in both staff and relative satisfaction...

Overall, the outcome from the ‘National Deconditioning Awareness and Prevention Campaign’ to get patients to “Sit up, Get Dressed, Keep Moving” has had a positive impact on patients and staff.
Supporting quote for the innovation from key stakeholders:
Many people were pleased with the information that was given to them about the ‘Deconditioning Awareness and Prevention Campaign’ and how it can affect a patient’s well-being. Here are a few supporting quotes that showcase how the campaign has been effective and successful, being adopted across different NHS Trusts:

“Hi Amit
This is a great campaign. Thanks for sharing it with us. As Andy said, it should fit well within the Care of the Elderly teaching blocks.”


“Hi Doctor Arora,
I am a physiotherapy student at Keele University and have recently started placement on frail elderly at UHNM. Whilst embarking on pre-placement reading, I came across the deconditioning awareness campaign. I have also highlighted deconditioning and behaviour change as potential topics for my placement presentation.”


“Thank you so much Amit.
I wish there were more stars in the NHS like you. Normally sharing material is not an easy matter & people get protective over their material. I will send you updates when we get them produced.”


“Hi
We love your staying active in hospital patient information and would like to have permission to use in Western Sussex Hospitals NHS Foundation Trust.
Of course credit still going to University Hospitals of North Midlands.”


Here are some supporting quotes from Dr Amit Arora himself on how he came to create the ‘Deconditioning Awareness Campaign’ and how deconditioning can affect a patient’s well-being:

Dr Arora said: “Many years ago I was subject to restricted mobility following an emergency appendicectomy. It took me a surprisingly long time to regain my strengths and abilities. I noted that despite my youth and the will, my muscles would not move. It took a while to recover back to normal.

When I related this to the frail old people that I see in hospitals, I can understand why someone who was able to function well before they came to hospital takes longer to regain their functions. A prolonged hospital stay, bed rest and other risks lead to loss of muscle power, strength and abilities…”


Dr Arora also said: “We should encourage patients to wash and dress independently, walk to the toilet where possible, provide appropriate mobility aids earlier on and encourage patients to keep their arms and legs moving in bed or chair. Even moving arms, legs and sitting up in bed offers a small degree of physiotherapy. It sounds so simple yet very often it just doesn’t happen.”

Amanda Futers, Clinical Nurse Specialist said: “Staff and families have an important role to play in preventing deconditioning. There is sometimes a misconception by families that staff should be doing everything for their loved ones because “they are in hospital”. Educating patients, relatives, carers and staff about the dangers of deconditioning is vital, since bed rest continues to be expected during a hospital stay, despite the considerable evidence showing potential adverse effects from inactivity. Of course there are times and conditions when best rest would be advisable, but more often than not this is not the case.”
Which local or national clinical or policy priorities does this innovation address:
With the support from the British Geriatrics Society and NHS England, within a month there were requests for our material from clinical staff at over 20 hospitals, including hospitals from Australia, New Zealand and Canada and more have joined since. This campaign also received unprecedented support from the #endpjparalysus campaign and Jane Cummings (Chief Nurse, NHS England) and the efforts to prevent deconditioning became popular. Overall, this innovation generates awareness about this common condition in older people especially when they are hospitalized and less active. It also addresses how deconditioning syndrome can be prevented. Furthermore, the campaign’s material was requested by 40 NHS hospitals and more enquires have followed from the UK. The freely available downloadable material has already been requested by 40 hospitals; the team has certainly made an impact.
Plans for the future:
  • To continue to build on ward-based exercise groups to maintain muscle tone and abilities.
  • To launch campaigns and engage influencers at local Older People’s Day events.
  • Hold national/international conferences at UHNM in 2018.
  • Continue to speak at national conferences to generate awareness.
  • Help nurses, therapists and medics conduct further research on methods of effective implementation of such programs.
  • Continue to roll out locally and nationally via schools, fire service, public, patient and CCG networks.
  • Engage champions from ward to board and into community.
Overall, we must continue to build on the campaign’s message.
Tips for adoption:
If you would like some tips on how to adopt the ‘Deconditioning Awareness Campaign’, “Sit up, Get Dressed, Keep Moving” then do not hesitate to download our material (This material may be copied without prior permission being sought from the copyright holder provided the purpose of copying is not for commercial gain and due acknowledgement is given):

View 'Poster' here (fo​r hospitals and care homes​)​​
View 'Bann​er' here
View 'Patient Information Leaflet' here​​
View Screensavers here

Or contact Dr Amit Arora:
amit.arora@uhns.nhs.uk
@betterageing
www.betterageing.co.uk
Contact for further information:
Contact Dr Amit Arora:
amit.arora@uhns.nhs.uk
@betterageing
www.betterageing.co.uk
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