A national call to action: We need to keep preventing avoidable harm to our patients
By Dr Siobhan Lewis, Consultant Physician and Geriatrician, Clinical Lead Goals 5&6, Six Goals for Urgent and Emergency Care Programme
1 in 3.
1 in 3 older people are discharged from hospital with a disability that they didn’t have when they first arrived.
This is a stark and saddening fact. Why does this happen to our service users?
This can be a result of deconditioning, which doesn’t just happen to our older population – it can affect anyone. Some people may have heard the term ‘deconditioning’ before.
“Deconditioning can be defined as a complex process of physiological change following a period of inactivity, bedrest or sedentary lifestyle. It results in functional losses in areas such as mental status, degree of continence, and ability to accomplish activities of daily living.”
(Gillis et al 2005)
Put simply, the longer a person remains in hospital not moving, the more quickly their functional ability deteriorates. For example, if a person remains in bed, their muscles and joints can stiffen, leading to a reduced ability to walk. When there’s difficulty walking, there can be an increased risk of a fall. When a person is afraid of a fall, they’re less likely to go to the bathroom unaided, leading to potential incontinence and constipation. If they’re not going to the toilet, they may not want to eat and drink enough which can bring on dehydration. This can bring on issues with swallowing which, in the worst possible case, can lead to potential pneumonia.
It’s easy to see how the cycle of deterioration can take hold and can start within a matter of hours.
If we think back to the 1 in 3 people that I mentioned at the start of this blog; at least 60% of those affected are not back to their usual levels of function after 12 months. That’s a whole year after being discharged from hospital. This shows the devastating, lasting consequences of deconditioning.
As well as the effects this has on our service users, there’s also repercussions for the wider NHS system. For example, if there are more patients needing longer lengths of stay in hospital to recover from deconditioning, staff face increasing workloads in already pressurised environments. This negatively impacts on staff wellbeing and could lead to potential burnout. With more patients occupying more beds and using more continence products and equipment, this comes at a literal cost to the NHS. More beds being occupied results in longer ambulance wait times for other people needing hospital beds. This can result in an increased number of complaints and concerns from patients and their loved ones as they’re not receiving a positive care experience. As more patients are discharged requiring more packages of care as their health has deteriorated, this puts an increased pressure on our social care settings.
So how can we prevent deconditioning from happening?
It’s important to remember, deconditioning isn’t caused by just one factor: it’s a combination of factors – some which we can’t directly affect.
However, it’s encouraging to see that most of the teams from the Preventing Deconditioning workstream, part of the Safe Care Partnership, are already trialling improvements in their respective areas to help tackle this issue. Some teams are bringing new initiatives to encourage more movement among patients while others are looking at how they can adapt existing tools such as National Early Warning Scores (NEWS) and acute deterioration observation charts to better understand the factors that can cause deconditioning for a particular patient.
Project teams will be looking to develop improvements and changes that work and will be calling upon your help as colleagues to help them spread these to other areas.
My plea – and theirs – to you is to please support them and help embed these improvements into daily routine. Over time, not forgetting the pressures that we face on the frontline, we’ll be able to manageably scale these changes, one improvement at a time.
Together, we can all work to keep our service users safe from avoidable harm.