How do we measure the harm that happens to our patients in hospital?
By Rachel Taylor, Assistant Director, Six Goals for Urgent & Emergency Care National Programme
“World leading work”
Not my words, although I can’t help but agree. But the words of Professor Brian Dolan. He said this as we finished our presentation at the End PJ Paralysis Summit last month.
#EndPJparalysis is a worldwide movement started by Professor Dolan in a bid to reduce immobility, muscle deconditioning and dependency for patients in hospital. In essence, its focus is to get patients up, dressed and moving in hospital wards in a bid to prevent long-term damaging effects on a person’s functional ability (i.e. deconditioning).
Now in its seventh year, the #EndPJParalysis global summit runs every July with speakers and attendees representing health boards and trusts across the globe.
At the Summit, we presented the work done over the last two years, by the Six Goals programme to prevent hospital-acquired deconditioning, including our most recent work with our Quality, Safety and Improvement team as part of the Safe Care Partnership.
It was pleasing to receive so much positive feedback from attendees, some joining us from across the globe, who said they’ll be waiting to see the results of our work. However, the part that gained the most excitement was our new measurement tool that we’re developing to measure deconditioning in hospitals.
“There was no method of measuring the overall ‘syndrome’ of deconditioning”
Within the National Optimal Hospital Flow Framework created by the Six Goals for Urgent and Emergency Care National Programme, there’s a focus on preventing hospital acquired deconditioning. Deconditioning can be described as the unintended ‘hidden harm’ that currently occurs in hospital.
As we established the framework, it quickly became apparent that there was no method of measuring the overall ‘syndrome’ of deconditioning, but only individual components such as mobility, delirium, continence etc. One of the main focuses is measuring falls and trying to prevent these in hospital. However, feedback from professionals and staff indicated that focusing on falls as a measurement gave the unintended consequence of increasing deconditioning, as patients weren’t necessarily encouraged to get out of bed and be more mobile due to a fear that they will fall.
The question we then asked ourselves was, how can we prevent deconditioning if we can’t even measure it to begin with?
As a team, we knew that if we can quantify deconditioning using a validated tool, we have a verified way of evidencing preventions. We sought advice from Wales Value in Health who provided funding, along with Six Goals, to commission CEDAR to work on designing a tool.
Almost 18 months in the making with views from both staff and patients sought, the tool measures 11 different domains, ranging from mobility, continence and cognition, through to social engagement and the ability to manage daily activities, that can all lead to deconditioning. Having a tool that allows staff to assess a person across the domains enables straightforward monitoring, where the first signs of deconditioning can be spotted early on. This allows staff, patients and their families to implement interventions at pace and gives our service users the best chance of stopping the cycle of deconditioning in its tracks.
The tool has been piloted on selected wards in health boards across Wales, and we’re now running a second testing phase of the tool, incorporating feedback from the pilot.
Initial feedback proves positive
Initial feedback from the pilot reinforces the need for this tool, with staff reporting that it’s easy to use. Early evaluation also shows that the tool can highlight patients who are deconditioning and in which areas.
We’re working to finalise and unveil the tool at our National Preventing Deconditioning Summit on Tuesday 4 November. We’re also in discussions about digitising the tool, so it allows us to report both locally, and nationally, on hospital-acquired deconditioning.
Following the Summit, we’re hoping to have the tool readily available so all health boards and trusts across the NHS can use it. The hope is that the tool can confidently measure, and hopefully prevent, deconditioning to our service users.