Can developing an active ward ethos translate into Cystic Fibrosis patients “Stepping Up” during an inpatient stay?

Purpose

Inactivity continues to be a global concern. There is a growing body of evidence to suggest that exercise and physical activity may contribute positively to patients with Cystic Fibrosis (CF).

Despite this our cohort of patients reported (via inpatient satisfaction survey) that their activity levels are significantly lower when in hospital than at home.

Our aim was to investigate if developing an “active ward” ethos could have a positive effect on inpatient physical activity levels.

Prior to PDSA 1
71% of patients reported their activity levels in hospital were less than at home (n=30), 12% “the same” (n=5),17% reported a “little more” (n=7).


Using the “PJ Paralysis” audit,
47% of patients were out bed by 12:00 pre-PDSA 1, by PDSA cycle 3 this had increased to 100% and remained at 76% following a cool-off period of two weeks.

Approach

The QI (Quality Improvement) project was completed in the format of 3 PDSA (Plan, Do, Study, Act) cycles;

1. “raising awareness” using brand posters, aiming to engage a wide patient group, 2. “maximising reach”, using existing technology to present relevant infographics to patients and staff and 3. “generating engagement”, introducing a step count competition.

This involved MDT professionals and patient representatives using wearable activity trackers to monitor their step count. We repeated the activity related questions of our original survey following cycle 3.

An additional “PJ Paralysis” audit, assessing the number of patients out of bed and dressed by 12:00, was completed before PDSA 1 and following PDSA cycles 2 and 3.

Outcomes

Prior to PDSA 1, 71% of patients reported their activity levels in hospital were less than at home (n=30), 12% “the same” (n=5),17% reported a “little more” (n=7).

The most frequent causes for reduced activity were; “feeling unwell” n= 33, “IV regimen” n=19, MDT reviews n=11, “isolation” n= 10.

Following intervention, 75% of patients continued to report their ward activity levels as less than at home.

Using the “PJ Paralysis” audit, 47% of patients were out bed by 12:00 pre-PDSA 1, by PDSA cycle 3 this had increased to 100% and remained at 76% following a cool-off period of two weeks.

IV timings remained the leading cause of reduced activity on re-survey. Informal patient feedback was varied but generally positive.
 

Inpatient physical activity levels are significantly lower than at home. To improve this takes a “ward round” attitude with continuous effort by all to promote activity. Mostly patients respond positively to challenging their activity levels.

Implications

This project highlighted that there was a higher proportion of patients up and moving during the day following intervention.

There are considerable logistical barriers that could potentially be improved to generate a greater change (i.e IV or review timings).

Further development of virtual platforms within healthcare, whereby healthcare teams are better informed and patients are more accountable for their activity levels, may generate a more tangible change to attitudes surrounding activity.

We also suggest further work assessing the effect of clear timetabling of a patient's day to facilitate free time for physical activity. 

Funding acknowledgements

This study was not funded.

Additional notes

This work was presented at Physiotherapy UK 2019