The purpose of this project was to reduce the effects of deconditioning and promote functional independence on an elderly care ward, with the ethos inspired by the End Pj Paralysis campaign. The first aim was for over 55% of patients to be sitting out daily for lunch on the ward. The aim was also for over 20% of patients to be wearing their own clothes daily on the ward. Secondary aims including improving patient experience, increasing staff knowledge on deconditioning and maintaining and reducing length of stay.
An MDT quality improvement approach was taken with several PDSA cycles completed within the project. One key service development was the introduction of a chair based exercise group called “Groove Group”, held in the patient's bay. The exercise group included 45 mins of gentle aerobic, strengthening and group fun exercises with the primary outcome patient's self-reported pictorial mood scoring. Another key service development was a patient education video which was shown between staff and patients, following feedback from a patient experience questionnaire. Promotion of the project for staff, families and patients was continuously conducted on the ward through posters, screensavers, shared lunches and the staff intranet. Teaching programmes on the effects of deconditioning were also conducted for staff to increase awareness and knowledge.
Overall, since the start of the service development project, there has been an average 10% increase in the number of patient's sitting in the chair for lunch since April 2018. The average number of patients sitting out is now between 55-65%. Initially there was no improvement in the number of patients wearing their own clothes, but since October 2018 there has been an average 10 %. The exercise group has been increased to twice a week and now in bedded in practice, due to the improved efficiency in therapy sessions, and the significant evidence of improvement in patient's mood seen in the consistent improvements in mood scores. The project resulted in no change in the average length of stay.
Overall, the Move Groove Improve Quality Improvement project has resulted in a positive change in the culture on the geriatric ward, which has been sustained over 6 months. There has been a statistically significant improvement in the number of patients whom are sitting in their own chair, and wearing in their own clothes. Groove group has become a sustained integral part of the weekly routine on the ward, with consistent improvements in the patient's reported mood scores.
Cost and savings
There were no costs to run the project. The savings were not analysed due to staffing changes. Groove Group involved patients receiving more therapy sessions than normal care, and in the future an analysis of the benefit on length of stay would be beneficial.
This project demonstrates the ability for a MDT quality improvement project to take place on a busy acute ward, and sustain a change with ongoing staff involvement. The project also provides evidence that a greater focus should take on patient experience in service development projects to help sustain change. The project has also demonstrated that there is ability for the frailest population to engage in rehabilitation on an acute geriatric ward.
Top three learning points
This work was unfunded.
This work was presented at Physiotherapy UK 2019
For further information about this work please contact Emily Richards.