A multidisciplinary team initiative toend pj paralysis was successful inachieving cultural change on an acutegeriatric ward

ABSTRACT

Introduction Prolonged bedrest amongst the elderly causes deconditioningleading to;increased hospital length of stay, additional socialcosts and decreased quality of life. An audit on an acute geriatricward in November 2018, found that over a third of patientsmedically fit (PMF) to sit out remained in bed all day. Therefore, aservice development initiative was undertaken, addressing themisconception that keeping elderly patients in bed is safe, when infact, unintentional harm results. Method In a root cause analysis, four main reasons for bedrest wereidentified risk aversion, unknown function, widespread “bed issafe” culture and lack of equipment. The project tasked gettingPMF out of bed each day and was audited daily from November2018 to present, involving all members of the multi-disciplinaryteam (MDT) and using a “plan, do, study, act” approach. Results Initially, the project showed an increase in percentage of PMFsitting out each day, but this subsequently decreased with winterpressures. However, for a whole year (February 2019-February2020) a sustained and significant improvement was achieved(64.3%-89.7%). The pre-COVID19 period (February-March2020) saw fluctuations in PMF sitting out. Data collection haltedduring the COVID19 peak, although observationally most patients remained in bed. Auditing resumed from June 2020 (COVID19recovery phase) which showed a steady increase in PMF out of bed,with recent figures surpassing pre-COVID19 levels (97.8%). Conclusion Cultural change takes time to embed and needs persistentreviewing by a dedicated and engaged MDT. Improvements weremade through more accessible doctor's advice, better MDTeducation and communication, daily feedback of data and sourcing additional equipment. Disruption to working patternsover the COVID19 period made this unachievable and the projectlost impetus. In the COVID19 recovery phase, the specialized MDTreformed and worked successfully to restore the cultural change asevidenced by audited data.