Authors (including presenting author) :
CHAN NM(1), KWOK WY(1)
Affiliation :
(1)Medical Acute Stroke Unit, Queen Elizabeth Hospital
Introduction :
Hospital admission is a significant risk factor for the loss of independence, especially for older people. Even only a few days of bed rest can cause cycle of deconditioning of patients. Pyjama (PJ) paralysis is a term describing these negative impacts of patients who have prolonged bed rest in their pyjamas or hospital gowns during hospitalization.
A #EndPJParalysis 70 Day Challenge was launched by The United Kingdom's National Health Service (NHS) aiming to achieve a million collective days of patients being dressed and up during hospital stay at different participating hospitals.
Objectives :
1. 30% of admitted patients will get out of the hospital gowns and clothes and be dressed in their own clothes and able to mobilize each day
2. To reduce of length of stay
3. To increase the awareness of patients, carers and healthcare professionals' to the risk of pyjama paralysis
Methodology :
A 2-month 'End Pyjama Paralysis' scheme can be launched in medical acute stroke unit from 11/2 to 11/4 in order to prevent unnecessary bed rest and inactivity. Patients who are stabilized and able to enter the post-acute rehabilitation phase are encouraged to get dressed in own clothes instead of hospital pyjamas and get engaged in out-of-bed activities where appropriate. Relatives or carers are reminded to bring comfortable clothes and footwear for daytime mobilization. Physiotherapists and occupational therapists are liaised to maintain or train up patient's functional level. Ward nursing and supporting staff are encouraged to help patient get changed and sit out of bed regularly.
The number of patients who are dressed in own clothes are recorded everyday in designated folder. A short video is made by ward staff in order to promote the idea of early mobilization in own clothes. The promotional video will be played in the television during visiting hour. Quantitative tool is developed to monitor the percentage of patients in PJs and not in PJs. Data will be collected and analyzed including total bed days, out of PJ days and PJ days. The length of stay in two groups of patients, out of pyjama patients and pyjama patients, will be observed and counted when patients are discharged. Brochures and posters providing information of pyjama paralysis are prepared and distributed to raise awareness. A badge printed with slogan of the scheme, “換走病人服，郁動快康復”, will be given to patient who participated in the program as identification and also encouragement.
Result & Outcome :
There were total 213 patient admissions during the designated 2-month period. 70 patients were identified to be eligible that were stabilized and entering the post-acute rehabilitation phase. 40 patients were recruited into the scheme, 16 male patients and 24 female patients respectively. This is approximately 57% of the total eligible patients. The remaining 43% of patients were not recruited due to 1. No relatives available to bring clothes 2. Patient refused 3. Patient was not cooperative. Recruited patients were mobilized and participated in out-of-bed activities, such as engaging in occupational therapies, moving under supervision of physiotherapists, self-grooming and self-feeding etc. Most of the participants have positive feedback and increased morale dressed in own clothing.
Average length of stay of acute stroke patients in acute stroke unit is 15 days according to American Heart Association. The total length of stay of the participants in the program was 325 days with average of 8.1 days per participant. In turn, a decrease in 7 days of length of stay per participant was obtained. Although selection of patients may vary the result, objective of reduction of length of stay can be achieved.
