A FEW years ago staff at a hospital in Nottingham started looking into the reasons why patients were not getting up out of bed during their stay when they were fit enough to move.

They concluded that a significant factor was that patients had no day clothes to wear – only their pyjamas, nighties or hospital gowns – and this encouraged a culture of staying in bed.

But failing to get up and move about can have significant consequences for people and particularly the elderly. It can lead to muscle ageing and loss, increased dependency, de-motivation and depression as well as longer hospital stays and greater risk of falls after discharge.

And the staff at Worcestershire Acute Hospitals NHS Trust decided to see if they could improve the patient experience and reduce hospital stays at the county’s three sites in Worcester, Kidderminster and Redditch by encouraging patients and their families or carers to bring in day clothes for them to wear.

The aim was to help patients have a sense of their own identity by wearing the clothes they would wear at home and to help encourage them to move about within their own wards and into common areas in the hospital.

It also aimed to help medical staff, as well as families and carers, to see them differently – as people rather than patients.

Stephanie Cooke, team lead physiotherapist at Worcestershire Royal Hospital, said they started looking at how patients could be encouraged to bring in their day clothes last August and officially launched a project in January – testing it out on seven wards within the hospital.

“It was mostly driven by the physios at the start and some wards have been fantastic and with others we have to work a bit harder,” she said. “We chose particular wards to start with because of the expected benefits for those particular patients in those wards.”

She said each patient is assessed to see if they are safe and strong enough to get out of bed, get changed – with or without help - and move about. “If someone is independent at home and their mobility and strength are good then we try and help them get out of bed and into their day clothes.

“We look for stability, weight tolerance and the shoes they wear are important – whether they are slippers or shoes, they need to be safe.”

Deputy chief nurse (quality) at Worcestershire Royal Hospital Jackie Edwards said: “When I did my training in the 1980s we were encouraging people to get up and about. Now people who come into hospital bring their night ware but not their day clothes. We have to look at how we change the culture for these people.”

She pointed out that the challenge is to change the culture among patients, families/carers and the hospital staff, and after the initial launch in January there was another launch focusing on families.

Jackie added that the hospital is well aware of the danger of falls involving elderly patients but it is now trying to create a balance so that people who are safe to move and would benefit from getting up can do it with help.

This approach aims to both reduce the length of stay for hospital patients, prevent deterioration cause by staying in bed too long and promote independency so people can make the most of their lives.

The NHS is currently running its own national 70-day campaign to bring an end to what it calls “pyjama paralysis”. It started on April 17 and runs until June 26 – finishing in time for the 70th anniversary celebrations of the NHS on July 5.

The national campaign was launched by Professor Jane Cummings, chief nursing officer for England, and is the largest ever national campaign to get patients up, dressed in their own clothes, and moving to boost their recovery.

The campaign aims to get older people back home to their loved ones living much happier and fuller lives. Making the most of valuable patient time is particularly important – as figures show nearly half of people aged over 85 die within one year of a hospital admission.

Professor Cummings said: “For many wearing pyjamas reinforces feeling unwell and can prevent a speedy recovery. One of the most valuable resources is a patient’s time and getting people up and dressed is a vital step in ensuring that they do not spend any longer than is clinically necessary in hospital.

“I urge all those caring for our older patients to help end ‘PJ Paralysis’ and get involved in the 70-day challenge and show the impact they can make.”

For many, wearing pyjamas reinforces being sick and can prevent recovery. Studies show that three-in-five immobile, older patients in hospital had no medical reason that required bed rest and doubling the amount of walking while in hospital reduces the length of stay.

A Worcestershire NHS Acute Trust spokesman said: “End PJ Paralysis is not about forcing patients out of bed – it aims to prevent avoidable deterioration in their long-term health.

“This is where people remain in bed for longer than necessary which impacts on mental and physical wellbeing. It can increase the risks of falls from muscle weakness and reduced balance.

“It can cause disorientation, confusion, constipation, incontinence and swallowing and digestion problems, which can all lead to a longer stay in hospital than necessary.”

As part of the local campaign Vicky Morris, chief nursing officer and Jackie Edwards donned their own pyjamas and visited patients on wards to encourage patients to get up, dressed in their own clothes, and describe the benefits this can have.

The trust is continuing its own campaign after the national one finishes but giving ward managers their chance to introduce measures in their own wards to embed a new culture of helping patients get up and about – reducing their hospital stay and preventing unnecessary deterioration.

Stephanie said: “We want them to tell us how they can change things and we are going to have figures to show how the wards have been doing.”

Jackie added: “We are creating a social movement and everyone can get the benefits from it.” She is encouraging both patients and families to ask staff whether patients can take in their day clothes.

Driving force behind the national campaign Professor Brian Dolan from the Oxford Institute of Nursing, Midwifery and Allied Health Research said: “End PJ Paralysis has galvanised nurses, therapists, doctors and managers in a way I’ve not witnessed in a 30 plus year career and so many are passionate about doing the right thing.

“Patients wearing their own clothes in hospital further enhances their dignity, safety and retains their sense of identity and when something works well for patients it works for staff too. “Encouraging patients to get dressed everyday rather than remaining in their pyjamas or hospital gown when they do not need to boosts recovery and makes the most of precious time so it can be better spent with loved ones.”

For more information visit http://www.last1000days.com/, https://www.england.nhs.uk/2018/03/70-days-to-end-pyjama-paralysis/ and http://www.worcsacute.nhs.uk/news-and-media/714-70-days-to-end-pyjama-paralysis