Getting patients out of gowns speeds recovery

Sometimes the simplest innovations are the best, Isabel Henderson writes.

Innovation in health care can come down to the simplest of ideas.

And the End PJ Paralysis initiative within Alberta Health Services is indeed remarkably simple — hospital patients do better physically and psychologically if they are able to get up, get dressed in their own clothes and keep moving.

The evidence of harm from deconditioning — changes in the body caused by physical inactivity and lack of use — has been clear for decades. But too often, in a care culture centred on the hospital bed, hospitals have allowed some patients to be immobile in their pyjamas or gowns for up to 90 per cent of the day.

That began changing about three years ago when Dr. Brian Dolan and his colleagues in the United Kingdom’s National Health Service launched the innovative End PJ Paralysis program. It has since become a global movement propelled by social media and taken up by nurses, therapists and other medical professionals, as well as countless patients and their families.

Here at home, AHS staff has embraced End PJ Paralysis with the goal of helping patients feel healthier and happier and to recover more quickly.

The program is currently in place at a number of AHS facilities, including many Calgary and Edmonton hospitals and several rural sites. Many other sites are actively planning to implement the initiative or are contemplating doing so.

Currently, the program is mostly seen in acute care and is targeted to older hospital patients.

Patient immobility for seniors can have a particularly negative effect and not only on the patient, but the wider health-care system.

Literature shows 65 per cent of patients admitted to hospital are age 65 or older. A senior over 80 who spends a week in bed will typically lose 10 per cent of their muscle mass.

There is overwhelming evidence that immobility in hospital leads not only to deconditioning, but also may result in cognitive decline and loss of functional ability. All of this has the potential to increase a patient’s length of stay and reduce the opportunity for them to return home after being discharged.

Even when seniors are able to return home, extended periods of inactivity in hospital can mean they will require additional supports afterward.

Reviews of End PJ Paralysis have consistently demonstrated it also reduces avoidable harm such as falls, incontinence and pressure injuries and decreases the risk of infection. As well, it improves patient experience and well-being, increases family engagement and cuts the length of hospital stays.

Wearing a hospital gown can contribute to feeling institutionalized and not in control, while patients who wear their own clothes are more likely to stay out of bed as they shift from feeling sick to getting better.

At AHS, patients are engaged as partners and can choose to take part in End

PJ Paralysis wherever it’s offered.

Friends and family members are encouraged to support the program. They can contribute to the care of their loved one by bringing in items such as comfortable day clothes, toiletries, walking aids, glasses, hearing aids and well-fitting shoes and by taking care of these items while the patient is in hospital.

Around the world, the End PJ Paralysis movement is spreading fast. It’s also changing hospital cultures and attitudes to care by helping patients stay independent, maximizing their well-being and improving their health outcomes.

The next step is for patients living in the community — for example, having all healthcare providers highlight the risk of deconditioning so patients continue to keep active in their homes and local community.

End PJ Paralysis — it’s a simple idea, but one that’s having a positive effect on individuals and Alberta’s health-care system.