Improving patient activity in hospital

Lianne McInally, I’m an Improvement Advisor at Healthcare Improvement Scotland on secondment from NHS Lanarkshire.  I’ve been working with staff, patients and carers at Kello Hospital, Biggar on #ThinkActivity improvement project.

A recent social media campaign #endpjparalysis highlighted that for older people in hospital, ’10 days in bed, ages the muscles by 10 years.Researchers have also found that older people in rehabilitation wards move less than community dwellers.  This can often lead to poorer outcomes for people when they are planning to go home.  For some this may be the difference between independence or being dependent.  Age UK reported that 47% of people with a dementia are physically less well and able on discharge from hospital. 

#ThinkActivity improvement project was taken to improve outcomes for older people in collaboration with NHS Lanarkshire, Healthcare Improvement Scotland & Glasgow Caledonian University.

We worked with patients, carers, volunteers and staff to develop a definition of activity for the ward so that everyone was working toward the same goal.

We asked patients, carers, volunteers and staff what matters to you?  How could we improve Kello ward to support you to take part in activity? What are the challenges to take part in activity on Kello ward?

People were keen to move and exercise more on the ward and told us:

"I'd like to walk more and for staff to allow me to take risks to walk on my own".

"I want to be encouraged to move, not just left to sit".

"It would be nice to have children visit to entertain us".

Patients wore ‘Activpal’ monitors to measure the amount of activity they were doing during their stay.  We found that before we made any improvements, patients took an average 668 steps, sat for 22 hours and were standing/stepping for 1 hour 30 minutes in total.  This was surprising on a rehabilitation ward, but the results were similar to that of other research, so not uncommon!

We continued to measure physical activity using "Activpal" whilst making improvements on the ward to ensure our actions made a difference. Improvements to date include:

• Education and awareness raising for staff and patients
• An activity notice board
• Patients are now up and dressed earlier, usually by 10:30am or when they choose
• Biggar High school pupils have volunteered to work with patients
• Reminiscence Interactive Therapy and Activities (RITA)
• Staff and patients are recording steps to climb Tinto together

The most significant improvements have been seen following the introduction of an activity passport that the patients and staff developed together.   Sitting time has reduced, step counts increased and the amount of time people are moving has increased.  

Margaret Waye has been a great advocate of the passport with other patients saying, ‘I enjoy the activity passport. It’s encouraging me to do more on the ward.  I’m doing my exercises regularly.  I’ve not been well and was keen to get back to using my passport.  I can see my progress over time.’

If you have an experience of Kello Hospital you would like to share, please speak to a member of staff, respond on Care Opinion, or visit the “Your Feedback” Section of the NHS Lanarkshire website to see the other ways to get in touch www.nhslanarkshire.org.uk