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To support our staff campaign to reduce long hospital stays, called Where best next?, here Ann Marie Riley, Deputy Chief Nurse at Nottingham University Hospitals talks about how deconditioning can be life changing for patients.
Hello….my name is Ann Marie Riley and I am a Deputy Chief Nurse at Nottingham University Hospitals (NUH).
Let me introduce you to Ellen. Ellen is 70 years old and lives with her husband who she cares for. Neither of them currently require support at home.
Ellen tripped over a step outside her house whilst putting her washing out and ended up being taken to the Emergency Department (ED) with a painful hip and a cut on her head. She was very upset as she doesn’t like hospitals and she was worried about her husband. She was in ED on a trolley and was eventually admitted. She tried not to move too much due to the pain and wouldn’t ask for painkillers as she didn’t want the nurses thinking she needed them (as Ellen thought that might mean she had to stay in longer). She didn’t sleep at all that night.
The morning after she found moving difficult due to stiffness and pain, she didn’t eat and she felt weak and nauseous (in part because of the pain and in part due to lack of sleep). The cycle of pain and lack of sleep went on for a few days. Although she had never suffered delirium before being admitted to hospital, she became acutely confused. The team were becoming increasingly concerned about Ellen’s ability to manage at home. Ellen was not discharged from hospital to her home address.
What would normally happen now do you think? Would your organisation consider investigating why a lady who was completely independent before being admitted to hospital had suffered functional decline and wasn’t able to return home? I wonder how many cases like Ellen’s ever result in organisational learning?
What if tell you that Ellen lay on a trolley in ED and wasn’t given the option of sitting in chair, on the ward she was asked about her pain score regularly but she refused analgesia –staff noted she was uncomfortable but no-one sat down with Ellen to understand why she was reluctant to take painkillers, the MDT didn’t question how often Ellen was walking and therefore notice that she was barely moving, staff did not take Ellen to the toilet and used a commode at her bedside.
Ellen’s case is loosely based on the experience of someone I know; someone who, due to deconditioning, had an unnecessary longer length of stay, who lost muscle strength and mass, who became anxious and depressed and who was away from her husband far longer than she wanted or should have needed to be. It took almost a year after her discharge for her to return to her old self and yet some simple changes in her plan of care whilst she was in hospital could have seen a different outcome for her.
So for changes you can make on your wards today take a look at the new Where Best Next? campaign which highlights actions nurses, doctors, pharmacists and therapists can take to help make positive changes for patients.
The five principles relate to different stages of a patient’s stay: some to the moment of admission, some to their time on a ward and some to the end of their stay.
Deconditioning harm can be life changing, independence can be lost forever and yet there is little evidence that we are learning from cases such as Ellen’s to ensure we can proactively change the way we plan and deliver care for people. Don’t we owe it to those who use our services to learn from hospital acquired functional decline harm events?