Toward a transformational roadmap to end pj paralysis: A mixed-methods impact study on patient ambulation initiative at hospitals in Alberta

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Wai, Gurech
PJ Paralysis , patient mobilization , Functional decline , End PJ Paralysis , Hospital-acquired disability , Rehabilitation , Get up, get dressed and get moving , Physiological deconditioning , Patient ambulation , Prolonged bedrest , Pajamas paralysis , Healthcare provider experience , Functional capacity
Background: Pajamas (PJ) paralysis describes the adverse physiological effects experienced by patients with low mobility during hospitalization. Therefore, preventing pj paralysis during hospitalization is the primary objective of the examined initiative. Older adult patients who spend long periods immobile are at an increased risk of physiological deconditioning and functional decline. More than 30% of hospitalized older adults become disabled in at least one basic activity of daily living during admission due to immobility-induced functional decline. Multiple hospitals in Alberta implemented the End PJ Paralysis initiative to mitigate this debilitating problem. The End PJ Paralysis is a patient-centred initiative aimed at preserving the functional capacity and dignity of patients by enabling them to get up, dress in personal clothes, and move as much as possible. Methods: We conducted a mixed-methods study to understand the impact of this initiative based on select outcome and process measures: Length of stay, inpatient falls, discharge disposition, pressure injury, provider experience, and patient mobilization and dressed rates. We analyzed quantitative datasets, including 32,884 patients discharge abstracts, based on the Interrupted Time Series design. Thereafter, we interviewed 19 healthcare providers to understand their experiences and examined the resulting transcripts using thematic analysis. Results: The analysis results, averaged per unit per month, showed the length of stay was reduced by 1.8 days (B2=-1.80, p=0.044, 95% CI [-3.54, -.05]), inpatient falls were decreased by 2.2 events (B2=-2.22, p=.005, 95% CI [-3.75, -.69]), and the percentage of patients discharged home was gradually increasing by 0.39% overtime (B2=.39, p=.006, 95% CI [.11, .66]). The overall provider experience was favorable and supportive of the continued spread of the initiative in Alberta. The overarching themes suggest the initiative was simple and yet impactful, driven at the grassroots by champions, faced operational constraints, and should be improved upon while spreading it. Conclusions: Overall, the initiative produced the intended impact based on patient health outcomes and provider experience. However, there were improvement opportunities to consider in the next phase of implementation. Therefore, the most important practice implication from this study is the impetus for the development of a transformational roadmap to improve the initiative while spreading it in Alberta.
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