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Health Promotion Service
Physical Activity Pathway
Ward Based Audit
Dec 13 – Jan 14
Lydia Jenner
Orthopaedic FY1 RIE
Physical Activity
Pathway Audit
Primary question: ‘Is the Physical Activity Pathway being used by Health Care Professionals on the wards?’
-Patients chosen at random on one of four orthopaedic wards
-Asked patients whether they had been asked about their levels of Physical Activity before by a member of the healthcare team
-If so; by whom? Had they found it a useful exercise? How long had the conversation lasted? And finally; had it made a difference?
Setting Audit carried out at the RIE Orthopaedic Wards (Trauma
and Elective)
Trauma wards (108 &109) – each 36 beds
Elective wards (208 & 209) – 24 and 36 beds respectively, often also used for trauma patients
Trauma wards – typical patient load: older age adults; fragility fracture (hip) multiple co-morbidities; approximate ward stay 4 to 14days
Elective wards – typical patient: middle age adults; elective joint replacement (knee); some co-morbidities (arthritis; diabetes; COPD); approximate ward stay 3-4days
Audit carried out over Christmas/New Year period – less elective patients; staffing levels reduced; less continuity of care
Results so far 31 sets of patient data collected so far; only small sample size!
Age range 29 – 87,
Mean age: 61.03
Male : Female ratio – 13:18
Percentage asked about Physical Activity levels: 9 patients (29%)
Therefore only 4 out of 31 patients asked about levels of PA during current inpatient stay.
9 Patients
4 - GP 3 - Physiotherapist 1 – Asthma Nurse (GP) 1 – Pre-op assessment
Cont. Out of 9 patients asked about PA; 8 were interested to
discuss PA and received brief advice/more thorough
intervention
Advice/interventions ranged in time duration from 2
mins to 15mins
Out of those 8; 6 patients intended to follow some of
the advice given to them to increase their levels of PA.
Feedback from Patients High level of interest from patients.
Patients were happy to discuss
Common patient perceived barriers to PA – age,
weight, co-morbidities (arthritis), un-aware of
availability of local facilities
Patient perceived barriers to Healthcare Professionals
discussing PA – time restraints, priorities.
Incidentally… Physical Activity Pathway not openly displayed on any of the
four wards
Staff unaware of PA pathway & minimum levels of activity/week
Impromptu poll of staff: 10 junior doctors
3 orthopaedic registrars
1 Medicine of Elderly registrar
1 MOE Nurse Practitioner
4 Orthopaedic Nurses
4 Physiotherapists
1 Pharmacist
Not one member of staff asked has used the PA pathway
Only one member of staff asked had heard of the PA pathway.
My Experience of using
the PA Pathway
-patients were generally interested and engaged in
conversation easily
-patients commonly stated co-morbidities as barrier to
being more active but were able to do at least one form of
exercise
-simple tool to use; exit pathways useful for patients who
are clearly disinterested.
Conclusion
High level of patient interest
Not being implemented on orthopaedic wards presently
Low level of staff awareness
Suggestions
Enrolling Junior Doctors
Opportunities to promote PA pathway to junior doctors:
-the ‘Shadowing week’ lectures at the start of FY1;
mandatory lectures for the new intake of junior doctors in
July.
-FY1/FY2 mandatory teaching – held once a week at
every hospital, include in the curriculum to promote to
current Junior Doctors
Suggestions cont. - Potential to include a few questions about levels of PA in
the Admission document
PLANNING AHP ROLL-OUT
Chris Kelly Health Improvement Senior
Kat Savage AHP EPR Project Lead
AHPs and Electronic Patient Records
Why EPR?
In line with NHS Scotland's eHealth Strategy, NHS Greater Glasgow and Clyde acute sector is moving to paperlite working
Work to date:
600 WTE
PT / OT Acute Staff
Estimated 359,393 Sheets
of Paper per Year
60,691 New Patients per
Year
120 Versions of
Documentation
8 electronic forms (eForms) shared documentation
23 word documents
AHPs and Physical Activity
AHP Directors Pledge:
“We will work with a range of partners to increase the level of physical activity in Scotland”
CEL
“NHS staff routinely highlight the importance of physical activity for patients in hospitals as part of their rehabilitation and for prevention of future
illness”
A Games Legacy for Scotland
"We want to inspire the people of Scotland to be more active. To take part in physical activity and
sport. To live longer, healthier lives."
What are we asking? Within the AHP Record of Care eForm, the physical activity question is
embedded. This eForm will be used during every inpatient Physio and / or OT
episode of care.
Training
• NHSGGC’s 1 hour generic Raising the
Issue
• Physical Activity topic bolt-on
– Health Scotland's Raising the Issue of
Physical Activity e-module
Benefits
• All staff will be asking the same
questions
• Shared documentation cuts down
duplication
• Signposting information available to all
online
• Plan to extract information to audit
number of patients who were asked the
question
Challenges
• Tackling knowledge and behaviour of
staff
• Measuring impact
• Training staff ahead of roll out of
electronic documentation.
Next Steps
• Train 600 wte Physio’s/OT’s
• Pilot template
• Create a data reporting mechanism to
allow for audit
Thank you!
Chris Kelly
0141 201 4956
Kathryn Savage
0141 201 1525
Promoting Physical Activity
in Palliative Care
Mandy Trickett
Macmillan Physiotherapist
Macmillan Day Care Unit,
Specialist Palliative Care Services, Dundee
Background
2007
2010
• Evidence?
• What was happening elsewhere?
• Scoped local exercise classes and other hospice exercise classes.
• E-networking UK and worldwide – benchmarking
• What did the patients want?
• Would it benefit the organisation?
Questions….
AHP Practice Development
Apprenticeship Scheme (Sept 2012 – 2013)
Aims : To support development of AHPs
• evidence based practice
• Improvement demonstration
• to develop AHP as leaders for practice development.
Philosophy:
Learn as you do through group based activities and practice based learning.
• Led by Dr Jacqui Morris,
• funded by CHPO (Jackie Lunday)
• Tayside Centre for Organisational Effectiveness
• MCN Lead for Nutrition
• supported by AHP directorate
Outcomes of interest
• Improve QOL
• Improve physical performance
• More patients seen in a group setting
• Patient centered approach
• Staff engagement in promoting physical activity
Methods Participants – all patients who attended April – Oct 2013
• 23 ½ hours video, focus group work
• All new patients screened using Scottish Physical Activity Pathway – referred to physiotherapy or given information.
Intervention –
• 8 week circuit based exercise class -
strengthening, cardiovascular, balance, flexibility exercises using evidenced based guidelines.
• pacing, planning, exercise diary, goal setting, relaxation, motivational interviewing Health Behavior Change.
Outcomes --
• Improvement tools used to develop and design the programme.
• Range of validated outcome measures used to assess change.
Improvement Tools
• Literature review
• Stakeholder communication
• Communication plan
• Project Definition statement
• Process Mapping – patient pathway
• Driver diagram
• Project plan
• Informing, Engaging, Consultation Plan (IEC)
23 1/2 hours, gained patient feedback - focus groups, flip charts, information leaflets, emotional touchpoints,
• Data collection
• Staff engagement – patient documentation
Results
• 18/89 patients took part in the exercise group.
• (cancer n=9, COPD n= 5, MND n=2, MS n=1, cardiac n=1)
• 50 % dropped out due to disease progression, 9 completed.
• 7/9 - increase in physical performance, Palliative Performance Scale and
QOL.
• 2 /9 - decrease in physical performance, Palliative Performance Scale but
QOL still increased.
• 3/10 - taking part in an exercise class was “important” to them.
• 7/10 - would prefer other types of activities such as walking, gardening or
Chi Gung to help remain physically active.
• Patients who completed, reported their general physical activity levels had
improved
• More patients were seen in a group setting
• Daycare staff became more pro-active in addressing patients activity levels.
Measureable outcomes - tested before and after the
exercise class
Benefits of the project
Patients Express their choices
Demonstrated benefit
Significantly more active afterwards
Equal access
Staff
Evidenced improvement and
patient centred care
Utilise time more effectively
Have feedback on patient choices
Organisation
Proof- evidence based, equally accessible and
effective
Person-centred approach
Increased use of resources
Group exercise
- evaluation
What is the situation now?
1 100% of all Macmillan Day Care patients have their physical
activity levels screened on admission and promoted in line with
Scottish Physical Activity Questionnaire/Pathway
2 Group exercise (circuit class) is available for all patients based on
need not diagnosis.
3 Patients are taught self-management skills such as pacing, planning
and goal setting to continue to remain physically active and
independent for as long as possible.
4 Next steps –
Walking programmes and Chi Gung (like Tai Chi) are now under
development for those who do not wish to or are unable to take part
in an exercise group but would like to undertake physical activity.
New IEC plan.
“You matter because you are you, and you matter until the last moment of your life. We will do all we can, not only to help you to die peacefully but also to live until you die.”
Dame Cicely Saunders
(founder of the modern hospice institute)
Thank you.
Closing Remarks
• Be a champion and raise awareness with your colleagues
• Lead by example through your own practice and physical
activity
• Use and promote the professional support tools available
• Link with your HPHS Lead, Physical Activity Lead and QI
colleagues to collaborate on projects
• Make sure you work is recorded and recognised
• Share your practice with professional peers and through
national groups
With many thanks to our collaborating national and local colleagues
who have supported, contributed to and influenced the work to date.
With particular thanks to:
- Event Steering Group and planning team
- All our presenters
- All our facilitators
- All delegates for their participation
- All marketplace presenters
- All those sharing work on our interactive wall
Please share your learning and reflections from today
with your colleagues, and signpost them to our resources.
