Table 1.
Summary of ward situational analysis.
| Topic | Observations | Actionable Issue |
|---|---|---|
| Mobilisation | Proportion of patients sat out of bed: 83% (min 71%, max 93%) | Mobilisation opportunities were ad-hoc and depended on patient and nurse/HCA. Patient passive – waiting for assistance. Low levels of mobility for exercise. Prolonged period of sitting in chair. |
| Proportion of patients walking 55% (min 44% max 77%) Median proportion time walking 8am-5pm: 8% (min 5%, max 16%) | ||
| Proportion of patients walking for exercise 55% (39%-77%) Median time walking for exercise: 6.5% (min 0, max 25%) | ||
| Median time sitting 8am-5pm: 44% (min 43%, max 62%) | ||
| Nutrition | Eating half or less of meal: 56 % (min 45%, max 68%) | High proportion of food waste. Quality of meals perceived as good, but portion sizes too big. Textured modified diet poorly tolerated. Patients generally received timely feeding assistance. No alternative or snack offered if low intake at mealtime. No snack/hydration rounds available on acute care wards. The nursing teams had limited influence over aspects of nutrition (scheduling of mealtimes, tailoring to patient food preferences, availability of ward-based snacks, drinks/snacks rounds). |
| % of meals where patients sitting out of bed: 64% (min 31%, max 100%) | ||
| % waiting >10 mins for assistance to eat: 1.5% (min 0%, max 2%) | ||
| Meal interruptions: 38% (min 15%, max 55%) | ||
| Cognition | 34% (0 min-83% max) of time resting (doing nothing, but not asleep) | The majority of day spent resting, or sleeping. Most frequent distraction activity was talking on or looking at phone. No visitors due to COVID-19. No non-pharmacological interventions for patients with distressed behaviour. |
| 27% (15-34%) of patients had cognitive impairment, dementia or episodes of distressed behaviour | ||
| Intra nursing & MDT Communication on fundamental care | No record of daily mobility, no mobility goals visible to patient or bedside nursing team. Food charts recorded for high risk patients. MDT board rounds. No nursing team huddles, no discussion on nutrition/mobilisation/cognition unless distressed behaviour disrupting ward activity. Paper based medical records, difficult to locate information/decipher hand writing. | Professional silos - minimal communication between nursing and therapist on individual patient goal setting or action plans. Variable attitude of nurses/HCA role on assisted patient mobility for exercise. Increase opportunities for direct communication between therapist and bedside nursing team |
| Staffing levels | Registered nurse to patient ratio: Site 1= 1: 3.3 (min 1:3. Max 1:4); Site 2 =1: 4.9 (min 1:4.8, max 1:5.2). Healthcare assistant 1-2 per ward. One physiotherapist per ward, six monthly rotations. Nursing staff perceived the main barrier was insufficient staffing levels to meet patient acuity and dependency. Therapists also perceived their service was understaffed. | The FCB intervention had no influence over staffing levels. Nursing staff levels were often unpredictable due COVID-19. Staff experienced fatigue and stress from uncertainty of pandemic, wearing PPE, post-viral fatigue. |
Key: FCB Frailty Care Bundle; MDT multi-disciplinary team; HCA Health Care Assistant; PPE Personal Protective Equipment.