PJ paralysis Twitter campaign gets trusts moving

What started as a simple Twitter discussion about getting patients dressed and out of their pyjamas has snowballed into an international success story.

What started as a simple Twitter discussion about getting patients dressed and out of their pyjamas has snowballed into an international success story

Cambridge University Hospitals NHS Foundation Trust is using posters
featuring Lego characters with the slogan 'Get dressed – Get moving!'

It started as a simple discussion on Twitter and has snowballed into an international success story in a matter of months.

The aims of the #EndPJParalysis campaign are simple: get patients out of bed and dressed during the day, and then into chairs, activity rooms or to dining rooms for meals.

Increased activity can help recovery, reduce muscle wastage, maintain independence, and lead to patients being discharged sooner.


days in a hospital bed is equivalent to 10 years of muscle ageing in a person over 80 years old

(Yale University study, 2004)

The idea was sparked by a discussion at Nottingham University Hospitals NHS Trust last November about hospital patients spending their days in pyjamas.

Switch to day clothes

NHS-trained nurse Brian Dolan, director of service improvement at Canterbury District Health Board in New Zealand, had been invited to Nottingham to talk about his Last 1,000 Days campaign, which is aimed at improving the lives of older patients and ensuring they are valued. This prompted a discussion about patients wearing pyjamas.

Following a twitterchat after Mr Dolan's talk, the #EndPJParalysis campaign was born, spearheaded by Nottingham trust’s deputy chief nurse Ann-Marie Riley.

Posters are displayed on the trust's wards to encourage patients and their families to bring in day clothes and comfortable shoes.

And thanks to the EndPJParalysis hashtag, news of the campaign has spread across the UK.

 Piqued interest

‘I don’t quite know how something that started as an improvement idea for one hospital can turn into what it has,' says Ms Riley.


days in bed can lead to a 10% loss of strength and leave an older person unable to climb the stairs

(Yale University study, 2004)

‘The thing that is hardest to grasp is that the evidence of harm to patients from being immobile has been around for decades. We haven't created any new evidence, we have just shared evidence already out there, but for some reason it has captured the hearts and minds of staff.’

Ms Riley estimates that every region in England now has at least one trust using the hashtag, while interest has piqued in Wales and Scotland, and in hospitals in Europe, America, Australia and New Zealand.

High-profile support

One high-profile fan is NHS England's chief nursing officer Jane Cummings.

She wrote in her regular blog in February: ‘It is something that I am passionate about as a nurse – making small changes to improve patient outcomes.

‘No matter how old a patient is, they will lose muscle strength during their stay, albeit at different levels, so it really is in the interests of our patients to help them be as mobile as possible.’

Ms Riley believes a grassroots approach to the campaign has been the key to its success.

By getting teams to follow it and adapt it to suit individual patients, it has won support, she says.

Looking better

Nottingham’s Stroke Rehabilitation Unit physiotherapy team lead Rachel Tomasevic says: ‘It’s such a simple idea and we have seen changes.’

She says as a physio she had always encouraged getting patients up and dressed, and now it is no longer seen as just a therapist's job, but one for everyone.


Patients remained immobile for up to 90% of their day in hospital before the campaign launched, Ann-Marie Riley estimates

‘I think the thing is, if we saw somebody slumped in bed and in pyjamas, and the nurse and doctor said they don't look good, we as physios would try to get them up. We’d get them dressed and into a chair, and then the same staff would come back and say they look better.

‘People feel better for getting out of bed. On the stroke unit some people may only get up for one or two hours, but others can stay out of bed for longer periods.’

Privacy and dignity

Although there is no hard evidence of the direct impact, it is believed the PJ Paralysis campaign has helped reduce pressure sores and, with other initiatives, improved patient flow.

Matron Caroline Wise, who works in trauma and orthopaedics, says the initiative is a ‘fantastic idea’.

‘Many of our patients will be admitted after a fall so they come into hospital without spare clothes.

‘My first thought when I heard about it was “why haven’t we thought about this before?"

‘Getting up and dressed as part of rehabilitation: hospital gowns may be easy to put on and use for staff, but they aren’t great for a patient’s privacy and dignity.’
She added that staff and former patients have set up a clothes bank so patients who don’t have day clothes can pick out something to wear.

Posters and ‘proper clothes’

One of the latest trusts to adopt the campaign is North Bristol NHS Trust.

Senior nurses used their monthly ‘Back to the Floor’ day to promote #EndPJParalysis and listen to what patients had to say about it.

Director of nursing Sue Jones says older patients explained that they felt more dignified being in their proper clothes, especially when receiving visitors, something she says was less of an issue for millennials – those who reached adulthood at the turn of the century – who are more used to wearing jogging bottoms and onesies.

To promote the campaign, senior staff swapped their uniforms for pyjamas for a photo shoot.

Ms Ford says nurses have been challenged to design posters promoting the benefits of the campaign, while patients – who predominantly have their own rooms – have been encouraged to sit in groups for meals and activities.

The next step will be to receive feedback from ward sisters during the next Back to the Floor day.


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