Every Minute Matters: Helping patients maintain independence

A quality improvement project helping patients maintain their independence, dignity and mobility during their hospital stay is set to be expanded across Somerset following encouraging early results at Crewkerne and Wincanton Community hospitals.

The initiative, led by matron Tania Collin, inspired by the national #EndPJParalysis campaign and part of our Every Minute Matters campaign, encourages patients who are clinically able to get out of bed and use the toilet rather than relying on bedpans or bottles.

While the change may sound simple, the project is designed to tackle one of the biggest challenges facing healthcare services: deconditioning, the physical and mental decline that can occur when patients spend long periods inactive during a hospital stay.

The pilot began at Wincanton Hospital in June before being introduced at Crewkerne Hospital shortly afterwards.

Early findings have shown a significant reduction in bedpan and bottle use, alongside positive feedback from both patients and colleagues.

Tania says: "This quality improvement project is trying to achieve a reduction in deconditioning, which has such a devastating impact on elderly patients in particular and can affect their recovery, discharge and future care needs.

"It's linked to dignity and confidence, which I feel is exceptionally important - I don't think any of us would choose to use a bedpan behind a curtain. It's so undignified and it's really important that we address this.

"We also want to get a bit more normality into our hospitals for patients, as we can become task focused due to pressures on the wards.

“This is not in our patients’ best interests though, and changing our focus on toileting out of bed brings normality onto the ward and helps prevent deconditioning, confidence and ultimately independence.

“We're often very task-focused, but actually it's the patients who we want to do this for because otherwise they can completely lose their independence.

“When they go home, they're obviously going to need to use the toilet, so as simple as it may seem, we need to help them maintain those skills while they're with us."

The project was inspired by an Every Minute Matters event organised by our chief nurse, Deirdre Fowler, and led by Professor Brian Dolan, one of the founders of the international #EndPJParalysis movement, which encourages healthcare teams to prevent unnecessary inactivity during hospital stays.

As part of the trial, colleagues from nursing, therapy and advanced clinical practitioner teams received training and worked together to identify patients who could safely be supported to stand, transfer or walk to the toilet as part of their rehabilitation.

Every patient is individually assessed, and the approach is only used where it’s clinically appropriate.

Tania says: "Wherever we think it's possible and clinically safe, we will be encouraging people to get up and go to the toilet with assistance.

"Even if somebody needs transferring off the bed and into a wheelchair, we'll do that as all mobilisation, even a transfer, can support the reduction in deconditioning. Every patient is treated individually, and we always consider what's right and safe for them."

The work has also strengthened multidisciplinary team working across the wards.

Tania says occupational therapist Naomi Moran had highlighted how healthcare assistants, nurses and therapists were working more closely together, raising concerns earlier and identifying solutions more quickly when patients needed additional support. This also ensures any issues are raised early and it assists with discharge planning.

"Our colleagues have really got on board with it and understand how it's making a big difference," she adds.

"Just getting a patient standing up and helping them transfer can have a positive impact."

Patient feedback has also been overwhelmingly positive, with many patients describing how being supported to walk to the toilet helped them feel more independent and closer to normal life.

One patient said: "Walking to the toilet feels like normality." Another added: "So much better and helping my walking."

Audit data collected during the trial showed bedpan use reduced by 88% and bottle use by 86% compared to baseline levels. Mobility data also found that seven out of 10 patients improved their mobility during their stay, while the remaining three maintained their existing level of independence.

Although the project has faced challenges, particularly overnight when patients can be more reluctant to mobilise, Tania believes the benefits for patients and colleagues are clear.

"I think this is all about getting patients back to normality and being treated like a person rather than a patient, which is incredibly important," she says. "We want to try to help people do things rather than do things for them.

"I also think this gives colleagues better job satisfaction because they can see how they're helping somebody achieve something and maintain their independence. Personally, I'm really pleased with how it has impacted patients in such a positive way."

Following the success of the pilot, plans are now underway to extend the approach to Frome and West Mendip community hospitals, before expanding more widely across our other hospitals.

The longer-term ambition is to introduce the initiative within acute hospital settings at Musgrove Park Hospital and Yeovil Hospital.

Tania recently showcased the work on an international stage after being invited to present the project at the 2026 #EndPJParalysis Global Summit, where healthcare professionals from across the world shared examples of innovative work to reduce deconditioning and improve patient outcomes.

She says: "This is all about valuing patients' time, helping them maintain their independence and treating them with dignity and respect.

"If we can help people stay active, recover more quickly and get back to doing the things that matter to them, then that's a success for everyone."