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The EDDM Programme

The EDDM Programme

The beauty of The EDDM Programme is that it can be moulded, adapted and implemented however best fits your setting and service! There is no 'one-size-fits-all' product or intervention, but this programme of work should guide services on how to take a systematic approach to implementing change or interventions to prevent deconditioning. The main focus of The EDDM Programme is to cultivate a shared responsibility among multidisciplinary staff to deliver activity-driven care and reinforce positive feedback on eat, drink, dress and move activities to ensure the risks of malnutrition, dehydration, cognitive decline, functional deterioration and immobility are proactively addressed.

 

The below information focuses on how to introduce The EDDM Programme in the acute setting on hospital wards, however the key principles of activity promotion can and should translate into Community, Primary Care and Public Health/Leisure services. If you've introduced The EDDM Programme into these settings, please get in touch to share how you've achieved this!

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The EDDM Programme in the Acute Setting

​Aims:

  • Increase patient engagement in daily Eat, Drink, Dress and Move activities whilst on hospital wards  

  • Support patients to be accountable and play an active role in their recovery  

  • Cultivate interdisciplinary accountability for promoting activity and mobility with patients in hospital 

  • Empower staff to consider small, positive changes following continuous improvement methodology to achieve the above 

  • Drive culture change 

  • Reduce harms associated with acute deconditioning including pressure injuries, delirium, pneumonia, urinary tract infections, falls, incontinence and venous thromboembolism. 

  • Maintain individuals' usual level of function and current abilities  

  • Examine the impact of EDDM on a selection of hospital metrics (eg. discharge destination, packages of care and length of stay) by preventing acute physical, psychological and functional decline 

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The EDDM Programme provides a systematic approach to reconditioning and combatting acute deconditioning and associated harms for all wards to engage in. Using an 8-step framework, we hope that ward staff feel encouraged and empowered to consider continuous improvement ideas to prevent acute deconditioning and sustain positive change through EDDM activity promotion. Taking inspiration from the Johns Hopkins Activity and Mobility Promotion (JH-AMP) Programme's 8-step framework*, the success of The EDDM Programme requires:

  1. Organisational prioritisation

  2. Systematic measurement and promotion of daily EDDM Activities

  3. Mitigation of barriers to EDDM activity promotion

  4. Workforce – interprofessional roles and responsibilities in EDDM activity promotion

  5. Integrating EDDM into electronic and human workflow

  6. EDDM Education and Training

  7. EDDM Activity Data feedback

  8. EDDM Promotion and Awareness

+ Patient experience and involvement

+ Continuous Quality improvement methodology

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The EDDM Programme Framework

What does success look like? 

  • By identifying and addressing barriers to EDDM activities on the ward, staff can consider improvement ideas to promote EDDM activities and prevent acute deconditioning 

  • By measuring patients current EDDM ability, staff can promote appropriate daily EDDM activities for them to complete

  • By completing daily EDDM activities whilst in hospital, patients will remain active and reduce their time spent in bed or immobile

  • By remaining active in hospital, patients are less likely to suffer the effects of acute deconditioning!

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The success of The EDDM Programme requires engagement from both staff and patients/relatives to recognise that staying active will support patients recovery to leave hospital sooner

Organisational prioritisation

​Recognising The EDDM Programme as a priority for everyone is crucial to its success. It should be everybody’s business to recognise 1) the problem of frailty and acute deconditioning and 2) the solution – Eat, Drink, Dress, Move! 

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The EDDM Programme should integrate with other patient safety and harm free care priorities, such as: pressure injuries, delirium, pneumonia, urinary tract infections, falls, incontinence, dehydration, malnutrition and venous thromboembolism. 

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The benefits of The EDDM Project on strategic system-wide initiatives should also be recognised, such as: length of stay, readmission rates, discharge planning/pathways and criteria to reside. 

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Hospital leadership must engage in and support The EDDM Programme, elevating it as a priority and ensuring accountability. Where possible, The EDDM Programme must also have the support of: 

  • Chief AHP

  • AHP Leads (PT/OT/SLT/DT)

  • Occupational therapy clinicians

  • Physiotherapy clinicians

  • Speech & language therapy clinicians

  • Dietetics clinicians

  • Health Care Assistants

  • Nurses

  • Ward managers

  • Matrons

  • Discharge support workers

  • Consultants

  • Medical staff

  • Silver command

  • Exec team

  • Tissue Viability Nurses

  • Infection Prevention Control

  • Storage

  • Equipment

  • Patient safety team

  • Business Intelligence team

  • IT team

  • Communications team

  • Education teams

  • Quality Improvement team

  • Patient experience & involvement team

  • Patients

  • Visitors

  • Volunteers

  • Charities

  • EDDM Technician

  • ISS

    • Hostess

    • Catering

  • Housekeepers

  • Estates

Consider completing a Stakeholder Analysis ​- a process for identifying, assessing, and prioritising individuals or groups who can affect or are affected by The EDDM Programme. Take your list of stakeholders and consider their interest and influence using a power-interest grid, eg. below*:

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Then, consider how you will earn the engagement and support of each group of stakeholders. How do you introduce The EDDM Programme to them? How do you keep them informed? What results are meaningful to them? 

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It's also helpful to have a core group of Programme Leads from medics, therapies and nursing to ensure representation of these clinical groups. This EDDM Programme Lead group should meet frequently to discuss ongoing programme planning, barrier mitigation and progress with any change ideas. 

Systematic Measurement and Promotion of EDDM Activity

For The EDDM Programme to be successful, multidisciplinary staff must adopt a common language for activity and mobility when: 

  1. Assessing current level of ability, 

  2. Setting daily EDDM activities for patients to complete, 

  3. Documenting activity and mobility performance. 

1. Assessing current level of ability: What is this patients current level of ability for activities* and mobility**? *Activity – the ability to perform meaningful and purposeful tasks within the environment / **Mobility - the ability to physically move around within the environment 

Standardising the measurement of a patients current level of ability across all clinical disciplines helps to identify any changes in a patients function and encourages the multidisciplinary team to consider activity and mobility as a ‘vital sign’.  

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Utilising a standardised tool to measure current ability, staff can then set daily EDDM activities based on what a patient can do and compare this to their actual performance each day. This will help to promote activity and mobility using a strengths-based approach, reinforce positive feedback on performance and allow us to track promotion efforts.  

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The EDDM ‘Currently, I Can…’ Tool simplifies two scores: 1) The Modified Barthel Index and 2) The Manchester Mobility Score, to generate a scoring system for staff to use to communicate a patients current level of ability in eating, drinking, dressing including grooming, and moving activities. 

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2. Setting daily EDDM activities to complete:

Based on a patients ‘Currently I Can…’ score (current level of ability), all multidisciplinary staff can then consider an appropriate minimum activity for that patient to complete each day using The EDDM Activity Promotion Tool. The daily EDDM activities should be communicated to all multidisciplinary staff involved in the patients care, the patient and their visitors, and included in handovers, ward rounds, etc.  

 

It is important to involve the patient in deciding on their daily EDDM activities to complete. To help, ask the patient a few questions: 

  • What can you do for yourself/do you want to do for yourself?

  • What matters to you in relation to eating, drinking, self-care/identity and movement?  

  • What would make a good day in hospital? 

  • What can we help you to achieve today? 

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For examples of EDDM Activities aligned with a patients Currently I Can... score, click here

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3. Documenting activity and mobility performance:

Has this patient completed their daily EDDM activities today? Documenting a patients EDDM activity performance helps to reinforce positive feedback to further drive patient activity. It also allows us to track promotion efforts and ensure staff are supporting patients to complete their daily activities.

 

For successful implementation and sustainability of EDDM activity promotion, The EDDM ‘Currently, I Can…’ Tool and Activity Promotion Tool must be built into the electronic patient record.

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Building in alerts can flag at-risk patients who are not achieving their daily EDDM activities, or who’s current ability scores start to deteriorate. This will allow the multidisciplinary team to consider reasons for deterioration, e.g. medically acutely unwell, inactivity and immobility, patient choice, etc. and deliver appropriate proactive interventions to address this. 

Mitigation of Barriers to EDDM Activity Promotion

It is important to identify and address barriers to activity and mobility promotion. These may include barriers related to staff, patients, visitors, environment, equipment, space, education, resource, electronic patient record/documentation, processes and/or procedures. Promoting EDDM activity requires practical ways to remove these barriers in the healthcare setting, see the table below* (click on image to open larger table in new page).

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Conducting a staff and patient survey to better understand barriers to EDDM activity promotion allows you to identify and address barriers following a quality improvement process. Staff should use survey results to inform an ongoing, continuous improvement process throughout the implementation and sustainment  of The EDDM Programme.

Interprofessional Roles and Responsibilities in EDDM Activity Promotion

Each ward implementing The EDDM Programme should establish clear roles and responsibilities for all multidisciplinary team members, for example:

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Ward Managers

  • Monitor ward performance (% patients with daily EDDM activities set, % patients with daily EDDM activities completed)

  • Disseminate EDDM data feedback to ward staff

  • Identify and address barriers to completing EDDM activities

  • Ensure new staff complete EDDM education and training

  • Reinforce EDDM as a priority

  • Promote and encourage team to meet EDDM activities

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Nursing staff

  • Complete daily EDDM Assessments in electronic patient record for patients under their care

  • Support routines for high functioning patients to achieve their daily EDDM activities

  • Promote independent/assisted activity and mobility with every patient

  • Reinforce EDDM as a priority

  • Attend and discuss EDDM activities at MDT meetings

  • Attend EDDM education and training

  • Support HCA’s for patients to be in correct positions

  • Promote mouth care

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HCAs

  • Promote daily EDDM activities with all patients

  • Reinforce EDDM as a priority amongst the MDT

  • Identify and address barriers to completing EDDM activities

  • Attend EDDM education and training

  • Liaise with EDDM Tech for guidance on EDDM activities with patients  

  • To always ask the patient what they can do for themselves with personal care

  • Ensure patients are sat up and out of bed for meal times

  • Ensure that fluids are maintained and fluid and food charts are updated in as timely manner (especially in afternoon and in warm weather)

  • Promote mouth care

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Occupational Therapy Staff

  • Serve as EDDM activity content-area experts regarding activity and mobility – advise on cognitive and functional activities including groups eg. UL or ADLs

  • Support more complex patients to achieve their EDDM activities – advise on level of assistance/encouragement with washing, dressing, transferring in wheelchair to day room or support to sit out for meals.

  • Direct resource to patients with greatest functional impairments

  • Reinforce EDDM as a priority

  • Identify and address barriers to completing EDDM activities - washing, dressing and toileting

  • Complete daily EDDM Assessments on patient electronic patient record (Current ability score and daily activities) if not up to date for patients on caseload

  • Ensure new staff complete EDDM education and training as part of OT local induction and preceptorship

  • Discuss EDDM activities at board round/RAG/MDT meetings – especially wash, dress, toileting, eating and drinking (link Eating and drinking with SLT)

 

Speech and Language Therapy Staff

  • Act as EDDM champions and promote EDDM wherever possible

  • Provide expert input for eating, drinking and swallowing for EDDM activities

  • Be aware of patients functional baseline prior to admission and provide eating, drinking and swallowing therapeutic goals to maintain this level of function

  • Support MDT in patients achieving other EDDM activities

  • Provide support and training to EDDM tech

  • Jointly set daily EDDM activities with patient and MDT, with specific focus on eating and drinking

  • Think about EDDM when setting therapeutic goals with patient

  • Activities should always be holistic with EDDM focus e.g. if promoting patient to eat and drink, this should be done in conjunction with the recommendation to sit out of bed at all meals

  • Attend regular training sessions on EDDM

  • Provide training as required around eating and drinking and link this with EDDM

  • Encourage patients to communicate their needs and jointly set EDDM activities and provide communication support to those who may find this more challenging

  • Highlight organisational issues that may impact on EDDM and explore solutions e.g. meal service

  • Support the MDT with more complex patients

  • Offer opportunities to achieve EDDM activities, eg groups, lunch clubs

  • Clearly communicate EDDM activities and document effectively

  • Complete daily EDDM Assessments on patient electronic patient record (Current ability score and daily activities) if not up to date for patients on caseload

  • Use therapeutic strategies to reduce the effects of any deconditioning

 

Dietetics Staff

  • Act as EDDM champion and promote EDDM within the MDT

  • Serve as EDDM experts regarding eating and drinking and the harms associated with malnutrition and sarcopenia

  • Provide appropriate training and support to the EDDM Technician

  • Support the EDDM Technician to establish a caseload of patients for EDDM activities including supporting eating and drinking and improving environment and patient experience at mealtimes.

  • Jointly set EDDM activities with patient, families and MDT, with specific focus on eating and drinking and the importance of good nutrition and hydration.

  • Ensure patients have access to correct menus, appropriate meal choices, drinks, snacks, and equipment to be able to participate in their daily EDDM activities

  • Encourage opportunities to achieve EDDM activities, e.g.  lunch clubs, sitting out at mealtimes and walking to drinks trolley to make drinks independently

  • Provide training as required around eating and drinking and link this with EDDM

  • Ensure patients have access to correct menus to make appropriate meal choices to suit individual and cultural needs.

  • Support the MDT with more complex patients

  • Clearly communicate EDDM activities and document effectively

  • Complete daily EDDM Assessments on patient electronic patient record (Current ability score and daily activities) if not up to date for patients on caseload

 

Physiotherapy Staff

  • Serve as EDDM activity content-area experts regarding mobility

  • Complete physical and functional assessments for patients who have a physical and/or functional change on admission, providing EDDM activity recommendations based on this

  • Support more complex patients to achieve their EDDM activities

  • Direct resource to patients with greatest mobility and functional impairments

  • Reinforce EDDM as a priority amongst the MDT

  • Identify and address barriers to completing EDDM activities with patients

  • Ensure patients have access to the correct mobility/transfer aid, seating, footwear and clothing to be able to participate in their daily EDDM activities

  • Complete daily EDDM Assessments on patient electronic patient record (Current ability score and daily activities) if not up to date for patients on caseload

  • Ensure new staff complete EDDM education and training

  • Discuss patient EDDM abilities at RAG/MDT meetings for early identification and escalation of patients who deteriorate in EDDM Current Ability score, or frequently do not complete daily EDDM activities as high risk of acute deconditioning and associated harm

  • Provide education to patients around the negative impacts of inactivity and immobility in hospital.

  • Signpost/refer to appropriate community services to remain active on discharge

  • Support the running of group ward-based exercise and/or activity sessions as appropriate

  • Support the EDDM Technician to establish a caseload of patients for EDDM activities including mobility

 

EDDM Technician

  • Complete EDDM Assessment and set daily EDDM activities with patients

  • Support patients to complete their daily EDDM activities

  • Document EDDM Activity completion for all patients

  • Reinforce EDDM as a priority amongst the MDT

  • Receive a delegated caseload from therapies teams

  • Facilitate 1:1 and group activity sessions (lunch clubs, exercise groups, activities sessions)

  • Ensure patients who can sit out for mealtimes are doing so

  • Educate and empower HCA colleagues to promote EDDM activities with all patients – support enabling patient independence vs. providing assistance

  • Support the EDDM Programme leads to audit, obtain qualitative feedback and review the outcomes of projects to increase EDDM activity on EDDM wards

  • Oversee the activity of EDDM volunteers when appropriate

 

Medical staff

  • Discuss patient EDDM abilities at RAG/MDT meetings for early identification and escalation of patients who deteriorate in EDDM Current Ability score, or frequently do not complete daily EDDM activities as high risk of acute deconditioning and associated harm

  • Ensure patient activity and mobility is a priority during ward rounds – sit patients out in chair during ward round vs. keeping them in bed

  • Integrate EDDM activities and performance into medical plans and documentation

  • Promote activity and mobility by reducing barriers (eg. reduce lines, tubes, drains, pain management, polypharmacy)

  • Support the integration of EDDM/preventing acute deconditioning with service line initiatives (elderly care vision, frailty, criteria to reside, length of stay)

  • Reinforce EDDM as a priority amongst the MDT

  • Complete daily EDDM Assessments on patient electronic patient record (Current ability score and daily activities) if not up to date for patients

  • Provide education to patients around the negative impacts of inactivity and immobility in hospital.

Integrating EDDM into daily electronic and human workflows

The EDDM Programme must itegrate into current electronic and human workflows for all Multidisciplinary staff. This should include, for example:

  • Communicating EDDM activity and mobility levels during clinical handovers, MDT/RAG meetings, ward rounds, etc.

  • Daily EDDM Activities must be displayed in highly visible areas, eg. Posters and Bed Boards

  • Reviewing EDDM Assessment in CRS, all staff should know a patients daily EDDM activities to complete, their progress, and proactively address barriers to them completing these activities

  • Patients and their visitors should be educated on the importance of remaining active and mobile during admission, and the importance of completing their daily EDDM activities, eg. Patient information leaflets, welcome post cards, ward banners and posters

  • Introduce improvement projects and roll-out as the ‘norm’ with involvement from all multidisciplinary staff members (QIP shared approach)

    • Bed Boards

    • Lunch clubs

    • Activity hour

    • Mobile library with tea trolley

    • Activities trolley

    • Singing/music

    • Mobile wardrobe

    • Dementia & Delirium activities

Consider taking a continuous improvement approach to introducing change and sustaining it as the new way of working. For more information see the Continuous QI page!

EDDM Education and Training

Education is a continuous process. Frontline clinicians should be able to access education and training for EDDM regularly. This could take the form of:

  • EDDM Staff information leaflet/z-Card – an educational tool to summarise the EDDM approach to tackling frailty and deconditioning on hospital wards. See the Resources page for a copy!

  • AHP and Nursing Preceptorship EDDM sessions

  • Nursing Induction EDDM sessions

  • F1 and F2 doctors EDDM sessions

  • Student Placements/Education

  • An EDDM Study Day

  • Local and Regional Health Care modules 

  • The EDDM podcast – signpost staff, patients and public to listen on Spotify or Apple

  • The EDDM programme website – www.theEDDMprogramme.co.uk – signpost staff, patients and public to view

  • Patient and staff stories of success!

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EDDM Data Feedback

Providing data feedback to stakeholders and frontline staff is really important to communicate and celebrate progress and performance. The EDDM Programme focuses on two key performance indicators (KPI):

  1. Compliance with Currently I Can… (Current level of ability) score and Daily EDDM Activity setting, i.e. completion of EDDM Assessment in patient electronic record

  2. Daily EDDM Activity completion by patients

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These KPIs should be built into recurring staff meetings and progressed displayed/presented to staff on the ground to prompt continuous improvement ideas.

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The goal for the first KPI is that each patient will have their current level of Eat, Drink, Dress and Move ability and a suitable Daily EDDM Activity documented at least once per day. Without these, daily activities cannot be set and promoted with patients.

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The second KPI provides an insight into a patients current level of ability compared to their actual performance and capacity to remain active in EDDM activities whilst in hospital. It allows for a deeper dive into potential barriers to certain activities that are consistently not being completed, whether that’s eating, drinking, dressing or moving.

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On top of these key activity promotion measures, you may want to compare metrics in relation to harms (falls, pressure ulcers, DVT, etc.), length of stay, readmissions and discharge pathways pre- and post- introduction of The EDDM Programme to evaluate what, if any, impact this has had.

EDDM Promotion and Awareness 

The EDDM Programme promotion and messaging materials boost visibility and sustain momentum of quality improvement projects associated with increasing EDDM Activities in hospital. The EDDM Programme uses the EDDM brand, colours, designs etc. for consistency and recognition. Consider getting the brand onto TV screens, posters, computer screen savers, mousepads, pens, badges, videos etc. As with education, consider ward posters and banners, prompts ‘has your patient completed their EDDM activities today?’, etc. Consider games, education display boards, competitions, activities, EDDM themed events. Promote The EDDM Programme via social media! Visit the Resources page for access to some examples!

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Promotion and awareness must target clinicians, patients and visitors.

Clinicians:

  • Evidence supporting benefits of activity and mobility, preventing acute deconditioning and associated harms

  • The importance of assessing and communicating a patients current level of ability

  • How promoting daily EDDM activities with patients can help

 

Patients and visitors:

  • Benefits of activity and mobility

  • Harms of inactivity and immobility

  • EDDM activities are essential for recovery and good outcomes

  • How completing daily EDDM activities can help

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Patient Experience and Involvement 

The EDDM Programme puts the patient at the heart of care. Patient experience and involvement should be considered at every stage of The EDDM Programme. As discussed above in Step 2. it is important to involve the patient in their EDDM activty setting.  Ask the patient a few questions:

  • What can you do for yourself/do you want to do for yourself?

  • What matters to you in relation to eating, drinking, self-care/identity and movement?

  • What would make a good day in hospital?

  • What can we help you to achieve today?

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Patient feedback is also really important within the continuous improvement process of delivering The EDDM Programme. Consider using a short survey to seek patient and visitor feedback on change ideas and activity promotion as part of The EDDM Programme in hospital.

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If you have access to Patient Experience teams within your setting, reach out for support on how to best involve patients in The EDDM Programme!

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