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About Jacqui

Jacqui Holmes MCSP

MSc Physiotherapy (pre-registration) / BSc Medical Sciences

Jacqui Holmes obtained a first class BSc in Medical Sciences with year in industry from the University of Leeds in 2016 after which she studied MSc Physiotherapy (pre-registration) at the University of Birmingham and qualified as a Physiotherapist in 2018. Remaining in Birmingham, Jacqui gained clinical experience as a Junior and Senior Physiotherapist across a variety of specialist areas within the Queen Elizabeth Hospital Birmingham before specialising as Team Lead Physiotherapist for Health Care of Older People in 2022.

In April 2024, Jacqui moved into an Operational Lead role for Inpatient Physiotherapy at Kingston Hospital NHS Foundation Trust and is currently leading on several projects associated with the Trust’s 2024/25 Quality Priority to prevent deconditioning across acute and community settings. Jacqui is passionate about improving care for frail older adults, with a particular focus on preventing hospital acquired deconditioning and reducing the harms associated with bed rest and immobility in the acute setting. Her primary focus currently is around embedding Eat, Drink, Dress, Move into routine care to drive activity and mobility promotion.

Jacqui’s work to prevent hospital acquired deconditioning began in November 2022 when she engaged in the Emergency Care Improvement Support Team (ECIST)’s #ReconditionTheNation initiative. Her work so far has been recognised across the country, with Jacqui speaking on a number of regional, national and global webinars and podcasts to share learning and improvements in relation to the national #ReconditionTheNation and #EndPJparalysis social movements.

Jacqui’s work was also awarded a high commendation in the ‘Improving Health Care for Older People Initiative of the year’ category at the HSJ Patient Safety awards in 2023 and she was personally invited to attend the 7th Annual Johns Hopkins Activity and Mobility Promotion (JH-AMP) Programme Conference in Baltimore, USA.

Jacqui has also released a new educational podcast for health care staff and students, focused on the principles of ‘Eat, Drink, Dress, Move’ to prevent deconditioning – find out more heading to the theEDDMpodcast page on this website!

Alongside her clinical and quality improvement work, Jacqui is heavily involved in the education and training of staff across the wider multidisciplinary team, leading on the production and delivery of Frailty and Deconditioning training sessions and study days. Jacqui's Poster on 'Education and Training on Eat Drink Dress Move (EDDM) Principles to Prevent Deconditioning' was selected as Winner of the 'Education and Training' category in the 2024 HSJ Patient Safety Congress Poster Competition. Take a look at the winning poster here.

Jacqui is also embarking on an exciting journey with Training Made Easy who provide a variety of professional development training courses. Find out more about Jacqui’s ‘Fighting Frailty and Deconditioning in the Acute Setting’ Online Course with Training Made Easy here.

History of Eat, Drink, Dress, Move

In November 2022, the Emergency Care Improvement Support Team (ECIST) launched their mission to #ReconditionTheNation off the back of the success of East of England's 'Deconditioning Games'. The aim of #ReconditionTheNation was to:

Improve patient outcomes by prevention of deconditioning.
Improve staff wellbeing by introducing joy in their work.
Improve the health of the nation by introducing wide scale change across health and care sector.

Jacqui was really inspired by this. She wanted to engage and encourage her entire Health Care of Older People (HCOP) Multidisciplinary Team (MDT) to consider small improvement ideas that could tap into promoting reconditioning with their patients whilst feeding into this National #ReconditionTheNation initiative. So, they got involved! Jacqui and her team implemented small improvement projects including: Frailty and Deconditioning Training, 'My Movement Boards', Group ward-based exercise classes, MDT Bed-Boards, Patient information leaflets and posters. Jacqui shared her success stories across the #ReconditionTheNation learning and sharing platforms both regionally and nationally. She was also invited to speak about her work at the 2023 and 2024 #EndPJparalysis Global Summit!

As her work continued to expand, Jacqui thought it was the right time to integrate her work and ideas to refresh previous attempts to get ‘Eat, Drink, Dress, Move’ launched at UHB NHSFT. So, she set about re-branding and re-launching 'Eat, Drink, Dress, Move' to further raise awareness of deconditioning and share the success of her team's reconditioning project efforts. UHB initially launched this as a therapy-led approach to care but, whilst Jacqui appreciated reasons for a therapy-led initiative, she felt it was much better to re-launch this as a multidisciplinary approach to care, in which preventing deconditioning was everybody's responsibility, not just therapists.

Evidence suggests that acute deconditioning should be prevented through a shared responsibility among staff, culture change and goal-driven care which reinforces positive feedback on performance to increase physical activity in patients. The EDDM Project aims to do just that; support patients to actively participate in their recovery by eating and drinking well, managing self-care and dignity in getting washed and dressed in day clothes and footwear, and moving and being as active as possible in hospital.

Jacqui spent time seeking feedback on her new brand design, creating an 'Eat, Drink, Dress, Move' logo which represented the key messages she wanted to communicate:

All Eat, Drink, Dress and Move elements must be promoted at all times by all staff, which is why the design is circular with no start or end.
Each Eat, Drink, Dress and Move element can influence and impact on one another, hence why you see each word placed around the circle, each element leading into another.
Care should be patient centered, which is why you see a person at the heart of the logo in the center.

Once the logo was designed, Jacqui really promoted this brand through everything she did. She funded EDDM badges and created EDDM Certificate's of Excellence to reward staff for their efforts to embed EDDM principles into their work to prevent deconditioning. She developed and delivered an EDDM Study Day to further educate MDT staff on the principles of EDDM and the roles we can all play in promoting this in our work. Jacqui worked closely with Matrons and Ward Managers to identify EDDM Champions for each ward, and she continued to celebrate and share the success of her team and others who were embracing the brand and the principles behind it.

The more Jacqui spoke about her work on various platforms, the more other NHS Trusts began to engage and enquire about using and adapting the EDDM brand in their own clinical settings. This included Kingston and Richmond NHSFT, who worked alongside Jacqui to enhance their own EDDM brand and create the version you see today! Jacqui wanted to harness and utilise this momentum and engagement from the wider national community of people working to prevent deconditioning, and so she created TheEDDMpodcast as a platform on which others could learn about, share and celebrate successful ideas and projects which build upon EDDM principles.

And so, here we are! If you'd like to find out more about Jacqui or her Eat, Drink, Dress, Move journey please don't hesitate to get in touch via the social media buttons/tags, email address at the bottom of this page, or TheEDDMproject contact page!

TheEDDMproject

The beauty of TheEDDMproject is that it can be moulded, adapted and implemented however best fits your setting and service, as long as the following key principles are promoted throughout any interventions or changes introduced to prevent deconditioning: a shared responsibility among multidisciplinary staff to deliver goal-driven care which reinforces positive feedback on eat, drink, dress and move activities to ensure risk of malnutrition, dehydration, cognitive decline, functional deterioration and immobility are proactively addressed.

The successful implementation and sustainability of TheEDDMproject relies on taking a systematic approach, utilising quality improvement tools and methods. Taking inspiration from the Johns Hopkins Activity and Mobility Promotion (JH-AMP) Programme's 8-step framework*, the success of TheEDDMproject requires:

Organisational prioritisation / stakeholder engagement to recognise TheEDDMproject as the approach to prevent deconditioning
Systematic measurement, communication and documentation of daily EDDM Activities
Proactive identification and mitigation of barriers to EDDM activity promotion
Recognition of interprofessional roles and responsibilities in EDDM activity promotion
EDDM and Deconditioning Education and Training
Integration of EDDM into current workflow
EDDM activity promotion data feedback
EDDM Promotion and Awareness

TheEDDMproject at Kingston & Richmond NHSFT

Teams from Kingston & Richmond NHS Foundation Trust and Your Healthcare (YHC) are embarking an EDDM project of their own!

Organisational prioritisation: Kingston and Richmond NHSFT have identified preventing deconditioning as a quality priority and recognise TheEDDMproject as the approach to prevent deconditioning. TheEDDMproject at Kingston Hospital (KHFT) and Teddington Memorial Hospital (HRCH and YHC) aims to:1. Increase mobility and activity promotion amongst staff for patients on their ward2. Improve patient engagement in mobility and activity3. Improve communication regarding current mobility and function between MDT members.

Systematic measurement, communication and documentation of daily EDDM Activities: TheEDDMproject utilises a newly developed Activity Promotion Tool to align daily Eat, Drink, Dress and Move Activities with a patients' current level of function or capabilites. Appropriate daily activities are then set with patients, who are encouraged and supported by staff to achieve these every day whilst in the acute hospital or bedded community units. The idea is that patients maintain their pre-admission routine, level of mobility and function by engaging in more meaningful and purposeful daily activities - just like they would at home. Daily EDDM Activities are written on an EDDM 'Today, I can...' Bed Board within the patients bed space, so they are prompted to complete these activities every day.

Examples of Daily EDDM Activities include:

Eat - lunch in shared dining space, sit in chair for all meals, independent 2x daily mouthcare

Drink - make own cup hot or cold drink from hydration station, refill water jug x2

Dress - strip wash and mouthcare sat at sink in bathroom, wear own clothes

Move - mobilise length of bay x3 with frame and supervision, complete seated exercises independently

By focusing on what patients can and should already be able to do, and communicating this through EDDM activities, staff will hopefully feel more confident and comfortable in encouraging patients to get up, move and do more for themselves from day 0! Since the impact of deconditioning can be seen within just 24 hours, it is important to discourage bed rest and encourage normal routine and function as soon as we can during the inpatient journey.

We, as health care staff, do a lot for our patients… we make and bring hot drinks and meals to them, we provide them with a wash bowl to wash in the bedspace, there often isn’t access to cognitive activities like watching the TV, reading books or playing games, and we limit the areas to which they can mobilise. Whilst doing things for patients may seem kind, we are actually removing the need for them to engage in purposeful activities – like getting up, washed, dressed and into the kitchen to make breakfast, lunch, dinner, or a hot drink – we are removing their independence and their need to remain active in hospital. This leads to patients adopting that ‘sick role’, staying in bed and becoming more and more inactive. Which then results in acute deconditioning and associated harms.

By involving patients in setting their own daily EDDM activities, alongside activity and mobility promotion from staff, the hope is that 1) patients no longer worry about what they can or cannot do whilst in hospital or bedded community units - the permission and expectation to remain as active as possible is already there from the moment they arrive, and 2) staff stop doing too much for patients and instead encourage more independence where possible.

Proactive identification and mitigation of barriers to EDDM activity promotion: Staff are provided with the opportunity to feedback on barriers to activity promotion through an attitudes and beliefs staff survey which considers the impact of common barriers around documentation, communication, environment, space, equipment, time, staffing and patient factors whilst allowing staff to elaborate on any other barriers they face. This means, as a group of multidisciplinary staff, we can identify and address these proactively to ensure we are all able to promote EDDM activities.

Recognition of interprofessional roles and responsibilities in EDDM activity promotion & Integration of EDDM into current workflow: Teams are working together to define roles and responsibilities amongst the multidisciplinary team when it comes to activity and mobility promotion. This also includes how to integrate EDDM into current workflow so as not to create more work or tasks for any one health care professional. For example, nurses, medis and therapists should be able to identify a patients current level of mobility and activity through information gathering with the patient and/or next of kin. Nursing staff can support patients to maintain that level of mobility for low risk patients, whilst therapy staff can assess and advise on the more complex mobility and functional needs of more complex patients. Medics can support by removing barriers to activity where possible including pain, lines and attachments. To ensure equal importance is placed on mobility/functional optimisiation as it is for medical optimisation, EDDM Activities should be discussed and documented in MDT/Board Rounds and care plans.

EDDM and Deconditioning Education and Training: Staff have developed a package of education tools and resources to increase awareness of deconditioning and how EDDM can tackle it. These tools range from staff information leaflets, to 5-min or 30-min EDDM education sessions, to a whole EDDM study day.

EDDM activity promotion data feedback: TheEDDMproject measures % patients with daily EDDM Activities set, and % patients who complete their daily EDDM Activities. This is fed back to front line staff to identify areas of improvement and celebrate successes.

EDDM Promotion and Awareness: With support from the Communications team, awareness of TheEDDMproject is promoted and celebrated through regular updates in bulletins and emails, EDDM stickers, badges and pens, EDDM certificates and pledges.

We are at the very start of TheEDDMproject at Kingston Hospital and Teddington Memorial Hospital so watch this space for updates on our progress!