'Magic table' makes washing up more convenient, process for cataract surgery is improved and waiting time for beds is reduced

Just add a little 'magic' to that trademark tender loving care from nurses, and patients will thank them for it.  That about sums up one of the ideas shared when nurses across the SingHealth cluster of institutions got together.

Nurses at Ward 44 of Singapore General Hospital (SGH) had come up with what they dubbed the 'magic table', to help patients with mobility issues to, say, brush their teeth without leaving their beds.  The SGH nurses discussed their innovation at the health-care group's Quality Convention yesterday.  The convention showcased 72 initiatives that improved patient care.

SGH's Ward 44 caters to the orthopaedic surgery and rehabilitation medicine departments. About 70 per cent of their patients have mobility difficulties or are at risk of falls.  Its magic table, a mobile washing station, was put together after nurses found that much time was spent each morning to help patients to and from the bathroom.  'It helped free the nurses' time and let them perform other duties and promote patients' independence,' said nurse clinician S. Vasuki, who headed the project.

A table with rollers was modified to include a mirror, large plastic water containers, cup holders and a towel rack.  The set-up is then wheeled to a patient's bedside for morning routine activities such as washing up and brushing of teeth.

Since then, ward nurses have reduced the time needed to assist patients in washing up by 60 per cent, from an average of 29 minutes per patient to 11.5 minutes.  The magic table has proven a boon for Madam Ngiam Seow Yee, 50, a double leg amputee, since she was transferred to Ward 44 last Monday, following an infection in her left stump.  'In the past, everyone needed the bathroom in the morning and it led to a long wait. By the time I got back, my breakfast would be cold,' the housewife said.  'This table is more convenient and I get to enjoy my breakfast while it's still piping hot.'  There is now just one magic table but Ms Vasuki hopes to see its use extended across the hospital.

An idea from the Singapore National Eye Centre (SNEC) - to improve the cataract surgery process for patients - was also trotted out at the convention.   Nurses there came up with a special pupil ruler and a pupil dilation chart. These now help ensure that a patient's pupil has dilated to the necessary size prior to surgery.  In the past, when the nurses used eye drops to dilate the pupil 11/2 hours before surgery, the pupil size was measured only when the patient was in the operating theatre.

Associate Professor Chee Soon Phaik, a senior consultant at SNEC's cataract service department, said: 'If the patient's pupil is inadequately dilated on arrival at the operation room, we resort to using more potent eye drops that may have side effects.  'Sometimes we even have to inject medication or use pupillary expansion devices. All these make surgery more complicated and costly.'
The chart now enables nurses to check the progress of dilation at regular intervals prior to the patient entering the operating theatre.  More medication may be administered only if needed.  Checks are done with the pupil ruler: a small torchlight and a pupil gauge, for nurses to measure the pupil size.  This pupil ruler was specified by the nurses at SNEC to suit their needs. An external vendor supplied the device. Each nurse in the eye centre is now given one such ruler.  SNEC sees about 50 people a day for cataract surgery.

Meanwhile, nurses at the National Heart Centre Singapore (NHCS) have implemented new ways to cut waiting times for patients who have to be admitted into the wards.  The NHCS has a high bed occupancy rate, and new patients often have to wait for others to check out.  But now, patients who are due to check out and can leave their beds earlier are asked to wait in special transit lounges for their families to pick them up.  The lunch hour of its cleaning staff has also been shifted earlier. Cleaning staff previously had their lunch at 11.30am. But many patients also checked out around this time.  The result: Beds were empty but cleaning staff were not around to remake the rooms.  These staff now take their lunch breaks at 10.45am. Nurses too now pitch in to help remove dirty linen.

Since then, the number of patients who have been admitted in less than three hours has increased from 66.3 per cent to 90 per cent.  SingHealth's group chief executive Tan Ser Kiat said: 'Each project demonstrates how staff think out of the box to enhance the level of clinical care and service delivery for the benefit of patients.'