Friday, 23 November 2012

Hospitals ready for the elderly

Singapore hospitals are undertaking big renovation projects - Tan Tock Seng Hospital is spending more than $30 million - to meet the demands of a rapidly ageing population
By Ng Wan Ching, The Straits Times, 22 Nov 2012

At four newly renovated class B2 wards in Tan Tock Seng Hospital (TTSH), each ward cubicle of five beds now has its own nurse's station.

This means nurses assigned to these stations have a direct line of sight to their patients.

Previously, there was only one central nurses' station in each ward. This station will remain.

The new configuration means nurses can see their patients better and can respond to patients sometimes without the need for bell calls. It has resulted in 14 per cent fewer bell calls since the renovated wards were completed in September.

When the patients do have to press their bells, the nurses' response time has improved by 13 per cent, said the director of nursing at TTSH, Mr Yong Keng Kwang.

Also, fewer patients are falling when getting out of their beds to look for a nurse. TTSH renovated one of the wards as a pilot project a year ago. Just one fall a year was recorded in that ward - much fewer than six a year in other wards.

And nurses find they are getting more time to spend with their patients. Direct patient care has gone up to 18 per cent of a nurse's time during a shift, compared with 10 per cent before the renovation.

"Our target is to increase direct patient time to 50 per cent of a nurse's time at work," said Mr Yong. The hospital aims to do this without increasing the number of staff.

All of the remaining 29 wards at TTSH, including nine private wards, will be upgraded along the same lines as the four newly renovated class B2 wards. Two are currently in the process of being renovated.

Mr Yong said: "It took a bit of work and persuasion, but in the end, the hospital management saw it fit to invest more than $36 million to build such 'wards of the future'."

All over Singapore, hospitals are gearing up to provide better care to a rapidly ageing population.

Almost a third (32 per cent) of Singaporeans will be older than 65 years old by 2050, up from 9 per cent in 2010.

Hospitals being built now are taking that into consideration in their design, while other hospitals are undertaking big renovation projects to improve their wards.

The call bell system at TTSH has also been improved. Patients now have a three-in-one control that also allows them to control the light and ceiling fan over their beds.

Other changes include more toilets in the wards for patients, more fans to circulate the air and padded flooring so patients will not hurt themselves badly if they fall.

Each nurse's station at TTSH is equipped with a computer, telephone and supplies such as alcohol swabs, diapers and manual blood pressure sets.

Ms Wong Mui Peng, deputy director of the nursing service department at TTSH, said: "This means nurses don't have to go running off to a central supply room every time a patient needs something. It saves time and the distance they have to walk every day."

Nurses who usually walk up to 8km during their nine-hour shifts are now walking half that distance.

The renovations of B2 and C class wards are expected to be completed by 2014. Renovations for B1 and A class wards will start after that.


Similar improvements are being made at other restructured hospitals.

At the National University Hospital (NUH), a nurse's station is also being added to each cubicle in every general ward. Each ward has an average of seven cubicles. A B2 class ward cubicle has six beds and a C class ward cubicle has eight beds.

This will allow the nurses to respond more swiftly to patients' needs, said a hospital spokesman.

Basic items such as gloves and aprons will also be kept at the station so nurses do not waste time running to the store to get such frequently used essentials.

Each station will also have a sink to make frequent handwashing convenient.

Ward renovations will include the addition of a tutorial room for teaching and training nurses.

Nine of the 17 general wards have been renovated. The remaining wards are expected to be renovated in the next four years, said adjunct Associate Professor Lee Siu Yin, the director of nursing at NUH.

Improvements at the Singapore General Hospital will also be undertaken over the next few years. These include remodelling the wards and also revamping the signs throughout the hospital to help visitors find their way around, said its deputy director of operations, Mr Kevin Low.

Each cubicle in every ward will have its own toilet, shower, satellite nurse station and storage cupboards.

"This will greatly reduce the cross movements for the nurses and patients," said Mr Low.

At the two-year-old Khoo Teck Puat Hospital, many of these features are already in place.

In addition, the hospital has two geriatric wards with their own gym so elderly patients can do simple exercises without having to go to the clinic, said its spokesman.

The beds also provide pressure relief equivalent to a low-grade pressure-relieving mattress.

Pressure-relieving mattresses can make a person more comfortable in bed and may help prevent and treat pressure sores.

"The beds can be lowered to heights that are lower than normal to reduce fall and fall-related injuries," said the spokesman.

Next to the geriatric ward is a soothing garden.

Even the colour tones have been chosen carefully. "We do not use harsh or dark tones, but rather soothing colours that help to calm patients," said the spokesman.

The hospital is also piloting a programme in the care of elderly patients with mental impairment.

It offers music therapy in the dementia unit to provide a non-drug form of behavioural management for patients with difficult and challenging behaviour.

There is also a restraint-free policy in the unit to maximise the use of other forms of behavioural management. This provides vulnerable patients with more autonomy, said the spokesman.

Moves to improve care of the elderly are also being made at Changi General Hospital, which together with St Andrew's Community Hospital, is building a $200 million integrated care wing, to help patients make the transition back to daily life.

Built to feel like home, the Integrated Building will include a Geriatric Day Hospital, and Centre for Independent Living where patients can work on gaining independence in the work and home environment.


Doctors said these are important developments for the future.

Dr Veerendra Chadachan, adjunct assistant professor and consultant at the TTSH general medicine department, said: "The new wards are redesigned for the long-term benefit of patients. Not only do we want to provide a more conducive and healing environment for patients, we are also looking at having a well-coordinated and efficient care team."

Dr Eugene Fidelis Soh, TTSH's chief operating officer, said: "The renovations will make it easier to do the right thing for our patients. It is sometimes the simplest improvement that can make the most difference."

Work has become more efficient and therefore satisfying, said Ms Catherine Hu, 24, a senior staff nurse.

"With the new design layout, the nurses get a better view of the patients in the ward. We can monitor patients more closely and ensure their safety at all times. Working in these new wards helps to bring home the true meaning of nursing. I feel happy just knowing that I am able to do more for my patients," she said.

TTSH patients like the new wards too.

A patient who wanted to be known only as Madam Soh, 77, said she liked the layout of the newly renovated B2 class ward that she stayed in.

"The nurses are nearer to me, I can see them clearly and they are more attentive. I can also go to the toilet on my own as it is nearer," she said.

Mr Mohammed Ahail, 62, who stayed in a newly renovated B2 class ward for a few weeks, said: "I felt comfortable. The wards are brighter and cooler. They become like 'medicine' to the patient, helping them to heal."

Focus on the silver tsunami

The two newest hospitals being built in Singapore have an eye firmly on the future, especially where the care of the elderly is concerned.

The 700-bed Ng Teng Fong General Hospital in Jurong, slated for completion in 2014, will incorporate some design firsts.

For instance, every patient will have a window to improve ventilation, comfort and privacy.

This concept will be realised not only in the subsidised and private wards, but also in the intensive care units and high-dependency beds to promote healing for critically ill patients, said a spokesman for the hospital.

Studies have shown that access to natural light, which reinforces the natural circadian rhythm of the patient, can aid in patients' physical recovery and improved mental state in health-care settings.

All wards are fan-shaped and simulation studies have shown that airflow through the new wards will be twice as fast as that in conventionally shaped wards, said the spokesman.

The east-west orientation of the ward towers, where the subsidised wards are located, will take advantage of prevailing wind conditions to promote better ventilation.

Patients in private wards will have the choice of an air-conditioned room with an individual thermal control or a naturally ventilated environment.

To be ready for the silver tsunami, elder-friendly features have been incorporated within the design, including the use of colour contrasts between the floors and the walls and prominent signages with large letterings or icons to aid the elderly with poor eyesight.

There will be toilet and shower facilities within each cubicle of six to eight subsidised patients. This also allows for closer supervision by nurses so they can provide assistance and prevent falls.

On every floor, there will be two central stations used by health-care professionals which will be supported by five nurse's stations. This means that each nurse's station will attend to a cubicle of six to 12 subsidised patients.

At the nurse's stations, staff can access patients' records, order tests and review results by accessing electronic medical records.

This is the platform for clinical, nursing, laboratory, rehabilitation and other services to be coordinated in a seamless manner, said the hospital spokesman. Nurses will be able to monitor the patients more closely and patients benefit from greater interaction with doctors, nurses and other staff, the spokesman added.

In each ward, there will also be clean utility cupboards near the ward cubicles for storage of often-used consumables such as diapers and alcohol swabs.

Even the emergency department at the hospital will be elder-friendly. It is designed for faster care, shorter waiting times and is able to accommodate an anticipated increase in patient load. Critical patients can be transferred to the operating theatres, intensive care units, radiology unit, inpatient wards and other procedural services via dedicated lifts to ensure they receive appropriate treatment with no delay.

With its proximity to Jurong Island, the emergency department is also designed to be trauma-ready to step up to any crisis involving mass casualties or hazardous materials.

Ensuring that the entire 700-bed Sengkang General Hospital will be elder-friendly is imperative, said Professor Christopher Cheng, the provisional chief executive officer of Sengkang Health, which will run the hospital slated to open in 2018.

Currently in the planning phase, it has the benefit of learning from other restructured hospitals and public service organisations, adapting and fine-tuning ideas towards making it an "aged-friendly hospital", he added.

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