Proactive care of patients reduces call bell usage by 20%

NUH deputy director of nursing Ng Sow Chun with the paper clock (right) that hangs outside each ward cubicle. After each visit, the nurse shifts its hand two hours ahead to remind the next nurse when she has to visit.
NUH deputy director of nursing Ng Sow Chun with the paper clock (right) that hangs outside each ward cubicle. After each visit, the nurse shifts its hand two hours ahead to remind the next nurse when she has to visit.ST PHOTO: MARK CHEONG

NUH's structured system also allows nurses more time to do other tasks

WHEN lorry driver Ramlan Abdul Hamid landed in hospital with a chest infection earlier this month, he was struck by how caring the nurses were.

"They were very friendly and took the time to come around a lot," said the 50-year-old, who was warded at the National University Hospital (NUH) for five days.

A proactive approach at the hospital, where nurses visit patients on a set schedule to talk to them and anticipate their needs, is working well for patients, who are reaching for their call buttons less. And nurses, used to being rushed off their feet, have found that their workload has eased as well.

It works like this: Instead of attending to patients mainly when it is time to give medicine or when they ask for help, the nurses go to them every two hours for a three- to five-minute chat, where they explain medical procedures and offer help for toileting needs, among other things.

A paper clock hangs outside each ward cubicle and, after each round of visits, the nurse moves its hand two hours ahead. This reminds the next nurse what time she has to visit.

Since this approach was rolled out hospital-wide last year, the number of call bells pressed has gone down by one-fifth on average, allowing nurses to perform other tasks, such as paperwork and preparing medicine, more efficiently.

For instance, a team of 12 nurses looking after 44 patients used to answer about 100 call bells a day, but now sees to fewer than 80. "This approach decreases interruptions so we are able to concentrate on each patient better," said senior staff nurse Mao Liang Cui, 30.

Said Mr Ramlan: "When you know the nurse is coming around soon, you don't need to press the bell so often. They also introduce the next nurse after their shift, so the care feels more personal."

Deputy director of nursing (nursing quality) Ng Sow Chun, who introduced the scheme as part of ongoing efforts to transform bedside care, said she had learnt of the approach through medical literature, as it had shown good results in the West.

But an NUH pilot with two wards in 2013 was not all smooth-sailing.

"It takes time to change mindsets, from reactive to proactive," Ms Ng admitted. "And when it gets busy, people tend to forget."

So she introduced the paper clock as a visual reminder, among other measures.

Yesterday, Ms Ng got international recognition for her efforts. She was awarded the prestigious Practice of the Year award from the Association for Patient Experience, a non-profit organisation sponsored by the Cleveland Clinic in the United States. NUH is the first institution in Asia to receive the award.

When contacted, the Singapore General and Khoo Teck Puat hospitals said they have similar practices in their wards.

Meanwhile, Tan Tock Seng Hospital started decentralising nurses' stations several years ago, so that they can tend to patients' needs more efficiently. This has resulted in a 14 per cent drop in call bell usage, the hospital said.

kashc@sph.com.sg