KTPH geriatric wards see improvements as they go restraint-free
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Senior occupational therapist Giang Thuy Anh (standing, left) and senior staff nurse Siti Nur Aisyah Ibrahim with a patient at Yishun Community Hospital.
ST PHOTO: SHINTARO TAY
Follow topic:
- KTPH's geriatric wards marked one year without physical restraints, including vests and limb restraints, improving elderly patient care.
- Restraint-free care led to greater patient mobility, reduced refusal of care by 82%, and less agitation, alongside higher staff empathy.
- Over 500 staff trained in Humanitude adopted alternatives like therapy and pressure mats, improving patient well-being; NHG Health plans wider adoption.
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SINGAPORE - A move by Khoo Teck Puat Hospital (KTPH) to improve the quality of care for elderly patients has hit a milestone, with all five of its geriatric wards marking one full year without using physical restraints in August.
These include body vests, as well as arm and leg restraints, which are used to prevent patients from harming themselves or others, stop them from removing medical devices such as catheters, and to protect them from falls.
The move to go restraint-free has shown results, with patients showing greater physical mobility and an 82 per cent reduction in refusal of care, said KTPH, a hospital under the NHG Health public healthcare cluster.
“Patients also demonstrated higher levels of interaction and decreased agitation,” the hospital said in a statement on Dec 9.
Hospital staff, meanwhile, showed greater empathy for patients and a 20 per cent decrease in self-reported burnout, it added.
KTPH first began avoiding the use of restraints with the establishment of its Care for the Acute Mentally Infirm Elder ward for patients with dementia in 2012. Extending this approach to all of its geriatric wards, which have about 160 beds, marks a significant expansion of this initiative.
Geriatric wards are typically for patients with diseases that affect seniors specifically, such as dementia.
KTPH senior consultant geriatrician Philip Yap said that frail seniors make up more than half of the patients at the hospital.
Of those in the geriatric wards, up to three-quarters have cognitive impairment in the form of dementia or delirium, and many also struggle with depression and agitation, which leads to them not cooperating with healthcare workers and refusing care, he said.
The task-oriented nature of work at the hospital means staff are often unable to take the time to get to know patients and their preferences, he added.
While restraints may ensure the physical safety of such patients, they can also make patients more aggressive and less likely to accept care, he said.
To ensure KTPH staff know how to care for elderly patients with complex needs, more than 500 employees, primarily nurses, were trained in Humanitude – a care methodology that aims to improve the quality of life for those with dementia by focusing on respect, empathy and connection.
Rather than using restraints, the hospital found other solutions.
These included the use of pressure-sensing mats that send out alerts when patients try to get out of their beds.
Different types of therapy – involving music and movement as well as horticulture, with plants brought to the bedside of patients
Familiarity with their patients’ personalities also means nurses are able to work with their behaviours, rather than restrain them, said senior staff nurse Siti Nur Aisyah Ibrahim.
“We’ve had cases where patients with dementia were restless and preferred to walk around. Our nurses found creative solutions – inviting them to join meetings or sit with us while we did administrative work,” she said, noting that this kept seniors engaged rather than isolated.
Caregivers are also allowed to stay with their loved ones outside visiting hours and overnight.
Madam Foo Soon Leng – who serves as an eldercare companion at KTPH, looking after the socio-emotional needs of patients with conditions such as dementia – described the restraint-free approach as “thoughtful and compassionate”.
Her late parents, who both received care at the hospital’s geriatric wards before their deaths, were supported with “warmth and patience”, she said.
“Allowing elderly patients non-restrictive movement and treating them with respect helps them stay calm and comfortable,” said the 72-year-old retiree.
Restraints will still need to be used should patients become violently aggressive or reject life-saving resuscitative care. But Associate Professor Yap said that this has not happened in the past year.
Over the next three years, KTPH will expand the Humanitude approach to 10 non-geriatric wards, to better support patients aged 65 and older.
NHG Health group chief nurse Yong Keng Kwang described achieving a year without the use of restraints as “remarkable and inspiring”.
He added that the aim was to spread the practice to the other NHG Health institutions in due course.
Prof Yap said that other hospitals have also begun introducing restraint-free practices at some of their wards.
“What we have done... is to enhance care in a more personalised manner, to go beyond safety and risk management to securing the well-being of these patients,” he said.
