A Nursing Journey Towards Excellence CELEBRATING A DECADE OF DISCOVERY & GROWTH

Transcription

1 A Nursing Journey Towards Excellence CELEBRATING A DECADE OF DISCOVERY & GROWTH

2 Over the last decade, NUH nursing has been pushing the boundaries of nursing practice. We have transformed the delivery of nursing care in order to meet increasing demands in healthcare. Even as the professional landscape undergoes unprecedented transformation, NUH Nurses stay true to the basic tenets of nursing. We continue advocating for our patients with great humility and integrity. Our Nursing Vision, Mission and Philosophy illuminate the values and beliefs that ground our practice, and are congruent with the hospital s vision and mission. SPECIALLY D TO NUH For your co commitment an You h heartfelt Nursing Vision Nurses in NUH, as one, are committed to delivering professional and personalised nursing care to our patients. Nursing Mission We are committed to specialised nursing care of the highest quality, built upon continuous improvement as well as evidence-based practices within an environment of nursing research and education. Nursing Philosophy We believe that our Nurses have the primary responsibility of providing personalised, specialised and safe care to our patients. We believe in the professional growth of our Nurses in order to achieve the full potential of our staff. We believe in working in collaboration with all concerned for the interest of our patients.

3 EDICATED NURSES ntributions, d compassion, ave our thanks. CONTENTS 04 Message from the Chief Executive Officer 05 Message from the Director of Nursing 06 Transformational Leadership 07 Empowering Nurses 10 Towards a Model of Professional Practice 12 Innovating and Improving Care 15 Envisioning the Future

4 MESSAGE FROM THE CHIEF EXECUTIVE OFFICER In the last 10 years, we have seen nursing at NUH transformed, in the nurses role in the delivery of patient care and their professional development. Today, nurses partner medical and allied health professionals to develop care plans for patients. There are ample opportunities for professional and career development through the many new and diverse roles and career tracks created for nurses. Our Advanced Practice Nurses count among the pioneers of their cohort in Singapore. Our nurses continue to break new ground and lead in the way we deliver care with innovation and through research, and the adoption of evidence-based practices for our patients. However, one thing remains amidst the changes the care and warmth that nurses bring to our patients and your steadfast commitment to making a difference for those in need. On behalf of the rest of us at NUH, I congratulate all our nurses for your achievements and thank you for all your contributions to patient care. We are proud of you, NUH Nurses! Adjunct Associate Professor Joe Sim 04

5 MESSAGE FROM THE DIRECTOR OF NURSING My Fellow Nurses, We have had 10 very exciting years, and have achieved much. SARS was a national crisis and we supported each other to overcome it with great determination and an unyielding spirit. We then soldiered on to achieve excellence via the Joint Commission International Accreditation, the American Nurse Credentialing Center Accreditation for Nursing Education, and the Trendcare Patient Acuity System. Recently, we also initiated the Nursing Rapid Improvement Event to Transform Care at the Bedside, and more. These were memorable moments when we rallied around each other, when we celebrated triumphs together, and built strong bonds in the process truly special moments which should be captured permanently, so that they can be shared with many, and for years to come. Indeed, as we look back, we have much to be proud of. However, we will not rest on our laurels but continue to march on to bring Nursing to an even higher plane and to do the profession and NUH proud! I hope you will enjoy this book and the fine collection of our works. Adjunct Associate Professor Lee Siu Yin 05

6 TRANSFORMATIONAL LEADERSHIP Who are the transformational leaders at NUH? From the Director of Nursing to nurses by the bedside, nurses at NUH lead the system as they collaborate with partners across professions to bring about improvements in patient care. They are the catalysts for positive change at NUH. NUH Nurses lead a wide range of quality improvement initiatives with a high degree of leadership and operational agility. From simple workflow changes, 6S projects in individual wards to Rapid Improvement Events or Root Cause Analysis, NUH Nurses make a significant impact on processes and practices at ward, department and hospital level. Leading Hand Hygiene Awareness Nurses play a key role in promoting and advocating hand hygiene (HH) in the patient care areas. The adoption of the World Health Organisation HH Improvement Strategy has boosted compliance rates steadily from 69% in 2009 to 74% in In fact, NUH Nurses HH compliance remains the highest amongst all health care professionals. Transforming Nurses Work Environment: Safe and Patient-Centric Design In 2010, when plans kicked in for Psychiatric Ward 12 to be relocated to Ward 33, the Nurse Manager led a team on a Process Preparation (2P) session to redesign the new ward. The result? Inefficient work processes were eliminated, and valuable nursing resources were directed towards more value-added patient care activities. Nurses are strong advocates of Hand Hygiene. Nursing Rapid Improvement Events (RIEs): Transforming Care At The Bedside In 2010, we embarked on a series of RIEs. Nurse Leaders resolved to improve patient care by increasing direct nurse-patient contact time from a baseline of 31% in 2010 to 60% in With the commitment of all levels of nurses, the Nursing RIEs reaped significant improvements in work processes and care delivery. Pilot wards, Wards 53 and 54, saw an increase in direct nurse-patient contact time from the 31% baseline to 49% in June Simultaneously, teamwork and communication also improved from 61% to 74%. The redesigned Nurse Report Room enhances safety because patients remain in the nurses view during shift handovers. Section of the ward transformed to a place for patients to relax and recuperate Active implementation of Clinical Track with the inauguration of the Nursing Speciality/Sub-specialty Committee. Picture of Service implemented in all Wards Embarked on Job Redesign Project for Nurses

7 EMPOWERING NURSES NUH Nurses are engaged and involved in decision-making, particularly in matters that impact their practice and work environment. This participatory approach in decision-making gives nurses greater autonomy in making decisions in both clinical and professional practice. Ground nurses have access to a variety of platforms and committees that provide them with channels of dialogue and feedback. Besides leading in their own ward or within the department, NUH Nurses also feature prominently in hospital work improvement projects. Through teamwork and collaboration, nurses engage in innovative solutions that often have significant impact on hospital operations. Nursing Quality Framework: Every Nurse Counts Revamped in 2005, the Nursing Quality Framework adopts an inclusive approach in nurturing a culture of continuous improvement within Nursing. This is done via a well-structured and coordinated quality improvement programme. Ward and departmentbased Nursing Standards Teams (NST) are made up of ground nurses, who contribute through the identification of practice or work challenges. They then lead the team within their unit to address issues and concerns as well as undertake projects to improve nursing quality. Some practice and process changes and projects are escalated to the unit and clusterlevel Nursing Standards Committee and the Nursing Quality Steering Committee (chaired by the Director of Nursing) for endorsement and spread across Nursing. Auto-trigger Cuts Time for Admission Nurses at the Emergency Medicine Department (EMD) used to have to make several calls before admitting a patient to the general wards. Nurses had to make between four to seven calls on average to check on the ward s readiness. In 2009, an auto-trigger workflow was implemented so that the EMD staff would be able to view updates on a dashboard screen and immediately tell when beds became vacant. This reduced time spent on phone calls and more importantly, patients wait-time for a bed. With the new auto-trigger workflow, patients wait-time for admission is reduced. Nurses make important contributions to process/ practice changes Introduced Turning Team concept to reduce Pressure Ulcer rates Commenced Singapore Nursing Board accredited Critical Care Programme 07

8 EMPOWERING NURSES NUH Nurses are encouraged to learn, grow and contribute to shaping their practice through continuing education and formal academic programmes. Resources such as the Talent Development Award, Academic Medical Development Award, Nursing In-house Programmes, are dedicated to augment the knowledge and skills of our nurses. Since FY2005, 373 deserving nurses have benefited from sponsorship for their academic pursuits. Close to $3 million has also been set aside to support nurses training and development activities in FY2012. Graduate Nurse Residency Programme: Transition to Practice Introduced in 2010, the one-year milestone programme was specially designed for graduate nurses to ensure their successful transition from nursing students to professional nurses. Besides the structured interactive workshops, the programme also features a supportive facilitation. The support aims to increase the Residents confidence and competence as they work to become competent practitioners and clinical leaders by the bedside. Simulator Laboratory For Critical Care Training In May 2009, NUH became Asia s first hospital to launch a simulated laboratory for critical care training. The 100-square feet laboratory consists of a High Dependency room and an Intensive Care Unit room (replicas of the actual set-up), as well as a seminar room with live feed facilities for practical training classes. Our first batch of Nurse Residents. Nurses get to practise and hone their skills in a simulated environment First public hospital in Singapore to achieve the Joint Commission International Accreditation (JCI)

9 From Clinical Nurses to Leaders: Roadmap for Nursing Development In 2005, a structured framework for developing potential Nurse Leaders was established. The roadmap guides the professional development of staff nurses by mapping out development plans and training activities for staff of different job grades. These programmes expose nurses to the real work they can expect to take on as future Nurse Leaders. The phased and graded exposures to their future leadership roles help prepare them for the transition. Formal Accreditation for in-house Nursing Courses As of 2012, over 3,000 NUH nurses have undergone in-house Nursing courses accredited by the Singapore Nursing Board (SNB) or the American Nurses Credentialing Centre (ANCC). These in-house courses (16 SNB-accredited and 17 ANCC-accredited) are designed and delivered based on rigorous and evidence-based national standards. Our commitment in obtaining accreditation for our key programmes demonstrate our on-going commitment to provide quality education, encourage improvement and stimulate innovation to improve patient care. National Awards Our nurses are recognised for the contributions they make to the hospital and the nursing profession. We are proud that our nurses are regular recipients of National Awards such as the Healthcare Humanity Awards, Nurses Merit Award, National Day Awards, Tan Chin Tuan Nursing Awards, and Excellent Service Award. Two of our nurses, Director of Nursing, Adjunct Associate Professor Lee Siu Yin and Deputy Director of Nursing, Dr Emily Ang, were also awarded the nation s most prestigious award for nurses President s Award for Nurses. NUH is accredited as a provider of continuing nursing education by the ANCC s* Commission on Accreditation. Our nurses - Proud recipients of the MOH Nurses Merit Award *ANCC is the world s largest and most prestigious nurse credentialing organisation. Nurses As Teachers NUH supports our nurses appointments as Adjunct Faculty Members at nursing schools in the polytechnics and universities. This allows them to participate in academic strategies and activities and contribute to the Nursing profession at large. Twelve NUH nurses are currently holding official adjunct appointments at tertiary institutions and many more are involved as guest lecturers and tutors Nursing Quality Steering Committee formed Evidence-Based Nursing Unit formed Implementation of the Friartuck Optimising Workforce Management System 09

10 TOWARDS A MODEL OF PROFESSIONAL PRACTICE At NUH, our commitment towards patients and their loved ones directs all that we do. We continually work to introduce and refine structures and systems to ensure that our nursing practice actualises professionalism, safety and quality of care. Specialty Nurses & Advanced Practice Nurses (APN) Nurses with good clinical skills have opportunities to train in their specialty of interest. Our specialty nurses render clinical care to our acute patient group and are involved in complex clinical decision-making. In particular, Master-level trained APNs are pushing the peak of specialisation, working as independent partners to the doctors in their respective areas of expertise as they diagnose, treat and manage acute and chronic illnesses (including the ordering and interpretation of diagnostic tests). NUH Nurses Perform Physical Assessment Physical assessment is an important clinical skill for nurses. It impacts clinical decision-making and allow for prompt interventions. Gaining competence in physical assessment means that NUH Nurses are equipped to identify patients clinical abnormalities that are not manifested through visual cues. Nurse performing auscultation on patient. APN Wendy Yue attending to her patient Organised the Inaugural Evidence-based Nursing Seminar Staff Development Roadmap Implemented Set up NUH Advanced Practise Nurses Development Workgroup Welcomed our first APNS Formation of JCI Nursing Workgroup Official opening of the Centre for Nursing Education First hospital in Singapore to implement the Trendcare Patient Acuity System

11 Nurse Leaders recognise the need to actively advocate for resources and formulate resource allocation plans. NUH has been an active vanguard in leveraging innovation and technology to do so. In 2005 and 2006, NUH Nursing adopted the use of the Friartuck Optimising Workforce Management System and the Trendcare Patient Acuity System to improve planning of nursing resources to better meet the needs of our patients. These initiatives have allowed us to enhance our patient care as well as improve the work-life balance of our staff. Team-Based Rostering and Handover Process Our focus on improving continuity of care for our patients has led to the introduction of team-based rostering and review of the nursing handover process. This enables our patients to be cared for by familiar nursing staff who have a good grasp of their conditions, having cared for them throughout the duration of their stay in the hospital. *Work-Life Works! (or WoW!) Fund a grant by Ministry of Manpower to facilitate the development and implementation of work-life strategy at the workplace, in particular, flexible work arrangements. Before: Nurse managers verify shift requests manually. Nurses on the current shift handing over to the next shift. Optimising Nursing Resources with e-rostering To enhance nurses work schedules, NUH Nursing embarked on an e-rostering system project backed by a $30,000 grant from the WoW Fund*. The e-bidding module allows nurses to bid for preferred work shifts in advance whilst the e-rostering module enables nurse managers to manage the rostering of nurses through a synchronised and well-managed process. Since the system was implemented in 2005, time spent by nurse managers on workforce management-related activities reduced by over 70%. Nurse managers have since been able to spend more time on patient care and other value-added work. After: Nurse managers are able to review requests online and these information are synchronised with the electronic roster Introduced one-to-one career counselling clinic with Director of Nursing Simulation Lab was set up Introduction of Nurse Rotation Scheme Nurses trained in Physical Assessment of Patients Introduction of Cubicle Training for Nursing Students 11

12 INNOVATING AND IMPROVING CARE NUH Nurses share a vision for advancing knowledge through translational and innovative research, quality improvement endeavours, and life-long learning. As strong proponents of evidence-based practice, we continually create a culture of scientific inquiry which permeates our daily work. Through these, we aim to improve the quality of care for our patients and develop new models of care that improve care for our patients. NUH s Evidence Based Unit & Evidence-Based Nursing (EBN) Seminar The Evidence Based Nursing Unit was established in May It aims to adopt evidence-based practices to deliver quality nursing care, and promote translational action research within the organisation. The department organised the inaugural Evidence- Based Nursing Seminar in Mar 2006 which saw an encouraging turnout of more than 200 participants. We were privileged to have Ms Ang Beng Choo, then Chief Nursing Officer, MOH and her team join us in the seminar. Collaborating Centre of the Joanna Briggs Institute The NUH Centre for Evidence-based Nursing, Collaborating Centre of the Joanna Briggs Institute, was established in The centre collaborates with nursing academia from NUS Alice Lee Centre for Nursing Studies (ALCNS) to advance nursing clinical studies and provide opportunities to introduce evidence-based practice to undergraduate and postgraduate students through their studies and clinical practicum. Getting the Right Dose of the Right Drug to the Right Patient at the Right Time Under NUH s medication safety initiative, the hospital set about to leverage its information technology programme to enhance its medication-use process. The Electronic Inpatient Medication Record order system and Electronic Medication Administration Record in 2008 were designed for this purpose. These systems were integrated with the Inpatient Pharmacy Automation System, resulting in a Closed-Loop Medication Management System (CLMMS) to help staff ensure the right medication is administered to the right patient at the right time. This project won the Most Innovative Use of Infocomm Technology (public sector) at the National Infocomm Award Our end-to-end CLMMS aims to improve patient safety by reducing medication errors. NUH Nursing team at the JBI Convention Collaboration with Alice Lee Centre for Nursing Studies (ALCNS), National University of Singapore to develop the Master in Nursing (Critical Care) Established the Collaborating Centre of the Joanna Briggs Institute

13 Over the years, we have implemented a variety of quality improvement initiatives that have had positive impact on our work as nurses and outcomes for our patients. Our performance on key clinical indicators serve to provide important insights on areas we have done well in and those that we need to improve on. Catch Them Before They Fall Hendrick s Fall Assessment The Hendrich Falls Assessment and the multiple targeted falls interventions were implemented hospitalwide in The incidence rates continued to decline to below 1 following the implementation of the Hendrich II Falls Assessment tool and targeted multiple falls preventive interventions, well below international falls rates of 1.5 per 1000 patient days for The implementation of the evidence based falls prevention programme has shown encouraging results in reducing the falls incidence rate in acute care setting. Visual Aids improve Quality of Care What started off as a simple idea in Surgical Ward 44 and later spread to our general wards has helped significantly reduce the occurrence of Nosocomial Pressure Ulcers in our patients. The use of a Turning Chart as a visual aid helps remind both nurses and caregivers to turn the patients timely. Coupled with patient education and clinical care from wound care nurses to help improve wound care practices, the incidence rate for pressure ulcer has dropped significantly since these interventions started in Decentralised Nursing Stations Decentralised Nursing stations located within individual patient cubicles allow nurses to have an increased visibility of patients. The change in architectural design of the ward allows nurses to identify potential fall incidents in a timely manner and intervene before the fall occurs. Patients are more vulnerable to pressure ulcers when their positions of rest are not changed. From the Nursing Station in the cubicle, nurses are able to respond swiftly to patients needs Embarked on Nursing Rapid Improvement Events guided by the Transforming Care At the Bedside Concept Introduction of the Graduate Nurse Development Programme 13

14 INNOVATING AND IMPROVING CARE To our nurses, the greatest source and gratification comes from knowing that they have made a difference to our patients. Such affirmations often come in the form of a smile from our patients, a brief note of appreciation, or a simple thank-you card. We were deeply touched when the daughter of a late patient took a step further with a book written in appreciation of the care we provided to her father. Specially to Dad s Extended Family Members at NUH On the day when my Dad embarked on his battle against advanced colon cancer, he was treated by the best attending surgeon A/Prof Dean Koh and his team of doctors; he was nursed and cared by the best nurses and staff of NUH Ms Sandra Choo (centre) with the healthcare team at the presentation. Sandra Choo, from the book Ward 43: How My Father Challenged Cancer and Encountered Humanity. Sandra s book is a touching reminder to healthcare workers that the seemingly routine and simple things nurses do daily matter a great deal to patients and their families Formation of the APN Council Staff Forum introduced to Inpatient Wards Established the Magnet Steering Committee and Workgroups Organised the 1st NUS-NUH International Nursing Conference in partnership with ALCNS, NUS Established the Nursing Unit for Academic and Practice Excellence in collaboration with ALCNS, NUS

15 Envisioning The Future I hope you have enjoyed reminiscing about the past as much as I have. As we move on, building on the strong foundations we already have, let us continue to visualise and actualise the future that we seek. The three missions of clinical, education and research excellence will be our guide. We will continually harness innovation and technology to optimise resources, streamline processes and workflow. This will, in turn, enhance care standards and the quality of patient care. A teaching and learning environment is one of the key features of an Academic Medical Centre. As such, inter-professional education is continually promoted and creative teaching models are utilised to impart knowledge and skills to all staff. Finally, let us instil and stimulate the spirit of inquiry in all our nurses. Let us persist in our pursuit of evidence-based and best practices for patient care. I look forward with great anticipation and excitement to be part of this vision and I hope you ll join me on this journey. Adjunct Associate Professor Lee Siu Yin 2012 Formation of the Professional Practice Council 15

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