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Escalation Protocols of VSM to alert Dr/ Nurses

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Escalation Protocols of VSM to alert Dr/ Nurses

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Good & Drinks Classification and Testing

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Good & Drinks Classification and Testing

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Mixing Tips**

Hot drinks
A hot drink will reach desired thickness after about 30 seconds of stirring. For safety reasons, allow the thickened hot drink to cool down slightly before serving. A drink thickened with ThickenUp Clear may be heated in the microwave.

Carbonated beverages
For optimal results, stir carbonated drink to reduce the amount of carbonation. Pour the powder into a clean, dry cup, add carbonated drink on the powder and start stirring immediately for 20-30s until powder is well dissolved.

Milk
After adding ThickenUp clear, it may take up to 15 minutes to reach required thickness.

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Dr daily round and Medication Counting Update

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Dr daily round and Medication Counting Update

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Dear Nurses,
With immediate effect, we will have 2 changes on the ground for you all to note.

1. Doctors will be making daily rounds however for documentations it will only be done for selective patients (patient NRIC will be highlighted in orange on masterlist if documentation done).

Each patients will have at least 1-2 documentations by doctors weekly.

Should you pick up any abnormalities do inform Doctors to review accordingly.

2. All patients returning from TCU or New inpros with medications.

a. Nurses are to count the medications

b. upload medication list to GPC

c. keep 2 weeks supply of medications needed, balance stocks are to be given to NM tgt with the pharmacy medication list.

d. During our weekly Monday stock count, if medications are insufficient for 2 weeks, nurses can approach NM on Tuesday for topup.

Thank you for your cooperation. 🙏🏻

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For cytotoxic precautions .................... (name of cytotoxic medications)
- Not to be handled by nursing or pregnant women

When serving medications
- Wash hands before and after serving the medications
- Wear gloves while handling tablets [avoid touching the pills directly]
- Serve in disposable cutlery and/or containers
- Do not throw the unused medication into normal trash
- For safe disposal: medication blister pack to seal in ziplock bag either before dispose to general waste or to bring back to PHI pharmacy - they will help to dispose

When dealing with body fluids
- Wear glove when changing diapers
- Double bag all soiled clothes for separate wash (inform the housekeeping team)
- Flushing of toilet 2x times (close toilet bowls) after voiding
- If use urinals/pans, clear body waste into toilet bowls and flush twice (close toilet bowls). Double bag the urinals/pans before disposing them

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1. Be punctual at work and arrive on time for your shift.

2. Inform your nurse manager and team lead as soon as possible, at least 24 hours before your shift starts if you need to cancel your shift duty.

3. Ensure that you have a valid SNB APC and BCLS certification.

4. Practice infection control by following the 5 moment hand hygiene technique and taking necessary precautions for contact, airborne, and droplet infections.

5. Practice aseptic technique when caring for post-surgical wounds or PICC lines.

6. Attempt blood taking or VI line setting a maximum of three times. If veins are difficult, refer to the doctor in charge of the patient. Change the IV cannula after 72 hours.

7. Administer medications for oral, IV, MI, SC, SL, PV, and PR. Apply all principles of medication administration without any shortcuts.

8. Participate in the patient's ADLs and work as part of the team.

9. No playing of YouTube or social media. No earphones, eating, or drinking are allowed while on duty. Only plain water is allowed at medpost.

10. Sleeping is prohibited during night duty unless given break hours. Return to the work area in time after allocated timing.

11. Count all medications supplied from the hospital on the first day of arrival to TCF and upload to GPC after counting. Count all meds on every Monday during night duty. Hand over insufficient supplies to the next day shift RN. The last medication counting will be held 2-3 days prior to discharge to ensure there are sufficient supplies for 2 weeks.

12. No eating or drinking at resting area. Tidy and clean up the area before leaving.

13. Provide CGT (caregiver training) to helpers, caregivers, and NOK. Fill up the checklist before release the caregiver.

14. If unsure about any issues or queries, ask the ground leads or senior staff. Check and triple-check all instructions before carry out. Never assume.

15. Document all relevant information in the GPC and handover to the upcoming shift duty nurse. Do not copy paste blindly when there is a new update on the patient's care plan/treatment.

16. If you are still using your colleague's GPC account, submit your details to the nurse manager.

17. Do not amend in the elMR if there are medication changes. Write it down manually and take a picture, verify with the ordering doctor, and clarify any discrepancies prior to administration.

18. Wear appropriate attire - all RNs should wear a scrub suit while on duty. No slippers or crocs are allowed. Shoes must be covered, long hair tied up, and finger nails kept short and clean.

19. Handle all expo items, instruments, and equipment such as laptops, adapters, cables, CoW, and printers with care.

20. Safeguard your own valuable belongings. Do not leave them at the patient's bedside. Every valuable, cash, or your IT gadget is at your own risk.

Thank you, everyone

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Dear nurses  ! Kindly take note if there is any   photo need to be taken involved those body area / part ,kindly utilise the one  off time button which circled in green before notifying  Doctors, .. to provide privacy & dignity for our patients please,Thank you everyone ya 🙏🏻

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Example to Amend Medication Changes Manually on IMR hardcopy 

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Example to Amend Medication Changes Manually on IMR hardcopy 

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Hi nurses ! ... this is one of the sample to amend medication changes manually  on IMR hard copy ...always double check  with eIMR from the master list...Any discrepancy pls verify before serving 🙏🏻

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Documents for patients going home/ Shelter home 

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Documents for patients going home/ Shelter home 

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Only provide these for patients going home/shelter home:

1. Patient copy discharge summary (usually only contains diagnosis and meds list) (NOT detailed hospital discharge summary)
2. Memos to polyclinic, specialist (NOT memo to TCF)

The rest are kept with us:
1. Detailed hospital discharge summary
2. Memo to TCF
3. Nursing handover
4. PT OT ST Dietician reports
5. Etc

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Non Urgent matters: Replenishment of meds during Night shift

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Non Urgent matters: Replenishment of meds during Night shift

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Hi nurses, for non urgent matter please handover to day shift to inform dr. Especially replenish meds.

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Accurate documentation on I/O chart for NGT

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Accurate documentation on I/O chart for NGT

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This is good documentation. Indicating NGT measurement to spigot vs tube so there’s no confusion. 🙏🙏

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Dear RNs,
For counted medications during inpro, the usual practice was to upload in the Google drive. Moving forward, this file should be uploaded in GPC instead together with your inpro notes. This was requested by our doctors and they also feedback that some of the patients do not have these records. Please ensure medications are counted and documented properly during admission. For everyone’s compliance please. Anyone not sure on how to upload attachments in GPC, please seek assistance from your RN colleagues or you can approach me or the leads.
Thank you 🙏

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Dr rounds and changes will be reflected on GPC, H9 Masterlist - Rounds (male), Rounds (female) tabs. We usually finalise the changes around 12pm (different doctors finalise the changes at different times)

If there are any uncertainties, please contact the doctor in charge of your patient. There's no issue in clarifying or raising any doubts about the changes and plans.

If Dr gave some verbal instructions but not clearly documented in GPC, also can inform us to document if you're unsure.

2-way comms important: do acknowledge the changes if possible. Thanks guys.

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Dear nurses! pls utilise Neuro vascular chart for assessment neuro, ortho post surgical patient in our TCF.  Thank you all!

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Caregiver training can only be arranged from MON-FRI 10am-8pm. There will be no training on weekends and Public holidays. please also ensure that the helper has food for her lunch break and etc as food won’t be provided in the facility.

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Hi team, for MRSA patients, TCF will standardise our protocol for MRSA decolonisation:

*5 days of chlorhexidine and mupirocin intranasal application (complete 10 applications) then deisolate*
We do not follow the hospital's regime even if they provide other forms of MRSA clearance protocol.

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Instructions for taking oral Bisphosphonate 

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Instructions for taking oral Bisphosphonate 

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Dear nurses, this is for educational purpose. Some of our patients here have osteoporosis and hence on oral bisphosphonate (e.g. weekly Alendronate).

One of the common side effects is esophagitis / GERD. So in order to reduce the risk of side effects, here are the usual instructions for taking oral bisphosphonate

1. Take on an empty stomach, 30 min before breakfast
2. Take the medication with about 200cc of water
3. Maintain upright (no lying down) for at least 30 mins after taking the dose

Thanks ya!

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Dear team,

SGH MSW complained in email that "TCF provided the mobile number to NOK", and "Please let your colleagues know, please not provide our mobile number to our patient and patient's family."

In future, if the NOK wants the MSW number, say we are not allowed to give mobile number, but the office number we can give.

Generally, we do not provide any NOK with anybody's personal HP. Only provide official no.

Thanks.

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Patient Privacy and Confidentiality Policy

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Patient Privacy and Confidentiality Policy

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Attention to ALL STAFF in TCF,

It is imperative that we uphold the values of privacy and confidentiality in our daily operations. As healthcare professionals, we understand the importance of safeguarding people's rights to their own personal information.

Privacy grants individuals control over the disclosure of their information, which includes the details, timing, and circumstances under which they are shared. In addition, confidentiality refers to the protection of personal and clinical data.

As members of the nursing and HCA team, it is our responsibility to maintain privacy and confidentiality in relation to all information concerning those under our care. It is critical that we only disclose pertinent information required for the provision of care to individuals directly involved in the process.

Let us all work together to promote a culture of privacy and confidentiality to provide the best possible care.

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It is a common practice here to allow patients to take home leave in order to facilitate their recovery and improve their overall well-being.

However, it is important to note that *medical team do not follow patients during their home leave*

The reason for this is that medical teams are only responsible for providing care within the medical facility.

Once patients are allowed by doctors to take home leave, they are expected to manage their own recovery and seek help from their primary care physician or emergency services if necessary.

Please check with NM on duty if in doubts.

Do not arrange or agree to accompany patient for home leave by yourselves.
Especially using own vehicle or extending your shifts (for OT).

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Steps for Maintaining Patient Confidentiality 

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Steps for Maintaining Patient Confidentiality 

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Healthcare staff can ensure they are maintaining patient confidentiality while providing necessary information to other healthcare professionals by following these steps:

1. Use minimum necessary information: Share only the information that is required to provide care and treatment to the patient.

2. Obtain patient consent: Obtain the patient's consent before sharing any information even with other healthcare professionals.

3. Use secure communication: Use secure communication methods that are compliant with privacy regulations when sharing patient information. For example, sharing patient information through secure email, secure messaging or other secure electronic systems.

4. Limit access to patient information: Limit access to patient information to healthcare professionals who require the information and have a need to know to provide care/treatment to the patient.

5. Follow privacy policies: Follow the policies and procedures set forth by the healthcare organization to protect patient privacy.

6.Respect patient rights: Respect patient's rights to confidentiality and always ask their permission before sharing their information.

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Hello Team, we already emphasised please do not dispose the urinals in the bins, use the MACERATOR. If still you are not aware on where to find and how to use it please approach your leads. Thank you

In addition, appreciate the effort in collating Urinals for macerating. Reminder also that the macerator can only take in a max number of urinals. Please DO NOT CHUCK ALL AT ONCE IN MACERATOR. Please also ensure it does not leak 🙏🙏🙏. As it will emit smell and dirty the area. URINE MUST BE CLEARED prior to urinals being disposed off in this bin. Thanks !!!

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Understand that there are many who do not understand the consistency of thickeners. Just sharing a video about thickeners hope that this helps!

Please do not continue feeding if patient is coughing persistently during feeding.

Video approved by NMs. 😊

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Document any discomfort or pain reported by patient in EMR

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Document any discomfort or pain reported by patient in EMR

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Gentle reminder:

If patient has any discomfort or pain. Please document inside emr and inform dr.

Especially if patient had a fall and told you that there is pain over any body parts.
*Must inform dr and document*

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Hi team, kindly follow this format whenever we report a fall incident to our doctors as per Dr Phuah. Thank you

*Fall incident*
Patient identity: Name, bed, IC
time:
location:
witnessed/ unwitnessed
Describe mechanism of fall
Ask patient what happened, slippery floor? black out? leg weakness?
check for obvious injury: pain, wound, bleeding, bruise, swelling
any loss of consciousness, head injury?
check full VS and GCS
Alert doctor

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Do Not touch E trolley items for Non-Emergency use

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Do Not touch E trolley items for Non-Emergency use

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Hi team, if there are any items that is not available (non-emergency/urgent) , please approach the team leads.
Please do not take from the e-trolley. Items in the e-trolley is only for emergency use.
After taking or breaking the seal, it needs to be rechecked and top up.
This is to avoid missing items during emergency or Resus .

🙏🙏🙏 thank you

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Protocol for nasal/oral pharyngeal suctioning use

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Protocol for nasal/oral pharyngeal suctioning use

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Hi all,

Please note that our standard practice based on protocol for nasal/oral pharyngeal suctioning, we discard suction catheter after each use and to replace the suction tubing every 24hrs. For everyone’s compliance please.

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Hi all, reminder we hv hypoglycemia protocol

In case of hypoglycemia, pls consult doctor via grpchat before serving meds, you may proceed with serving sugar drinks or IV dextrose whichever appropriate.

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Orange urine is a known side effect of Rifampicin (TB medication)

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Orange urine is a known side effect of Rifampicin (TB medication)

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I have an interesting urine colour for this patient. After looking at the past history and medication, this is the assessment:
Orange urine is a known side effect of Rifampicin (TB medication)

The concentrated urine from dehydration is not so orange, it's more yellowish.

So for this case, we do not need to do any action. I'm sharing because this is a fairly interesting urine colour that we do not need to do further action if we determine it to be the side effect of Rifampicin. This is not dehydration. Hope it's interesting knowledge for everyone.

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Dear Nurses, we provided hard copies of these charts in all medposts as your guide if you are unsure on the amount of reconstitution, further dilution, duration of administration, the stability post reconstitution and dilution of Injectable drugs both Infectives and Non-infectives. Please always refer to this and never do blindly. Approach any of the senior nurse around or NMs on shift if you have any clarification. Thank you

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Below is the workflow:

1. Tcf admin will print stickers and prepare blank form.

2. Tcf admin will bring the labels and labelled form to dr for them to tick the tests they want.  We will not do the ticking of lab form.

3. Tcf admin will pass the ticked and labelled lab form + labels to nurses inside hall 9.

4.  Nurses to take specimens according to tests ticked.

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Update I/O chart for patients w IV fluids

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Update I/O chart for patients w IV fluids

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Hi RN, gentle reminder. Please don’t forget to update your I/O charts for patients with IV fluids too! Thank you! 🙏🏻

This should be automatic. Please don’t overlook on this.

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Hi MT a gentle reminder to follow this photo (showing uniforms returned) format whenever pt discharged/995/993. Thank you.

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We will stick this blue sticker on all DNR pt on the check list .

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Dear All, we have checked with our doctors and have come up with a way to measure pt meals.

For measurement of Puréed diets, we can use this as guide. One blended meal with meat and vegetables is equivalent to 150mls.
If patient complete 1/2 meal - it will be 75mls.
1/3 meal 50mls,
2/3 meal 100mls
1/4 meal 37.5mls
3/4meal 112.5mls
Please do not use syringe to feed patient.

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Hello Nurses, just to share with you my interaction with Dr Chin just now.

1) Do expect different duration for each patient on Tazocin.

2) Told Dr Chin, Drs to include in IMR Prescription for each patient's duration they want us to infuse.

3) Dr Chin shared, he did specifically ask the nurse incharge of the patient he reviewed to run on specific duration depending on patient case.

‼️ Bottomline, if serving IV Tazocin do ensure you verify with Drs on the duration they want us to infuse for that particular patient. Just ask them to document it in GPC and IMR. ‼️

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Hi all ,
I would like to share with you on cradle nursing ! Cause we do have two patients on cradle nursing.

Cradle nursing is basically to put patient in a position where you allow air to circulate around upper part of the lower limb .

So since our patient is on diaper right , secure it very lightly. Dont secure so tight. Let patient wear sarong or if dont have , can use the blanket and put it like this.
Two pillow at the side to allow air to go in.

Other than that ;

- Regular diaper change
- Apply barrier creams or any other creams Dr prescribed.
- Keep skin clean and dry
- 2 hrly turning
- Cushioning ( cushion the patient bony parts with pillow)

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Hello Nurses. Would like to highlight to you’all that if you’all do dressing & if the dressing will soak through. Could we kindly seek your help to place blue sheet or draw sheet that will help to avoid staining the linen as our HCA have a hard time from MA when they do 1to1 exchange of linens. Seek your assistance thank you! 🙏🏻

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For activation of 993 (from 9am to 9pm by TCF Admin team)
- Nursing team will activate 995 in hall 9.
- HQ will call NOK to inform for all activations.

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Hello Nurses! Just to share with you’all. I spoke to RH lab with regards to collecting PT/INR. The lab technician mention that all sodium citrate tubes need to draw blood till this line. For accurate results, solution in this tube + blood ratio has to be as such (meaning till the line no less no more). In addition, the lab say max should be 4hrs (with ice) before they receive the blood tubes, so if we factor in time to reach the lab, the earliest we should draw the blood should be 2hrs before dispatch. Thank you☺️

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Hi all,

Regarding the PRN lorazepam (for agitation) and Trazodone (for insomnia)

Please update the behavioural chart for any of the above symptoms so that morning rounds Dr can understand indication for serving the meds.
E.g.  trazodone, (patient unable to sleep)
Lorazepam (patient is restless or agitated or behavioural issues - specify)

If unsure, can always ask the doctors prior to serving the meds.

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Hi nurses: in future if u need to report urine dipstick result to Doctors pls utilise this sample

Name : XYZ
NRIC   : 123X
Bed no:
Urine Dipstick Result ⤵️
SG :
PH:
LEU :
NIT :
PRO:
GLU :
KET:
UBG :
BIL :
ERY:
Thank you

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Bring along s/c recormon & other injections for Renal patients going for dialysis

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Bring along s/c recormon & other injections for Renal patients going for dialysis

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Moving forward, when all renal patients going for dialysis like what we normally do, bring along their s/c recormon & other injections.... to also inform in Dr's chatgroup also so that Dr can inform Dialysis Centre to administer there.

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Hi all, Just a reminder for PEG feeding, we need to aspirate to check for residual volume and update I/O chart under the aspirate column. Inform Dr as well if significant amount.

In addition: PUIs controlled drugs such as Fentanyl patch or morphine is to be kept and recorded in Nurse Managers office - Request when needed and return to PUI when discharge.

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Ensure to check their name & IC when doing ART/PCR for PUI

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Ensure to check their name & IC when doing ART/PCR for PUI

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Hi all. Dr kok would like to reinforce that for all ART/PCR done for PUI, always ensure to check their name & IC, do not just see bed number. Due to fast turnover of PUI, sometimes masterlist will have 2 PUI in same bed as well. Do highlight to them if they forget to remove from the list. Thanks.

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Patient on Paxlovid to withhold Statin for 5 days (Latest Guideline)

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Patient on Paxlovid to withhold Statin for 5 days (Latest Guideline)

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Shared by Dr Lynn. Now Statin withold for 5days instead of 3 days. Take note 👍🏼

Withhold 5 days after last dose of paxlovid. Total 10 days

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Principles of administration of serving medication

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Principles of administration of serving medication

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Hi all, just a reminder on the principles of administration of serving medication.

6️⃣ Rs 👉🏻 Right  👉🏻Patient 👉🏻Right Medication 👉🏻Right  Route👉🏻Right Time👉🏻Right Dosage ,& 👉🏻Right Documentation .

BRING ALONG the IMR to pt's bed side when u administer the meds, double check the meds against PUI wrist band and the Medication with the IMR ...

CHECK ALLERGY HISTORY , LAST MEDICINE TAKEN , SIGNED right after u administer the meds .  Strictly NO PRE SIGN either.

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The chart is designed to help doctors measure the time it takes for food to pass through your body and leave as waste. The shape and form of your poop may also point your doctor toward a diagnosis of some digestive problems.

The ideal stool is generally type 3 or 4, easy to pass without being too watery. If patient is type 1 or 2, he or she is probably constipated. Types 5, 6, and 7 tend toward diarrhea

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Nursing Management of Pressure Ulcers in Adults 

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Nursing Management of Pressure Ulcers in Adults 

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Staging of Pressure Ulcers

The staging of pressure ulcers uses the National Pressure Ulcers Advisory Panel four-level staging system (NPUAP 1989; NPUAP 1998).

Stage I: An observable pressure related alteration of intact skin whose indicators as compared to the adjacent or opposite area on the body may include changes in one or more of the following: • skin temperature (warmth or coolness) • tissue consistency (firm or boggy feel) and/or • sensation (pain, itching). The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.

Stage II: Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater

Stage III: Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without sinus tracts extending into adjacent tissue.

Stage IV: Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g. tendon, joint capsule). Sinus tracts also may be associated with Stage IV pressure ulcers.

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Refer to MOH guidelines

https://www.moh.gov.sg/docs/librariesprovider4/guidelines/nasogastric-tube-feeding---book.pdf

pH Testing

• A combination of aspirate appearance and pH testing can be used to help make correct predictions about tube placement in the stomach.

1. pH less than 5 indicates gastric placement, whereas a pH more than 5 indicates intestinal or respiratory placement. (Metheny, 1993; Metheny and Stewart, 2002)

2.  Auscultatory method (also known as air insufflations test) should not be relied on as the sole method to determine the location of the feeding tube. (D/4 - ASPEN, 2005 & JBI, 2006)

3. Documentation: Update nursing notes in GPC on left or right nostril is inserted, length..etc

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Nasogastric (NG) Tube Insertion - OSCE Guide

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Medical Team do not reveal discharge dates to PUI/ NOK. MA to call NOK

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Medical Team do not reveal discharge dates to PUI/ NOK. MA to call NOK

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For discharge date (DC) - whether you are in RZ or HQ - We do not inform PUI or correct the DC dates. Get MA to call NOK. You can say - "May we get your name and contact number and someone will contact you with the necessary information." Or get them to call MA. Contact number?

Request for clothing - please get MA to follow up. We only settle on medication issues.

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HCA to check Dentures every morning during breakfast and update Hand Over List

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HCA to check Dentures every morning during breakfast and update Hand Over List

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Denture cup (blue top, white container-provided by us) for those PUI came in with dentures IF they do not have their own denture cups.

To label on the white cup:
PUI's Name
4 last NRIC
Indicate also Top/  Bottom / Both dentures

To put the denture cup on PUI's cupboard instead of the cardiac table as cardiac table could be easily/accidentally "exchanged" with the neighbour.

Paste masking tape on the back of the wall and indicate number of dentures.

HCA to inspect dentures during breakfast and indicate present in hand over list.

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Please adhere to this with immediate effect.

1. Meals - strictly in assigned canteen hall. No snacking  in public area. The waiting areas in lobby for hall 7/8 is meant for our in-pros . Do not linger around there. All movements are monitored via CCTV.

2. Dress appropriately at work. Those in HQ- white top / black bottoms. White top means covered t-shirt not crop tops. black bottoms means not black shorts . Covered pants please.

3. No multiple earrings / chunky accessories.

4. Ensure you are wearing covered shoes even if you are at HQ.

5. No feeding of stray cats at CTF or anywhere else. (prohibited by law)

6. Smoke only at designated smoking area and no vaping allowed.

7. Breakfast Bentos are reserved only for night shift staff only. 0930- if there’s any excess,  then AM shift can help clear.

All to align to the above practices.

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Dear Everyone, Just to take note the above mentioned items that can be requested from MA. Items not in this list will be from Medical Team. If you are unsure, check in with the Leads/Managers.

Add Item 11. Soluble bags to dispose HIV+ linens

For Discharge date/ liasing w NOK for clothes - please hand this to MA for follow up. We focus on Meds w NOK and informing NOK of falls/ 995calls.

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Double bag Biohazard boxes before disposing it into the Biohazard Bin

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Double bag Biohazard boxes before disposing it into the Biohazard Bin

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Reminder on the proper disposal of sharp boxes. Please double bag the boxes and tie tightly (won’t open by any chance) and throw into the biohazard bin. Thank you!

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We will not activate ambulance for NG insertion. Nurses will do Wef 31 July 2022. Do ensure the following is done NG tube insertion.
Methods of confirming NG tube position
1. Auscultation of air insufflated through the feeding tube ('whoosh' test)
2. Testing the acidity/alkalinity of aspirate using PH indicator
3. Monitoring bubbling at the end of the tube.

If there’s any difficulties, flag out to NM on duty.

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Refer back to the NH IMR if our Drs IMR does not tally w current Meds

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Refer back to the NH IMR if our Drs IMR does not tally w current Meds

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For all PUI who admitted from Nursing Home. If the medicine does not tally with the DR-made IMR, kindly always refer back to the NH IMR. The start date might be 10 years ago for chronic meds but as long not sign off as discontinue we follow the NH IMR. Thanks.🙏🏻

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Please be reminded all End Stage Renal Failure or kidney failure PUIs has to put on  fluids restriction 500mls/ day , which means they are only allowed to consume fluids not more than 500mls a day which include  plain water ,milo ,juice ,tea / coffee/ soups etc...

kindly remove all extra drinking water which already placed at their bedside , paste a masking tape over the  head of bed or on the wall  write clearly Restrict Fluids 500mls/ day and please educate PUI as well.

🙏 Record all fluids intake in I/O as well .
🙏please comply the workflow
🙏🏻 Thank you all🙏🏾

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Visual cues for Top-up and Prescribed Meds

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Visual cues for Top-up and Prescribed Meds

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Please note from 24/7/22 onwards, those taking top-up/ ad-hoc prescribed meds from the transfer room. HQ staff will shade the meds label with colour highlighter as visual cues. Pink 💕for female ward and 💚 green for male ward. Please note the colour and place it at the right gender med post hence reducing errors of misplacement and delay in delivering the medications to the PUI. For your info and action. TY.

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Good Practice to check Health Discovery or EMR on patients  Blood pressure before serving BP meds.

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Good Practice to check Health Discovery or EMR on patients  Blood pressure before serving BP meds.

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It’s good practice to check the health discovery system for your patient’s BP before serving them their anti-hypertensive meds. If their BP is on the Low side (> BP 100/60), please highlight Dr to see if it needs to be omitted.

For easy reference, you can sort by location codes and see your patients at one glance. Shouldn’t take long to check. This will safe guard yourself. We don’t want patient turning hypotensive here 😖

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Counter measures to be placed at PUI bedside

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Counter measures to be placed at PUI bedside

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All countermeasure meds is to kept at patient's bedside ,and please do not forget to administer in due time. Ensure accurate dosage and timing is followed. Withhold statin 8 days during Paxlovid Rx and followed by 72 hours after Paxlovid Rx.

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This is the order of tubes for injecting the bloods in. Yellow then purple then fluoride. Lab will reject if contaminated.

The reason the tubes are assigned this order is to prevent the cross-contamination of chemicals into other tubes which may cause errors in testing. This process is called reflux, which means the chemical can move from the tube and enter the needle. Once the next tube is activated it will have the previous chemical enter the tube, causing the contamination.

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Hi Nurses. 2 learning points to share.

1. Pls check IMR for any drug allergy prior to requesting for meds like paracetamol to be ordered from our doctors. Refer back to 6 rights of safe meds admin...

2. If PUI is on 'day 1' for Paxlovid. Pls help to cross-out or/and insert a remark on the row of "Statin Meds" in the IMR "to refrain from taking X number of days" in order to prevent Meds error.

If got any other good practices from your area of work. Do share with the rest. TY. 😊

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Reminders on IV sites, IMR for self medicated PUI and highlighting any abnormal skin integrity

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Reminders on IV sites, IMR for self medicated PUI and highlighting any abnormal skin integrity

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Good evening angels & warriors :
Just need to reinforce again to everyone

1) Do take note and pay attention on all IV site especially post IV remdesevir,  iv drip or iv ab ; every iv site only can keep for the most 3 days (72 hours), if still needed for further IV infusion pls re-site or re-insert a new iv plug.

2)  For hall 9/10 : any independent PUI ,who is able to consume own chronic medications without supervision, but  they are having  countermeasures Rx from any other private hospitals or other institutions, Kindly commence IMR for them ,especially those who is on Paxlovid with existing statin Rx ,they need to be supervised during their stay in our CTF although the Cx Mx Rx was not ordered by our own doctor

3) Please remind all of our staff , if they have noticed any new sign of skin breakdown, post iv site redness, swelling, or skin tear etc.., do inform SN in-charge. SN pls highlight to the respective leads or doctors for further mx.

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Reminder to record gastric aspirate in the Fluid Balance Chart

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Reminder to record gastric aspirate in the Fluid Balance Chart

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If you are performing gastric aspirate, pls record the amount in the fluid balance chart under 'gastric aspirate'

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For all PUI with insulin & H/C less than 5mmol/L kindly put up an I/O as well when we do the IMR. This will ensure that our HCA can assist us to monitor their intake & prevent hypoglycemia. For immediate compliance, pls.

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Purple - FBC, ESR,HBA1C
Gray - Glucose
Blue - PT, PTT, D-dimer
Yellow - Renal, Lipid, Liver, Thyroid, Cardiac Enzymes, Crea

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if HIV+ PUI has soiled linen w bloods and fluids,
>need to *use water soluble bag *and tie it
>this can be thrown in the linen bin.
>Water soluble bags can be obtained from MA
>For staff changing diapers, have triple gloves and dispose after asap
👆⛔️⚠️REMINDERS⚠️⛔️👆

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With immediate effect as at 20 Oct 2022, we will check Temp, spo2 and heart rate for pre-discharges. Omit Bp.

But must take full set of vitals during morning vitals round.

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Escalation Protocols upon discharging PUI.

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Escalation Protocols upon discharging PUI.

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Escalation Protocols upon discharging PUI.

a. Vital Signs Monitoring
i. Temperature:  Inform doctor if temperature above 37.5°C

ii. Blood Pressure:
1. Inform Staff Nurse IC if SBP (top number) > 180 or SBP < 90
2. Inform Staff Nurse IC if DBP (Bottom Number) > 110 or DBP < 50

iii. Heart Rate:
1. Inform Staff Nurse IC if HR > 110/min or < 60/min

iv. SpO2:
1. Inform Staff Nurse IC if SpO2 < 95%
b. Symptoms
i. Inform Staff Nurse IC for any signs & symptoms that patient complains before discharge
ii. Chest Pain or Shortness of Breath
iii.     Check skin integrity if patient develop pressure sore