A 'change agent' who has widened role of nurses

Three NUHS nurses – Ms Margaret Lee Kwee Hiang, Chief Nurse at Alexandra Hospital (AH), Ms Katherine Leong Shiao Peng, Assistant Director of Nursing and Advanced Practice Nurse (APN), Khoo Teck Puat - National University Children's Medical Institute (KTP-NUCMI), National University Hospital (NUH), and Dr Shefaly Shorey, Assistant Professor at the NUS Alice Lee Centre for Nursing Studies – received the President's Award for Nurses from President Halimah Yacob at a virtual award ceremony yesterday.

Described as a change agent in healthcare leadership in The Straits Times, CN Margaret started a system at AH that allows nurses to take the lead in caring for certain groups of patients, such as those who are undergoing certain treatments, those in rehabilitation, and patients who are almost ready to be discharged. She commented to CNA Digital that nurses have strong support from doctors and allied health colleagues partnering them in this unique model of care. Last year, when Covid-19 measures led to restrictions in hospital visitorship, the mostly elderly patients at AH were left without caregivers by their side. CN Margaret is now piloting a project in which caregivers are involved in the patient's hospital care.

In an interview with CNA, Dr Shorey, the first university academic to win the award, shared more about the "Train-the-Trainer" programme to educate nurses in vaccine administration and standardise practices for the nation's vaccination roll out. Dr Shorey also champions research in parenting and children's health.

The New Paper featured ADoN Leong, Singapore's first paediatric-APN working in oncology, who said that she is honoured and she would receive the award on behalf of all nurses in Singapore, who are in the same mission together. 8world highlighted that she bonds well with her patients and their caregivers who would treat her as family and send her Mothers' Day greetings. One of her previous patients was inspired by the care that she received and became her nursing colleague.

• The Straits Times Online, 14 July 2021
• Channel NewsAsia, 14 July 2021
• Channel NewsAsia, Singapore Tonight, 14 July 2021
• Channel NewsAsia, 15 July 2021
• The New Paper, 15 July 2021, Page 13, Nurses who leads by example
• Mediacorp 8world, 14 July 2021
• Berita Mediacorp, 14 July 2021

Over half of seniors polled unlikely to use telemedicine

A survey by the Singapore Eye Research Institute (Seri) during the circuit breaker last year found that about 55 per cent of 520 people aged 60 and above were unlikely to use digital medical services if the Covid-19 pandemic continues. Although half the respondents agreed that telemedicine would be helpful in reducing non-essential contact in clinics and hospitals, 77 per cent of them said they were uncomfortable with artificial intelligence (AI) interpreting their medical results.

Seeking healthcare online has become a more well-known option as a result of the pandemic. In May alone, more than 8,000 teleconsultations were done by institutions under the National University Health System (NUHS), said Mr Peter Forbes, NUHS' group chief digital officer.

Telemedicine is not just limited to video consultations with doctors, phone calls, chatbots and AI. Physiotherapy, rehabilitation, and even audiology services are being done over Zoom.

For instance, Ng Teng Fong General Hospital's audiology department offers tele-audiology services, which include connecting to a patient via a video call, and connecting to the patient's hearing device so that the audiologist can adjust the patient's hearing aid remotely.

Dr Gary Lee, the hospital's head of audiology, said patients aged 60 and above were seven times less likely to opt for tele-audiology sessions compared with younger patients: "The most commonly cited reasons include tele-audiology features being too complicated, the lack of technological skills and a general preference for face-to-face consultations.

But Dr Lee observed that live demos in the hospital or clinic and technical support from caregivers make elderly patients feel more comfortable to use tele-audiology in follow-up sessions.

Dr Teng Gim Gee, head of Alexandra Hospital's chronic programme, said digital platforms or apps can be designed with older patients in mind, so that they will be more receptive to telemedicine: "(These include) ease of access, intuitive design, larger font size, and simplifying the steps needed. For example, many have problems turning on audio upon launching Zoom."

• The New Paper Online, 5 July 2021

本地社区疫情虽受控 专家：公众仍须保持谨慎 (Even as community transmission of Covid-19 remains under control, experts advise caution)

Community cases of Covid-19 have remained in the single-digits over the past five days, while unlinked cases have been decreasing steadily – experts say these signs indicate that the pandemic is effectively under control.

Dr Louisa Sun, Consultant of Infectious Diseases and Chronic Programme at Alexandra Hospital, says this is to be expected with the government carefully easing safe management measures in phases. However, she said it is too early to celebrate and that everyone should continue to be vigilant to prevent another major outbreak of infection.

Prof Teo Yik Ying, Dean of NUS Saw Swee Hock School of Public Health (SSHSPH), commented that most of the COVID-19 cases for the past two months were due to the more infectious Delta variant strain, therefore the public should continue to remain vigilant. He explained that there are bound to be some hidden cases in the community, especially in the context of steadily increasing vaccine coverage, where many vaccinated people will not display obvious symptoms.

专家：Novavax 重组蛋白冠病疫苗 较易调整以应对新变种毒株 (Experts: The Novavax protein-based vaccine can be easily adapted to deal with new variant strains)

​Lianhe Zaobao quoted Prof Dale Fisher, Senior Consultant, NUH Division of Infectious Diseases, and Dr Louisa Sun, Associate Consultant, Infectious Diseases and Chronic Programme, AH. Prof Fisher commented that clinical trial data shows that the Novavax vaccine is comparable to other mRNA vaccines. It does not have serious side effects and mild side effects will usually subside within a day or two. He added that this vaccine does not need to be transported and stored under extremely low temperatures. This is a major advantage and is expected to be safe for people who are allergic to mRNA vaccines. 

People visiting critically ill patients at hospitals may stay for more than 20 minutes, must undergo Covid-19 test from June 21

From 21 June 2021, the Ministry of Health said that every visit at public and private healthcare institutions should not last more than 20 minutes except for selected extension of visitation time under extenuating circumstances. Hospitals under NUHS – NUH, NTFGH and AH – will implement the measures from 22 June 2021.

Singapore hospitals trial bringing care to patients’ homes

The Ministry of Health Office for Healthcare Transformation (MOHT) has partnered NUHS to drive the NUHS@Home pilot programme to care for patients in their homes. Dr Stephanie Ko, Associate Consultant, Division of Advanced Internal Medicine, Department of Medicine, NUH, shared how providing medical care at home has the potential to be more patient-centred and reduce the possibility of hospital-acquired infections, while lowering cost and increasing bed capacity. Ms Tay Yee Kian, Assistant Director of Nursing, Advanced Practice Nurse, Regional Health System Office, NUHS, said that such a shift in care delivery requires a significant mindset change from both medical professionals and patients. Patients can be assured that the type of treatments they receive will be on par with that in hospitals, with five consultants from NUH’s Division of Advanced Internal Medicine and Alexandra Hospital’s Department of Medicine taking turns to provide care.
 
The pilot is expected to be concluded in September 2021 and provide valuable findings for evaluation of this care model.

New measure will help against virus, but some have concerns

The Straits Times cited Prof Paul Tambyah, Deputy Director of Infectious Diseases Translational Research Programme, NUS Medicine, who said that it was logical to extend the requirement of mandatory pre-departure testing to Singaporeans and Permanent Residents who are returning from lower-risk places as the risk classifications can change rapidly. Prof Teo Yik Ying, Dean of NUS Saw Swee Hock School of Public Health (SSHSPH), said that implementing the new measure may be more challenging than expected as not every jurisdiction will have commercial polymerase chain reaction testing capacity that is accredited and trustworthy. 

专家：本地社区病例 两周内趋稳令人鼓舞 (Experts: Five cases in Westgate store do not rule out possible transmission in public toilets)

Lianhe Zaobao cited Prof Teo Yik Ying, Dean of NUS Saw Swee Hock School of Public Health (SSHSPH), and Dr Louisa Sun, Associate Consultant, Infectious Diseases and Chronic Programme, Alexandra Hospital (AH), who commented on the possible risk of transmissions in public toilets as masks would be removed and how close contact between individuals remain as a high risk of transmission. Prof Teo also shared that workers such as cleaners who are working in high-risk areas should be vaccinated and receive training on personal protection. 

Cleaners in higher-risk areas get priority for vaccination

Vaccinations helped S'pore avoid second circuit breaker, says expert

​At the latest webinar on COVID-19 updates in Singapore organised by NUS Medicine, experts shared that vaccinations are a more sustainable way of protecting the population, though the current slew of fairly aggressive COVID-19 curbs are necessary. 

International Nurses’ Day (12 May 2021)

​In a live Zoom interview on ‘Asia First’ morning show on CNA, Alexandra Hospital (AH) Nurse Clinician K. Nitiah from Urgent Care Centre and Dr Michael Yong, Group Chief of the National University Health System's (NUHS) Psychology Medicine were invited to the ‘live’ segment to talk about the stresses and sacrifices made by nurses in Singapore to mark International Nurses’ Day. Sister Nitiah said that although the going over the past year and counting has been tough and mentally stressful, it helps to have strong team spirit and teamwork to rise up to the challenge, and also be psychologically prepared for the long haul in fighting the pandemic.  She said having built-in coping mechanism such as team, family and most importantly, the nation’s support, is key. Dr Yong suggested the psyche of nurses the world over in being ‘the strong one’, the face to fight the pandemic, and being there for patients and their families to lean on in trying times like this. He listed the initiatives by which nurses in turn can cope with the work stress and for the organisation to help to look out for signs which warrant support and assistance for nurses.  

Covid-19 Pandemic: Healthcare workers face increased stress, burnout, mental health issues

​The National University Health System's (NUHS) Group Chief for Psychological Medicine Dr Michael Yong and Alexandra Hospital's (AH) Nurse Clinician Nitiah were interviewed by CNA on International Nurses’ Day to talk about the impact Covid-19 has had on those at the frontlines of the battle against the coronavirus – from physical aspects like exhaustion, to the mental strain from the caseload and deaths, and the toll on the profession in general.

专家：社区无关联病例虽增加但仍受控 新港航空泡泡不至于会取消 (Experts: Unlinked community transmission on the rise but under control; Singapore-Hong Kong air travel bubble may not get cancelled)

​The Singapore-Hong Kong air travel bubble may not start if the threshold of a seven-day moving average of five or fewer unlinked community cases in either city is breached.  In Singapore, the number of unlinked Covid-19 cases in the community increased from five cases in the week before to seven cases in the past week. 

Public healthcare institutions step up as use of telemedicine grows

IHIS data captured that during Covid-19 last year, telemedicine numbers had been on the rise. The report captured that the National University Health System (NUHS), which conducts more than 3,000 specialist outpatient and allied health teleconsultations each month, plans to expand its telehealth service to more patients, said group chief digital officer Peter Forbes. Teleconsultations, via video or phone calls, are now only offered for repeat visits, and the level of physical assessment needed is one of the considerations when selecting patients for telehealth, he noted. NUHS is working on videos to help patients use its telemedicine service, added Mr Forbes. Dr Teng Gim Gee, the head of Alexandra Hospital's chronic programme and lead of telemedicine, added that about 10 per cent of the hospital's patients have opted for telemedicine.

• The Straits Times Online, 19 April 2021

Telemedicine use continues in Singapore even as COVID-19 outbreak is under control

​IHIS data captured that during COVID last year, telemedicine numbers had been on the rise.  The report captured that the National University Health System (NUHS), which conducts more than 3,000 specialist outpatient and allied health teleconsultations each month, plans to expand its telehealth service to more patients, said group chief digital officer Peter Forbes. Teleconsultations, via video or phone calls, are now only offered for repeat visits, and the level of physical assessment needed is one of the considerations when selecting patients for telehealth, he noted. NUHS is working on videos to help patients use its telemedicine service, added Mr Forbes. Dr Teng Gim Gee, the head of Alexandra Hospital's chronic programme and lead of telemedicine, added that about 10 per cent of the hospital's patients have opted for telemedicine.