Adapt and Adopt — this was alumna Katherine Leong’s in deep end of philosophy when she was tasked to lead a team to set up nursing operations at a community care facility (CCF) in western Singapore during the height of the covio-1y outbreak in May. Singapore has recorded more than 50.000 cases of COVID-19 infections to date, the majority being migrant workers residing in dormitories.
These residents have mild or no symptoms and lower risk factors, so they are treated in the CCFs which were first introduced in April to free up healthcare resources at the hospitals tor more acute and emergency cases.
This community health care setting that is very different from the clinically intensive, operationally ready hospital environment that Ms Leong was used to in her work as a pediatric Advanced Practice Nurse (APN) and Assistant Director of Nursing at the Khoo Teck Puat-National University Children’s Medical Institute.
When the National University Hospital (NUH) was charged with turning a repurposed a factory site in Tuas South into a 1,622-bed community health care facility in just 10 days, Ms Leong was approached by her Chief Nurse Dr Catherine Koh to be its Nursing lead.
Her job was to implement a radically different model of nursing care where the objective was to empower residents of the CCF to self-care and monitor. This included heading to the mobile kiosks where they could take their vital signs, including their oxygen level, blood pressure and temperature, and inputting the data into electronic tablets. The information would then be sent to a dashboard which could be monitored by nurses. Residents were also advised to flag any clinical complaints to receive prompt medical assessment.
RADICAL CHANGE
Starting a community health care facility from the ground up was a huge challenge, says Ms Leong but thankfully, the Tuas South CCF was not the first such facility in Singapore, allowing the 49-year-old to apply her “adapt and adopt” strategy.
The CCF at the Singapore Expo started up in April and houses more than 6,000 patients, most of whom are migrant workers with mild or no symptoms, and many have recovered with minimal intervention. Although it operated on a much larger scale, the principles were very much similar, so we went over to the Expo to study its operating framework, layout and format, and ‘adopted and adapted’,” says Ms Leong.
TECHNOLOGY AND AUTOMATION
What could not be adopted had to be adapted, largely because the Tuas South CCF was dispersed across three three-storey buildings, unlike the Expo’s contiguous, ground-level halls.
“We had to leverage technology and automation more intensively to manage our residents’ care due to the logistics challenges posed by the CCF’s multi-storey and -building layout,” explains Ms Leong.
To that end mobile kiosks with iPads, blood pressure machines, pulse oximeters and thermometers were set up by the Integrated Health Information Systems (IHIS team in the hot zone for residents to monitor and record their vital signs. At admission, residents were given detailed instructions on how to measure and record their vital signs one to three times daily as part of their treatment.
“More importantly, we had to ensure the brothers understood why they needed to comply with the vital signs management, which is to ensure that anyone with abnormal readings can be promptly attended to,” she explains.
The readings keyed in by the residents were then transmitted to a dashboard and monitored by a member of Ms Leong’s nursing team.
“The Vital Sign Monitoring (VSM) nurse literally sits in front of her laptop and monitors the readings throughout her 12-hour shift, much like a stockbroker keeping track of the market. If any patient’s readings go beyond the healthy range, the system floats the reading to the top of the spreadsheet and highlights it in red. The nurse would then contact the brother’s dorm in-charge to get him to repeat his measurement. If the second reading is still abnormal he will be directed to a medical post within the facility.
“We’ve caught a few clinically unstable cases, such as residents with hypertensive crisis, prolonged tachycardia and desaturation who had to be transferred to the hospital in this manner,” says Ms Leong.
The Tuas South community health care facility consistently achieved close to 100 per cent compliance rate in its vital signs taking, thanks to the dedicated VSM nurses, diligent residents and patient education.
“Seeing the residents learn the importance of monitoring their own vitals and getting discharged were among my proudest moments,” says Ms Leong.
EFFORT AND TEAMWORK
She also counts her team of trusted colleagues who rose to the occasion whenever she needed help, as a blessing. “The success of the facility was a result of the great effort and teamwork from staff of various disciplines coming together with a common goal of providing safe, seamless and effective care for our migrant worker brothers.
“Like a cogwheel, if one part does not turn, nothing moves,” she says, acknowledging the team camaraderie between the medical, nursing, operations and informatics teams and the CCF’s management agent for these triumphs. “In addition, the Chiefs of NUH–Chief Executive Officer, Chief Operating Officer and Chief Nurse–were on the ground to get their hands dirty too when needed, exemplifying true leadership.”
Leading the nursing team of full-timers and locus at the Tuas South CCF, Ms Leong’s management style is guided by the values of the National University Health System–teamwork, respect, integrity, compassion, excellence and patient-centeredness (TRICEPs).
“TRICEPs were the values that inculcated in my nursing team at the hospital and at the CF. Living by these values, we worked well as a team and everyone had a sense of belonging and purpose,” she said.
As a sign of her successful management style, more than half of her locum staff has signed on as full-time staff with NUH.
Ms Leong’s experience has taken her out of her comfort zone and thrown her into the deep end. The graduate from the schools Master of Nursing programme (Class of 2014) credits her APN training for helping her thrive amid challenges. “The programme taught us to think independently and actively, and to always be on our toes, whether it’s in assessing problems, identifying symptoms, or offering appropriate diagnoses.”
“It is a principle I use in my clinical practice and has been applicable in this unprecedented situation.”
MORE RECOGNITION FOR NURSING
On how the pandemic has changed nursing, Ms Leong says that nursing has been evolving even before COVID-19. “Nursing has become more recognized, acknowledged and appreciated since SARS, and this pandemic will continue to build on what SARS has achieved.”
She adds that an area in which nurses need to bush forward is research. “We don’t eat and breathe data and evidence, which I think we must, in order for nurses to be more professional. We have to be more evidence-based, more analytical.”
Ms Leong’s last day of running the CCF was 9 July 2020. Since then, the CCF has been stood down as directed by the Ministry of Health, although she remains ready to be activated for her next assignment.
