Innovative Project in Geriatric Ward

Slides prepared by Jr Brian Hogan

Faculty of Medicine and Health Sciences Universiti Malaysia Sarawak MDJ 4364 Nursing Elective

Course: MDJ 4364 Nursing Elective Project name: EZ Sarong Ward of attachment: Medical 3 Ward (Geriatric Unit), Sarawak General Hospital Target population: Bedridden elderly patient (aged 60 years old and above), ward staffs and student nurses Period of project: 14/11 24/11/2011
Group members: Agatha Ng Suk Qian (20603) Agnes Lau Siew Yen (20604) D Fester ak Musa @ Guy (20846) Foong Hui Foh (20979) Ivy Tong Siaw Wei (21090) Jr Brian Hogan Paulus (20570) Lai Pao Chu (23789) Rina Cheong (24892)
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Presentation Outline
Introduction Elderly People Problem Scenario Our Innovative Product Implementation Good Points about EZ Sarong

Limitations Recommendations
Conclusion
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Introduction Elderly People

Elderly persons are individuals aged 60 years old and above (World Health Organization, 2011)

Introduction Elderly People

Figure 1: Estimated growth in the number of Malaysians aged 60 and above

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Retrieved from http://www.hpp.moh.gov.sg/HPP/1250487880166.html

Introduction People
Percentage of elderly among all patients admitted to government hospitals

40% 60%

Elderly (60 years old and above)

Non-elderly (below 60 years old)

Figure 2: 40 percent of patients admitted to government hospital are elderly

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Retrieved from http://www.hpp.moh.gov.sg/HPP/1250487880166.html

Introduction Five Geriatric Giants

Intellectual impairment

Iatrogenesis

Instability

5 Geriatric Giants
Incontinence

Immobility

Bedridden
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Figure 3: Five geriatric giants

Problem Scenario
A real-life reflection that led to the idea to invent EZ Sarong

Problem Scenario
Mr. Lau, a 68 years old male Chinese patient was admitted to the ward and diagnosed with cerebrovascular accident with right-sided hemiplegia. He is currently incapacitated and dependent on nurses to maintain self-hygiene. He was on continuous bladder drainage and diaper. His diaper was soaked with watery stool, which dirtied his thigh and lower limbs when the stool-stained sarong is removed. After bed bathing him, his sarong was changed.

This scenario led to several reflections in view of patients and caregivers perspectives.
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Problem Scenario
Reflections in patients and caregivers perspectives
Patients Caregivers (nurses and relatives) Friction while removing sarong Changing sarong is difficult and could impair patients skin energy-consuming integrity Manipulation of indwelling urinary Frequently handling patient can catheters tubing increases risk of contribute to musculoskeletal urinary backflow thus risk for injury (back pain and knee pain) urinary tract infection Frequently handling patient would Changing sarong is timecause them discomfort consuming since the ward has shortage of nurses
Thus, we came out with our innovative product - EZ Sarong.
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Problem Scenario

1) Lifting of urinary bag (patient with indwelling catheter): a) Lifting urine bag and putting it on bed is an inappropriate practice (Makic, Von Rueden, Rauen & Chadwick, 2011) b) It will cause reflux of bacteria and may lead to urinary tract infection (Pratt & Pellowe, 2010)
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Problem Scenario
2. Friction between patients skin and sarong a) The friction can impair patients skin integrity and lead to development of pressure sore (National Institute for Clinical Excellence, 2001; Clinical Review, 2007)

b) Age-related changes in skin of elderly persons (thinning and attening of the epidermis, atrophy of the dermis, decreased vascularity of the dermis, loss of collagen and elastic bres, decreased number of oil and sweat glands, compromised vascular response, abnormal nerve endings, and a reduction of subcutaneous tissue) increase their vulnerability to friction-related skin breakdown (Myer, 2000; Royal College of Nursing, 2001)

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Problem Scenario

3. Occupational hazard a) Back pain may develop when you perform heavy physical activities like lifting, positioning, and turning patients body on bed (Yip, 2001) b) The tendency increases with incapacitated patient that needs complete handling by nurses (Omokhodion, Umar, and Ogunnowo, 2000)
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Our Innovative Product EZ Sarong

Do you know that EZ Sarong was designed with the concept of Releasable Clothing? 14

Our Innovative Product EZ Sarong

Product name: EZ Sarong Objectives of invention: 1) Reduce frequency of turning bedridden patient when putting on the sarong minimise discomfort 2) Reduce friction while removing sarong turn patient instead of pulling down the sarong 3) Reduce risk of urine backflow from urine bag - reduce risk of urinary tract infection 4) Reduce risk of occupational hazard such as back pain 5) Reduce time and energy consumption in changing sarong - nurses shortage in Geriatric Unit, Sarawak General Hospital

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Our Innovative Product EZ Sarong

Schematic Layout of EZ Sarong
Width: 200 cm

Height: 110 cm

Strings

Picture 1: Schematic layout of EZ Sarong

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Our Innovative Product EZ Sarong

Production Cost

No. 1 2 3

Item Cost (RM) Linen for EZ Sarong (20 metres) 96 Detergent for laundry-washing 28 Tailors service fee (none) Total cost 124.00

Ethical Approval Approval and permission to implement EZ Sarong in Geriatric Unit (Medical Ward 3) was obtained from the Clinical Research Centre and Nursing Sisters in the ward.
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Implementation
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Implementation - Details of our project

Timeline of implementation: 14th 24th November 2011 (10 days)

Ward of implementation: Medical 3 Ward (Geriatric Unit)

Targeted samples: 10 bedridden patients aged 60 years old and above

Number of EZ Sarong being applied: 9

Number of respondents in the survey: 31 (staffs, student nurses, caregivers, patients)

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Implementation Demonstration Video

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Implementation - Analysis of result from survey

Name of questionnaire: Innovative Project EZ Sarong Questionnaire
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10
8 6 4 2 0

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staff nurse and ward manager student nurse care giver 5 3 patient

Categories of respondents
Diagram 1: Categories of respondents in survey
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Implementation - Analysis of result from survey

Question 1: How do you evaluate the goodness of using EZ Sarong? / Bagaimanakah anda menilai kebaikan penggunaan EZ Sarong?
18 16 14 12 15 respondents, 48.4% 10 16 respondents, 51.6% **All respondents rated EZ Sarong as at least memuaskan (satisfactory) sangat memuaskan memuaskan tidak memuaskan

8
6 4 2 0

Responses
Diagram 2: Respondents response to Question 1
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Implementation - Analysis of result from survey

Question 2: Does EZ Sarong ease your work in changing and applying it? / Adakah EZ Sarong memudahkan anda dalam kerja penukaran dan pemakaian sarong?
18 16 14 16 respondents, 51.6% 15 respondents, 48.4% 12 ya tidak pasti tidak

10
8 6 4 2

0
Responses
Diagram 3: Respondents response to Question 2
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Implementation - Analysis of result from survey

Question 3: Does EZ Sarong saves your time when changing and putting on sarong? / Adakah EZ Sarong menjimatkan masa anda semasa kerja penukaran dan pemakaian sarong?
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Frequency Percentage
25 26 respondents, 83.9% 20 15 10 5 0 Responses
Diagram 4: Respondents response to Question 3
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Ya
5 respondents, 16.1%
ya tidak pasti tidak

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83.9% 16.1%

Tidak 5 pasti Tidak 0

Implementation - Analysis of result from survey

Question 4: Does EZ Sarong saves your energy when changing and applying it? / Adakah EZ Sarong menjimatkan tenaga anda semasa kerja penukaran dan pemakaian sarong?
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30
25

Frequency Ya 29 2 0

Percentage 93.5 6.5 0

20 15 10 5 0 Responses

ya tidak pasti Tidak pasti tidak

Tidak

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Diagram 5: Respondents response to Question 4

Implementation - Analysis of result from survey

Question 5: Are you satisfied with the usage of EZ Sarong? / Adakah anda berpuas hati dengan penggunaan EZ Sarong?
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25
20 ya 15 10 5 0 Responses
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Frequency Percentage

Ya

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87.1
12.9 0

tidak pasti

Tidak pasti 4 Tidak 0

Diagram 6: Respondents response to Question 5

Implementation - Analysis of result from survey

Question 6: Will you use EZ Sarong in future? / Adakah anda akan menggunakan EZ Sarong pada masa akan datang?
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20
ya 15 10 5 tidak pasti

Frequency Percentage Ya 21 67.7 32.3 0

Tidak pasti 10 Tidak 0

0
Responses
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Diagram 7: Respondents response to Question 6

Implementation
Question 7: Sila beri cadangan anda untuk menambah baik sarong ini
The material to make the sarong should be changed to 100% cotton

Make the sarong colourful so that it will look cheerful

Comments from Respondents

Nurses or caregivers can save time when applying sarong on patient

EZ Sarong is definitely easy to apply on bedridden patients

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Good Points about EZ Sarong

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Good Points about EZ Sarong

Save time

Self-value

Advantages

Reduce friction on the skin

Less strenuous
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Good Points about EZ Sarong

Save Time
Can save time when applying EZ sarong to patient Ratio nurses to patient in Geriatric ward is 7:38 Workload for nurses is too heavy and not enough time to do job properly EZ sarong easy to be apply and taken off from patient EZ sarong can be apply together with bed sheet
Source: An Overview of Nurses Workload Measurement Systems and Workload Balance, 2006
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Good Points about EZ Sarong

Reduce Friction on the Skin

Elderly has fragile skin Friction or excessive shear force can cause skin to be rubbed away faster and replace EZ Sarong can reduce friction to the skin when apply EZ sarong apply using less pulling the sarong underneath patient body/skin Less friction could reduce the changes of having bedsore/injuring the skin

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Retrieved from http://www.the-pillow.com.au/resources/pressure_sores,2011

Good Points about EZ Sarong

Less Strenuous
EZ Sarong simplifies the process of changing sarong compared to the traditional ward sarong Less lifting of patients limbs is required therefore it is less strenuous for nurses to apply The simple process of applying EZ Sarong on patient reduces the risk of developing back pain during related procedures (bed bath, perineum cleaning, etc.)

Retrieved from http://www.the-pillow.com.au/resources/pressure_sores,2011

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Good Points about EZ Sarong

Self-value
Proper clothing for patient is important to maintain self-esteem/self-dignity Provide comfort and holistic care for patient One of the nurses roles is advocator/supporter and protect patient privacy Nurses need to advocate/support patient to reach/obtain their Maslows Hierarchy needs.
Retrieved from http://www.wpro.who.int/internet/files/pub/85/1-6.pdf
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Limitations
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Limitations
Single-sized EZ Sarong

Financial limitation

Limitations
Laundrywashing

Shortage of respondents

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Recommendations
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Recommendations

Improve the quality of linen used to make EZ Sarong

Introduce the usage of EZ Sarong in other wards

Recommend further implementation of EZ Sarong in Geriatric ward

Propose the idea of EZ Sarong to higher authority for future implementation national level
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EZ Sarong is generally aimed to improve the quality of nursing care of bedridden elderly patients and reduce nurses risk of occupational hazard. It received positive reception from staffs, nursing students, caregivers and patients in the ward. We believe that with further improvement in its design, it could serve better purpose for the benefits of both patients and caregivers. In future, we hope EZ Sarong would be implemented in hospitals for the better care of bedridden elderly patients.

Conclusion

Quality improvement is a never-ending journey and not a destination

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EZ Sarong is in fact, beneficial. I really appreciate the effort of nurses in improving the quality of care of elderly patients.

Thank you.

The End

Prepared by Jr Brian Hogan

Quality improvement is a never-ending journey and not a destination

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References Clinical Review. (2007). Causes and risk of pressure sores. Nursing & Residential Care, 9(11), 516-523. Department of Statistics Malaysia. (2010, August). Demographic Indicators. Retrieved December 3, 2011, from Department of Statistics Malaysia: http://www.statistics.gov.my/portal/download_Population/files/BPD/ind_20 10.pdf Jaul, E. (2010). Assessment and management of pressure ulcers in the elderly. Drugs Aging, 27(4), 311-325. Kumar, S., Selim, M. H., & Caplan, L. R. (2010). Medical complications after stroke. The Lancet Neurology, 9(1), 105-118. Lindgren, M., Unosson, M., Fredrikson, M., & Ek, A. C. (2004). Immobility - A major risk factor for development of pressure ulcers among adult hospitalized patients: A prospective study. Scandinavia Journal of Caring Sciences, 18(1), 57-64. Livesly, N. J., & Chow, A. W. (2002, December 1). Infected pressure ulcers in elderly individuals. Clinical Infectious Disease, 35(11), 1390-1396. Retrieved December 5, 2011 from http://www.jstor.org/stable/4483329. Makic, M. B., Von Rueden, K. T., Rauen, C. A., & Chadwick, J. (2011). Evidence-based practice habits: Putting more sacred cows out to pasture. Critical Care Nurse, 31(2), 38-61. McKenzie, M., & Gainor, M. (1997, November 18). Releasable clothing with temperature sensor for bedridden patients. Lawrence, Kansas, United States of America.

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Myer, A. H. (2000). The effects of aging on wound healing. Topics in Geriatric Rehabilitation, 16(2), 1-10. National Institute for Clinical Excellence. (2001). Pressure Ulcer Risk Assessment and Prevention. UK: National Institute for Clinical Excellence. Nazarko, L. (2008). Reducing the risk of catheter-related urinary tract infections. British Journal of Nursing, 17(16), 1002-1010. Omokhodion, F. O., Umar, U. S., & Ogunnowo, B. E. (2000). Prevalence of low back pain among staff in a rural hospital in Nigeria. Occupational Medicine, 50(2), 107110. Pratt, R., & Pellowe, C. (2010). Good practice in management of patients with urethral catheters. Nursing Older People, 22(8), 25-29. Royal College of Nursing. (2001). Pressure Ulcer Risk Assessment and Prevention. UK: Royal College of Nursing. World Health Organization (2011). Definition of an older or elderly person. Retrieved December 1, 2011 from http://www.who.int/healthinfo/survey/ageingdefn older/en/index.html Wong, T. S., Teo, N., & Kyaw, M. O. (2010). Prevalence and risk factors associated with low back pain among health care providers in a district hospital. Malaysian Orthopaedic Journal, 4(2), 23-28. doi: 10.5704/MOJ.1007.004. Yip, Y. (2001). A study of work stress, patient handling activities and the risk of low back pain among nurses in Hong Kong. Journal of Advance Nursing, 36(6), 794804.

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