KEEPING PATIENTS SAFE · falls or infection — mum had developed urinary tract infection at the...

A HEALTHIER, HAPPIER LIFE

ISSUE 2 2019

中文由 23页起

PNEUMONIA VACCINATIONS GETTING IMMUNISED CAN SAVE YOUR LIFE

ALL ABOUT HYPERTENSION HOW TO BEAT THIS SILENT KILLER

KEEPING PATIENTS SAFE

How sterilisation keeps diseases at bay

ISSUE 2 2019 CARING 1

CONTENTS

FLU SHOT

1836

2223

0224

1234

For many patients, stepping into a hospital for a medical procedure requires a lot of trust on their part — trust that they will be in the good hands of the hospital staff and the institution. At CGH, we have taken steps to ensure that patients receive safe care, including providing an environment that is clean and free from infection. Learn how a special group of healthcare staff work to ensure all medical instruments are safe for use (page 8).

Good communication is vital not just in delivering appropriate care, but also in building relationships. As part of our efforts to better involve patients in their care, we have updated our i-COMM app to improve communication with patients who converse primarily in dialects (page 12).

If you find that your loved one is suddenly unwell and behaving erratically, this could be due to delirium. Find out more about this condition on page 4.

In this issue, we’re introducing a new column by the Eastern Community Health Outreach (ECHO) team. We discuss hypertension, a chronic disease that is now affecting an increasing number of younger people (page 18). CGH’s ECHO team is regularly out on the ground, conducting health screenings in communities in the east of Singapore, so look out for upcoming screenings in your area.

Lastly, don’t forget to participate in our reader survey on page 17. Let us know what you think so that we can better bring you stories you will want to read and share.

Till the next issue!

Sarah Abdul KarimEditor

Supervising Editor Vivian Song

Editor Sarah Abdul Karim

Contributors Sarah Abdul Karim Dr Troy Puar Dr Clarence Chiang Dr Paul Ang Translators Yip Laimei Alan Li

Photographer Lumiere Photography

Design & Production NewBase Content

Media Specialist: Sarin Wee Email: [email protected]

Materials: Doreen Lau Email: [email protected]

MCI (P) 087/01/2019. Company registration number: 198904226R. All rights reserved. Copyright © 2019. No part of this publication can be reproduced in any form or by any means without the permission of the publisher. The views and opinions expressed or implied in are those of the authors or contributors and do not necessarily reflect those of the publisher.

Share your copy of Caring with others or recycle it. Caring is also available online at www.cgh.com.sg/CARING

TELL US!

We want to hear from you. To get in touch, provide feedback or update your subscription details, email us at: [email protected]

Caring is published bi-monthly for Changi General Hospital by NewBase Content

USEFUL NUMBERS

Appointments and general enquiries 6850 3333

Pharmacy enquiries 1800 787 8787

Feedback 1800 850 2823

02 A JAB IN TIME SAVES NINE Why getting vaccinated against pneumonia is important

04 DELIRIUM: AM I GOING MAD? Facts about this condition and how to detect and treat it

08 KEEPING INFECTIONS AT BAY How surgical instruments are sterilised to ensure patient safety

12 BREAKING THE LANGUAGE BARRIER WITH I-COMM A mobile app to facilitate communication with patients

14 IMPROVING TURNAROUND TIMES FOR BETTER PATIENT CARE Reducing transition periods between CGH and nursing homes

17 TELL US WHAT YOU THINK! Take our reader survey

18 THE SILENT KILLER: WHAT TO DO ABOUT HYPERTENSION Limit your salt and sugar intake to prevent high blood pressure

20 YOUR GPs CAN TREAT THESE CONDITIONS On diabetes and travel medicine

22 HEALTHY EATS Fragrant Spiced Chicken

23 吃出健康香辣鸡

24 及时的一针能救命为何接种肺炎疫苗如此重要

26 谵妄症：我要疯了吗？了解如何发现及治疗这个病症

30 预防受感染如何为手术工具消毒，确保病人安全

34 用i-COMM打破语言障碍一款手机应用程序成与年长者的沟通桥梁

36 无形杀手：如何应对高血压少糖少盐，摆脱高血压

38 您的家庭医生能治疗这些病症！有关糖尿病和旅行必备药物

EDITOR’S NOTE

2 CARING ISSUE 2 2019 ISSUE 2 2019 CARING 3

HEALTH NOTES

In a world where bacteria are increasingly resistant to antibiotics, can you afford to skip a life-saving vaccine?

A JAB IN TIME SAVES NINE

Cheryl paused mid-stride and turned towards the walls of the lobby corridor at CGH — several educational

posters for a World Immunisation Week 2019 exhibition were on display.

Though she had little time to spare, having taken a long train ride to the hospital during her lunch break to visit her father-in-law who was warded there, she nevertheless felt compelled to pause and read the posters. She found herself in front of one titled ‘What is pneumonia?’. “What a coincidence,” she thought. Her father-in-law, Mr Tan, had just been warded with a suspected case of pneumonia.

Like most Singaporeans, Cheryl had heard of the condition, but understood little about it. Skimming the poster, she discovered that pneumonia is an infection

where air sacs in the lungs would be filled with fluid, resulting in coughing, breathing difficulties and fever.

“Cheryl!” a voice called out, which she instantly recognised as Susan’s, her mother-in-law.

“How is father?” Cheryl asked.“He has a bad cough with green phlegm,

not like his usual smoker’s cough, has difficulty breathing, and was shivering with a 40-degree fever last night,” said Susan. “Come, let’s go up and see him.”

Minutes later, in the ward upstairs, Cheryl was greeted warmly — though also a little weakly — by her father-in-law.

“Aiyah, it’s nothing. I shouldn’t even be here,” wheezed Mr Tan.

“That’s not true, father. If you have pneumonia, it can become life-threatening,” said Cheryl.

Pneumonia vaccinations protect the elderly Later, the doctor informed them that Mr Tan had a form of pneumonia caused by a virus.

He recommended that both Mr Tan and Susan receive the pneumococcal vaccine, which protects elderly adults aged above 65 from pneumococcal pneumonia.

He emphasised that vaccines have a long record for being safe and highly effective. They save millions of lives every year and are widely recognised as one of the most successful and cost-effective health interventions.

In particular, the pneumococcal vaccine is needed to protect elderly folk like Mr Tan and Susan, as Streptococcus pneumoniae accounts for up to 30 per cent of community-acquired pneumonias. It is also commonly carried by as many as 60 per cent of preschool children. In Singapore, pneumonia is the second principal cause of death and the third-most common cause of hospitalisation. In 2017, more than 4,000 deaths were due to pneumonia.

Eventually, after a little persuasion from Cheryl, both Mr Tan and Susan decided to get the pneumococcal vaccine.

DID YOU KNOW?MediSave accounts may be used to pay for the pneumococcal vaccine at MediSave-accredited healthcare institutions, such as hospitals, polyclinics and CHAS GP clinics.

WHAT CAUSES PNEUMONIA? Pneumonia is a lung infection caused by bacteria, viruses or fungi. Pneumococcal pneumonia is the most common type of bacterial pneumonia. Caused by the Streptococcus pneumoniae bacteria, the condition also gives rise to otitis media (ear infections), meningitis (infections of the protective membranes covering the brain and spinal cord), bacteraemia (a type of blood infection), septic arthritis (infection in the joints) and osteomyelitis (infection of the bone and bone marrow).

Streptococcus pneumoniae is highly infectious and spreads easily from person to person via direct contact with saliva or mucus.

Pneumonia tends to be more serious in children younger than five years old and adults over the age of 65.

The risk of hospitalisation for pneumococcal pneumonia is 10 times greater for adults older than 65 than it is for those aged between 18 and 49.

GET VACCINATED IF YOU TRAVEL FREQUENTLY

1 Streptococcus pneumoniae infections

are not the only vaccine-preventable diseases that target the elderly. Invasive meningococcal disease (IMD), caused by the Neisseria meningitidis bacteria, is common and deadly as well.

2Early symptoms of IMD

are difficult to distinguish from other more common infections, and include flu-like symptoms such as headache, nausea and vomiting.

3 Symptoms can rapidly progress to

possible death between 24 and 48 hours, leaving a narrow window of opportunity to deliver life-saving treatment.

4Travellers over the age of 65 who

are heading to areas where IMD is common, such as Central Belt Africa, or going for Umrah or Haj pilgrimages are advised to get the meningococcal conjugate vaccine.

FLU SHOT

HOW IT WORKSFlu vaccines cause

antibodies to develop in the human body about two weeks

after vaccination. These antibodies act as a form of protection against infection with the viruses that are in

the vaccine.


MENTAL WELLNESS

Former high school teacher Alice Rozario, 89, was diagnosed with delirium in early 2018. Together with

a full-time helper, daughter Irene Gomez is now her mum’s primary caregiver.

But while looking after her mum isn’t the first caregiving experience for Irene (she had taken care of her best friend, eldest brother and father when they were critically ill), it has been an entirely new, stressful and even frightening experience handling a loved one suffering from delirium. Here, Irene, who is chief inspiration officer of the communications agency she founded, shares her story with Caring.

How did your mum’s delirium start?In late 2017, mum had gone to India for a four-month vacation. However, she returned a month-and-a-half later with cellulitis in her foot and was admitted to CGH for a few days. The following month, she started to behave erratically and strangely, obsessing about money and her personal clothing. We took her to CGH, where she was diagnosed with having low sodium levels in her body and hospitalised for about two weeks. Though she was given medication

It’s a condition few understand and is a warning sign that something is wrong. Raising awareness about delirium is thus crucial to identify it early and treat its underlying causes

DELIRIUM: AM I GOING MAD?

Irene Gomez and her mother Clara

Alice Rozario

HOLISTIC SUPPORT, BETTER CARE MANAGEMENT IRENE SUGGESTS WAYS TO HELP CAREGIVERS IN THEIR WORK

• Provide better education and access to resources, such as brochures and relevant weblinks

• Offer respite options, access to support groups, counselling services, social engagement activities for the patient, etc

• Provide a toolkit designed for the caregiver. This can include information and tips on early detection, diagnosis and recovery

• Promote more engagement with the health and medical community through talks, training while in hospital or through outreach (eg. CGH’s Community Health Services)


MENTAL WELLNESS

and appeared fine upon discharge, in late March, she started showing signs of erratic behaviour and hostility, and we found her talking to herself. We had to forcibly take her to the hospital, where Dr Bharathi Balasundaram from the Department of Psychological Medicine evaluated her condition and diagnosed her with delirium.

What was the outcome of the diagnosis and first steps of treatment?Dr Bharathi explained the entire spectrum of mental disorder/impairment in the elderly. We learned that delirium is a short-term condition that can result from pain, falls or infection — mum had developed urinary tract infection at the time. Dr Bharathi prescribed medication to help with the mood and behavioural changes. Concurrently, Dr Barbara Rosario from the Geriatric Medicine department followed up on my mother. She evaluated her and prescribed additional medication to help control her fear and anxiety. In all, mum was in hospital for a month.

How have you and your mum been coping since?Mum has been back to the hospital several times — usually with some infection or other. The good thing is, with all that we’ve learned from the doctors and from our own research, we are now able to detect the onset of delirium, which happens as a result of some infection or pain, and take mum to the hospital before full-blown delirium hits. Mum continues to have follow-up visits with both doctors.

Helping a loved one with delirium can be overwhelming. Where did you get the support you needed for your caregiving journey?I couldn’t have done it without the doctors and nurses in geriatrics and psychological medicine at CGH. I learnt a lot from them last year when my mum was hospitalised six times. The nurses were ever ready to offer advice and support to our helper. Our doctors went out of their way to educate and assure us and were always willing to listen and talk to us. They also tried different types of medication to help treat mum’s various medical situations.

What do people need to understand about delirium? Are there any common misconceptions? Some people we know still have a problem understanding delirium. I try to share my experience with people whose parents exhibit all the classic symptoms of delirium, but they tend to put it down to their parents just having a fall or infection. When I suggest they seek medical advice, they brush it aside. Another common misconception is that delirium is the same as dementia.

What is one important advice you have for caregivers, especially those taking care of someone with delirium?Find out all you can about the illness, ask for help or clarification and talk to doctors to better understand the causes, symptoms and available treatments. Do your research so you can ask the right questions and better help the person you are caring for.

Dealing with delirium is not only stressful, it can also be scary to both the patient and their loved ones. When it first happened to my mum, we thought she was going mad and felt daunted by the whole situation — only because we didn’t understand it. Now we know that delirium is a short-term condition, and with proper help and medical care, we can better manage mum’s condition.

My uncle once told me: When you learn about the illness you’re dealing with, you’re halfway there to getting the help you need to get better. So don’t be afraid to educate yourself, the person you are caring for, family members, friends and other caregivers.

CGH doctors and Irene, together with Dr Laura Tay Bee Gek from SKH, at a panel session on World Delirium Day 2019

DELIRIUM SYMPOSIUM “It is crucial that we raise awareness among healthcare professionals and family caregivers to assist in the early identification, diagnosis, assessment, treatment and prevention of delirium,” said Dr Bharathi Balasundaram. This year, CGH marked World Delirium Day by launching the Delirium Symposium. This joint initiative by the Department of Psychological Medicine (Geriatric Psychiatry service) and the Department of Anesthesiology and Surgical Intensive Care was a pivotal step forward in raising awareness about the condition.

HOW CAREGIVERS AND FAMILY MEMBERS CAN HELP

WHAT IS DELIRIUM?

Caregiver involvement is crucial for early recognition, diagnosis, management and recovery.

Some strategies caregivers could use include:

1 Remind your loved ones where they are and what day it is by using calendars or a clock to aid orientation.

2 Ensure they have spectacles and hearing aids.

3 Talk in a reassuring tone and give them time to answer questions.

4 Provide mental stimulation by keeping your loved ones updated on current affairs, reading etc.

5 Minimise noise and distractions around them.

6 Alert your medical team about changes in behaviour.

Delirium is a sudden onset of mental confusion, typically lasting hours or days, that may occur when a patient is unwell, especially if he is older. While delirium may cause behavioural changes and even coexist with dementia, both conditions are different. However, a previous dementia diagnosis puts individuals at higher risk for delirium.

Causes of delirium*:• Illness • Pain• Recent surgery• Dehydration• Constipation• Medication

* Delirium may occur due to a combination of causes.

Symptoms of delirium:• Being more forgetful than usual• Having trouble concentrating• Confusion over the time of day• Being restless and upset for no

apparent reason• Appearing less or more alert

than usual• Seeing or hearing imaginary

things

The symptoms associated with delirium disappear when the underlying cause is treated.

Reference: rcpsych.ac.uk/mental-health/problems-disorders/delirium

8 CARING ISSUE 2 2019

COVER STORY


Infections can be fatal to patients, especially for those whose immune systems are weakened by illnesses, making it harder for them to fight diseases. Thus,

it is vital to keep the hospital environment clean by adhering to proper cleaning criteria. This goes all the way down to the medical instruments used in surgery and other clinical procedures. But who takes care of this?

In the basement at CGH, out of public sight, staff in the Central Sterile Supply Department (CSSD) play a significant role in the prevention of surgical-site and healthcare-associated infections. Reusable medical instruments used in the different parts of the hospital, including the operating theatres, are collected by the team to be cleaned, disinfected, inspected, assembled and sterilised before they are distributed to the operating theatres and other patient care areas.

To achieve patient safety and stop the spread of harmful microorganisms, attention is given to details such as the manual brushing of every instrument with lumen, because sterilisation cannot be achieved without good cleaning. Though the team work on their own, the fruits of their labour are evident every single day, in the operating theatres, clinics and wards at CGH.

KEEPING INFECTIONS AT BAYEnsuring surgical instruments used in the hospital are clean and sterile is an important part of patient care

Awarded for excellenceWhile technology has changed the way we work, disinfection and sterilisation of tools is still a manual task that requires vigilance. Team members take it upon themselves to upgrade their skills through peer learning and various forms of training. Due to the team’s exemplary work, the CSSD was recognised as a Centre of Excellence in the delivery of quality disinfection and sterilisation services. CGH is the only public hospital to win the award this year, after qualifying as a participant for the audit by Asia Pacific Society of Infection Control (APSIC) on 21 January.

Yvonne Lew, nurse manager with the CSSD, travelled to Vietnam to receive the award. She said, “We had put in our best effort. We felt that if other countries could win this, so could we.”

Interestingly, there are a few nurses on the CSSD team. Yvonne herself was a former nurse who worked in operating theatres. In joining the CSSD team, she has brought over transferable skills like a clear understanding of the functionality of each surgical instrument, which is essential in ensuring an efficient cleaning and packaging process for easy access by the instrument’s user.

Yvonne shared, “If we don’t do a good


COVER STORY

If we don’t do a good job, the

doctor’s work and, indirectly, patient care are affected

job, the doctor’s work and, indirectly, patient care are affected. We always put ourselves in the shoes of patients’ families and imagine our loved ones on the operating table. Would we allow the instruments we are re-processing to be used on them? If our answer is yes, it means that we have done our job well.”

The next time you are at the hospital for a medical procedure, know that you are safe because of the efforts of our CSSD team.

• Organise and scan items• Sort instruments• Manual/machine wash• One-way flow (from

decontamination to packaging)

• Users check that all reusable items have been returned

• CSSD staff collect dirty items/used sets

• Items are scanned before they are counted and checked for defects and cleanliness

• Assemble and package items according to checklist

• Items are labelled

• Check for external/ internal indicators before use

• Discard single-use items, sharps and waste after use

• Store dirty items in covered containers

• Select the appropriate sterilisation method

• Perform physical checks after each cycle

• Quality is assured• Store sterilised items

• Maintain inventory register• Weekly inventory checks• Shelf life is “event-related”*• Sterilisation process indicator

chart for reference

* CSSD reprocesses items according to the shelf life of the item packaging.

• Organise and scan items• Delivery via enclosed

containers• Clean delivery and

dirty collection are done separately

DECONTAMINATION AREA

RETURN

PACKAGE

USE

STERILISE

STORE

DELIVER

RECEIVE

• Delivery to operating room is done via lift in CSSD (clean area)

• Operating room users send all used items via lift to CSSD (decontamination area)

• Collect set report for verification from CSSD

• Receive sterile reusable items/disposable items

• Check change in colour of the external chemical indicator tape and the integrity of the packaging

• All items must be washed, but not all items can be washed in the washer disinfector or ultrasonic cleaner.

• Staff impose traffic control. This is a restricted area, and only authorised personnel are allowed to enter the department.

• CCTV monitoring is done at strategic locations.• Strict dress code: All staff entering the department

must change into surgical scrubs, wear head covers and change into washable footwear. Staff assigned to the decontamination area are required to wear full personal protective equipment.

• Hand hygiene is mandatory at all areas.• Work area cleanliness

a) Clean area: Floors are mopped daily and scrubbed weekly, workstations are wiped every morning; the walls at the packing, sterilisation and storage areas are wiped weekly. b) Decontamination area: Floors are scrubbed at the end of each day, workstations are wiped daily and all spills are mopped immediately.

• Standard precaution is practised: Everything received in decontamination area is handled as potentially infectious.

PRECAUTIONS AT CSSD

CSSD

USERS

Sarah Abdul Karim is Executive, Corporate Affairs, at CGH

HOW SURGICAL INSTRUMENTS ARE CLEANED AND STERILISED


FEATUREFEATURE

Communicating with elderly patients is made easier with this mobile app

Communication is a vital part of the care process. But what happens if a patient is able to converse only in a

single language that healthcare staff are unfamiliar with? Nurses at CGH used to struggle with communicating with patients who speak only in vernacular Chinese languages — particularly the elderly who tend to communicate solely in Hokkien or Cantonese — but a mobile tool launched in 2014 has helped them with this.

i-COMM, or Integrated Healthcare Communicator, was jointly developed by CGH and Integrated Health Information Systems (IHiS) as a proof of concept, with 100 Cantonese phrases specific to nursing included within, such as instructions on medication and nursing advice.

This app has now been newly expanded to include Hokkien and Malay. In total, i-COMM now has as many as 500 phrases, while a range of multimedia options, including audio output, pictorial aids and a visual phonics guide will help nurses identify key words. The aim is such that with continued use, they would be able communicate with patients without needing the app.

A nurse-led initiative i-COMM was originally designed with input from a team of 19 CGH staff, which included 13 nurses. It was conceptualised

following the observation that staff had difficulty communicating with dialect-speaking patients.

“I used to have difficulty communicating with patients, as most of them spoke in dialect, and I frequently felt anxious when I could not tend to their needs. To bridge the communication gap, I attended Cantonese classes and picked up basic Malay from my colleagues,” said Ms Li Jing, a staff nurse at CGH. “i-COMM provides a comprehensive guide on the common dialects in Singapore and has useful phrases that we frequently use, so I now use it frequently to show patients and communicate with them.”

To enhance the app, the team working on it focused on developing introductory and nursing care phrases, such as medical procedure terms and nursing advice commonly used in the wards. Professional translators were appointed to help develop phrasal translations, which CGH nurses then reviewed and refined to ensure a more conversational and colloquial tone. Voice-over artistes were also used to accurately capture the pronunciation and intonation of phrases. In addition, a selection of stock images and photographs were used to create pictorial aids to supplement the phrases.

“With the enhanced i-COMM, nurses and other staff, such as our Patient Service

BREAKING THE LANGUAGE BARRIER WITH i-COMM

Associates, can communicate more effectively with dialect-speaking patients. We can better recognise patients’ needs and convey care instructions, thereby creating a more meaningful patient experience,” shares Mr Wong Kok Cheong, deputy director of the nursing department at CGH. “This is especially useful when communicating with our elderly patients, and is part of our efforts to create an elder-friendly environment.”

He added: “i-COMM is also designed to facilitate self-learning of vernacular languages, and is a resource that healthcare professionals can rely on for commonly used phrases in healthcare settings.”

More enhancements to comeThe app is designed for future expansion to include more languages and phrases to meet different needs and settings. Since its launch, clinical departments from Rehabilitation Therapy to Radiology at CGH have requested that our developers incorporate phrases that cater to their specific areas of work.

With our investment in technologies such as i-COMM, CGH looks forward to better serving the needs of our patients. A more effective mode of communication can lead only to better care.

DENTURE Malay: Gigi palsuCantonese: 假牙 ( Kah ngaa)Hokkien: 假牙 ( Gey kee)

ARE YOU IN PAIN?Malay: Adakah anda merasa sakit?Cantonese: 你有冇觉得痛？( Nei yao mo gok dark tong?)Hokkien: 你有什么地方感觉痛吗？ ( Lee woo card teet tiah bo?)

WOULD YOU LIKE TO SHOWER NOW?Malay: Adakah anda mahu mandi sekarang?Cantonese: 而家要唔要去冲凉？ ( Yi kah you mm you hoi cheong leong?)Hokkien: 你现在要去冲凉吗？ ( Lee jit zhun eye key zang chwee bo?)

COMMON PHRASES FOUND ON i-COMM

PLEASE USE THE CALL BELL TO ASK FOR HELPMalay: Sila tekan loceng panggilan untuk meminta bantuanCantonese: 请㩒钟叫我哋帮忙。 ( Cheng gum zhong kew ngor day bong mong)Hokkien: 有需要请按铃。 ( Na see lee su yao bunk bung chia lee chee zeng)

If you think i-COMM would be of value to you, you may

download it here:

For iOS

For Android


FEATURE

CGH’s new process has reduced transition periods between the hospital and nursing homes, easing the bed crunch and reducing long wait periods

IMPROVING TURNAROUND TIMES FOR BETTER PATIENT CARE

CGH serves more than one million patients living in eastern Singapore, most of whom are the elderly. When there is a need for an elderly patient to be transferred from the hospital

to step-down care institutions like nursing homes, the transition should be smooth and seamless.

A long turnaround time (TAT) for such patients can result in unnecessary, lengthier stays and affect the hospital’s bed capacity for the admission of those who require acute medical care. A long hospital stay may also create more anxiety in elderly patients and increase the financial burden on their families.

Based on 2015 data from the Agency for Integrated Care (AIC), TAT between CGH and admission to a voluntary nursing home (VNH) was 72 calendar days.

How was this issue addressed? By working collaboratively with our partners. CGH, together with the AIC, Peacehaven Nursing Home and All Saints Home (Tampines) to set up a project team to manage the problem, with the aim to:

• Reduce TAT by improving the end-to-end process and coordination between CGH and the other three organisations in the team

• Reduce the number of times a referral is reverted between CGH and the AIC


FEATURE

Both internal (different disciplines within CGH) and external stakeholders (the AIC, Peacehaven and All Saints Tampines nursing homes) convened to identify the challenges and bottlenecks at the different touch points. They performed value-stream mapping that looked into making the current application process simpler and processes more efficient with shorter TATs.

The team then recommended the following changes:

• The AIC would relocate two Residential Referral Team (RRT) members from its headquarters to CGH to enhance collaboration and discussion. Medical social workers (MSWs) from CGH would discuss with RRT staff before creating any referral.

• Therapist assessments can be excluded during application, but the therapist’s report should be provided at a later stage.

• The AIC’s RRT would complete the patient’s Resident Assessment Form, Functional Status and Nursing Procedures to reduce the number of reverts and facilitate the correct siting of applicants.

• An AIC RRT member, instead of an MSW from CGH, would inform the patient’s family when a bed is available. This helps minimise miscommunication between the various parties.

Win-win situationThe work process project has been replicated in other hospitals, such as Tan Tock Seng Hospital, Khoo Teck Puat Hospital and Singapore General Hospital, with positive results.

The CGH project team’s effort was also recognised at the Asian Elderly Care Awards this year, where they won the Gold Award in the Excellence in Quality Elderly Care Service category.

“The team worked extremely hard to redesign and implement the new work process to improve healthcare delivery. Winning this award is an honour and a strong affirmation of the team’s collaborative

The new work process was implemented on 11 July 2016. As of 30 June 2018, there has been a marked improvement in TAT.

TAT BEFORE: 72 daysTAT AFTER: 28 daysNUMBER OF REVERTS BEFORE: 5.2NUMBER OF REVERTS NOW: 017,996 Savings in terms of hospital bed days

This has allowed patients from the hospital’s Accident & Emergency department to be allocated beds quickly and for medical care and resources to be spent in the right areas. Our patients also receive the necessary follow-up care quicker and caregivers are assured the continuum of care.

POSITIVE RESULTS

effort,” said Yeo Seok Tin, Master Medical Social Worker, Medical Social Services.

It is heartening to know that when your loved one enters the hospital, not only will they be provided the best care possible, but when necessary, community partners are involved to help support their medical journey.


SURVEY

Thank you for reading Caring all these years. We want to hear what you have to say about the magazine. Let us know what you think and stand a chance to win CapitaLand vouchers!

1. How long have you been reading Caring? 1 year 2 to 5 years Too long ago that I can’t remember!

2. How old are you? Under 16 16 to 25 26 to 49 Above 50

3. How do you receive your issue of Caring? I'm a subscriber From CGH magazine stands Community centres Polyclinics Others: please state ________________________________

4. Which format do you prefer to read Caring? Printed copy Website Email No preference

5. Would you continue to read Caring if it were available only as digital copies? Yes No Not sure

6. Would you recommend or share Caring with your friends and family members? Yes No Maybe

TELL US WHAT YOU THINK!

7. Should the articles in Caring also be translated into other languages, such as Malay or Tamil? Yes No

8. Does reading Caring enable you to better understand the services that CGH has to offer? Yes No Somewhat

9. Which is your favourite section in the magazine? Health Notes Mental Wellness Cover Story Feature Healthy Eats My GP Answers

10. What other topics would you like us to cover?__________________________________ ________________________________________________________________________________________________________________________________________

To participate, simply complete this survey, take a snapshot of this page and send it to [email protected]. We hope to hear from you soon!


FEATUREFEATURE

Hypertension is defined as having blood pressure that is above 140/90mmHg. It is often described as a silent killer,

as most people who suffer from it tend to feel perfectly normal even when their blood pressure goes up to 160/100mmHg. When left untreated, hypertension is a major cause of heart attack, heart failure and kidney failure. It is also the most important risk factor for stroke.

The condition is twice as common

sweetened drinks and desserts — gives rise to diabetes, while hypertension is caused by excessive salt intake.

But which is worse — sugar or salt? The answer is both. I remember how a Scandinavian senior professor used this illustration during an overseas conference many years ago: We go to a fast-food outlet, pay $1 more for an upsized meal, take lots of salty fries and wash that down with a huge cup of sugary soft drink. Salt makes us thirsty, and we consume a cold soft drink to quench that thirst. In Singapore, the equivalent to this would be eating a plate of fried rice or char kway teow, followed by a large glass of sugarcane juice, soya bean drink or bubble tea!

Affecting more young adultsWith obesity rates increasing, there are more young adults (and even adolescents) being diagnosed with diabetes and hypertension. Being diagnosed with high blood pressure at a young age can significantly impact an individual’s future well-being. For women, conceiving can be difficult, and pregnancy will be riskier for both mother and foetus.

It is now not uncommon to see younger patients aged 30 to 40 years old suffering from heart attacks and strokes. Hence, the importance of leading a healthy lifestyle and avoiding smoking cannot be overemphasised.

For those who suffer from hypertension, it is certainly a treatable condition. Treatment begins with adopting a healthy lifestyle and eliminating harmful habits like smoking. Sometimes, medication is needed to better control your blood pressure. There is now a wide range of medication that your doctor can prescribe, depending on your needs. Bringing your blood pressure back to normal will reduce your risk of heart attack and stroke.

It is worth stressing that having a blood pressure monitoring set at home is very

as diabetes, affecting one in four adult Singaporeans. People who suffer from hypertension are more likely to have diabetes, and vice versa, while having both is even more harmful. This is hardly surprising, as the risk factors for both diseases are largely similar: Unhealthy dietary habits, a sedentary lifestyle, lack of exercise and obesity. Consuming foods that are high in carbohydrates — in particular starchy food like rice, or sugary food like

Limit your intake of salt and sugar to stave off high blood pressure

THE SILENT KILLER:

WHAT TO DO ABOUT HYPERTENSION

Welcome to the new edition of A Simple Guide to Healthy Living, now presented as ECHO, a regular column in Caring. With this transition, we hope to provide more readers important and relevant information on chronic diseases and living well. This issue, we touch on the important topic of high blood pressure, which affects one in four Singaporeans. For upcoming screening sessions and registration details, visit echohealth.com.sg. We look forward to seeing you! Dr Linsey Utami Gani, ECHO Programme Director

Dr Troy Puar is Consultant, Department of Endocrinology, at CGH

2019 ECHO Health Screening

ECHO health screening sessions are coming to Kembangan-Chai Chee. Singaporeans aged 40 and above with no known chronic disease and who have not had a health screening within the last three years are eligible to participate.To register, simply head to any of the community centres listed below. Please bring your NRIC and, if required, Pioneer Generation card or CHAS Card together with cash for payment.If you have family members, friends or relatives living in these constituencies, please encourage them to register for ECHO’s health screening!

Venue Date

Kampong Ubi CC 22 Jun, Sat

Fee: Pioneer Generation: $0 CHAS: $2 Non-CHAS: $5Permanent residents: $10 (walk-in only)

useful. These should preferably be those that wrap around your upper arm, not your wrist. Home monitoring provides a more accurate measurement of one’s usual blood pressure. With the availability of numerous phone apps and Wi-Fi-enabled devices, it is also easier to record your daily readings so you can share them with your doctor on your next visit. And as hypertension typically runs in the family, you can also use them to screen your family members.

So, do not delay. Have your blood pressure checked at least once a year, and keep to a healthy diet and regular exercise plan.

FOR MORE INFORMATION on health screenings, please contact ECHO at 67888833 or email [email protected].


MY GP ANSWERS

Dr Clarence Chiang is a family physician at Northeast Medical Group. He has a special interest in treating chronic diseases and works passionately with patients towards effectively controlling their conditions. He has completed his Master of Medicine, with a specialisation in family medicine, and has undergone rigorous training at many hospitals and polyclinics. He believes that well-controlled chronic diseases, including diabetes, can be achieved in any case.

YOUR GPs CAN TREAT THESE CONDITIONS

The GPFirst Programme was launched in 2014 to encourage patients in eastern

Singapore to see their general practitioners (GPs) for mild to moderate medical conditions, rather than head straight to the emergency department. In this regular series, our eastern community GPs offer advice on common ailments Caring readers might face.

In this issue, we focus on diabetes and travel medication. Do visit www.gpfirst.sg or see your GP for more information on other common conditions such as nausea, headaches, sprains, fevers, cuts and bruises and mild scalds.

Dr Paul Ang is the founding director of Zenith Medical Clinic in Punggol, deputy director of Class Primary Care Network and director of MaNaDr Mobile Health. His passion is education and mentorship, and he strongly believes that by applying the Socratic method and asking younger learners the right questions, we can help them learn and make the world a better place.

DIABETES MELLITUSI am a 48-year-old housewife who loves food. A recent health screening at a community centre revealed that my Body Mass Index (BMI) is 33.1 kg/m2. Lately, I have been feeling thirsty more often, so I stocked up on my favourite homemade sweetened chrysanthemum tea in the fridge. I also frequent the bathroom many times a day. Additionally, I have noticed that my skin has turned dry and itchy! My husband thinks these could be signs of diabetes and has strongly advised me to see a GP. How can my GP diagnose my condition?

Diabetes is a common chronic condition, in which your blood sugar (blood glucose) rises to a high level. Your husband is correct to say that frequent thirst and urination may be symptoms of diabetes.

Other symptoms include increased

may also perform an oral glucose tolerance test (OGTT) at a later stage to confirm the diagnosis. In addition, your cholesterol levels and blood pressure will also be measured.

If your test results show that you have diabetes, your GP will begin discussing treatment options, tailoring them to the amount of glucose control that is needed. Treatment usually takes a holistic approach, which includes monitoring your condition and possible complications, lifestyle modifications and medication, if needed.

Strict adherence to a low-sugar or low-carbohydrate diet, coupled with regular moderate-intensity exercise of 150 minutes or more per week, aiming for gradual weight loss, will help improve blood-glucose control.

It is essential to identify complications of diabetes early. Regular check-ups and compliance with prescribed medications are important. In today’s clinics, there are a wide variety of medications from which GPs will carefully select to suit each patient’s needs.

If you experience the above symptoms or if you are above the age of 40 and have never had your blood sugar levels checked, we encourage you to consult your family doctor.

TRAVEL MEDICINEI am a 21-year-old tertiary student who will be graduating in a few months. My friends and I are planning to go on a 20-day graduation trip to Taiwan. As this is the first time I am travelling abroad for a long period, I am unsure which medicines I should take with me. I have also heard that the bus ride into Alishan National Park is pretty rough and I am worried about motion sickness. How can my GP help me?

Congratulations on your graduation! Taiwan can be a really fun place for a visit, and you wouldn’t want illness to spoil the fun. Although healthcare in Taiwan is very accessible, you would not want to have to

change your itinerary at the last minute to accommodate a clinic visit.

Firstly, always buy travel insurance — it is a small price to pay for peace of mind.

Secondly, always get vaccinated early, as it takes time for the body to build immunity against diseases. Check the official CDC website (bit.ly/cdctaiwan) for the vaccinations you will need. Again, this is a small price to pay for not losing precious time on your vacation!

Thirdly, always carry medication in your personal bag — not in your check-in luggage. Most GPs will have a set of travel medications that they can recommend. These will usually include those for pain, stomach pain, vomiting, diarrhoea, allergies, sore throat, motion sickness and, for ladies, medication to control menstruation. And of course, if you suffer from conditions such as asthma, don’t forget to take along your regular medication for them.

As for motion sickness, medication typically prescribed for it should work, provided that you have no drug allergies. You can take them an hour before the bus ride. Be aware, however, that they can cause drowsiness.

Otherwise, bon voyage!

appetite or excessive hunger, weight loss, lethargy, slow-healing wounds, blurred vision, numbness or tingling sensations in the hands and feet. The skin may become dry and itchy, while some patients may have velvety dark skin around the neck and armpits. In women, recurrent yeast and urinary tract infections may develop, while poorly controlled diabetes in males may lead to erectile dysfunction.

Some risk factors for diabetes include obesity, a family history of diabetes, a history of gestational diabetes and high cholesterol levels.

Your GP or family physician can diagnose and treat diabetes. Typically, he will first conduct a series of blood tests to measure your blood glucose levels. If required, he


吃出健康HEALTHY EATS

FRAGRANT SPICED CHICKEN

WHAT YOU’LL NEEDChicken ½ (about 600g), skinned

Marinade:Cooking oil 2 tbspShallots 55g, peeled and choppedLemongrass 30g, tough outer

leaves removed, ends trimmed, bruised and finely chopped

Galangal 2.5cm knob, peeled and finely chopped

Dried chillies 6, soaked until soft, seeded and chopped

Red chillies 55g, blendedFennel 1 tspCumin 1 tspSalt a pinchGround black pepper a pinchWater 200ml

NUTRITIONAL INFO (PER SERVING)Calories 186kcalCarbohydrates 3.3gFat 10.2gCholesterol 57mgFibre 0.2g

营养信息（每份）卡路里 186千卡碳水化合物 3.3公克脂肪 10.2公克胆固醇 57毫克纤维 0.2公克

所需材料鸡肉半只，约600克，去皮

调味料：食用油两汤匙小葱头 55克，去皮，剁碎香茅 30克，去掉外层的硬叶片，

切掉头尾，平拍一下然后切成细片

姜根（Galangal）一小节（2.5公分），去皮，切碎

辣椒干 6个，浸泡在水里至软化，去籽，剁碎

红辣椒 55克，搅成糊状茴香 1茶匙孜然芹 1茶匙盐少许黑胡椒碎少许清水 200毫升

做法• 准备调味料。把油倒入炒锅用中火加热。放入小葱头，炒香后加入香茅和姜根。加入辣椒和辣椒干，把火候降至小火。炒3到5分钟，然后加入茴香、孜然、盐和胡椒碎。倒入清水后再炒3到5分钟，关火。放凉备用。

• 把鸡肉放入一个大搅拌碗里，加入调味料。揉搓鸡肉确保调味料渗入鸡肉里。把碗盖上后放入冰箱过夜。

• 烹煮当天，把烤箱预热至160摄氏度。把腌好的鸡肉放置在一个抹上了少许油的烤盘。烘烤30分钟或至鸡肉变嫩滑，而用叉子刺入鸡肉最厚的部分时，流出的鸡汁是透明的。

• 把鸡肉切成片。随意加上装饰菜，立即上桌。

This recipe was first

published in A Cookbook

for Diabetics by a Dietitian and a Chef, which is available at all major bookstores. 该食谱于《A

Cookbook for Diabetics by a Dietitian and a Chef》中首

次出版，现已在各大书局出售。

香辣鸡这道香味四溢的菜肴使用多种香料，恰好与嫩滑多汁的鸡肉形成最佳搭配

Try this aromatic dish filled with spices that complement the juicy tenderness of chicken

30min

PREPARATION TIME SERVES

PREP 1 DAY AHEAD

METHOD• Prepare the marinade. Heat the cooking oil in a medium-heated

wok, then add shallots and sauté until fragrant. Next, add lemongrass and galangal and fry until fragrant, before adding dried and fresh chillies. Reduce heat to low, then fry for 3 to 5 minutes. Add fennel, cumin, salt, pepper and water, then stir-fry for another 3 to 5 minutes before setting it aside to cool.

• Place the chicken in a large mixing bowl and add in the marinade. Rub the marinade in thoroughly to season the chicken well. Cover and refrigerate overnight.

• Preheat the oven to 160°C. Place the marinated chicken on a lightly greased baking tray. Bake for 30 minutes or until the chicken is tender and juices run clear when the thickest part of the chicken is pricked with a fork.

• Slice the chicken into serving pieces. Garnish as desired and serve immediately.

30分钟

准备时间可供

前一天开始准备


保健小笔记

及时的一针能救命细菌越来越猖獗，最强的抗生素都未必能对付它们，您还在犹豫是否要接种疫苗？

FLU SHOT

雪儿在樟宜综合医院的走廊上突然停下脚步，并且转头看着墙上有关

2019年世界免疫周展览的教育海报。她是为了探望家翁，才趁着午餐时间从

市区搭乘地铁来到樟宜综合医院。虽然时间不多，但她不知何故，却决定停下看一看海报上的信息。她看着一张有关肺炎的海报。“怎么这

么巧？”她心里想着，因为她的家翁陈先生昨夜就是怀疑患上肺炎入院的。像大多数新加坡人一样，雪儿也听说

过肺炎，但对其却是一知半解。她略读海报上的头几句，发现肺炎是指肺部受到感染，而随着气囊逐渐充液，病人便会开始咳嗽、感觉呼吸困难以及发烧。“雪儿！”雪儿的家婆苏珊突然出现在她

身旁。她回过神后问：“爸爸怎么样了？”

“他不但有严重的咳嗽，还带有绿色的痰，不像他平时的烟客咳。他也有呼吸困难，全身发抖，而且昨夜还发烧至40度。”苏珊回答道。“走，我们上去看他。”几分钟后，她们来到了病房。陈先生虚

弱地向她们打招呼。“哎呀，没事的啦。我根本不用住院

的。”他边喘气边说道。“才不是呢，爸。如果您患上的是肺炎，

这可是会有生命危险的。”雪儿说道。

肺炎疫苗可保障年长者的命后来，医生证实陈先生患的是由病毒所引发的肺炎。但医生仍建议苏珊和陈先生在出院后去

接种肺炎疫苗，因为这可预防65岁以上的年长者患上肺炎球菌性肺炎。

不说您不知在保健储蓄认可的保健机构，如医院、综合诊疗所和CHAS家庭诊所中，您可使用保健储蓄来支付接种肺炎球菌性肺炎疫苗的费用。

他强调，疫苗在安全性与有效性上的效果一直很显著。它们每年拯救成千上万的生命，而且被广泛视为全球最成功及最符合经济效益的保健干预措施之一。肺炎球菌性肺炎疫苗尤其能够保护如

陈先生和苏珊这类型的年长者，因为肺炎链球菌占社区肺炎感染病例的30%，而且有高达60%的学前教育孩童是带菌者。在新加坡，肺炎是导致死亡的第二主要原因，也是导致住院的第三大因素。在2017年里，有超过4000起死亡病例是因肺炎所致。经过雪儿的一番游说后，陈先生

与苏珊终于决定去接种肺炎球菌性肺炎疫苗。

肺炎是因肺部受细菌、病毒或真菌感染所致，而肺炎球菌性肺炎是最常见的细菌性肺炎。由肺炎链球菌所引起，它也可能引发中耳炎（耳朵发炎），脑膜炎（脑部外层和脊椎发炎）、菌血症（血液受感染）、化脓性关节炎（关节发炎）和骨髓炎（骨骼和骨髓发炎）等。

肺炎链球菌的传播性极高，并且容易通过唾液或黏液传染给他人。患有肺炎的5岁以下孩童和65岁以上成人会出现较严重的情况。患上肺炎球菌性肺炎的65岁以上成人的住院风险与18至49岁的患者相比高出10倍。

肺炎的导因

经常出国，请接种疫苗

1 肺炎球菌性肺炎并非年长者

唯一能够通过接种疫苗来预防的疾病。由脑膜炎奈瑟球菌所引发的侵袭性脑膜炎球菌病也是常见的可致命疾病。

2脑膜炎的早期症状与常见感

染病症状相似且难以分辨，其中就包括感冒症状，如头痛、作呕和呕吐等。

3症状可在24至48小

时内迅速发展至死亡，因此施救时机非常短。

465岁以上且经常到脑

膜炎较为普遍的非洲中部或是出国朝圣，都应该接种脑膜炎疫苗。

保健小笔记


这个鲜少人知的病症可敲起警钟，因此提高对它的意识对及早发现与治疗至关重要

谵妄症：我要疯了吗？

现年89岁的Alice Rozario原本是一名高中老师，但她在2018年初被

诊断患上谵妄症。她现在与女儿IreneGomez和一名全职帮佣同住，并由她们进行看护工作。虽然对曾照顾过病危的好友、大哥及父亲的Irene而言，看护工作并不陌生，但照顾患有谵妄症的亲人却是个全新高压，甚至恐怖的体验。目前在她所创办的公关公司担任创意总监的Irene就与本刊分享了她的经历。

您母亲的谵妄症是怎么开始的？在2017年末，母亲原本安排到印度度

假4个月。但1个半月后，她因足部出现蜂窝织炎，所以回国并且在樟宜综合医院留医。一个月后，她的行为开始变得无常，举止也很怪异，总是想着钱和她的个人衣物。我们带她到樟宜综合医院求医，结果诊断出她体内钠含量过低，以致在医院住了2个星期。虽然在服了药，在出院时也表现正常，但在2017年3月低，她开始行为无常、对他人有敌意、自言自语等。我们只好强行把她送到了医院。心理医学科的Bharathi Balasundaram医生为母亲进行检查，并且首次诊断母亲患上谵妄症。

保健小笔记


诊断结果意味着什么？治疗该如何开始？Bharathi医生为我们耐心地解释年长者

可患的各种精神病。我们了解了谵妄症是一个短期的病症，并可因疼痛、跌倒或受感染所引发（母亲当时患有尿道发炎）。医生为她开了可控制情绪与行为的药物，而老年医学科的Babara Rosario医生也为母亲的情况进行跟进，并评估病情及为她开额外药物以控制她的恐惧与焦虑。母亲最终在医院呆了一个月。

您与母亲是如何应对谵妄症的？母亲至今已几度回到医院，主要因感

染或其他病症所致。所幸的是，通过医生与我们自己的查询，我们现在可以及时发现谵妄症的症状，一般由感染或疼痛所引发，以免谵妄症全面爆发。母亲也继续与两名医生进行复诊。

照顾患有谵妄症的亲人并非易事，您是如何获取所需支持的？如果没有樟宜综合医院老年医学科与

心理医学科的医生与护士们的帮助，我想我办不到。去年，我母亲共入院6次，而我从他们身上学会了很多。护士们总是在一旁指导和帮助我们的帮佣。医生们也竭

尽所能地教导和聆听我们的问题并给予建议，还会根据母亲不同的情况，让母亲尝试不同的药物控制病情。

人们该如何理解谵妄症？是否对它有什么误解？我们的一些朋友至今仍无法理解谵妄

症。我会尝试与那些父母呈现谵妄症常见症状的友人分享我的经历，但他们总是认为父母仅跌倒或受到感染。当我建议他们向心理医生查证时，他们总把我的话当耳边风。此外，大家也常把谵妄症误解为失智症。

您会为其他谵妄症患者的看护者提供什么宝贵建议？首先，请尝试了解病症，寻求帮助或

澄清，并与医生交谈以助您更了解病因、症状及治疗方法等。您也应查询资料，增广对病症的知识以助您提问相关问题。应对谵妄症不但压力大，而且对病人与看护者来说都是一件恐怖的经历。当母亲第一次患病时，我们以为她疯了，并且完全招架不住，因为我们对它一无所知。现在，我们知道谵妄症是一种短暂病症，而通过正确的治疗和帮助，病情是可以受到控制的。我叔叔曾告诉我，当您了解您要对付的病症时，您已距离寻求帮助及获得治疗不远了。不要害怕将知识传授与分享给患者、家人、朋友和其他看护者！

什么是谵妄症？

看护者与家人如何帮助患者？

谵妄症是一种突发性的神经错乱，一般可持续几个小时或数日。它可能会在患者，尤其是年长者，生病时发生。虽然谵妄症会导致行为上的改变，且可与失智症同时发生，但它们是不一样的病症。可是，早前诊断患有失智症的病人罹患谵妄症的风险较高。

谵妄症座谈会

Bharathi医生说：“提高保健专业人士及家庭看护者有关谵妄症的意识是非常重要的。他们能有助谵妄症的及早识别、诊断、评估、治疗及预防。” 为庆祝今年的世界谵妄症日，樟宜综合医院将举办谵妄座谈会。这项由心理医学科（老年心理服务）与麻醉学和外科部门联合举办的座谈会有助提高大家对谵妄症的认识。

谵妄症的导因*：• 生病• 疼痛• 近期内动过手术• 脱水• 便秘• 使用药物

* 在某些情况下，谵妄症的导因可能是综合性因素所致。

谵妄症的症状：• 比往常更善忘• 无法集中精神• 昼夜不分• 不耐烦且无故感到难过• 警觉性比往常高或低• 产生幻觉和幻听

谵妄症的相关症状一般会在潜在病因治愈后消失。

以上信息摘取自rcpsych.ac.uk/mental-health/problems-disorders/delirium。

看护着在及早发现、诊断、管理和康复过程中扮演着非常关键的角色。

您可采用的策略如下：

1使用日历与时钟来提醒患者现在身在何处及日期，以助他认知定向。

2确保患者戴上眼镜和助听器。

3用沉稳的语调与患者交谈，并给他时间回答问题。

4尽量减少噪音和会使他分心的事物。

5尽可能减少噪音和会使他分散注意力的事物。

6如果患者行为出现变化，马上通知医护人员。

樟宜综合医院的医生与Irene以及盛港综合医院的Laura Tay Bee Gek医生参与了世界谵妄症日的座谈会

Irene Gomez与她的母亲Clara Alice Rozario

Irene为帮助看护者，提出以下建议

• 提供更好的教育素材和资源（如手册、网址）

• 提供休养空间，如提供其他支援小组的联系方式及辅导服务，甚至为病人举办社交活动等

• 提供专为看护者而设的工具配套（内容可包括及早发现、诊断和康复的信息与贴士）

• 促进与保健或医疗机构的互动（通过讲座、住院期的培训或樟宜综合医院社区保健服务等的宣传活动）

全面性支援，更佳的看护管理

30 CARING ISSUE 2 2019

封面故事


预防受感染确保医院内的手术工具都已消毒干净是关怀病人的重要一环

受到感染可致命，尤其是对因疾病而免疫力下降的病人，因为他们将无法对抗疾病的侵袭。因此，

遵守正确的清洗要求以保持医院环境干净无菌是非常重要的。这当然也包括为手术室内的医疗工具进行清洗与消毒。但究竟是谁在负责这项工作呢？在樟宜综合医院的地下室内，有一处是

公众看不到的地方。在那里，中央消毒供应部门的工作团队正在为医院内所有可再使用的医疗工具进行清洗、消毒和检验，然后再将它们送回手术室及病房。这个团队在预防手术室内及医疗护理的相关感染上扮演着举足轻重的角色。为确保安全及避免有害微生物的滋生，

团队须细微观察及清洗，如使用刷子人工刷洗管状医疗工具的内部，以完成清洁及消毒工作。虽然消毒团队看似是独立执行

工作的，但他们的辛劳成果却是大家每天在手术室内、诊所或病房内有目共睹的。

卓越表现获嘉奖虽然科技正在不断改变大家的工作方

式，但为医疗工具消毒的工作仍依赖人工的警觉性来执行任务。团队成员会通过相互学习及接受各种训练，不断提升自己的技能。他们对工作的热忱获得亚太感染控制协会的认可，让他们荣登模范消毒供应中心。樟宜综合医院也是唯一一家在今年荣获这项殊荣的公共医院。中央消毒供应部门的护士经理Yvonne

Lew在今年1月21日前往越南领奖。她说：“我们都是竭尽全力工作，因为我们深信，如果其他国家可以获得这个奖项，我们也可以。”有趣的是，团队中有不少的护士，而


封面故事

如何清洗及消毒手术工具？

• 整理及观察物品• 将工具分类• 人工/机器清洗• 单向流程（从除污区到包装区）

• 使用者检查是否已归还所有可再使用物品

• 中央消毒供应部门人员将受污染物品/已使用工具收集起来

• 在进行计算前观察物品，检查是否损坏和清洁

• 收集及根据清单为物品进行包装

• 对物品贴上标签

• 使用前检查外部/内部指示• 丢掉使用后的一次性物品、尖锐物品及垃圾”

• 将受污染物品储藏在有盖容器

• 选择适当的消毒方式• 在每个循环后进行再检查• 质量保证• 储藏已消毒物品

• 保持库存登记• 每周库存检查• 保质期与使用次数相关*• 参考消毒流程指示表

*中央消毒供应部门根据物品包装的保质期重新处理物品

• 整理及观察物品• 通过密封容器进行派送• 清洁物品的派送与污染物品的收集是分开进行的

除污区

归还

包装

使用

消毒

储藏

派送

获取

• 通过中央消毒供应部门（干净区）的电梯派送至手术室

• 手术室使用者通过电梯将所有已使用物品送至中央消毒供应部门（除污区）

• 从中央消毒供应部门获得报告以进行核对

• 获取已消毒可再使用物品/一次性物品

• 检查外部化学指示胶带的颜色变化及包装的完整性

中央消毒供应部门

使用者

• 所有工具都须清洗，但并非全部工具都能放入清洗消毒器或超声波清洗器。

• 人员限制出入的人数，仅有获许可的人员才可入内。• 内部的特定位置设有监控器。• 着装规范——所有入内人员都须穿上手术袍，戴上头罩和耐洗鞋。在除污区工作的人员须全身穿上保护衣服。

• 保持双手的卫生在所有工作区是强制性的。• 工作区的清洁a)干净区——每天洗抹地板、每天早上擦洗工作站，每周洗刷地板；每周洗擦包装区、消毒区及储藏区墙砖b)除污区——每天下班后洗刷地板；每天擦洗工作站，所有泄漏立即抹干净

• 我们采取全面防护措施——所有被送来除污区的工具都一律被视为具传染性。

中央消毒供应部门的预防工作

Yvonne正是一名前手术室护士。她把在手术室中所吸取的宝贵经验带到这份工作中，例如她了解每个工具的功能，而这确保了有效率的清洗和流畅的包装过程，以便其他医护人员的使用。“如果我们没把工

作做好，外科医生的工作就会受到影响，而且还会间接殃及病人。我们会换位思考，设想自己是病人的家属，而亲人躺在手术台上，我们会放心让他们使用那些工具吗？如果答案是可以，就表示我们已把工作做好。”她分享道。下次您到医院做检查时，您可以放心

使用医院内的医疗工具，因为我们中央消毒供应部门会不断努力，确保您的安全。

如果我们没把工作做好，外科医生的工作就会受到影响，并且还会

间接殃及病人

Sarah Abdul Karim是樟宜综合医院企业事务部门的执行人员


沟通是护理过程中的重要一环。但如果遇到只会说一种他们不熟悉的语

言怎么办？樟宜综合医院的护士过去在与仅会说福建话或广东话的年长病人沟通时，就面对这个难题。但2014年推出的一款应用程序为他们提供了解决方案。i-COMM是一个综合保健的语言应用

程序，由樟宜综合医院与综合保健信息系统公司（IHiS）共同研发，其中包含100个针对护理的广东话短句，如服药指示及护理上的建议等。该应用程序目前已升级，不但加入了

福建话和马来语，还把短句总数增至500句，并且增添了多媒体选项如音频输出、图像辅助以及发音视觉指南，以助护士们识别关键字及促进其学习过程。长远而言，通过持续的使用，他们希望能够无需利用它就能与病人沟通。

由护士们发起i-COMM是由19名樟宜综合医院员工

提供建议而设计开发的应用程序，其中包括13名护士。这个概念起源于发现职员与说方言的病人在沟通上出现了问题。“我刚开始在樟宜综合医院工作时，与

病人有沟通上的问题，主要因为他们大多都只会说方言。当我无法理解病人的需要时，我会感到焦虑。为了解决这个沟通问题，我报名上了广东会话课程，还向同事学习基本的马来话。”在樟宜综合医院任职护士的Li Jing说道。”i-COMM提供了本地常用方言的全面性指南，还包括我们常用的短句，所以我现在时常用它与我的病人沟通。”

为了优化应用程序，项目小组专注于设计初级以及护理相关短句，如在病房里常用的医疗程序和护理上的建议。小组聘请专业翻译员为短句进行翻译，然后由护士进行评估和改善，确保短句更口语化和本土化。小组也请来配音员，以更准确地掌握短句的发音和语调。此外，应用程序还采用许多图库照片来作为短句的搭配图像辅助。“有了升级版的i-COMM，我们的

护士与其他如病人服务人员的职员，现在可以克服语言障碍，更有效地与说方言的病人沟通。我们能更好地了解病人的需要及传达护理指示，以提供更完善的病人护理体验。”樟宜综合医院护理副总监WongKok Cheong分享道。“这在与年长病人沟通时特别有用，也为医院创造一个更亲年长者的环境。”他补充说：“i-COMM也是为帮

助员工自学语言或方言而创建，同时还可作为医护人员查看保健护理常用短句的参考资源。”

未来将增设更多功能应用程序的设计让它能够在日后加载更多语言和短句，以迎合不同的需求和护理情景。自推出以来，小组也收到如复健治疗部和放射性治疗部的各临床部门要求，希望应用程序

能加入针对他们工作领域的短句。随着对类似i-COMM的科技

产品进行投资，樟宜综合医院期待能够更好地满足病人的需求。一个更有效的沟通可搭起桥梁，为病人提供更好的照顾。

DENTURE Malay: Gigi palsuCantonese: 假牙 ( Kah ngaa)Hokkien: 假牙 ( Gey kee)

ARE YOU IN PAIN?Malay: Adakah anda merasa sakit?Cantonese: 你有冇觉得痛？( Nei yao mo gok dark tong?)Hokkien: 你有什么地方感觉痛吗？ ( Lee woo card teet tiah bo?)

WOULD YOU LIKE TO SHOWER NOW?Malay: Adakah anda mahu mandi sekarang?Cantonese: 而家要唔要去冲凉？ ( Yi kah you mm you hoi cheong leong?)Hokkien: 你现在要去冲凉吗？ ( Lee jit zhun eye key zang chwee bo?)

在i-COMM中的常用短句

PLEASE USE THE CALL BELL TO ASK FOR HELPMalay: Sila tekan loceng panggilan untuk meminta bantuanCantonese: 请㩒钟叫我哋帮忙。 ( Cheng gum zhong kew ngor day bong mong)Hokkien: 有需要请按铃。 ( Na see lee su yao bunk bung chia lee chee zeng)

特写

通过应用程序，搭起与年长者的沟通桥梁

用i-COMM打破语言障碍

该应用程序目前已升级，不但加入福建话和马来语，还把短句总数增

至500句

如果您觉得i-COMM可帮到您，您可扫描QR码下载至您的手机。

For iOS

For Android


特写

摆脱高血压，限制盐与糖的摄取量

欢迎您查阅新版的《简单指南》。它现已改名为ECHO，但仍是《关怀》杂志的常规专栏。我们希望通过这个转变，为更多读者提供慢性疾病和健康生活的重要及相关信息。这期，我们将深入了解高血压。这是个重要课题，因为每4名新加坡人中就有一人患有高血压。欲了解有关接下来的健康筛查时间表和登记详情，请浏览echohealth.com.sg。我们期待您的光临！

Linsey Utami Gani 医生，ECHO项目总监

无形杀手：如何应对高血压

高血压的定义为血压超过140 / 9 0mmHg。多数的高血压

患者在血压升至160/100mmHg时，都不会感觉任何异常。因此，高血压经常被形容为“无形杀手”。如果不接受治疗，高血压可导致心脏病、心脏衰竭和肾衰竭。此外，高血压也是中风的最大风险因素。高血压的普及率其实比糖尿病高出两

倍，在每4名新加坡成人中就有1人患有高血压。患有高血压的人会更容易患上糖尿病，反之亦然。如果患有两者，情况就会更严重。这并不让人意外，因为糖尿病与高血压的风险因素大致相同：不健康的饮食习惯、久坐不动的生活方式、缺乏运动和肥胖。摄取过多含碳水化合物的食物会导致糖尿病，尤其是淀粉类食品如米饭或含糖食品如加糖饮料和甜点。高血压则是由于摄取过多的盐所致。那究竟哪个比较糟糕，是糖还是盐？

答案是两者皆糟糕。还记得多年前，有一名北欧高级教授在一次海外座谈会上提出这个论点：我们到快餐店，多付一块钱买加大套餐，边吃着加了盐的薯条，边喝下一大杯加糖的汽水。盐份使我们感觉口渴，然后我们再喝加糖冰汽水解渴。以本地饮食为例，这相等于吃下一盘炒饭或炒粿条，再加上一大杯的甘蔗汁、豆浆或泡泡茶！

影响更多年轻人随着肥胖率在全球和本地不断攀升，有越来越多年轻成人（甚至青少年）被诊断患上糖尿病和高血压。在年轻时被诊断患上高血压可导致许多严重的不良后果。患有高血压的女性可能较难受孕，而即使怀了孕也会让母亲与胎儿承受更高的风险。现在不乏看见30至40岁的成人由于心脏病或中风而入院，因此拥有健康的生活方式及避免吸烟真的非常重要。如果您患有高血压，请放心，它并非

不治之症。治疗从拥有健康的生活方式及戒烟开始。有时，您可能也需靠药物

Troy Puar 医生是樟宜综合医院内分泌科顾问医生

2019 ECHO健康筛查

ECHO健康筛查将来到景万岸-菜市（Kembagan-Chai Chee）区。年龄在40岁或以上、无患慢性疾病，并且在最近3年内不曾做过健康检查的新加坡公民都可报名参加。您可到以下任何民众俱乐部登记报名。请记得携带您的身份证及建国一代卡或CHAS卡（如适用），以及现金（用于支付筛查费用）。如果您的亲友居住在以下区域，请鼓励他们登记报名接受ECHO健康检查！

来帮助控制病情，而医生会依据您的需求给予您不同的药物。把血压降至正常水平将减低心脏病发作和中风的风险。另一项重要信息：在家中备有一台血

压测量仪是非常有用的，但请购买可包裹上臂而不是手腕的测量仪。居家监测能够更准确地测量一个人平时的血压。随着市面上有越来越多的手机应用程序和可连接无线网络的电子设备，您现在可更轻易地把测量所得的数据记录下来，然后在复诊时与医生分享。此外，高血压也可能是因家族遗传，所以您也可使用测量仪为家人免费测量血压！别再迟疑了！现在就开始每年做一次

血压检查，并保持健康的饮食习惯和定期做运动。

欲知更多有关健康筛查的详情，请拨打67888833或电邮至[email protected]联络ECHO。

地点日期

甘榜乌美 (Kampong Ubi) 6月22日，民众俱乐部星期六

费用：建国一代：免费CHAS：$2Non-CHAS:$5永久居民：$10（当场登记）

家庭医生解答


旅行药物我是一名21岁的学生，而且将在几个月

后毕业。我和朋友打算到台湾旅游20天作为我们的毕业旅行。由于这是我第一次出国这么长一段时间，我不确定应携带些什么药物。我听说去阿里山国家公园的路程很颠簸，让我担心自己会在途中晕车。我的家庭医生能够帮助我吗？

恭喜您马上就要毕业了！台湾确实是个旅游的好地方，而在途中生病将会非常扫兴。虽然在台湾可以容易获得医疗服务，但我想您应该不希望需临时改变行程去看医生吧。首先，您应购买旅游保险。旅游保险

不贵，但却是很好的护身符。其二，及早接种疫苗。疫苗需在体内酝酿一段时间后才会发挥作用。您可浏览疾病预防控制中心（CDC）的官方网站（bit.ly/cdctai-wan）以查看您应接种哪些疫苗。与买旅游保险一样，接种疫苗的费用与您可能中途生病所损失的宝贵玩乐时间相比，一点都不算高！其三，把药物放在您随身携带的包包里

（而不是在托运行李箱里）。多数的家庭医生都备有一套“旅游药物配套”，配套里包括能够止痛、止腹痛、止吐泻、缓解

过敏反应、缓解喉咙痛、晕车等的药物，而女士们也可带上控制经期的药。此外，如果患有哮喘，您也应携带平时服用的喷雾剂或其他药物。在没有药物过敏的前提下，晕车药通

常是蛮有效的。您可在上车前的一小时服用，但它可能会让您感觉困倦。最后，祝您旅途愉快！

监控病情和并发症，让您改变生活方式，还会使用药物。严格限制糖和碳水化合物的摄取，加上每星期做150分钟或以上的中强度运动（目标是逐渐减轻体重），将有助更好控制血液里的葡萄糖水平。及早发现糖尿病的并发症至关重要。定

期进行检查和按时吃药也很重要。现在的家庭诊所备有种类繁多的药物，而医生会根据每一个病人的病情和需要，小心选择药物。如果您有上述症状，或您年龄在40岁以

上却从未做过血液检查，您应咨询您的家庭医生。

洪顶顺医生是榜鹅顶峰西药房的创办总监，也是初级护理关联网的副总监及MaNaDr 流动保健的总监。他热衷于教育和指导晚辈。他深信，通过让年轻一代思考苏格拉底式哲学道理及正确的问题，将让世界变得更美好。

您的家庭医生能治疗这些病症！

糖尿病我是一名48岁的家庭主妇，而且很爱吃

美食。我最近在民众俱乐部进行的健康检查显示，我的身体质量指数是33.1公斤/平方米。我总感觉容易口渴，所以我就在冰箱里存放我喜欢的自制加糖菊花茶，以便我随时解渴。我会经常上厕所，而且还发现我的皮肤变得又干又痒！我老公认为这可能是糖尿病的症状，还强烈建议我去看家庭医生，让他为我做检查。我的家庭医生能帮助我吗？

糖尿病是个常见的慢性疾病，而患者的血糖会上升至一个高水平。您先生所观察到的经常感觉口渴和频尿都可能是糖尿病的症状。其他症状还包括食量增加或过饥，体重减轻，无精打采，伤口难愈合，视力模糊及四肢发麻。皮肤也可能会变干发痒，有些病人的颈部和腋下皮肤还会变暗沉。女性患者可能会出现重复性酵母菌

感染和尿道感染，而男性若没有控制好病情则会有勃起障碍的问题。导致糖尿病的风险因素包括肥胖、家

族病史、曾患妊娠糖尿病和胆固醇水平失调等。您的家庭医生可以诊断和治疗糖尿病。他会让您做血液检测来测量您的血糖水平。如有需要，他随后还会为您进行口服葡萄糖耐量检测来确认诊断。此外，他也会测量您的胆固醇水平和血压。如果检测显示您患有糖尿病，医生将与

您商讨治疗方案，以制定葡萄糖水平所需的控制程度。他会进行全面性治疗，为您

东部医疗联盟于2014年1月份推出了“家庭医生首选”计划，为的是

要鼓励居住在新加坡东部的病人在碰到轻微或中度的医疗状况时首先向家庭医生求助。在这个专栏里，东部医疗联盟的社区家庭医生将帮助《关怀》的读者解答一些常见的疾病问题。浏览www.gpfirst.sg或咨询您的家庭医

生更多有关常见的医疗状况，如割伤、撞伤、轻微烧伤、呕吐、流鼻血、伤风、蚊虫咬、头痛、扭伤及发烧。以下是读者发来有关糖尿病和旅行药物的询问。

张瑞杰医生是东北医疗集团的家庭医生。他在治疗慢性疾病方面特别感兴趣，并且热衷于与病人合作达到最佳治疗效果。他通过本地的住院医生计划完成了家庭医学硕士学位。他曾在多家医院和综合诊疗所任职，并且受过许多技术上的训练。他相信，要有效控制如糖尿病等的慢性疾病不是不可能的事。

OBC_CAR_ Ad.indd 42 5/4/18 12:09 PM

KEEPING PATIENTS SAFE · falls or infection — mum had developed urinary tract infection at the...

Documents

Transcript of KEEPING PATIENTS SAFE · falls or infection — mum had developed urinary tract infection at the...