KK Women’s and Children’s Hospital (KKH) plays an integral role in the care of COVID-19 patients in Singapore, serving as the principal disease outbreak centre for paediatric cases. With 830 beds, KKH is the largest hospital in Singapore specialising in healthcare for women and children and serves as a tertiary referral centre managing high-risk conditions.

The KKH Children’s Cancer Centre is among the largest paediatric children’s cancer centres in Southeast Asia and treats 70 per cent of childhood cancers in Singapore, with a growing number of children with cancer from the region referred there. The hospital offers a comprehensive range of services and a multi-disciplinary team that comprises paediatric oncologists, neurosurgeons and oncology surgeons, anaesthetists, in-house pathologists and pharmacists, and specially-trained paediatric oncology nurses.

Ms Lim Yan Yin is a Nurse Manager at the Children’s Cancer Centre at KKH. Ms Lim shares about her experience of the COVID-19 pandemic in Singapore, and its effect on the hospital and its staff.

How have you adapted the facility and employees to focus on COVID-19?

Ms Lim: In general, we have adapted well with constant communication and guidance provided by the hospital’s senior leadership. The organisation has also supported the healthcare staff very well to ensure that we are well stocked with personal protective equipment (PPE) and the necessary resources needed to cope with COVID-19. The hospital has made concerted efforts to convert facilities into emergency triage, isolation rooms and wards for admission of suspect or confirmed COVID-19 patients. The clear workflows and protocols have helped us to carry out our duties effectively.

How are you prepared to continue the care of paediatric cancer patients who might test positive for COVID-19?

Ms Lim: We have a workflow and process in place that was planned out in our risk assessment as the situation progressed. The haematology and oncology department’s physician and nursing leadership discusses and communicates frequently with all stakeholders. Workflows and processes are adjusted to adapt to the Hospital Command Centre’s directions in response to the evolving COVID-19 situation.

Fortunately, we have not had any paediatric cancer patients test positive for COVID-19. We could evaluate how effective treatment is when that happens, and adjust treatment plans accordingly.

Will you continue treatment if patients test positive for COVID-19?

Ms Lim: Our hospital performs COVID-19 swab testing for all children who present with symptoms of acute respiratory illness such as sore throat, running nose or cough. In the event that a patient tests COVID-19 positive during cancer treatment, our physician-in-charge will need to assess the patient’s clinical status and exercise clinical judgment whether to continue with treatment.

Has the hospital moved any providers who normally care for paediatric cancer patients to COVID-19 patient care?

Ms Lim: Yes, as the institution stepped up to create more units for the care of COVID-19 cases. Deployment of nurses / doctors / allied health professionals to these units to support the operations were required. Few of our nurses were temporary transferred out to the newly set-up wards to provide further assistance. In the month of April 2020, more nurses and doctors were deployed to dormitories in the community to perform swabs for the migrant workers living in these quarters.

Have you experienced PPE shortages?

Ms Lim: We centralise a stockpile to better monitor and manage our utilisation rate. The hospital also provides clear guidance on the use of appropriate levels of PPE, based on job functions.

How is your staff maintaining their own personal health?

Ms Lim: For staff health and physical well-being, measures are in place to safeguard physical health, which include twice-daily self-temperature monitoring and recording in Staff Health Surveillance System, as well as constant reminders to visit the Staff Clinic if unwell and stay away from work, to observe safe distancing and exercise social responsibility.

We also have the support from the hospital’s medical social workers and Psychology Service, where staff are given a hotline number to call if they need support. The hospital’s staff wellness committee has also regularly given out meals and appreciation cards to the nurses in the unit to boost their morale during this challenging time. Emails of appreciation are regularly sent out from the hospital’s senior management. For nurses who are deployed out, the nursing leadership team in the unit consistently contacts them to ensure they are coping well in their new unit and communicates all updates via phone calls.

Have you experienced anything that could help other institutions through this pandemic?

Ms Lim: Many of the necessary measures to counter this pandemic have caused inconveniences and difficulties for staff, patients and caregivers. Managing staff emotions is the key to be better prepared to face the challenges at the frontline. By empathising with their needs and pre-emptively giving them the information and resources needed, we will be able to build a resilient workforce to weather through this storm in solidarity. KKH has done well in this regard.

For the paediatric oncology unit, there is constant and open communication with staff to keep us updated on changes to workflows and processes. References and resources are readily available in the hospital intranet for easy access, and the information is also updated in a timely manner. The nursing supervisors engage nurses on the ground daily to proactively address issues and provide clarity. We have recently created a ‘Gratitude Wall’ (Fig. 1) to pen and display notes of appreciation to our colleagues to thank them for their dedication every day.

Fig. 1. Staff can write thank-you notes to those who have helped them one way or another during their shift, and post these notes on the Gratitude Wall.

In addition, planning ahead is what keeps us on top of the game in resource management. For example, the Hospital Command Centre and Infectious Disease physicians will consolidate all COVID-19 activities and share key information via email or virtual meeting updates with the staff; pharmacists constantly review their supplies and take proactive steps to conserve stock, such as reducing frequency while maintaining the efficacy of drugs and beginning the discussion with stakeholders involved. We also prepared ourselves in readiness for a surge of admissions by converting facilities into isolation rooms and admission wards.

Acknowledgements Adapted from an article first published on the SIOP-St. Jude Global COVID -19 Resource Center webpage (https://covid19childhoodcancer.org).