“Nurses working night shifts in the wards face unique challenges from those working in the day,” shared NHCS quality improvement team, ReLight. “A notable issue is that the nurses have to type on keyboard on the Computer-on-Wheels (COWs) in the almost pitch dark environment when documenting patient care records.”

Issue one: Light…or no light
At night, lights at each cubicle in the ward are switched off to provide a conducive sleep environment for patients. All the bed cubicles are kept dark, with the only light source from the corridors. This poses challenges for nurses performing their routine nursing activities such as vital sign measurements, medication administration and recording these information in the patient system. 
Even with the patient’s overhead light turned on, nurses cannot see the keyboard clearly on the COW.

“The night duty nurses had to either switch on the ceiling light or the overhead light at the patient’s bed but that disrupted the patients’ sleep. They even tried relying on the light source from the sides of the bed but it was too dim. They had to strain their eyes to see the keyboard,” shared Nurse Clinician (NC) Zubaidah Bte Hassan, Nursing Informatics and leader of the ReLight team.

Issue two: Repetitive processes
As the main light source comes from the corridor, nurses had to station the COW outside the cubicles to record and update the patient data in the system. This would mean nurses having to walk to and fro from patients and the COW to update each nursing activity, and logging in and out of the system each time they return and leave the COW to attend to the patient.

“From our observation, the process was repeated at a staggering 250 times a night and that could impact not only our patients’ quality of rest but also the well-being and efficiency of our staff,” said Staff Nurse (SN) Damian Liew from Nursing Administration. A survey conducted with the patients by the team found that almost a third of the respondents were unable to sleep well due to the repeated nursing activities and glaring light in the ward.

LED strips and process redesign enhancing working environment
The team discovered a solution – the use of LED strip as light source which is convenient and portable. “Besides having a long operating life compared to other alternatives such as an incandescent bulb or torchlight, the LED strip can be easily installed and powered via a plug-in USB to the COW,” said co-leader, Senior Staff Nurse (SSN) Nor Syamsul Nazly Bin Mohamed Said from Nursing Specialty Care Unit. Now, with adequate light, the nurses can perform their data documentation as they move from cubicle to cubicle.

The LED strip emits a blue light which is soothing to the eyes and provides just the right amount of illumination for nurses to do their job while minimising disruption to the patient.

ReLight also found that the work processes for night duty were not well structured and unsystematic which could be challenging for new nurses to cope. They worked closely with the ward to redesign the workflow by grouping procedures based on specialty, and consolidating routine checks including vital signs, blood glucose and intake output charting at fixed timings. A standard operating procedure (SOP) was also established.

The streamlined process and the installation of LED strip worked well in tandem. The improvements helped save at least 30 minutes of the nurses’ time in data documentation for each patient. This could potentially translate to almost 42 hours saved in documentation per night in a full occupancy ward; and allowing our nurses to focus on patient care.

Senior Staff Nurse (SSN) Nor Syamsul Nazly Bin Mohamed Said, Nursing Specialty Care Unit, co-leader; SSN Mary Jane Seville Porticar, CTICU; SSN Parames D/O Manohar, Ward 47B; and Nurse Clinician Zubaidah Bte Hassan, Nursing Informatics, leader. Not pictured: Assistant Director of Nursing, Jonathan Sim, Nursing Informatics, facilitator; Staff Nurse (SN) Damian Liew, Nursing Administration; Assistant Nurse Clinician (ANC) Iryani Binte Hussein, Ward 44-CCU; and SSN Wan Juan, Short Stay Unit (SSU).

For their excellent improvement initiative, the Relight team received the Gold award at the Team Excellence Symposium, part of the Innovation & Quality Circles (IQC) movement organised by the Singapore Productivity Association.