​A simple, small change can have a big impact on making our work easier or safer, shares ADN Magdalene, who has over 20 Quality Improvement projects under her belt.

The simple act of changing a receptacle to a disposable single-use one yielded significant improvement in safety for our staff.

Ms Magdalene Ng, Assistant Director, Nursing, shared this observation from one of her Quality Improvement (QI) projects in 2016.

Explained ADN Magdalene, “Some patients want their placenta back after birth. So nurses would transfer the placenta from a stainless steel container into a plastic bag, exposing themselves to the risk of bloodborne infections. We replaced the container with a disposable single-use kidney dish, which the nurse can bag without having to touch the placenta.”

Through reduced handling of the placenta, ADN Magdalene and her team helped prevent cross infection and increase staff safety during placenta collection.

“So you see, QI doesn’t have to be complicated.  A simple, small change like this yielded a significant improvement in the safety of our staff,” said ADN Magdalene. 

Before, the nurse had to transfer the placenta from the stainless steel container to a plastic bag. Now she can put the disposable tray directly into a plastic bag without having to touch the placenta again.

Weekly alerts help nip lapses in the bud

In another QI project, sharing clinical incidents weekly instead of monthly helped reduce falls and medication error across four Internal Medicine Wards by 20 per cent within six months.

(Photo taken in 2019 before COVID-19) ADN Magdalene (center) and her team won the 2019 SGH Innovation & Quality Circles assessment Award for this project.

“Increasing the frequency of sharing from monthly to weekly allows clinical incidents to be shared promptly. By making staff aware sooner of the incidents, they are able to nip potential lapses earlier and prevent such incidents from being repeated. The increased frequency also signals to my staff that patient safety is a priority,” said ADN Magdalene.

(Photo taken in 2019 before COVID-19) The weekly huddle involved 250 nurses across wards 53C, 54D, 63C and 73. Together they look after 225 inpatient beds.

Every Monday since November 2018, she has been leading a safety huddle with nurses across four Internal Medicine Wards that she oversees. For an hour, the nurses share clinical incidents that happened in the past week. They continue the weekly sessions through a group chat during the current pandemic.

Learning is a continuous process

For the past 10 years, ADN Magdalene has participated in and coached over 20 QI projects. She became a QI coach in 2015. A major insight she has gained as a QI coach is that the learning does not stop. “I have to learn, unlearn and relearn my understanding of QI methodology to ensure that I apply quality improvement tools and techniques correctly when I coach others.”

ADN Magadalene is also an ESTHER Coach - facilitating and translating QI beyond the hospital to what patients really need in the community. For instance, she led QI projects to speed up complete healing of patients from Stage II and III pressure injury after they had been discharged. 

Any tips for fellow colleagues embarking on QI? “Just my 3 Ps - Perseverance, Patience and Purpose. With this motto in mind, you will be able to rise above the challenges and be committed to what has been set to be accomplished in due time,” said ADN Magdalene.

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