84th Anniversary Patient Ward, 4th floor West
The 84th Anniversary Patient Ward, 4th floor west is a special in-patient ward with 18 single rooms for orthopaedic patients aged nine years old up. The multi-disciplinary team comprises specialist, nurses and physiotherapists. The top five diseases found from 2011-2014 are spine surgery, fracture of the proximal part of femur, osteoarthritis of the knee, hip replacement and knee ligamentous injuries. The ward handled 400-500 patients per year on average. Spine surgery patients account for approximately 40-50 per cent of all patients. Occupancy rate per month is 60-70%. The ward has 24 staff members, including one head nurse, 10 nurses, 8 nurse assistants, one administrative officer and four general officers. In ward is managed to support vision and focus of the Faculty of Medicine Siriraj Hospital and the department. Its goal is to achieve safety, quality and productivity in patient care. In terms of safety, the department has a clear system in calling physicians. To ensure quality care, the ward ensures that critical patients always receive immediate attendance and care while adopting holistic patient care. The ward also monitors for postoperative complications such as infection, bleeding, neurological injury and pulmonary embolism. For spine surgery patients, the ward ensures that patients are free from neurological injury by implementing a postoperative neurological complication assessment project. From August 2013 – January 2014, the ward renovated its patient rooms for improved safety and patient care efficiency. As part of the renovation, restrooms are enlarged to increase convenience for patients using crutch, cane and walker and nurse call system and bathroom grab bars were installed near the toilet bowls, for example. Risks of falling have been regularly assessed by introducing the 4P Hourly Round system or checking patients regularly for “pain, pantry, potty and position”. This is because most of the patients are the elderly and all the rooms are single rooms.
In terms of quality, CPG Clinical Tracer and Clinical Tracer Plus systems have been introduced. The Department of Orthopaedic Surgery and the ward have worked together in improving such systems in order to ensure that patients receive high-quality treatment and fast services, feel good after the surgery and are satisfied with the services. To achieve this goal, the Department of Orthopaedic Surgery has provided skills and knowledge development support for the ward’s staff members, such as participation in the seminars and symposiums organized by the department and the Royal College of Orthopaedic Surgeons of Thailand, HA training by Healthcare Accreditation Institute (Public Organisation), and participation in the department’s patient monitoring project covering preoperative patient preparation, Hotline and consultancy service for postoperative patients and the get-together events for hip and knee replacement patients. The ward, through its medical illustration unit, has produced video to help patients prepare well before and after the lumbar spine surgery. The ward provides specific care to prevent bed sore which usually occurs after the surgery when patients still cannot move by themselves. Barden scale assessment is used when new patient is admitted, after the surgery and when the patient condition changes. The assessment is done every week until the patients are discharged. To prevent bed sore, the patients will be moved to change position every two hours while other equipment, such as air mattress, is used to reduce risk of bed sore. The “Easy Move” innovation was created in the Special Patient Ward 2 and introduced to the 84th Anniversary Patient Ward to help its nurses move patients easily and safely. At the same time, its staff members do not have back pain afterwards. Our staff members encourage patients to strictly follow advice on postoperative care and rehabilitation, such as the deep breathing exercise, leg muscle exercises, including ankle pumping ROM exercise, long roll patient move, walk training using pickup walkers as part of physical rehabilitation plan and indicator of each disease. In 2014, 80 per cent of lumbar spinal injury patients can ambulate within five days after surgery. Our staff members have done research on effects of Thai traditional medicine massage on bowel elimination in postoperative lumbar lamienectomy patients. The R2R funded research is under the process of data analysis. The ward won the Outstanding Unit Award in 2007, 2009, 2010 and 2012, Gold Star Unit Award in 2011, Outstanding Innovation/Project Award for our hair wash mobile unit in 2006, Fit for Fresh Project in2008 and Good-bye with Smile (well wishing card for discharged patients) in 2008.
In terms of productivity, the ward has adopted flexible people management system, allowing it to increase or decrease the number of staff members to match patients’ need and care and for safety. We also participate in the Share Jobs and Share Nurses Project with the 84th Anniversary Patient Nurse, 4th Floor East, which also handles orthopaedic patients in order to allow both wards to share staff members. We also participated in seminars and activities, such as New Year’s Party, merit making and paying respect to senior staff members, to strengthen relationship of staff members at all levels and promote staff members morale and commitment to provide the best possible patient care.
