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IntroductionWith the goal of patient engagement, an initiative was formulated to equip each patient in the general wards with a tablet whereby they can access their health information and patient education materials and communicate with their healthcare team. This paper presented the methodology of the implementation efforts as well as an evaluation of the preliminary outcomes.MethodsThe process of hospital-wide implementation was shared using the implementation research logic model. The bedside tablets were rolled out hospital-wide in a step-wedge manner over 12 months. Barriers and facilitators to this implementation were discussed together with strategies to optimize the situation. Preliminary outcomes of the implementation were evaluated using the RE-AIM framework.ResultsThe initial adoption rate for the bedside tablet was low. Additional strategies, such as survey audits and provision of feedback, development of education materials for patients, facilitation, and purposefully re-examining the implementation strategies, were used to improve adoption. The trend of adoption increased over the course of 2 years from the start of implementation.DiscussionThe initial lower adoption rates may reflect Singapore's paternalistic healthcare culture. While this implementation was driven by the need to move away from paternalism and toward patient engagement, more time is required for significant cultural change.

Background Hospital at Home programs have demonstrated to be safe, feasible and cost effective. However, challenges such as infection control, cleanliness, space constraints and insufficient resources may hamper the adoption and effectiveness of such programs. Aims To understand the challenges of providing and receiving healthcare in the community, design a solution to meet the challenges, and to pilot and evaluate the solution. Methods This is a three-phase mixed method study. Phase 1, nurses, patients and caregivers were surveyed to understand their challenges in providing or receiving healthcare at home. Results of the survey in Phase 1 were used in Phase 2 to design a solution. In phase 3, an integrated structure was designed and piloted for stakeholders’ evaluation. Results Twenty nurses and 50 patient-caregiver dyads responded to Phase 1 survey. Physical home environment was most cited by the nurses as their main challenge, particularly the lack of a dedicated and clean space to conduct nursing procedures. Medication management was the greatest challenge faced by the patient-caregiver dyads. Based on these findings, a prototype of an integrated structure was fabricated in Phase 2. Ten patient-caregiver dyads and nine community nurses tested the prototype in Phase 3. The participants found the structure useful to store and organize their healthcare items, and there was ample clean workspace to carry out nursing procedures. Conclusion An integrated structure that can fulfil the physical, spatial and interpersonal needs at an affordable price could be useful in facilitating the delivery of hospital care in the home setting. Patient Contribution Patient-caregiver dyads were key stakeholders in our study. They provided valuable feedback and suggestions on the prototype and design of the integrated structure.

Background: Older adults may have difficulty maintaining their functional capabilities during hospitalization. This pilot study aimed to investigate the impact of a bedside activity device on the functional status of hospitalized older adults., Methods: For this single-site randomized controlled trial, 48 participants were recruited between July 2019 and March 2021. Participants were randomized into one of two groups: the intervention group, which was given the use of a bedside activity device plus standard care, and the control group, which received standard care. Katz Index of Independence in Activities of Daily Living (Katz ADL) scores and Timed Up and Go (TUG) test times were used as indicators of functional status and were collected on admission (baseline) and at discharge.Mann-Whitney U and χ 2 tests were used to test for baseline similarities between groups. The Wilcoxon signed rank test was used to determine within-group pre-post changes in TUG and Katz ADL scores. The Mann-Whitney U test was used to determine between-group differences in TUG and Katz ADL change scores., Results: Within-group pre-post analysis showed significant increases in Katz ADL scores in the intervention group and no significant changes in the control group. TUG times decreased significantly in the intervention group and increased significantly in the control group. Between-group analyses showed significant differences in both TUG and Katz ADL change scores., Conclusion: The use of the bedside activity device in addition to standard care may prevent functional decline and increase independence in performing basic ADLs., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Nasogastric tubes are widely used in clinical practice for enteral nutrition, medication administration, and gastric decompression. Common complications of their use-such as tube blockage, displacement, and accidental removal-are well described in the literature. However, knotting-a complication that occurs when a knot forms in the nasogastric tube in situ-is rare. This report presents the case of a nasogastric tube that became knotted, causing difficulty in its removal. Key takeaways from this case are discussed, among them that more emphasis should be placed on safe nasogastric tube removal in practitioner training to better prevent such complications in the future., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)