APN Xiao Li proudly represents NHCS in this year’s SingHealth Nurses’ Day celebrations. Spot her on various visuals at NHCS and around SGH campus!
Advanced Practice Nurse Xiao Li’s nursing career of 25 years has been nothing short of exhilarating. Leading change is in her blood, making it fit to call her the future of nursing.
Xiao Li began as a staff nurse and underwent rigorous training before becoming an Advanced Practice Nurse (APN) – a registered nurse who has acquired expert knowledge base, complex decision-making skills, and clinical competencies for extended practice. APNs are also trained in diagnosing and managing common medical conditions.
Today, a large part of Xiao Li’s daily duties revolves around the care of post-operative patients at Ward 56’s Intermediate Care Area where she is part of a multidisciplinary team. With her advanced skill sets, Xiao Li is well equipped to perform patient review through history taking, physical examination, ordering laboratory investigation and interpreting the results, as well as initiating appropriate care management for patients in collaboration with the medical team.
Advocating for patient safety
APNs hold clinical privileges where they are certified to perform certain procedures typically done by doctors.
At the ward, Xiao Li routinely performs privileged procedures such as removing surgical drains and central venous lines, and taking blood cultures, amongst others. While managing central venous lines, a catheter that delivers medicine, fluids, blood, or nutrition to a vein near or inside the heart for patients after a heart surgery, Xiao Li realised that the catheter dislodges easily which has detrimental consequences if removed inappropriately.
“The dislodgement of a central venous catheter can potentially delay treatment or cause complications if removed without adhering to recommended guidelines. We formed a multidisciplinary team to analyse the incidences, review literature and guidelines, and collect feedback from stakeholders,” shared Xiao Li. These led to the implementation of standardised practices in catheter anchoring, dressing methods and material, daily assessment tool, and regular patient orientation and assessment.
Another recent improvement which Xiao Li pushed for, is the reduction of phlebitis rate. Phlebitis refers to inflammation of the vein caused by the peripheral intravenous catheter (PIVC). “We recognise that PIVC-related phlebitis is the most common issue arising from intravenous therapy across all healthcare settings. The condition causes pain, discomfort, and prolonged treatment required for patients,” shared Xiao Li. She added that despite NHCS having a lower phlebitis rate compared to national and global benchmarks, the rising trend prompted her to gather a team to bring the infection rate down further.
Effecting sustainable changes
In any process improvements, sustainability of solutions is key to instituting effective changes. While resolving the problem of central venous catheter dislodgement, Xiao Li led her team to identify avoidable and unavoidable causes leading to the issue. They discovered that avoidable causes such as inconsistent dressing and anchoring practices, and a lack of patient and staff awareness, could be solved by developing a care bundle to guide nurses to assess, dress and care for the catheter. To-date, the team has brought the incidence down to zero for avoidable causes. In unavoidable cases caused by patient delirium, her team made a significant reduction of 60% in incidences.
Xiao Li’s team implemented standardised practices to ensure the central venous catheter is secure and able to guard against accidental pulling.
A similar care bundle approach was used to bring down phlebitis rate. When her team found that evidence-based practices and new initiatives were not readily accessible nor practicable, they identified best practices and created a Phlebitis Prevention Care Bundle unique to NHCS. For easy recall and application, the bundle name was simplified into the acronym, 4SAFER - Site, Size, Sterility, Securement, Assessment, Flush, Evaluation for need, and Removal procedure. The team also conducted multiple workshops to educate stakeholders and performed regular audits to track and enhance compliance.
Doing no harm keeps her going
Since 2021, Xiao Li has been trailblazing the management of the chest drainage system. She was part of a team that spearheaded a project to
promote early ambulation of post-operative patients. They designed a multi-purpose device holder to ease patient movement and facilitate physiotherapy sessions, speeding up recovery and enabling patients to go home earlier. Thereafter, she enhanced the chest drainage management care standards which garnered positive feedback and subsequent adoption by SGH’s nursing department.
(L-R): Xiao Li training nurses and medical officers in the ward on the chest drainage system.
Xiao Li is currently leading a training workshop on chest drainage system to beef up healthcare workers’ standard of care in this area, with plans to incorporate into the orientation programme for new nurses, allied health, and medical professionals. She shared that the programme has potential to be extended to other departments and institutions in the future.
Part of Xiao Li’s work includes conducting smoking cessation for inpatients as well as training of SingHealth staff in this area (pictured above).
Indeed, Xiao Li’s passion for continuous improvements in patient care is inspirational. “Always caring, doing good and doing no harm are the fundamental principles I uphold as a nurse. Initiating changes may be challenging, as do managing team members from different disciplines with different schedules, but knowing that our goal is the same, keeps me going strong!”
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Stories from the heart
