The Differences in The Acute Ward Management Practices of Australia & Singapore

The differences in the acute ward management practices of Australia and Singapore

The preparations need to be done in Singapore before a surgical operation performing on a patient like Ben are included: MRI, CT Scan, laparoscopic camera and telescope (with diff degree angles), Laparascopic system. Diathermy machine (coagulating machine). Also, there are needs special instruments from vendors), Anesthetic machine and monitoring such as vital signs and Ultrasound machine intro-operatively.

In Australia, a preoperative checklist to be completed in the ward by the acute care nurse in the ward which this checklist would include objects to be ticked off for example the patient experienced fasting in preparation, false teeth removal, jewelry removal, explain about infection risks, explain about surgery risks, allergies check, correct identification and ID, discuss and get the patient to sign consent after they have been understood and considered legally capable, ID wristbands must be placed to the patient, patient labels to be printed, the patient files and patient bed must be prepared, all equipment such as suction, Oxygen and Air should be prepare and checked.

In Australia, Victoria, a person who is legally capable is provide consent for a surgical procedure. Usually Adults aged 18 and over can provide this consent. If that person unable to do so, then the next would be a partner or relative with a medical power of legal practitioner can provide the consent. In special circumstances, minors can give consent to surgery if they are understood the purpose of the surgery. Otherwise emergency consent procedures can be commenced by surgeon’s request and a legal body of the hospitals can then provide the consent for the patient while in Singapore is a person who is legally able to provide the consent usually the age is 21 and over and if the person unable to give consent then the partner or wife can give the consent and if she is not available then go through doctor and legal body of the hospital.

In Victoria at the hospital like the Royal Melbourne Hospital, they’re using advanced technology is called Endovascular Clot Removal. Another technology that they’re using is called carotid endarterectomy at the carotid artery bifurcation may be performed to remove atherosclerotic plaque in the person who has experienced a TIA. -moderately invasive. Another technology that they’re using is when an occluded vessel is not directly reachable, an extracranial–intracranial bypass may be performed. final is a carotid angioplasty with stenting is a newer option for treating cerebral stenosis

In Singapore, usually medication is first given to decrease the affected clot and then surgery is decided after and depends on the affected site of the brain. It is minimally invasive. Not much bleeding has been seen. Depending on the seriousness of the surgery sometimes post-operative patient needs ICU care. But in Australia, the Endovascular clot removal is minimally invasive since a small catheter is inserted into an incision in the femoral artery and passed into the brain where the clot is recovered with the help of an angiogram to envisage the process. Carotid endarterectomy-moderately invasive since the carotid is cut open to remove the plaque. Extracranial–intracranial bypass -moderately invasive to establish the bypass. Carotid angioplasty with stenting-less invasive due to insertion into blood vessel with a minor incision.

In Singapore, Stroke treatment has decreased from $3,141 to $2,459 at the NUH. Care would go to long-term rehab or long-term home care. Patient with emergency operation ICU and rehab cost about $70,000. But this Can be a little costly because of the technology involved and sophisticated instruments used. Also the number of days patients stay in the hospital. In Australia, the cost it is 100% covered by Medicare for Australian permanent resident and citizenship but for international and foreign people there is high cost of treatment.

In Singapore, the assessment involved with patient like Ben would be MMSE, AMT, GCS, 2 hourly vital signs, limb and fingertip sensation. In Australia, the assessments included: ABCDE assessment (A-irway, B-reathing, C-irculation, D-isability, E-nvironment or E-xposure), head to toe assessment. Depending on the surgeon, observations are performed on the patient. And the diagnostics is blood observing is performed.

In Singapore, IV Walferen Midication 4 to 5 hours after the stroke and before surgery administrated to the patient. In Australia, Antiplatelet agents are often used to treat a person with a TIA or had stroke. E.g. aspirin, clopidogrel (Plavix), dipyridamole (Persantine). Another one is Anticoagulant drug therapy is often ordered for an ischaemic stroke such as warfarin (Coumadin), heparin and enoxaparin (Clexane). In Singapore, perform physiotherapy for patient like Ben during hospital stay and plan for quick discharge (due to people waiting to use acute ward in hospital) to community hospital and hire a local helper or must wait for a nursing home, or suitable home care services and follow-up physiotherapy. $500-$600 for hiring local helper.

In Singapore, carer training available for local helper amount of $200 a year. In Australia, care plan is included: Obs, anticoagulant therapy monitoring, inflatable mattress for pressure management, keep the patient warm, Risk management care, respiratory care, Endocrinology, Cardiovascular, Renal and skin care. In Singapore, Circulation nurse assist the scrub nurse in opening necessary instruments and sets, ensure the OT is prepared for the surgery, at the end of the case ensure that all the instruments, swabs, sutures are accounted for pass to the recovery nurse. anaesthetic nurseassist in anesthetist in intubation and extubating, hook up monitor like ECG, NIBP, spo2, BIS monitor. Scrub nurse prepare surgical trolley, assist surgeon in passing the instruments and sutures they need, keep track of swabs and sutures used, anticipate surgeons needs during surgery. Attend to the needs of patients and follow doctor’s orders. Day shift 12 patients and at night 18 patients in acute ward.

In Australia, Scrub nurse hands over instruments, scout nurse-assist as a runner outside the sterile area, anesthethic nurse-helps prepare the anesthethics, equipment and other drugs before the operation and helps monitor the patient before and after the operation, PARU nurse-post-anesthetic recovery unit nurse-monitors patient post-surgery in the recovery suite. And in acute ward nurse is monitors PCA, dispenses medication, monitors vital signs (all the responsibilities of a ward nurse).