Domiciliary service is an integral part of caring for a bedridden patient, writes Olivia Miwil.
RETIRED school principal Albert Thien, who received many excellent service awards for academic achievement, breathed a sigh of relief when a multi-disciplinary medical team arrived at his home in Kota Kinabalu, Sabah.
The team, comprising an assistant medical officer, staff nurse, occupational therapist and physiotherapist, were there for the first time since Thien’s bedridden wife was discharged from the hospital.
“I may be able to handle academic-related issues, but I need help taking care of my wife. Now I learn that massaging over a certain limit can cause harm to my wife,” he says.
Another caregiver, Aminah Mohd Shariff, 57, shares the same sentiment.
Her husband was paralysed after a stroke and was hospitalised for two months at the Queen Elizabeth Hospital in Kota Kinabalu.
“As the main caregiver, it was frightening when the hospital informed me that I had to take care of my husband myself. I do not know how to handle some of the medical equipment or deal with his medical condition at home,” she said during the medical team’s third visit.
Her 62-year-old husband, who is bedridden, needs tube feeding. He also needs to have fluid or phlegm removed from the tracheostomy hole in his throat. Those feeding and urinary drainage tubes also have to be changed on specific time intervals to prevent infections.
There is also a need for frequent repositioning of the patient confined to the bed.
HOME VISITS
Former teacher Aminah adds that the medical home visits provide not only knowledge on how to care for her husband but also assesses his medical condition and offers emotional support for the family.
The team from Luyang health clinic, led by assistant medical officer Eric Wong, explains that home visits, known as domiciliary services, are for those who need to care for bedridden patients who have been discharged.
The Health Ministry started the service in 2014 at selected clinics in Malaysia. Hospitals will refer discharged cases to clinics nearest to the patient’s home.
Other home visits are for postnatal mothers and psychiatric patients.
The domiciliary service expects that within three months, carers or family members will be able to care for the sick patients.
“During the visit, the team will take the patient’s vital signs, assess overall conditions, change tubes if necessary and communicate with caregivers on problems that occur while taking care of the patients.
“We try our best to help caregivers cope and also minimise common complications such as pressure sores and aspiration pneumonia, both of which are associated with being bedridden,” he explains.
Pressure sores, also known as bedsores, commonly form in areas where bones are closer to the skin such as hip, back, elbows, heels and ankles.
The skin suffers damage when it stays in a position for too long.
This condition can lead to infections, some of which are life-threatening. Aspiration pneumonia is caused by inhalation of gastric contents or fluid secretions which can inflame lungs.
EVALUATING CONDITION
On the first visit, a medical officer and dietitian will evaluate the patient’s medical condition and nutrition and may arrange for appointments at the hospital.
On the first visit, a medical officer and dietitian will evaluate the patient’s medical condition and nutrition and may arrange for appointments at the hospital.
Other aspects that the medical team will look into or advise are the use of a special cleaning soap to prevent skin dryness, the proper way to cut fingernails and the use of compression socks to maintain blood circulation.
The caregivers will also be taught how to position or lift a patient properly.
Physiotherapist Sabrina Mukri, who has 12 years experience, says the service has helped reduce bed occupancy rate in hospitals, besides preventing hospital-acquired infections.
“The move to discharge and support family members in caring for the sick also provides an opportunity for them to cope with the situation.
Usually, the acceptance of family members on the passing of the sick will be better compared to those relying solely on hospital care,” she explains.
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