Standing Order for Head Injury - การพัฒนาแนวทางด้านการบาดเจ็บที่ศีรษะ โรงพยาบาลบ้านบึง

Abstract

The head injury is an important medical problem. The statistics from Ban Bueng hospital
showed that the rate of patients with head injury was 63.44 per 100,000 in year 2006. It was one of
the top five causes of death in the hospital. The review of quality development of patient treatment
showed that each physician had one’s own approach without any precise standing order. This caused
errors in the treatment and some unwanted consequences including out patients returning to the
hospital in more severe conditions and inpatients being referred with more severe symptoms. To
cope with the problems, the hospital had developed a head injury standing order for physicians and
nurses in its emergency room so that the treatment fell into line. Although the standing order was
found to reduce unwanted consequences, it still had some flaws requiring further improvements.
This paper studied the problems and obstacles of the use of the standing order by analyzing the
medical records and inquiring the physicians and nurses who used the standing order and consequently
improved it. The outcomes of implementing the newly developed standing order for four
months were compared with those using the old one. The evaluation showed positive results. There
were more medical records and examinations. More skull’s X-ray was performed whenever there
were indications. More patients were also in the non-per-oral state. The new standing order still
was not completely followed and not fully operational. It is yet to be improved and further evaluation
is planned for at the end of 2011.
Key words: standing order, head injury