Standing Order for Head Injury

Abstract

The head injury is an important medical problem. The statistics from Ban Bueng hospitalshowed that the rate of patients with head injury was 63.44 per 100,000 in year 2006. It was one ofthe top five causes of death in the hospital. The review of quality development of patient treatmentshowed that each physician had one’s own approach without any precise standing order. This causederrors in the treatment and some unwanted consequences including out patients returning to thehospital in more severe conditions and inpatients being referred with more severe symptoms. Tocope with the problems, the hospital had developed a head injury standing order for physicians andnurses in its emergency room so that the treatment fell into line. Although the standing order wasfound 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 themedical records and inquiring the physicians and nurses who used the standing order and conse-quently improved it. The outcomes of implementing the newly developed standing order for fourmonths were compared with those using the old one. The evaluation showed positive results. Therewere more medical records and examinations. More skull’s X-ray was performed whenever therewere indications. More patients were also in the non-per-oral state. The new standing order stillwas not completely followed and not fully operational. It is yet to be improved and further evalua-tion is planned for at the end of 2011.