Development of Clinical Practice Guideline for Prevention of Increased Intracranial Pressure in Patient with Severe Head Injury at Sakon Nakhon Hospital

Abstract

         This research and development study aimed to develop and evaluate the clinical practice guideline (CPG) for prevention of increased intracranial pressure (IICP) in patients with severe head injury (HI) at Sakon Nakhon Hospital. The Iowa Model was applied as a research framework and comprised 3 phases 1) development of CPG 2) try out and 3) evaluation. The samples were twelve nurses, four head ward nurses and thirty patients with severe HI. The instruments for data collection were sample demographic questionnaires, the questionnaires of possibility of using CPG and satisfaction, and the incident of IICP. The instruments for research implement were the CPG for prevention IICP and the CPG user manual. Data were analyzed using the frequency, percentage, mean, standard deviation and t–test. The CPG for prevention IICP in patients with severe HI was developed from 21 synthesized evidences and composed of 5 components: 1) definition of IICP 2) assessment of IICP 3) decrease of IICP 4) nursing care and management for IICP and 5) monitoring and evaluation for IICP.

         The results showed that the satisfaction of using CPG were high. The CPG compliance rate was 93.3%. After the CPG implementation, the incidence rate of IICP was decreased from 22.73% to 13.34%. This developed CPG for severe HI could be used as common nursing CPG to enhance the quality of care and improve the clinical outcome by decreasing the incident of IICP.     
        Keywords: Clinical practice guideline, Increased intracranial pressure, Severe head injury