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นางชูขวัญ ศิลา 28 พ.ย. 2555 PowerPoint PPT Presentation


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การเขียนแบบประเมินตนเอง ระดับหน่วยงาน ( Service Profile ). นางชูขวัญ ศิลา 28 พ.ย. 2555. หัวใจ ของ HA. การเน้นผู้ป่วยเป็นศูนย์กลาง. การประเมินตนเอง. การทำงานเป็นทีม. ตอนที่ I. การวัด วิเคราะห์ และจัดการความรู้. ตอนที่ IV. การวางแผน กลยุทธ์. การมุ่งเน้น ทรัพยากรบุคคล.

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นางชูขวัญ ศิลา 28 พ.ย. 2555

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  • ( Service Profile )

28 ..2555


HA


I

IV

.

II

III

.. 2549



  • ( Hospital Profile )

  • ( Service Profile )



(Context)

(Purpose):

(Scope of Service):

:

:

:

(Key Quality Issues):

:


1

  • (Purpose)

    • /


( 2+ +HPH )

(Purpose)

Purpose


( )

24


Implicit need

Explicit need


Nurse

Lab




  • specimen


:


/ / / /

  • (Accessibility):

  • (Appropriateness):

  • (Competency):

  • (Continuity):


/ / / /

  • (Effectiveness): (responsiveness) (consistency)

  • (Efficiency): (timeliness)

  • (Safety):


(Key Quality Issure)

1. Acute MI Head InjuryShock Asthma COPD

2. Acute MI Shock Head injury Asthma COPD

3.

4. cardiac arrest Acute exacerbation c COPD Shock Respiratory failure

5.

6.



(ER)

  • refer .

  • CPR

()

6


(ER)

  • /

  • Revisit 48

()

  • Birth asphyxia



  • 11 ( 4 )

  • 2

  • 4

  • 1

  • RN 4 :EMT 1 :NA 1 RN 3:NA 1 RN 2 : EMT 1 :NA 1

  • 1.

    2. Refer EMS 1 ( EMT 1 )

  • 1. Infusion pump ()

    2. Computer ( IM on call. 24 .)


:

  • Holistic Care , Humanized Health Care


-

  • - 7

  • - 17 100 %

  • 2

  • 100 %

    - 100 %

    4 4 HHC


  • 1. Head Injury 24


2


2.1

  • Top down flow chart

    • specimen





2.2


2.2



2.3


2.3


?

?

?

?

?

?

?

,

Indicator:02


  • Clinical quality indicators

  • Service quality indicators

  • Management quality indicators


(Clinical quality indicators)

    • (Asthma)

    • (DM)

      • HbA1c


(Service quality indicators)


(Management quality indicators)

    • * ---

    • *

    • * (Out of stock)


    • /


3.

  • ( )

  • (CQI)


3.3


/:

/ /


/:

/ /


/:

/ /


/:

/ /


/:

/ /


/:

/ /


/:

/

/ /


/:

/ /


/:

/ /


/:

/ /


/:

/ /


Clinical Tracer: Ac Appendicitis

Research

Link

Prevention

Form/CPG/

CareMap Link

CQI

Link

KPI

Link

Risk

Care Process

Entry

Initial Assessment

Consultation

Predictive

value of US

Investigation

Delayed/missed

diagnosis

Patho. Diag.

confirmed

Use of

clinical sign

Diagnosis

Planning

Undetected change

Observation

Operation

Anesthesia

OR

Transfer

Preop Care

Anes complication

Anesthesia

Delayed operation

Door to operation time

Operative Procedure

Postanes Care

SSI

SSI rate

Postop care & monitoring

D/C plan

Follow up


....

..


12


1. (C3-THER)

//

- Case Shock, Head injury, Abd.pain, Asthma, AcuteMI

Case Case

  • Case (.. 50-.. 51) 34 Case

  • , , 3-5

    -

    -

    -


  • -


1. 38 6 . GCS 15 neck tender at C3 -4 pin pick sensation impair below C8 DTR 1+ all BBK not present

Diagnosis C spine injury 0.9 % NSS LAB DTX Electrolyte .

Protect C-spine

Trauma


2. 10 . . 1 . 1 ER 1 suction clear air way on O2 box 10 l/m Diazepam 3 mg 5% D/N/4 admit


3. 57 . 5 . 1 OPD ER O2 canular , Run EKG EKG NSR 92/min ST elevate V2 6 ASA grV Isordil 5 mg SL on 5%D/N/2 pethidine 25 mg IM stat 15 .

AMI


4. 49 2 . . EMS . V/S pulse 64-68/minBP 90-100 / 60/70 mmhg. good conscious H&L OK Dyspnea urticaria rash neurological GCS 15 0.9 % NSS loading CPM 1 amp IV Dexa 4 mg IV stat onO2 canular

ward

Shock Anphylactic shock

5. 84 9 . HT DM DTX 41 mg% On O2 canular 50 % Glucose 50 cc IV drip . 5 % D/N/2 1000 cc. hypoglycemia

NCD


6. 80 2 . . OPD EKG HR 150 16 0/min regular SVT O2 canular O2 sat V/S Adenosine CPR mornitor EKG Admit

HR 60 70 /min

Adenosine ,


2 //

//

  • ()

  • ()

  • ()

  • 4 Case

  • -

    -


3 //

  • Refer Refer Refer

  • 2

  • Case 1 /

    - 1 /

    - ER , NA ER

  • case Refer

  • Case Shock , On ET- tube , CPR .


3 //

1.

2.

3. /

4. .

5. Prolong Shock

6. Tracer Head Injury MI

7


5 (..50-..51)


(..50-..51)




Refer (..50-..51)


3 //

86 .. 23.09 . 1 underlying UGIB .. V/S BP=60/40 mmHg P=120/m R=18/m Hct stat=16% Larvage c 0.9% nss 4000 mlnot clear on 0.9%NSS iv drip free flow 300 ml BP=80/50 mmHg P=88/m ranitidine 1 amp IV stat Lab VCT CBC Cross math IV RLS on foley cath Hemccel 500 ml BP =80/50 mmHg .. 00.30 . ER .

Refer

Larvage 2000 ml clear ..


4

  • . 16.00-20.00 . 08.30-12.00 .

  • 20.00-08.30 .

  • 24 .




  • - 2550 - .. 2551 1568 case 1403case 89.48%

  • 165case 10.52%

  • 1. 46 case 44.23 %

  • - Hyoscine antispasmodic

  • - antihistamine ( 3 CPM syr 1 cc. x 3 pc. )

  • - chloram eye oint

  • - 7.5 . CPM syr 0.4 cc. x 3 pc

  • ( 2 cc x 3 pc)


  • 2. 11 case 10.58 %

  • - N/S

  • - N/S

  • 3. 3 case 2.88 %

  • - 2 Dx. Asthma Dx. bronchiolitis

  • 4. 31 case 29.81 %


5. . / / 13 case 12.50 %

- buscopan + domperidone

- 2 Flumucil + bromhexine

- 2 dimen + cinarazine

- antihistamine 2 Actifed + CPM

- NSAID 2 diclofenac + Ibrufen

-

antihismine /


-

-

-

-

- GCS EKG chest pain severe dyspepsia


  • - /

  • - / /


5

//

- Case

  • RM round

  • ER, RM


  • Clinical Risk .. 50 .. 51

  • (G-I) 5

  • (E-F) 7

  • (C-D) 22

  • (A-B) 11

  • Trigger tool

  • RM Round


  • case AMI MO 3 mg IV 1 IVMO 2 3 MO 3 1 MO MO

  • 6 R MO/Pethidine amp


6

  • case Excision

  • case

  • IC round 3

  • ,ICWN First in First out .

  • - ERICWN ICN

    - case Excision


..50 ..50


excision 1

- excision 1

- Retain foley catheter WBC 1

-


..51 ..51



..51 ..51


  • 1. Standard Precaution

  • 1.1.

  • 1.2. Sterile dispose

  • 1.3. mask

  • 1.4. One Handed Technique

  • 1.5.


()

  • 1.6. IV amp

  • 1.7.

  • 1.8.

  • 1.9.

  • 1.10.

  • - 0.5 % sodium hypochloride

  • - dispose

  • 0.5 % sodium hypochloride


()

  • 2.

  • - Supply

  • 1. 1 1

  • 2. 1

  • 3. + O2 Forceps 1

  • - Supply


()

  • 3. SepticTank

  • 4. Hand hygiene 4

  • 4.1. Normal hand washing

  • 4.2Alcoholic hand disinfectant(Alcohol hand rub)

  • 4.3. Hygenic hand washing

  • 4.4. Surgical hand washing

  • -


7

-

  • case

    - ER

    case


(Medication error)

  • 13 Colles Fracture Reduction+SAS petidine 25 mg IM MO amp IM

  • Administration error

  • ER

  • Sticker MO Pethidine


(Medication error

  • Preseribing error


(Medication error)

  • ( Medication error )

  • 2550 2551 40

  • ME A B -

  • ME C D 40

  • ME E F -

  • ME G - I -

  • 1. Preseribing error 39

  • - 25

  • - 13

  • 2. Administration error 1

  • - 1


(Medication error)

  • /

  • Dubble check

  • Stock ER

  • 6R.

  • Order

  • Sticker Pethidine


(Medication error

  • /

  • ER

  • +

  • ( Salbutamal )


  • ( Medication error )

  • 2551 13

  • ME A B -

  • ME C D 13

  • ME E F -

    ME G-I -

    1. Preseribing error 13

  • - 11

  • - 2

  • 2. Administration error -


  • ( Medication error ) 2551 15

  • ME A B -

  • ME C D 15

  • ME E F -

  • ME G I -

  • 1. Preseribing error 15

  • - 4

  • - 6

  • - Notify 3

  • - 1

  • - 1


  • ( Medication error )

  • 2551 7

  • ME A B -

  • ME C D 7

  • ME E F -

  • ME G I -

  • 1. Preseribing error 6

  • - 3

  • - 1

  • - 2

  • 2. Administration error 1

  • - 1

  • 43 30 Acute MyocardialInfarction MO 3 mg IV stat MO order


  • - ER

  • -

  • - Order

  • -

  • - Order

  • -


8

  • Case

  • -Case dead case

    -Case refer tube

    -Case

    -Case shock


8


  • 38 . 30 Ranitidine observe 30 arrest CPR 30 no response ER

  • -Dead ER

  • -

  • - EKG Severe dyspepsia 35

  • - MI

  • - chest pain

    - EKG


  • 18 .20 COMA SCORE E1V4M6 ,Confuse 4 . 0.8 . X-ray CXR,Pelvis,Foream Lt., X-ray complain 5 BP air hunger tube CPR 50 no response ER

  • -Miss Diagnosis to Head injury

  • -Cardiac arrest

  • - HI

  • - X-ray GCS< 13 SHOCK

  • - HI Hard Collar


9

/

-

- 5 %

  • 5% ER+ OPD ..50 ..51

  • 5% ER ..51 ..51

  • ER

    -

  • AE

  • admit , refer , observe, discharge


9

  • -

  • Part :4

  • Part :5

  • 1.

  • 2. Diagnosis

  • Part :6

  • 1.

  • 2.


9

  • 2551


9


9

  • 6 parts

  • Part 1 :

  • 1.

  • 2. ID 13

  • Part 2 :

  • 1.

  • 2.

  • 3.

  • 4.

  • What where when why who How many

  • Part :3 ( PE )

  • 1.

  • 2. PE HEENT ok DX. Ac. Pharyngitis

  • 3.


10

- 12

-

-

- competency


  • 12

  • 1. , refer Chest pain EKG

  • EKG ( .. 50)

  • Chest Pain EKG 85-94 90% CPGAMI


  • 2. 12 QMR ( .. 50 )

  • 12

  • 3. , refer 40


  • GCS

  • CPG Head Injury GCS ( ..50-..51 = 89.74% ) GCS EMS


  • 4. Competency

  • - CPR = 95.62%

  • - = 95.32%

  • - Cut down = 91.75%

  • - ICD=87.12%

  • - EKG = 96.17%

  • - Chest pain =93.17%

  • - Shock = 95.87%

  • - HAD = 99.16%

  • ICD ICD


  • 5.

  • , ,


11

  • Check

  • -

    ER

  • EKGDefrib

    -


12

  • -

  • - ER

  • Ac MI






  • ER ..50- ..51 7

  • 5

  • 2 4

    • 1 case HI

      • Miss Dx

      • Cardiac arrest

      • Case Acute MI

        Dx.

        Rx.

        AMI severe dyspepsia HI hard collar


  • 0 % (..50 ..51) 5.75%

  • AMI HI

  • 1. AMI HI

  • 2. AMI HI

  • 3.


  • UTI < 5% 15.38%

  • bed sore

  • 1.

  • 2.

  • 3.

  • -


HI

  • - HI /

    - HI


HI


HI

  • 1.

  • 2.

  • 3.

  • 4. CQIHI

  • 5. (CPG)/CPG


  • HI

  • - CPG 6.88%

  • - refer admit 1%

  • - ER 7

  • x-rayGCS x-ray

  • - HI GCS<13 /Shock/ x-ray

  • - Hard collar

  • -


  • - 3 3

  • - ( EMS , FR,.)

  • -

  • - 3 3

  • - .

  • - 1669

  • - FR


AMI

  • -chest pain Cardiac arrest

  • chest pain


AMI

5


  • 1. CPG AMI

  • 2. Competency ER EKG

  • 3. AMI ER

  • 4. Fast tract for STEMI

    • Fax - ( Refer ) EKG 12 Leads

    • Refer

    • Refer


AMI Cardiac Arrest ER 2 ER

1. Chest Pain EKG Severe Dyspepsia 35

2. ER EKG

3. CPG AMI


Clinical Tracer: AMI

Prevention

Form/CPG/

Care Map

KPI

Risk

NCD/OPD/ER

Entry

- /

-Cardiogenic

Shock

- Cardiac arrest

- EKG

- /

- Dx /

- cardio genic shock

- Cardiac arrest chest pain

- AMI Refer

- AMI Refer

- Refer 4 8.

- Re - Admit

Initial Assessment

Consultation

CPG AMI

Investigation

Diagnosis

Planning

- Cardiogenic Shock

- Cardiac arrest

- Dead

-

-

Undetected change

CPG Shock

CPG CPR

CPG AMI

Admitted(observe)

Oxygen therapy

Medication

- Refer

- cardiac arrest Refer

- Cardiogenic Shock Refer

- Dead Refer

-

-

- CPR /

Transfer

Oxygen therapy

Monitor EKG

Record vital sign

r /

Refer

D/C plan

Re - Admit

Follow up



?

?

?

?

?

?

?

,

Indicator:02


  • Clinical quality indicators

  • Service quality indicators

  • Management quality indicators


(Clinical quality indicators)

    • (Asthma)

    • (DM)

      • HbA1c


(Service quality indicators)


(Management quality indicators)

    • * ---

    • *

    • * (Out of stock)


10

1

5

10

1

Indicator:07



48




  • 24

  • 1 2

    3 4

    5


2


2.1

  • Top down flow chart

    • specimen





2.2


2.2



2.3


2.3


3.

  • ( )

  • (CQI)


3.3




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