ประสิทธิผลของการใช้แนวปฏิบัติทางคลินิกสำหรับการจัดการอาการกลืนลำบากในผู้ป่วยโรคหลอดเลือดสมองโรงพยาบาลเทพปัญญา จังหวัดเชียงใหม่

Abstract

Dysphagia is a significant complication in stroke patients. It causes stroke patients to be at risk from aspiration pneumonia, which increases length of hospital stay and can be a cause of death. Effectively managing dysphasia is vital. This operation study aimed to investigate the effectiveness of implementing clinical practice guideline (CPG) for dysphagia management among stroke patients, Theppanya Hospital, Chiang Mai province. The guideline implementation was based on the CPGs implementation framework of the Australian National Health and Medical Research Council (NHMRC, 1999). Subjects were stroke patients admitted at Theppanya Hospital, Chiang Mai province. These patients were divided into two groups. Group 1 included twenty six stroke patients admitted to the hospital before the CPG implementation, from June to November 2013. Four of these patients had dysphagia. Group 2 were 38 stroke patients who were admitted to the hospital during CPG implementation, from January to June 2014. Fourteen of these patients had dysphagia. The study instruments consisted of, 1) the CPGs for dysphagia management among stroke patients developed by Seetasan et al. (2010), 2) dysphagia screening instrument and 3) the aspiration pneumonia incidence measurement. The psychometric property of the instruments was evaluated by experts. Data were analyzed using descriptive statistics Results revealed that before CPG implementation, the aspiration pneumonia incidence was 4.01 per 1000 bed days of patients. During CPG implementation, there was no incidence of aspiration pneumonia reported. These findings suggest that the CPG for dysphagia management among stroke patients can decrease the incidence of aspiration pneumonia. To improve stroke patients’ care, prevent incidence of aspiration pneumonia and increase quality of care, this CPG is recommended for implementation by the hospital administration.