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1. . Happy Friday: The relaxing activities for medical students.

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2. . Stress level, Sources of stress and the Way to reduce stress among medical students

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3. . Comparison of Khon Kaen Universitys Nasal Packing Model to the Standard Nasal Packing Model

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4. . The best bedside teaching method for 6 th year medical students in Thailand

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5. . An assessment of why anatomical pathology residents are a minority group in Thailand

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6. . X-ray film interpretation efficiency before and after night shift of the surgical interns

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11. Stroke

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32. Laparoscopic Cholecystectomy

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37. : Hand free pumping warm bra

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92. Fast track STEMI 93. Bed Shampoo & Med. SKT 8 ( SKT8)

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1 2559

Happy Friday: The relaxing activities for medical students. . Background: Happy Friday is the extracurricular activity was held for medical students to relive pressure and teach non -medical skills for daily life. The purpose of this study is to evaluate the satisfactions and reflections of medical students on the happy friday activities. Summary of work: The 4th to 6th year medical students at Mahasarakham medical education center were enrolled in this study.Each student completed the questionnaire about their satisfactions level as overall of Happy Friday activities which consist of cooking, drawing, photography, movies and excellent service behavior (ESB). The scores range from 1(very poor/very dissatisfied) to 5(very good/very satisfied); the satisfactions score was interpreted as poor, fair and good. Summary of Result: 47 questionnaires (100%) were returned and analyzed. Overall satisfactions level was 4.8/5.The benefits of this project are relaxing and can be adapted to use in daily real life (80% and 70%) respectively, and all reflections suggest to continue this happy Friday activities. Discussion and Conclusions: The finding in this study showed the satisfaction rate was very good. The happy friday activities not only relieve academic stress but, also adapted to use in the daily life from this experience through process of learning by doing. Take-home messages: The medical curricular and the extracurricular activities were essential for medical students to become a good doctor in the future.

2 2559

Stress level, Sources of stress and the Way to reduce stress among medical students . Background: Stress is important common problem in medical education that may affect academic performance of medical students, there is no such study in Mahasarakham Hospital so this study aimed to assess stress level, sources of stress and way to reduce stress among medical students in Mahasarakham Hospital Summary of work: Cross-sectional study was conducted in 46 fourth to sixth-year medical students, they were asked to fill out the questionnaire including personal information and Suanprung stress test (SPST-20) Ministry of Public Health, Thailand. The response rate was 76% (35 questionnaire returned, male 15, female 20). Personal data was collected. The scores were measured and categorized into mild, moderate, high and severe stress Summary of result: The prevalence of high and severe stress was 54.3 % (19/35) of medical students, most of them were 4th and 6th year medical students (47.4% and 42.1%). The major sources of stress were academic activities like examination (85.7%), study (51.4%), duty (45.7%), the other sources of stress was relationship with staffs and friends. 77.1% of them stated that Medicine rotation cause stress most compare with other rotation. Sex, grade point average, duration of sleep showed no correlation with stress level (p > 0.05). There were many way to reduce stress such as listening (80%), seeing movie (71.4%), having party (63.6%), playing sport (38.2%) and meditation (11.8%) Discussion: The result revealed more than half of medical students had high and severe stress level which may lead to physical and mental problems. This might affect daily life and academic activities such as patient care, impair learning, judgment, graduation and even suicide. Conclusion: Prevalence of severe stress in medical students was high and these findings can make the staffs understand and help their students to cope with stress. Take home message: Stress among medical students should be explored so that we can prevent its effects

3 2559

Comparison of Khon Kaen Universitys Nasal Packing Model to the Standard Nasal Packing Model . Introduction: The Department of Otorhinolaryngology at Khon Kaen University (KKU) created an innovative model for anterior nasal packing. This study aims to evaluate KKUsnasal packing model to the standard nasal packing model. Material and methods: The Department of Otorhinolaryngology set up an anterior nasal packing class to teach and compare the standard nasal packing model to the KKU nasal packing model. Medical students practiced both models. A standard questionnaire (VAS 0-10) was used to compare the models based on a list of criteria: satisfaction; confidence in thetest;confidenceto perform the procedure; confidence when performing with a patient; procedure adequacy; and a sense of satisfaction. Results: The mean difference between the two models was not statistically significant: satisfaction was 0.48 (95 %CI -0.72, 1.68); confidence in the test was 0 (95 %CI-1.03, 1.03); confidence to perform the procedure was 0.33 (95 %CI-0.75, 1.42); confidence when performing with a patient was 0.86 (95 %CI-0.21, 1.93); procedure adequacy was 0.57 (95 % CI-0.44, 1.59); and 12 medical students reported being satisfied with both models (57.1%). Discussion: The standard model is three times more expensive than the KKU model. The KKU model can perform anterior and posterior nasal packing, tracheostomy and change silver tubes. The KKU model was found to be the model of choice and can potentially replace the standard nasal packing model due to greater affordability, durability and multi-functionality. It is also important to note that medical students felt that the standard model, having a cross sectional translucent plastic cover in 1 site of model, made it easier to perform and visualize the packing layers. The KKU model should look into further developing their model based on these points. Take-home message: The KKU model is more affordable, durable and demonstrated better performance by medical students than the standard model.

4 2559

The best bedside teaching method for 6th year medical students in Thailand . Background: In Thai medical school, we have two types of bedside teaching: discussion beside patient beds and outside discussion. The aim of this study is to discuss the best bedside teaching method for medical students. Summary of work: All 6th year medical students in pediatric department 2015 were selected. Two types of bedside teaching; i.e. discussion beside patient beds (mode in) and outside discussion (mode out) were taught to the students. Following the activity, the students were asked to complete the questionnaires. Mean and pair sample test were used to analyze the data. Summary of Results: The mean of stress in mode in was insignificantly higher than that in mode out (5.4 vs 4.1 in mode in; P=0.114). The mean of shame when they were unable to answer in mode in was significantly higher than that in mode out (3.95 vs 2.4 in mode out; P=0.036). The mean of the feeling toward the risk of being sued in mode in was significantly higher than that in mode out (4.0 vs 2.35 in mode out; P=0.05). The mean of students satisfaction toward mode out teaching was insignificantly higher than that of the mode in teaching (7.5 vs 6 in mode in; P=0.054). The means of the knowledge of the two teaching modes were not different (7.85 vs 7.5 in mode out; P=0.163). Discussion and Conclusion: Discussing beside patient beds caused shame for medical students when they were unable to answer the questions and also caused the feeling of risk of being sued. There was little difference between the two types of teaching in terms of the stress, the satisfaction, and the knowledge. Final remarks: Discussion outside seems to be more beneficial than discussion beside patient beds, and it may reduce the feeling of risk of being sued and the feeling of shame when they were unable to answer the questions.

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An assessment of why anatomical pathology residents are a minority group in Thailand . Background: In Thailand, anatomical pathologists are considered a minority in the medical field. There are no studies evaluating the reason behind this phenomenon. Due to the major lack of pathologists in Thailand, it is necessary to understand why current anatomical pathologists choose to specialize in anatomical pathology before their residency training. Methods: Structured questionnaire were designed and completed by 21 anatomical pathologists in 3 Thai medical faculties: Khon Kean University, Siriraj Hospital, Ramathibodi Hospital, Mahidol University. Results: 61.9% of the residents were female; aged between 2428 Years; and their response rate was 100%. The 80% reported choosing anatomical pathology because there was no need for personal contact with patients; 30% because they could train immediately upon graduation; 20% because they were proud of the profession; and 20% because they were satisfied by the income. Discussion: Anatomical pathology is not a popular specialization in the medical field in Thailand. Our findings show that Thai medical residents do not choose anatomical pathology because of role models or because of the proud profession. However, it is significantly associated with the working style of a pathologist. Based on our findings, we suggest that strategies to increase interest in anatomical pathology focus on (1) inspiring undergraduate

medical students through strong pathologist role models And (2) increasing the income of an anatomical pathologists in order to appeal to recently graduated medical doctors. Conclusion: Medical students choose to go the route of anatomical pathology because of the working style.

6 2559

X-ray film interpretation efficiency before and after night shift of the surgical interns .

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12 2559

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13 2559

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14 2559

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Type and Screen .. 2556

Type and Screen (T&S) T&S T&S (cross match) T&S .. 2556 : (retrospective study) Type and screen (T&S) 2556 (1 - 31 .. 2556) T&S (cross match) : 4,794 (6,654 ) T&S 2,883 (3,416 ) (cross match) 1,911 (3,149 ) T&S 50, 16.17, 24.59, 38.76, 26.72 6.28 T&S cross match 3,362 50.53 504,300 26.72 (cross match) T&S C/T ratio 2.0

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26 2559

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Home Ventilator

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10 10 3 5 50,000 11 10 2558 2 IVIG IVIG 2 1 25 2558 2 3 3 PICU PICU7 2559

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nures station Emergency Amp Emergency Amp Emergency 2 Emergency 1 60 5 .. 2557-2558 Emergency 3 5 0 -1 4 3 7 R Emergency 7 R : ( Medical error) 60 5 : (aging society) ..2552 11.5 14.4 ..2568 605 15 42.7 (Presbyopia) 9 40 1 (/) 60 5 ..2557-2558 Emergency 3 5 0 -1 4 3 7 R

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82 2559

BCG - :

1. BCG 2. BCG : BCG 2535 2557 BCG F BCG : 1. 2. - 3. 4.

2557 2558 2559 1. - -

BCG - -

- - - -

2.

-

- BCG

83 2559

2557 2558 2559 - - - FI-FO

- - 1

3.

-

-BCG - syringe - -

- BCG - -vaccine 1-2 -

: ( 1/7)

2794 2836

1425

800

410 204

400 405 203

0

500

1000

1500

2000

2500

3000

2557 2558 2559 (..58-..59)

84 2559

BCG

144000

73800

36720

0

20000

40000

60000

80000

100000

120000

140000

160000

2557 2558 02559 (..58-..59)

85 2559

HIV - :

1. HIV 2. 3. : HIV 2557 2 2 2558 4 1 1 2 : 1. 2. -

ANC ARV Viral load

- -ANC High risk - Viral load ANC // IPD Lab - ANC LR GA 34-35

86 2559

- ANC -

- -Lab : CD4 ,viral load -LR ARV 24 - LR Standing order -

-LR - -

- - - -

- Standing order -LR Standing orderLR

- - LR -

Standing order High risk

- Standing order High risk Check list -Standing order

87 2559

..58 ..59 .. . ..

HIV 6 2 3 4 1 Standard risk 6 1 2 3 1 High risk 0 1 1 1 0 100 100 100 100 100 0 0 0 0 0 :

88 2559

XDR-TB : 100% 2 : (Multi drugs resistant TB MDR-TB) 2 H R 6 18 24 2,500 80,000 100,000 60 5 (Extensively drug resistant TB XDR-TB) 10 30 XDR-TB 3 XDR-TB : 1) 2) 3) 4) 5) 6) Set 7) 8) : 100 % DOT 2

89 2559

:

90 2559

: : 580 2 2558 16 , 12 23 : : :

91 2559

, : 1. 2. : 2558 13.8 1000 CURN 1. 2. 1) MAAS 2) 3) 4) 5) 6) 7) 3. 4. 2559 46.43 /1,000 2559 9.09/1,000 ( P

92 2559

RECTAL Cath bed sore , : rectal cath with bag Incontinence Associated Dermatitis: IAD : Antibiotic associated diarrhea (Incontinence Associated Dermatitis: IAD) bed sore rectal cath with bag (IAD : incontinence associated dermatitis) : 1. bed sore AAC 2. rectal tube 2.1 Foleys cath 20, set flush, savlon 1:1,000, syringe 20 ml, sterile water, Xylocain jelly, , 2.2 - - - (Left Sim's position) - - rectal cath Xylocain jelly 2-3 - rectal cath 30 cc - bag 3. /

93 2559

2557 2558 2559

AID 0 /1,000 1 0.75 0 AID rectal cath 0 0 0 0 / 80% 95 95 100

AID rectal tube with bag IAD dressing rectal cath with bag IAD bed sore

94 2559

VAP ZERO : 1. VAP 2. VAP : (VAP) 90 % (OKeefe-McCarthy S., 2008) 22.8 (Augustyn, 2007)

2556 = 16.02 /1,000 Vent , Day CDC ( 10% /1,000 vent. Day) VAP 1. VAP 2. 10 1 6 3 2 3.2 2 4 2 (Content validity) 3 (Content Validity Index: CVI) 0.93 3. VAP 7 1) 2) 3) 4) 5) 6) 7) 4% CHX 0.12% CHX close system suction, nutrition bag Tri flow 4. VAP 5.

95 2559

2556 2557 2558 VAP 10% /1,000 vent. Day 16.02 14.26 6.82 5 6.0 5.6 5.0 6 6.2 5.7 5.1 85% 79.61 85.07 85.78 85% 85.58 95.63 96.09 VAP

100% 100 100 100

VAP

85% 72.9 92.8 94.0

1 / 0 4 8 1 / 0 1 1 : VAP 2559 VAP 4.87 /1,000 vent. Day VAP ZERO 2

96 2559

(Modern wound care) , : Silver Ag mesh : 0.9 NaCl 1 % 1 (Silver) Silver Ag mesh silver 70-100 ppm Broad Spectrum Aerobic, Anaerobic, Yeast, Antibiotic-Resistant silver 20-30 5-7 : 1. 2. (Silver) 3. Silver Ag mesh 4. (Silver) : 42 37 % second degree burn

Silver Ag mesh 1. scrub burn OR 2. OR 1 ET Tube OR scrub burn ward - 1 30 2 - Top 14 gauze 18 = 992 - Silver cream 2 379X2 =758

1.scrub burn OR 2. Silver Ag Mesh 1. 2. Silver Ag mesh 0.9%NSS 3. gauze

97 2559

Silver Ag mesh - NSS X2 = 78 - morphine dose 20 1,848 / 30 = 55,440 7,000 14 = 9,8000 3,300 X 14 = 46,200 =199,640 ( 1 )

4. Gauze 7. Silver Ag mesh 1 Silver Ag Mesh 6 1,400 = 8,400 Top 14 gauze 18 = 992 = 9,392 6 7000 = 42,000 8 X3,300 = 26,400 =77,792

: 2556 2557 2558 1. Silver Ag mesh

100 60 100 100

2. Silver Ag mesh 2

100 100 100 100

3. Silver Ag mesh

80 95 98 98

4. Silver Ag mesh

80 100 100 100

: Silver Ag mesh 5 3 2 Silver Ag mesh

98 2559

: Bird respirator 10 / 10 % : Bird respirator 2557 7 Bird respirator 2557 12 11 32 T-Way Expiratory Valve .. T-Way : 1. T-way 2 3 1 1,800 (2557) 2. T-Way T-Way ( 5 ) 1,600 / T-Way 41 3. Bird respirator 32 T-way 3 / IP(Inspiratory pressure) 15

cmH2O T-Way Tidal volume(TV) 240 cc T-Way 240.62 cc IP = 20 cmH2O T-Way TV = 460 cc T-Way TV = 469.37 cc IP = 20 cmH2O T-Way TV = 560 cc T-Way TV = 561.25 cc 4.

99 2559

: 1. 2558 4 2559

2. T-way 32 1,800 57,600 :

240

460

560

240.62

469.37

561.25

0

100

200

300

400

500

600

IP=15 IP=20 IP=25

Tidal volume

T-way T-way

7

4

0 0

1

2

3

4

5

6

7

8

..2557 ..2558 ..2559

Bird respirator()

TV

100 2559

: : Infectious marker Positive Infectious marker NAT : Infectious marker Positive : Infectious marker Positive ..2550-2558 5,197 4,530 666 60,000-100,000 :

101 2559

/ , : / 2559 12 6 50 ( 5 1015 ) 5 41.66 / 2559 15 35 0 2 25 : - - - : C line, A line, TPM 2559 92 C line, A line, TPM 12 /

102 2559

: 1. / 2. - - - 3. / 4. 5. / 6. 7. / : - < 5 - =100% - > 90% - / 2559 15 - 3 - 5 - 2 13.33 - 95 % : - -

103 2559

Safety locks A line , : Invasive monitoring A line 2559 5 E A line 1 20 3 60 Invasive monitoring: A line, CVP Safety lock A line 2559 4 A line 0 0 : 1) (Aterail line) 2) (Aterail line) : (Aterail line) Aterail line ABG (Aterail line) radial artery, Ulnar artery Brachail artery : 1) - - 2559 - -

104 2559

- Safety lock A line 2) : Safety lock A line - 10*20 . 8*10 . - - tunique - Safety lock A line Aterial line 3) : 1) (Aterial line) 48 0 / 2) Safety lock A line80 Aterial line Safety lock A line Safety lock A line 48

/ A - line

()

()

..59 2 0 0 1 50 ..59 2 0 0 2 100 .. 59 1 1 100 0 0 ..59 2 0 0 0 0 ..59 2 0 0 0 0

Safety lock A line Aterial line 2559 4

105 2559

Safety lock A line 80 : (Aterial line)

106 2559

Enoxaparin : Enoxaparin - 2559 15 5 33.33 Enoxaparin Enoxaparin (Cardiac Care Unit ) - 12 3 25.0 Enoxaparin : 1) Enoxaparin 2) Enoxaparin : (Acute Coronary Syndrome: ACS) (Low Molecular Weight Heparin: LMWH) Enoxaparin ,, (Hematoma) (Cardiac Care Unit) (Acute Coronary Syndrome : ACS) 2559 60 Enoxaparin 15 5 33.33 : , , Enoxaparin Enoxaparin Enoxaparin (Cardiac Care Unit) Enoxaparin (Cardiac Care Unit)

107 2559

:

1) Enoxaparin hematoma 2 Ecchymosis 3 2) Enoxaparin 3) Enoxaparin Enoxaparin Enoxaparin

Enoxaparin Enoxaparin

Enoxaparin: 1) Micropore/ 70 % Alcohol/ Enoxaparin/Cold pack 2) 2 3) Enoxaparin 4) 2 5) 1 6) Cold pack 5 7) 70 % Alcohol 8) 9) 90 10) 11) 30 12) Cold pack 5 13) 14) ,, 8

:

1) Enoxaparin 10 % 2) Enoxaparin 100 %

108 2559

Enoxaparin (Cardiac Care Unit) - 12 3 25.0 Enoxaparin : Enoxaparin Enoxaparin Enoxaparin

109 2559

, : set IV, heparin lock 2559 146 phlebitis 1 2559 103 phlebitis : : care IV Phlebitis : 1. - - - - 2. (2.1) - 7 - 1 - - 7 ,,,,,, (2.2) ()

110 2559

- - - - - - - (2.3) heparin lock 3. : 1. 10 % 2. 100 % :

111 2559

, : (femoral artery) 2559 2 Hematoma 1 50 (femoral artery) 2559 1 Hematoma 0 80 : 1) Hematoma 2) 3) : (femoral artery) 1 2 (bleeding) (hematoma) 2559 5 2 1 Hematoma Hematoma

112 2559

: 1) Hematoma 2) 2559 3) 4) 5) 1. 4 X 6.5 3 2. 4 X 40 1 3. 30 1 4. 1 1. 3 2. 2 6 24 3. 1 4. 5 : 1) Hematoma 0 2) 80

113 2559

Hematoma 2559 1 Hematoma 80 :

114 2559

extravasation 2 infiltration extravasation extravasation 1. 2. 3. extravasation 4. 2 extravasation 5. 6. extravasation extravasation 2559 30 extravasation extravasation 28 32 85 extravasation Pre test 83 extravasation 45 extravasation 22 ( 37) extravasation 49 ( 12) 72 48

115 2559

(Stroke) : (Stroke) : (Stroke) : 1. 2 (Stroke) Google Drive 2. 3. : (Stroke)

1 .. 2557- 31 .. 2558

1 ..2558- 31 .. 2559

1. 61.06 (185/303)

56.06 (245/437)

2. Barthel index >

80.28 (228/284)

88.53 (386/426)

: Internet

116 2559

-

(CSSD.) 42 4 + .. 17 320 2,000 2,500 / () - 250 / - CSSD. CSSD. Sterile CSSD. - Online (logistics) one stop service CSSD. -

117 2559

() : 1) 2) 3) : 26,291 425 1.62 73 10.11 ..2550 () : 2557 2559 1) 2) ICF (International Classification of Functioning, Disability and Health ) 3) 4) / . 5) 6) / 7) 8) 2557-2559

118 2559

38

12 11

5 3 4

70

1 0 0 0 2

0

10

20

30

40

50

60

70

80

: () 73 73 ( 2 )

() : 1) 2) 3) / 4) 5)

N : 73

119 2559

Emergency Severity Index: ESI , : (Triage) Triage 3 Emergency Urgency Non Urgency (E : U : N) Emergency Urgency (Triage) Emergency Severity Index (ESI ) () 5 : 1) 100 % 2) 100 % : 24 Emergency Severity Index (ESI) 5 Emergency Severity Index (ESI) 5 2555 = 87% Over triage/Under triage 2556 = 99.87 % 2552 = 80% Emergency Severity Index (ESI) 5

120 2559

: 1) Emergency Severity Index : ESI 2) 3) 4) 5 Emergency Severity Index : ESI 5) : 1) QA 2) Audit chart : 3) MESI 4) MESI : 1

121 2559

Total case , : 1) (primary nursing) 2) / / 0 3) (primary nursing) : 24 2557- 2559 52,477 48,526 48,566 (Primary Nursing) : 1) 2) ( Primary Nursing ) 3) 4) 5) Primary nursing : 1) (Primary Nursing) / / QA 2) (Primary Nursing) : (Primary Nursing) < 1 Closed training

122 2559

, : 24 85 % : 1) 2) > 85 % 3) > 80 % : 1) > 85% 2) > 80% :

-

-

- - - - -

-

- Focus charting

-

123 2559

24 2558 85 % : 1. Focus charting 2. 3. 4. Focus charting 5. 6. / 7. Audit chart : 1. Audit chart : 5 % 3 ( 2559 2559 11,669 580 2. 3. : - computer -

124 2559

drug express , : 24 Stat order - (QA) Stat order / ER drug express : 1) Stat order 2) 3) / ER : drug express : 1) 2) 3) / ER 4) 5) / ER : 1) Stat order / ER 3 2559 100 case 2) / ER : / ER 1 / ER

125 2559

(ventilator associated pneumonia: V A P) : VAP VAP / : VAP < 7 /1000 Vent , Day : 2555 2556 2557 VAP = 21.83 16.02 14.26 /1,000 Vent , Day 21 % 5.95 5.8 25.5 /1,000 Vent,Day 66.60 weaning protocol VAP : 1. ( R2R ) 2. 1) 4% CHX 5 moments 2) wean weaning protocol 3) cuff pressure drip 200 30-45 4) 70% alcohol 7 2 . close system suction 5) - 0.12% CHX 4 . 3. ICWN

126 2559

4. 1 :

2558 2559 VAP 7% /1,000 vent. Day 6.82 4.87 5 5.6 5.0 6 5.7 5.1 85% 79.61 85.07 85% 85.58 95.63 100% 82.4 86.8 VAP

85% 92.8 94.0

: VAP

127 2559

: (Computed Radiography ,CR) (Imaging Plate ,IP) (CR Reader) : : (Contrast) : 1) 2) Aluminum step wedge Aluminum step wedge 3) Agfa CR 85X 4) (Histogram) 5) PACS Image J (DICOM File) (Contrast to noise ratio ; CNR) 6)

128 2559

: (Wrist joint) : 1) 2) 3) 4) 5)

129 2559

: 1) 2) : ..2558 29 .. 2559 62 : 1. 2. 1. Glasgow Coma Scale 12 : 2 : Oro-Motor Exercise

: 3. 4. 5. - 6.

**: : 1 Oro-Motor Exercise

3. 4. 30 1

5.

130 2559

1. 2. 3. 4. 5. 30 **

: 2558 2559

1. 80

96.55 91.93

2. 5

0 0

: 1. 2. 3. : 1. 100% 2. 0%

131 2559

Beware ADR : 1) (Adverse Drug Reaction, ADR) 2) :

1) ADR EPS High Alert Drug ADR Clozapine 2) 3) 58 4 4) 56 ME record 1 / ( Clomipramine 25 mg Clomid 25mg)

: 1) ME 2) 3) 4) 5) MKH-FR-PSY-005 () 6) MSKH_40 7) 8) ADR EXCEL ADR

:

3

1

2

1

1

1

1

ADR 2559 Parkinson

Tardive dyskinesia

Anyichilinergic

AdrenergicS/E

NeurogicalS/E -

polydypsia

132 2559

:

5%

4%

1%(10)

0%

1%

2%

3%

4%

5%

6%

2557 2558 2559

10

133 2559

: 3 0 % : : 1) 2) 3) : 1) 2) 3) : 1) 2Q 9Q 8Q 2) 3)

134 2559

: 1. 80 2. 80 : 6 : 1. Bio-Psycho-Social-Spiritual 2. 3. D-method 4. 5. 6. 7. 8. 1 :

2557 2558 2559

56 82 89 84 88 92 :

135 2559

: 1) 2) 3) : 1 2557-2559 2,480 , 2,530 2,642 (set Infusion) 24 (set Infusion) 2557-2559 0 2557-2559 0 (Near miss) 5 2558 Set IV 24 set IV 35 set/ 315 / : / 1) 2) 3) 4) 5) 6) 7) 8) (1) S 8 (2) (3) (4) (5) (6) 1-2 / S 8 1. 2. 3. 4. 5. 6. 7.

136 2559

: 2557 2558 2559

1 0 0 0 2 0 0 0 3 (/ ) NA NA 315

:

1. 2. 3.

137 2559

: : 3 / 3 / 1 10 : 1. / / 2. 1 3. 2 / / : 57 6.0% 58 2.1% 59 4.4% 57 85% 58 90% 59 95% : 1) 2) 3)

138 2559

Fast track STEMI : 1) 2) STEMI 3) : S 3 STEMI ..2555 1669 6 23.91% (11/46) ER 30 6.52% (3/46) STEMI 2.17% (1) 27 (23 ) : PDCA 1) STEMI 2) STEMI Standard order, CPG, CNPG, Care Map 3) P3- S. 4) , STEMI 5) 1669 6) ACS Rally STEMI 7) Fast track STEMI Streptokinase MICU ,ER Streptokinase , Mini package Streptokinase,Plavix 8) Consult, Refer , Refer bypass .. , , . 9) Line : Refer MKH STEMI 10) 3 Streptokinase

139 2559

:

..2555

..2556

..2557

..2558

..2559 (..-..)

1. Door to Needle time < 30

> 50 % 6.52 7.31 42.85 72.78 43.63 (24/55)

2. Onset to Needle time < 6

> 80 % 76.09 73.91 84.78 89.15 96.36 (53/55)

3. < 10 % 2.17 7.31 1.35 3.03 1.04 4. GI,Heamorrhage

< 5% 0 0 0 0 0

5. SK/PCI

> 75 % 41.46 41.30 45.85 86.14 96.87

6. A-F2

100% 18.18 (2/11)

18.18 18.18 18.18 100 (11/11)

:

140 2559

Bed Shampoo & Med. SKT 8 ( SKT8) : 60 3 Bed shampoo SKT8 : 1. Bed shampoo 3 90% 2. bed shampoo

SKT 8 90 % 3. bed shampoo SKT 8 90% : 3 900 60 3 Bed shampoo , , SKT8 (Non Phamaco .. ) (Hygiene practice or Hygiene care) : 1. 2. 1 3. 2 1 4. 5. 6. 7. 2 8. / -

141 2559

27 37 - SKT 8 30-40 1 2 2 2 3 2 4 2 5 2 6 2 7 2 2 Graphic sheet Procedure :

1. Bed shampoo SKT 8 3

90% 80% 90%

2. bed shampoo SKT 8

90% 50% 98%

3. bed shampoo SKT 8

90% 94% 100%

:

142 2559

UR&UM 2557 96,436.96 EB 3 4 6 3 () () () 1. Re-use 3-4 2. 3.

1) Stock card Maximum EB 2) ED re-use bleed EB pressure 3) EB pack 4) EB 2558 58,815.72 60.99 100 % 2559 EB 13,250.88 86.26

143 2559

Safety bag

1 (WHO, 2013) 1 35 (,2558) .. 2557, 2558 2559 () 1.47, 0.67 0.14 54.84, 61.54 100 (hematoma) 2559 2 1 2 1 High technology (sensor) 2559 (CoPs LR) . safety bag 1 2559 1 1) 3.03 ( 4 /132 ) 21 Safety bag 30 370 192 2) 19 ( 8, 11) 84.21 94.74 Safety bag

144 2559

. .

() 2 (1) (.) () (2) . CUP (2.1) 4 . (2.2) .. 17 .. .. .. .. Palliative care 10 Home ward Home health care 14 Facebook () cup . (1) (, , , , , , , , ) (2) / (3) (4) (5) (6) (7) (8) (Non-adherence) (9) (10) 5 (Fatal Drug Interaction) (11) (High Alert Drugs) (12) (13) 3 1. 2. INHOMESSS (DRPs) 3. family

145 2559

folder Hos-xp () 2558- 2559 53 65.14 (SD) 65.21 (12.74) (, , ) 41.43 (11.43, 7.14, 7.14 ) 52.08 / 18.75 10.42 47.06 ( 100) , // unit dose 12.15, 11.21 10.28 91.58 ( 90)

146 2559

Smart use smart gloves , : Smart use smart gloves : smart use smart glove smart use smart gloves : ( consensus) Smart use smart gloves : 1. 2. Smart use smart gloves 3.

4. 5. Smart use smart gloves

: Smart use smart gloves :

147 2559

,

: 5 Grove Disposable, Syringe, Mask, Medicate, Injection pugs : 5

: 2559 1) 2) Over Stock/Dead Stock 3) 4) : Stock card (10%) (Maximum/Minimum) 5 Stock First In/First out (/) / 5 stock card (Maximum/Minimum) 5 .

148 2559

2 100 % : 2 ()

(..-.) (.-.) Grove Disposable 140,068 101,365 38,703 Syringe 277,290.6 286,771 9,480.4 Mask 31,080 22,720 8,360 Medicate 238,470.9 223,191.3 15,279.6 Injection pugs 1,547 2,243.5 696.5 688,456.5 513,631.6 174,824.9

syringe () .-. : 5

149 2559

(Trigger tool) . : 2558 F metformin induced lactic acidosis colchicine induced myopathy (Rational Drug Use Hospital; RDU) (Trigger tool) 2559 lab eGFR, LFT (DI) DI : Preventable ADE 0 : eGFR < 30 ml/min metformin (Isoniazid, Rifampicin, Pyrazinamide) LFT DI colchicine CYP3A4 P-glycoprotein clarithromycin 5 (medication reconciliation) : DI :

- eGFR

150 2559

colchicine induced myopathy clarithromycin colchicine 1 2 2559 3 5 1 1 1 colchicine colchicine 5 > 80 : (Trigger tool) RDU

151 2559

: (syringe) (mask) IC : (syringe) 3 2559 2559 : 5 . : - Stock card :

()

.. ..59 ..- ..59 () () 272 351 79

1 Dispos. Dispose.No.S 0 1

() + 1 + 97

2.Syringe 2.1 Syringe 1 cc (Insulin)

3 2 - 1 - 215.07

2.2 Syringe 3 cc 56 52 - 4 - 436.56 2.3 Syringe 5 cc 17 17 0 0

152 2559

()

.. ..59 ..- ..59 () () 2.4 Syringe 10 cc 6 2 - 4 - 744.72 2.5 Syringe 20 cc 6 1 - 5 - 882.75 2.6Syringe 50 cc 7 5 - 2 - 513.60

3. I.V. catheter (Medicut) 3.1 Medicut No.24 25 27 + 2 + 1,091.4 4. Injection pluge (Heparin lock. NSS. Lock)

200 400 + 200 + 700

5. Mask Dispos. 5.1 Mask Dispos. 16 11 - 5 - 200 5.2 Mask Dispos. 2 0 - 2 - 128.4

+1,888.4 3,121.1 1,232.7 :

153 2559

Identify patient , : 24 (patient identify) (Patient Identify) : 0 : (consensus) : 1. 2. 3. 3.1 (label indentify) 3.2 (triage board indentify) 3.3 3.4 (Active Communication ) 4. Chart : QA :

154 2559

: : (cholangiocarcinoma CCA) (intrahepatic CCA) (extrahepatic CCA) (perihilar CCA) 2548 10 25,000 70 3 2554 14,314 7,539 2,638 2556 1,765 63% (1,108 ) 18% (320 ) 55 40-60 (Opisthorchisviverrini) 20-30 20 6 (Praziquantel)

155 2559

( ,2558) 3 ( ,2558) :

78% 85% 75% 89%

: 2560 ./. :

156 2559

: : : 1. 2. 2558 Commander 2558 2559 (Field Commander) : 95.8 99.4 Commander 96.8 97.9 2000 3500 1 335 83 - 90 http://board.trekkingthai.com

http://board.trekkingthai.com/

157 2559

: Commander : :

158 2559

2554 3 .. 2554 .. 2556 1) smart phone 2) .. 2556 2557 ( 1) 1,297 2557 ( 2) 1,369 smart phone P4P 92 ( 1) 98.5 ( 2) 3.1 - 3.3 2556 - 2557 38,489,795 2557 20,221,617 58,711,412

159 2559

: Tumor .. 2554, 2555, 2556 60 , 86 120 1 .. 2556, 2557, 2558 10 ,19 15 UAO : 1. UAO Fast tract 2. 3. : ..2557 1. Routine upper airway obstruction care 2. ..2558 1. / BD Inner Tube 15 . ( ..) 2. ..2559

160 2559

: 2554-2559 1.

2554 2555 2256 2557 2558 2559

(..- .. 59) 60 86 120 143 132 139

1. Upper airway obstruction

100 % 100 % 100 % 100 %

100 %

100 %

100 %

2. Upper airway obstruction

100 % 100 % 100 % 100 %

100 %

100 %

100 %

6 8 10 19 15 11

1.

0 % 5.26% (1 )

0 %(1)

0 %(1)

0% 0% 0%

2. Fast tract

2256 2557 2558 2559 ..-.. 59

3 8 5 1 1. fast tract 30 ( )

100 % 100% (3 )

87.5% (7 )

100% (2)

100% (1)

2. fast tract

100 % 100% 100% 100% 100%

: 1. 2. // : 1. 2. Action Research

161 2559

: 1. 90% 2. 1% 3. 80 % : 24 -48 24 -48 6-8 .. 2557-2558 1,306 , 600 1,134 480 89.15%,80% / 7 5 , 1 , 1

162 2559

2558 2559

(..58-..59)

100 % 95 % 100 %

1%

1.17% (7 )

0

80 % 87 % 95 % :

163 2559

Colostomy : 2 3 4 11,496 / 6 ,845 / ( 2553) 2557-2558 28 35 35 8 colostomy re-admit colostomy 3 1 colostomy 1 1 2 colostomy colostomy Colostomy : 1. 100% 2. re-admit colostomy 0 3. 85% : 1) 2) Brain storming colostomy / / 3) Colostomy

164 2559

4) Colostomy 5) :

58 59 (..58-..59) 1.

100% 75% 100%

2. re-admit colostomy

0 8.57% (3/35 )

0

3. 85 % 80 % 92 % :

165 2559

12 2 3 3.9 : Kemmis Mctaggart (1988) 4 1) 2) 3) 4) 4 4 6 6 3 57 73 Bathel Index : 10 1) 2) 3) (Care Manager/Care Worker) 4) / 5) 6) Care Plan 7) 8) 9) 5 1. 2. 3. 4. 5. Bethel Index 45 / 98.5 / 97.3 ( 20 ) 35

166 2559

: 1. 2. : 92 Mann Whitney U- test Kruskal -Wallis Test : 1.

(x =3.90) 2.

(x =4.33) 3. (p=0.67) 4. .05 (p=0.04) 5. .05 (p=0.00) 6. (p=0.36) 7. .05 (p=0.01) 8. .05 (p=0.00) : : 1

167 2559

8 8 Kemmis Mctaggart (1988) 4 1) (Planning) 2) (Action) 3) (Observation) 4) (Reflection) 8 30 2558 2559 (Content analysis) (p-value

168 2559

THS 12 (Quasi-experimental Research) (One group Pretest-Posttest design) 30 2557 2558 8 12 THS 12 (Content analysis) (p-value

169 2559

1 .. 2554 8.00-16.00 . 35 16 1 333 2556 2557 11 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 1) 35 76 2) 2556-2557 1.11 1.28 3) 2.91 4) 4.59

170 2559

33 45 - 2558 1) 12 2) 3) 4) (N) (N) (P) (C) (A) NN-PCA

:

171 2559

1)

2) 1,679 28 10 (.36) 1) 1,679 96.12 1.85 41.39 1.55 65.75 34.25 +RIG 30.14 +RIG 29.122 28 () 6 22 3 7 4 3 7 24 3) (1) (2) (3) : ,

172 2559

2 3 : Kemmis & McTaggart (1988) : : 3 .. .. .. 126 3 7 11 49 3 40 4 30 2558 2559 HosXP : 6 1) (U:Unity Team) 2) (N:Need for Data situation) 3) (M : Meeting) 4) (A:Appreciation) 5) (G : Give support) 6) (E:Essential care) Mueang Model 52.11 53.78 54.69 58.02 TIS T : Team , I : Information , S : Supporting

/

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