Phaholpolpayuhasena Hospital Journal

Miss Effect of a Walking Rehabilitation Program using a Portable, Self-administered Walking Aid in Bedridden Patients in Bo Phloi District, Kanchanaburi Province

Chayatida Suphangasada — 2025-05-30

Objectives: To study the effect of a home-based walking rehabilitation program using a portable, self-administered walking aid in bedridden patients.

Methods: A single-group quasi-experimental design with pre- and post-intervention measurements was conducted between October 2024 – February 2025 The sample consisted of 35 bedridden patients in Bo Phloi District, Kanchanaburi Province, selected using purposive sampling. Participants received self-administered home-based walking aid and a walking rehabilitation program. The researcher conducted home visits once a month, and patients performed walking exercises three times per week for a period of five months. Data was collected using questionnaires and analyzed using descriptive statistics and paired t-tests.

Results: Following the intervention, the mean scores for self-care behavior (25.57±2.32 and 16.40±4.38), quality of life (52.09±7.73 and 100.94±14.77), and Barthel Index of Activities of Daily Living (2.74±1.88 and 12.00±1.57) significantly increased (p<0.001). The majority of patients demonstrated a moderate risk of falling during ambulation (51.43%), and most exhibited good quality of movement (42.86%), which increased from pre-intervention levels.

Conclusions: A 5-month home-based walking rehabilitation program using a portable, self-administered walking aid effectively improved the quality of life and activities of daily living in bedridden patients. It also enhanced their balance during ambulation and quality of movement. Therefore, this walking rehabilitation process should be considered for application in other patient groups with mobility impairments.

Prevalence and Factors Associated with Loss to Follow-up among Outpatient Psychiatric Patients at Phaholpolpayuhasena Hospital

Sukrit Vitavasiri — 2025-06-04

Objectives: To study the prevalence and factors associated with discontinuation of continuous treatment among psychiatric outpatients at Phaholpolpayuhasena Hospital.

Methods: This was a retrospective medical record review utilizing an analytical cross-sectional study design. The study population consisted of psychiatric patients who received outpatient services at Phaholpolpayuhasena Hospital in Kanchanaburi Province between January 1, 2023, and December 31, 2023, and met the inclusion criteria. A multi-stage random sampling method was used, with the first stage involving stratified sampling, dividing patients into two groups: new and returning patients, totaling 224 cases. Descriptive statistics were used to analyze general data, and group comparisons were conducted using the Chi-square test and multiple regression analysis.

Results: Among the 224 eligible patients, 62 (27.68%) had follow-up appointments less than once a month, indicating the prevalence of treatment non-adherence. When categorized by follow-up duration, the majority (110 patients, 49.11%) had follow-up appointments exceeding 10 months. Factors significantly associated with treatment non-adherence among psychiatric outpatients (p<0.05), after controlling for age, healthcare rights, diagnosis, patient type, and number of psychotropic medications, were identified.

Conclusion: Among psychiatric outpatients at Phaholpolpayuhasena Hospital, the prevalence of treatment discontinuity was relatively low. A multidisciplinary team should assess the risk factors for treatment discontinuation in individual patients and develop appropriate care plans. Particular attention should be given to high-risk groups, including individuals aged 45–60 years, those diagnosed with schizophrenia or mood disorders, follow-up patients, and those prescribed multiple psychiatric medications.

Pharmacy services improvement by using pictorial medication summary sheet and sample unit dose of drug in Sungkhlaburi Hospital, Kanchanaburi Province

Kaew Naveevitpadung — 2025-07-16

Objectives: To study the effect of enhancing patient overall understanding of medication use through the development of pharmaceutical services using pictorial medication summary and unit-dose packaging on medication adherence.

Methods: This research and development study consisted of two phases: Phase 1 involved the development of pictorial medication summary, with 30 participants. Data was analyzed using descriptive statistics.Phase2 aimed to evaluate the effects of the pictorial medication summaries combined with unit-dose packaging on medication adherence. This phase employed a quasi-experimental study with the one-group pretest-posttest design. Medication adherence was assessed using the Medication Adherence Scale for Thais (MAST). Sixty participants were enrolled, and data were analyzed using paired t-tests.

Results: The symbol comprehension test of the seven pictograms used in the medication summary found that all symbols had an accuracy of communication exceeding 85%. Following the intervention, patients who received the pictorial medication summary and unit-dose packaging showed a statistically significant improvement in medication adherence scores(32.93 ± 1.60 vs. 34.12 ± 2.53; p<0.001).

Conclusion: Pharmacy services using pictorial medication summary and unit-dose packaging can improve patient’s medication adherence. However, there may be some limitations for patients using medications other than oral formulations.

Development of a Paperless System For Inpatient Medication Ordering at Thakradan Hospital

Chutima Yimon — 2025-07-21

Objectives: To evaluate the impact of implementing a paperless ordering system on the incidence of medication errors in the inpatient department of Thakradan Hospital.

Methods: This quasi-experimental, before-and-after study compared medication error data obtained from the hospital’s risk management information system before and after the implementation of a paperless ordering system. Data were collected during January–March 2024 (copy order system) and the same period in 2025 (paperless system). The intervention involved the use of an electronic medication prescribing and inpatient data management system (NEO IPD paperless). Descriptive statistics and the Z-test were used for data analysis.

Results: Following the implementation of the paperless ordering system, the overall medication error rate decreased from 21.61 to 20.35 incidents per 1,000 patient-days (p=0.773). Errors during the medication administration stage significantly decreased from 8.84 to 2.91 incidents per 1,000 patient-days (p=0.080). A reduction in Category C errors was observed, and no Category E (serious) errors were reported. Additionally, the system provided enhanced alert mechanisms for error prevention. However, the rate of errors during the prescribing stage significantly increased from 2.95 to 10.66 incidents per 1,000 patient-days (p=0.034), most of which were classified as Category B errors.

Conclusions: The paperless ordering system demonstrated a potential to reduce the overall medication error rate, particularly during the administration phase, and to decrease the severity of medication errors. Nevertheless, the statistically significant increase in prescribing-phase errors highlights the need for system improvements and comprehensive training for healthcare personnel to ensure accurate and efficient system usage.

Situation of Elective Surgical Blood Reservation, Phaholpolpayuhasena Hospital

Piyapong Niyompong — 2025-07-21

Objective: To study 1) the situation of elective surgical blood reservation and 2) the appropriateness of blood ordering for elective surgery at Phaholpolpayuhasena Hospital.

Methods: This research was a 6-month retrospective data collection (April to September 2024) focusing on the demographics and blood requests of patients who underwent elective surgery. Data was reported using frequency, crossmatch-to-transfusion (C:T ratio), transfusion probability (%T), transfusion index (Ti).

Results: A total of 965 patients were scheduled for elective surgery, of whom 486 required blood transfusion. Although 2,534 units of blood were requested, only 938 units were transfused. The C:T ratio for all types of surgery was greater than 2.0, indicating over-ordering. Transfusion Probability and Transfusion Index for obstetrics-gynecology surgery were below standard criteria, while orthopedic, general, urology, and neurosurgery generally met these standards.

Conclusion: Physicians and surgical teams should review patient blood preparation and reservation guidelines to reduce costs, expenses and workload in blood preparation and ensure blood reserve is sufficient to meet the needs of patients in case of emergency.

Effect of pharmaceutical care in Type 2 Diabetic Patients in Somdej Prapiyamaharajrommaniyakhet Hospital

Nattapat Wongkaew — 2025-07-29

Objectives: To evaluate the effect on blood glucose control, medication adherence, and to identify drug-related problems (DRPs) in patients with type 2 diabetes mellitus after receiving pharmaceutical care based on the Pharmacist's Patient Care Process (PPCP).

Methods: A quasi-experimental, one-group pretest-posttest design was conducted. The sample consisted of 69 type 2 diabetes mellitus patients with an HbA1c level greater than 7% or a fasting plasma glucose (FPG) level greater than 180 mg/dL, or those identified with DRPs, who received services at Somdej Prapiyamaharajrommaniyakhet Hospital between February and April 2025. Outcomes, including FBS levels, medication adherence (measured by the Medication Adherence Scale for Thais), and drug-related problems, were assessed twice, with patients scheduled for follow-up after one month. Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test.

Results: After receiving pharmaceutical care, patients showed a statistically significant decrease in mean FPG levels (202.78±51.91 vs. 147.91±33.62 mg/dL; p<0.001) and a statistically significant increase in mean medication adherence scores (32.46±5.37 vs. 35.25±4.59 points; p<0.001). A total of 76 DRPs were identified, with patient non-adherence to medication being the most common problem, accounting for 50 instances (65.79%).

Conclusion: Pharmaceutical care for type 2 diabetes mellitus patients following the PPCP guideline resulted in improved FBS control, increased medication adherence, and a clear identification of DRPs. These findings suggest that this approach should be integrated into the treatment process for type 2 diabetes mellitus patients to help them achieve therapeutic goals.

A Comparison Between 0.1 and 0.2 mg of Intrathecal Morphine for Caesarean Section on Postoperative Pruritus in Phaholpolpayuhasena Hospital: A randomized, double-blinded, controlled trial

Tithita Virotjarumart — 2025-08-04

Objective: To compare the incidence of pruritus, nausea and vomiting, and pain scores between groups receiving 0.1 mg and 0.2 mg intrathecal morphine in pregnant women undergoing cesarean section under spinal anesthesia at Phaholpolpayuhasena Hospital.

Methods: This was a prospective, double-blinded, randomized controlled trial conducted on pregnant women undergoing non-emergency cesarean section under spinal anesthesia at Phaholpolpayuhasena Hospital between February and April 2025. A total of 72 participants were randomly allocated into two groups of 36 each using block randomization. The incidence of pruritus, nausea and vomiting, and average pain scores were compared at time intervals of 0–2, 2–12, and 12–24 hours post-administration. Data were analyzed using the chi-square test and independent t-test,

Results: The incidence of pruritus showed no significant difference between groups at all time intervals (2.78, 52.78, 30.56% vs 11.11, 69.44, 38.89%, respectively), although a decreasing trend was observed in the 0.1 mg group. Nausea and vomiting incidence at 0–2 and 2–12 hours did not differ between the groups. However, during the 12–24-hour period, the 0.1 mg group had a significantly lower incidence of nausea and vomiting (0 vs 13.89%; p=0.020). The average pain scores and analgesic use did not differ between the groups.

Conclusion: Reducing the intrathecal morphine dose to 0.1 mg did not significantly reduce pruritus but clearly decreased nausea and vomiting during the 12–24hour period, without compromising pain control. Therefore, a lower dose may help minimize side effects while maintaining analgesic efficacy.

Effectiveness of the nursing practice guideline in preventing pneumonia in older patients with Hip fractures at Phaholpayuhasena Hospital, Kanchanaburi Province

Waneenat Ruesingpisch — 2025-08-04

Objectives: To study the effectiveness of a nursing practice guideline in preventing pneumonia in elderly patients with hip fractures and to compare the knowledge of nurses before and after implementing the guideline.

Methods: This quasi-experimental, two-group study was conducted from July to December 2024. The sample consisted of 60 elderly patients with hip fractures admitted to the Orthopedic Ward at Phaholpolpayuhasena Hospital, divided into two phases: pre-implementation (n=30) and post-implementation (n=30) of the guideline. Additionally, 12 nurses participated. The research instrument was the nursing practice guideline for preventing pneumonia in elderly patients with hip fractures. Data were collected using questionnaires and analyzed using descriptive statistics and Fisher's exact test.

Results: Following the implementation of the nursing practice guideline, the incidence of pneumonia decreased from 2 cases to 0 cases (6.7% and 0.0% respectively; p=0.492). Most nursing practices within the guideline were consistently performed, with the exception of turning every 2 hours and effective hand washing, which were inconsistently performed at 13.3%. After training on the guideline, the mean knowledge scores of the participating nurses regarding pneumonia in elderly patients with hip fractures significantly increased (12.08 ± 1.50 and 13.67 ± 0.49; p=0.002).

Conclusion: The implementation of this nursing practice guideline effectively prevented and reduced pneumonia in elderly patients with hip fractures and enhanced nurses' knowledge. This guideline is suitable for use by nurses in patient care at the hospital.