The Development of Discharge Planning Guideline for Stroke Patients with Intermediate Care in Male Ward at Ban Phai Hospital in KhonKaen Province

Abstract

This action research aimed to investigate the situation and condition of model development, as well as the influence of model development on the discharge plan for middle-stage stroke patients (intermediate care).The current study was conducted by applying a research model based on the concept of Kemmis and McTaggart (1988). The study was divided into 3 phases. The first phase was the preparation period. During this phase, data were gathered using a record form for discharge planning and distribution of middle-stage stroke patients, and two 6-month periods were adopted, the first from January to June 2020 and the second from July to September 2020. There were four steps in the second phase of the operational phase utilizing the PAOR circuit: (i) preparation and discharge planning, (ii) discharge action, (iii) observation, and (iv) study reflection. This will result in the formulation of a suitable and successful discharge strategy for patients with middle-stage stroke. The last phase was the evaluation.

        Result: There were four programs in the development of a model for distribution planning for middle-stage stroke patients (Intermediate care) in a male ward at Ban Phai Hospital, Khon Kaen Province. First, determining the empirical strategies of the hospital on a multidisciplinary team in the discharge planning for patients. Second, determining the roles of the multidisciplinary team involved in the treatment and rehabilitation of patients consisted of internal medicine physicians, family medicine physicians, ward nurses, pharmacists, physical therapists, nutritionists, and network service unit nurses. Third, a brainstorming workshop to formulate the record form for the discharge plan for middle-stage stroke patients (Intermediate care). With a four-day sleeping schedule, all professionals can record the conversation in the care team. The primary caregiver's relatives are ready and able to take care of the patient correctly. Lastly, formulating referral records and follow-up care.