Management of the Rabies Post-exposure Prophylaxis Program according to the Thai Clinical Practice Guideline in Rabies: A study in Community Hospital and Tambon Health Promoting Hospital

Abstract

Currently, rabies is not curable. The treatment of rabies exposure had to follow the clinical practice guideline in rabies. Preventable vaccine applying the standard intramuscular regimen and tended to deliver the patients to Tambon Health Promoting Hospital where the patients was convenient to receive the vaccination after the evaluation the risk of infected disease by doctors and also injected the first vaccination. But found the treatment rabies still miss the medical practice and lacked of the connection and transferred the information between health care center and rabies exposure which did come to receive the vaccination as doctors appointed. So it should be developed the standard operating procedure for care of rabies exposure as the clinical practice guideline in rabies network of the service of Buengnarang Hospital, Phichit Province in order to rabies exposure to receive the standard treatment and come to vaccinate as the doctors appointed on time. Methods: This research was conducted using quality cycles technique in the Buengnarang District Health Service Network including Buengnarang Hospital and 6 Tambons Health Promoting Hospital: Banglai, Laemrang, Buengnarang, Phosaingam, Huaykaew and Banmai. The research approach also undertook brainstorming with multidisciplinary team. The flow chart depicts the process of the active current treatment service of rabies exposure. Research instrument passed the examination by three experts who consisted of doctors, pharmacists, and nurses who had many experiences in taking care of the rabies exposure. Results: The results of this research found the relevance of four quality cycles. The first cycle began with the current service procedure flow charts and the problem issues, included usage of the title of the questions to present and solve the problem. The problem was solved by linking clinical practicing guideline in rabies and patients care process. The process to take care of the patients aimed to mix the operational approach of network, assigned responsibilities, and also setting the criterion to evaluate which was stipulated at 80%. The second, third, and fourth cycles included: brainstorming to develop the treatment system of rabies exposure infected in the step that did not reach the assigned criterion which spent six months for the research. The standard in operational approach of treatment for rabies exposure concluded with the development from first for wound. When rabies exposure admitted to hospital which was the first place to treat wound instantaneously because most of them did not disinfect and used of antiseptics as well as advice about how to perform with patients and relatives. For that completeness, accuracy and agreement of medical record together reporting rabies exposure who was assigned that nurse screened the patients as well and filled information one by one with using the criteria of emergency room. Moreover, there was the development of the forwarding the information since developed referral letter of Tambon Health Promoting hospital for sending information of rabies exposure to Tambon Health Promoting hospital, then sending which was completely recorded to hospital in order to fill. Any advice for rabies exposure realized important of vaccinating. Increasing of the cooperation with doctors to confirm treatment, when there was the decision to treat that not correct as clinical practice guideline and also increased many duties of ambulatory pharmacist which was responsible for emergency room. Conclusion: The Management of the treatment for rabies exposure as the clinical practice guideline assigned the standard operating procedure by the multidisciplinary brainstorming makes the rabies exposure reaching of the treatment that is standardized and completely receives vaccination as increasingly assigned.