Development of a Surveillance Guideline for Patients with Unstable Conditions and Deteriorating Symptoms in the 6th Floor Special Ward of a Regional Hospital in Southern Thailand
Keywords:
Guideline Development, Surveillance Guideline, Unstable Conditions and Deterioration, Special WardAbstract
This action research aimed to: (1) develop a surveillance guideline for patients with unstable conditions and deterioration, and (2) study the outcomes of implementing the developed surveillance guideline in a special ward on the 6th floor of a regional hospital in southern Thailand. The participants included 24 healthcare personnel—registered nurses, nurse aides, and patient assistants—and 97 patients admitted to the special ward. Research instruments consisted of the surveillance guideline for patients with unstable conditions and deterioration, an evaluation form for compliance with the guideline, and a staff satisfaction questionnaire. Content validity was verified by three experts, yielding a content validity index (CVI) of 1.00. The reliability of the instruments was confirmed with a Cronbach’s alpha coefficient of .96, and inter-rater agreement was .90. Quantitative data were analyzed using frequency, percentage, mean, standard deviation, and the one-sample Wilcoxon signed-rank test, while qualitative data were analyzed using content analysis. The results reveal as follows.
1. The developed surveillance guideline consisted of three components: identification of at-risk patients, effective communication, and appropriate response upon receiving information about at-risk patients.
2. The median compliance score with the guideline was significantly higher than the 90% standard criterion (p-value < .001).
3. The unplanned patient transfer rate decreased from 8.86% to 3.86%, representing a 56.43% reduction.
4. Staff satisfaction with the surveillance guideline was at a high level (M = 4.47, SD = 0.66).
Based on these findings, it is recommended that the surveillance guideline for patients with unstable conditions and deterioration should be applied in special wards and other units with similar contexts. Hospital administrators should promote and continuously monitor the implementation to enhance the long-term effectiveness of patient care.
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