Development of Care Systems for Premature Infants in Phra Nakhon Si Ayutthaya Hospital and Networks.

Abstract

     This research was participatory action research in order to develop care systems for premature infant in Phra Nakhon Si Ayutthaya Hospital and networks. Researches and cooperative developmental studies on administrative systems of premature care have continuously been developed over time. The results of the development of premature care, as well as the obstacles encountered by developing premature care and networks of premature care lead to the process of sustainable development of joint research and development of premature care. Stage of development was classified into 3 stages. First stage was development of care system for premature infant. Second stage was developed care system for premature infant by results of study. Third stage was to find factors and obstacles of care systems for premature infant. Research study group composed of doctors and nurses who are responsible to premature care at Phra Nakhon Si Ayutthaya Hospital and networks about 57 persons. Research was conducted by collecting data of premature infant by health care personnel since October 1, 2012 to September 30, 2014. Tools of this study were medical records and questionnaires which are open ended. Data analysis was used the descriptive statistics, per cent and frequency. The McNemar statistic (Z-test) was utilized for year-to-year data comparison and to analyze qualitative data by creating a performance summary of the development of care for premature babies at Phra Nakhon Si Ayutthaya hospital and its network.
     The outcomes in development of premature infant care were 1) special wards for premature infants, 2) neonatal intensive care for infants that need closed monitoring, 3) standard clinical practice guidelines for premature infant care and networks of hospitals for caring premature babies, 4) reduction in referrals to supratertiary care hospitals by increasing the potential mother’s hospital network - this allows premature babies under the care of a hospital in the associated network to be transferred to the nearest hospital for treatment from 53.21 percent to 77.88 percent in the year 2013 and year 2014, 5) reduction in the death rate of premature infants whose weights were greater than 1500 grams. The death rate reductions were 6.99 percent in year 2013 and 5.08 percent in year 2014. This includes the decrease in complications of premature care, Retinopathy of Prematurity (ROP). ROP was decreased from 6.09 percent to 1.98 percent in the year 2013 and year 2014, respectively. These findings represent the potential and development of the care systems for premature in the same standard, prevention and reduction of risk that might occur. Management, maintenance of tools and equipment and their availability is also an important key. This includes conference management workshop and promotes the personnel development projects for taking care of new born to sustainability to achieve learning. Last but not least, exchanges of experience among care personnel in the premature care can help strengthen the premature care network and improve the efficiency and promote sustainable quality.