ระบบการดูแลผู้ป่วยเบาหวานที่มีแผลที่เท้า โรงพยาบาลอำนาจเจริญ Care System for Patients with Diabetic Foot Ulcer at Amnatcharoen Hospital

บทคัดย่อ

This action research aimed to develop care system for patients with diabetic foot ulcer (DFU) and investigate
the outcomes of care system utilization at Amnatcharoen Hospital. The study participants included 74 patients
with diabetic foot ulcers and 37 healthcare personnel who work at diabetic clinic who were nurses, nurse
case managers, and other multidisplinary members. Study was conducted from October 2015 to September 2016
using Kemmis & McTaggart’s action research design. The study participants shared their experiences in order to
gain mutual awareness of the problem leading to the development of new approach. There were 2 cycles of 4
developmental phases conducted in this study including 1) situation review through questionnaire administration,
in-depth interview, and focus group discussion and participatory observations, 2) situation reflection through brain
storming to determine problems and plan for newly developed care system, 3) care system utilization, and
4) evaluation the outcomes to review the system and plan for changes leading to the 2nd cycle.
Findings demonstrated that development of care system for patients with DFU contributed to 5 major outcomes
including: 1) work process that provided holistic care for patients with DFU, 2) innovative tools for example; a
guide for collaborative patient assessment, foot examination enabling process, and group activity to provide foot
examination education, 3) DFU assessment evidences to plan for treatment, 4) improvement of self-care potential
among patients with DFU, and 5) five role models to be the community key persons. The outcomes of care system
utilization showed that the percentage of DFU patients with abnormal blood sugar level decreased from 62.2% to
29.7%. On the other hand, the percentage of DFU patients with normal blood sugar level increased from 37.4%
to 70.3%. Additionally, the risk of having DFU at moderate and high levels decreased from 63.5% and 8.1% to
8.1% and 1.4%, respectively. In contrast, the risk of having DFU at low level increased from 28.4% to 90.5%.
Overall patient satisfaction to DFU care system was at high level with the average score 2.65. The satisfaction
level after using DFU care system was significantly higher than before system utilization (p<0.05). The adherence
of DFU system utilization among the healthcare team was 100%, which was confirmed by their overall high
satisfaction level of DFU system utilization. As a result, the DFU care competency and teamwork process were
developed for the registered nurses and nurse case-managers who worked in the out-patient and in-patient
departments. Lastly, the network for DFU care and guideline for DFU care were achieved