A dv a,urrufi9rufluu Original Article
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The Development of Clinical Pathway Planning System for Stroke
Patient by Nurse Case Manager at Sawanpracharak Hospital
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Siriwan Grisnapanth B.P.H.
Deputment of Nursing
Sawanpracharak Hospital
Nakhon Sawan
Sawanpracharak Medical Journal
VoLo No.r )anuary-April zooe
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The Development of Clinical Pathway Plming Syst€m for Stroke Patient
by Nurs€ Case Manags at Sawanpracharak Hospital 769
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Abstract
Obiective
Setting
Design
Subiects
Method
Result
Conclusion
To develope a holistic clinical pathway planning system that provide
continuous care for stroke patients by nurse case manager.
4 medicine wards, Sawanpracharak Hospital.
Action research
lncluding; 1) 10 Nurse case managers 2) A purposive sample of 62
patients with stroke and 62 main caregivers.
An action research based on mutual collaboration among members of
multidisciplinary team (patients, caregivers, researcher) was performed.
Role of care manager nurse consist of 4 step; problem identification,
planning, implementation, observation and feedback to improve the
system and suggestion of several strategies for long lerm development.
The clinical pathway planning system for patients with stroke in
sawanpracharak Hospital consist of 6 steps as follow. Evaluation of
patient and their main caregivers, planning and setting up purposes for
eacfi patient, nursing care aocording to dinical pathway, monitoring care,
evaluation, and planning for patient returning to community.Using this
multidisciplinary clinical pathway, the following complications were
decreased, ie; pneumonia and bed sore rate (33.U1,000 to O/1,000),
death rate (33.3/1,000 to 16.1/'1,000 persons).Length of stay was
shorten from 4.9 lo 4.2 days, cost of care reduced from g,761 baths
lo 7,621 baths, readmission rate within 28 days decreased from 84.5
times to none. Patients and their main caregivers were satisfied with
nurse case managers service at 86.7o/o and 85.Sol" respectively.
This study showed the importance of nurse case managers in clinical
pathway planning system of the strokes as part of devetopment of qualiV
of care at Sawanpracharak Hospital. Patients receive a proper health care
service and length of hospital stay was shorten. The most important,
benefit is the continuance of care and confidence of self care at home.
Stroke patients, nurse case managerKey words
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The Development of Clinical Pathway Plming System for Stroke Patient
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by Nuse Case Mmager at Sawmpracharak Hospital 775
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The Developrcnt of Cliuical Pathway Plming System fq Sroke Parimt
IlYl 5 quutl 1 N.A.-ttJ.il. 255 1 by Nune Case Manager ar Sawanprachardk Hospital 777
A A O u T yv 95|9 a - & A vfiazarfirua?n1v{ [un1:ouninuyrtrlula[nu frfumcffLfiuinr: or.:uu 6.:nrnruzuur:rluuuq{gsg
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Y{8JTla1flo; 2il1.6. lgantavicius DD, Hausman KA. Clinical pathways for collaborative practice. 1"ted.
Pennsylvania: WB Saunders com; 1995.
7. Petryshen PFl, Petryshen PM. The case management model: an innovative
approach to the delivery of patient eare. Journal of Advanced of Nursing 1992;17:
1 188-94.
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The Development of Clinical Pathway Planning Systm fo Stroke Patimt
by Nulse C6e Mffiger al sawmpmcharak Hmpital 779
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