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Ļ ÖćøđÿøĉöóúĆÜñĎšðśü÷ĒúąñĎšéĎĒúǰ(Empowerment)
ĻÖćøÿøšćÜÙüćöøĂïøĎšÿč×õćóéšćîÖćøĒóì÷ŤĒñîĕì÷ǰ(Literacy)
Continuity of Care
ĻÖćøéĎĒúêŠĂđîČęĂÜĔîßčößîǰ(Community care)
Ļ ÖćøêĉéêćöĂćÖćøĀúĆÜÖćøøĆÖþćǰ(Follow up)
ĻñĎšðśü÷öĊĂćÖćøìĊęđðŨîךĂĀšćöĔîÖćøøĆÖþćĔîøąĀüŠćÜìĊęĕéšøĆïÖćøøĆÖþćēé÷Ēóì÷ŤĒñîĕì÷ĒúąĒóì÷ŤìćÜđúČĂÖ
ĻÖćøüĉîĉÝÞĆ÷đóČęĂÿĉĚîÿčéÖćøøĆÖþćǰ(Finalized diagnosis)
Discharge
ĻñĎšðśü÷ĕöŠ÷ĉî÷ĂöìĊęÝąøĆïÖćøøĆÖþćēé÷Ēóì÷ŤĒñîĕì÷ĒúąĒóì÷ŤìćÜđúČĂÖ
Ļ ÖćøðøąđöĉîđóČęĂüćÜĒñîÝĞćĀîŠć÷ǰ(Discharge planning) øŠüöÖĆîÖĆïÿĀüĉßćßĊóǰ(Multidisciplinary team meeting)
ĻñĎšðśü÷öĊĂćÖćøìĊęÿÜÿĆ÷õćüąĒìøÖàšĂîĂ÷ŠćÜĂČęîǰđߊîǰöĊĂćÖćøïüöìĊęÿÜÿĆ÷ǰDVT öĊĂćÖćøðüéïüöĒéÜøšĂîĂĆÖđÿïǰđðŨîêšî
ĻñĎšðśü÷öĊĂćÖćøìĊęÿÜÿĆ÷õćüąĒìøÖàšĂîēøÙĀĆüĔÝǰđߊîǰđÝĘïĒîŠîĀîšćĂÖđÞĊ÷ïóúĆîǰĀĆüĔÝđêšîñĉéÝĆÜĀüąđÞĊ÷ïóúĆîǰđðŨîêšî
Ļ ÖćøðøąđöĉîĒúąêĉéêćöÖćøøĆÖþćĒêŠúąüĆîǰ(Reassessment)
ĻöĊĂćÖćøìćÜøąïïðøąÿćìĕöŠÿćöćøëéĎĒúøĆÖþćêŠĂĕéšǰđߊîǰßĆÖǰàċöúÜǰÿĆïÿîǰĂćđÝĊ÷îóčŠÜǰĒ×î×ćĂŠĂîĒøÜöćÖ×ċĚîǰđðŨîêšî
ĻÖćøøĆÖþćêćöĒîüìćÜðäĉïĆêĉđüßÖøøöĕì÷ǰ(TTM guideline)
ĻÙüćöéĆîēúĀĉêǰSBP < 90 ĀøČĂǰ> 160 ĒúąǰDBP < 60 ĀøČĂǰ> 100 öĉúúĉđöêøðøĂì
Care Delivery
Ļ ÖćøøĆÖþćêćööćêøåćîÖøöÖćøĒóì÷Ť/øćßüĉì÷ćúĆ÷ǰ(CPG)
ĻĕöŠÿćöćøëĀć÷ĔÝĕéšéšü÷êîđĂÜǰêšĂÜǰOn Oxygen öĊĂćÖćøĀć÷ĔÝĀĂïĀøČĂĀć÷ĔÝúĞćïćÖ
ĻßĊóÝøđêšîĕöŠÿöęĞćđÿöĂǰĀøČĂđêšîǰ< 60 ĀøČĂǰ> 100 ÙøĆĚÜ/îćìĊ
ĻĂčèĀõĎöĉ×ĂÜøŠćÜÖć÷ǰ> 38 ĂÜýćđàúđàĊ÷ÿ
ĻÖćøüćÜĒñîéĎĒúøĆÖþćøŠüöÖĆïÿĀüĉßćßĊóǰ(Multidisciplinary team planning)
ĻñĎšðśü÷ìĊęöĊĂćÖćøĕöŠÙÜìĊęøąĀüŠćÜìĊęĕéšøĆïÖćøøĆÖþćēé÷Ēóì÷ŤĒñîĕì÷ĒúąĒóì÷ŤìćÜđúČĂÖǰéĆÜîĊĚ
ĻÖćøøĆÖþćêćöĒîüìćÜðäĉïĆêĉđüßÖøøöĕì÷ǰ(TTM guideline)
Care Planning
ĻךĂïŠÜßĊĚÖćøÿŠÜêŠĂĒóì÷ŤĒñîðŦÝÝčïĆîǰ(Indication for Refer)
Ļ ÖćøøĆÖþćêćööćêøåćîÖøöÖćøĒóì÷Ť/øćßüĉì÷ćúĆ÷ǰ(CPG)
ĻÖćøüĉîĉÝÞĆ÷ÝĞćĒîÖÙüćöøčîĒøÜǰ(Diagnosis & Classification)
Ļ ÖćøêøüÝøŠćÜÖć÷đóČęĂðøąđöĉîĂćÖćøǰ(Patient Assessment): Barthel index/Impairment
Assessment & Dx
ĻÖćøàĆÖëćöðøąüĆêĉÖćøđÝĘïðśü÷ǰ(History taking)
ĻÖćøïĆîìċÖךĂöĎúÿŠüîïčÙÙúǰ(Personal data)
Ļ ÖćøúÜìąđïĊ÷î÷Čî÷ĆîêĆüêîđךćÿĎŠøąïïǰ(Identification)
Access & Entry
ĻÖćøÙĆéÖøĂÜđïČĚĂÜêšîǰ(Screening): New case/Refer back/Walk in/Re-admit ìĊęđךćđÖèæŤǰIMC
IPD-IMC Protocol
