Thammasat University Hospital Journal Online

Factors Associated with Postoperative Clinical Outcomes in Patients with Traumatic Brain Injury at Krabi Hospital

2025-09-10T13:52:37+07:00

Background: Traumatic brain injury represents a critical public health issue, contributing to mortality, disability, reduced quality of life, and substantial healthcare costs. Despite surgical intervention, a considerable proportion of patients continue to experience complications and variable clinical outcomes. Understanding the factors influencing these outcomes is therefore essential for the development of more effective management strategies.

Objective: To examine the factors associated with postoperative clinical outcomes in patients with traumatic brain injury treated at Krabi Hospital.

Material and methods: This study employed a retrospective cohort design. Data was collected from the medical records of patients treated at Krabi Hospital. The sample consisted of 308 medical records of patients with traumatic brain injury who underwent surgical treatment between 2020 and 2024. Data collection instruments included (1) a form for recording personal and health status and (2) a form for recording injury and treatment-related data. Personal and clinical data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation, as well as t-tests, while Spearman’s correlation was employed to examine associations between variables.

Result: The study findings indicated that several factors were significantly associated with post-surgical outcomes in patients with traumatic brain injury. Initial level of consciousness upon hospital admission (rₛ = -0.666), time from hospital arrival to surgery (rₛ = -0.605), midline shift of the brain (rₛ = -0.564), hypotension (rₛ = -0.597), pupil size and reactivity (rₛ = -0.637), type of surgical intervention (rₛ = -0.546), and postoperative complications (rₛ = -0.622) all demonstrated strong negative correlations with outcomes, with statistical significance at p < .001.

Conclusion: Significant factors associated with clinical outcomes following surgery in patients with traumatic brain injury include level of consciousness, time to treatment, severity of neurological symptoms, surgical factors, and postoperative complications. Notably, variables reflecting injury severity and timeliness of care play critical roles in determining patient outcomes.

Current status, problems, and needs assessment for diagnostic tools in bone age and growth monitoring in Thai children

2025-10-16T10:21:54+07:00

Background: Bone age assessment (BAA) is essential for diagnosing and monitoring growth in children. While the Greulich-Pyle (GP) method is widely used, it is limited by concerns regarding accuracy and inter-rater variability. Although other countries utilize Artificial Intelligence (AI) to enhance assessment efficiency, Thailand currently lacks data on the current status, problems, and needs for implementing AI in this context.

Objective: The study aims to investigate the current status, problems, and needs for utilizing diagnostic support tools in bone age assessment and growth monitoring.

Methods: This was a qualitative study involving document review and in-depth interviews with two user groups: 6 physicians (3 pediatricians, 3 radiologists) and 6 involved parents. Data were collected at Srinagarind Hospital, Khon Kaen University, and subsequently analyzed using content analysis.

Results: Current Status: All interviewed physicians confirmed using the GP method due to its convenience and speed. Problems: The GP method's reliance on physician experience in certain age ranges causes inter-rater variability. Foreign AI systems like BoneXpert are costly and not yet widespread in Thailand. Concurrently, parents lack knowledge in observing signs of early puberty, leading to delayed detection of growth abnormalities. Needs: Physicians perceive a need to develop AI tailored to the Thai child context to improve assessment accuracy and reduce variability. They propose this AI be integrated into a convenient application for both physicians and parents, capable of assessing bone age, predicting final height, and continuously monitoring growth and secondary sexual development, which aligns with parental needs.

Conclusion: Physicians currently favor the GP method, but its inherent complexity and high variability affect diagnostic accuracy and growth monitoring. A potential and promising approach is the development of AI for BAA, coupled with a suitable and convenient application, to continuously support growth monitoring within the context of Thai children.

Factors Influencing Behaviors in Delaying Progression of Knee Osteoarthritis among Patients with Stage 2-3 Knee Osteoarthritis

2025-09-11T10:36:07+07:00

Background: Perceived risk of disease, perceived severity of disease, perceived benefits of behavior, and perceived barriers to behavior influence health behavior. Therefore, beliefs or perceptions influence individual behavior and are related to the practice of activities to delay knee osteoarthritis.

Objective: To study the behavior of delaying knee degeneration and the factors affecting the behavior of delaying knee degeneration in patients with osteoarthritis stages 2-3.

Material and method: A cross-sectional analytical study was conducted to study the factors influencing the behavior of delaying knee osteoarthritis in patients with stage 2-3 osteoarthritis. A sample of 160 patients was selected using a simple random sampling method. The research instruments were a personal data record form, a health belief model perception test, a knee osteoarthritis delay behavior questionnaire, and a knee osteoarthritis severity scale with a Cronbach's alpha coefficient greater than 0.80. Data were collected at the outpatient department of orthopedic surgery at the hospital. General data were analyzed using descriptive statistics, and multiple regression statistics were used.

ระยะขอบ 2.54 ซม.

Result: The factors of self-efficacy perception in delaying osteoarthritis, severity of osteoarthritis symptoms, and perceived benefits of delaying osteoarthritis were significantly positively associated with behaviors to delay osteoarthritis (p < .05)

Conclusion: Self-efficacy, symptom severity, and perceived benefits significantly influence behaviors that delay knee osteoarthritis. Strengthening patient confidence and emphasizing preventive benefits can support effective self-care and slow disease progression.

Effect of exercise on muscle mass and physical performance in older with Sarcopenia: A Systematic Review

2025-10-20T15:27:56+07:00

Background: Sarcopenia is a major health concern among older adults worldwide, as it is associated with a decline in physical performance and an increased risk of injury. Prevention and management of this condition are therefore of great importance. The most effective treatment for older with sarcopenia is exercise; however, the optimal type, frequency, and intensity of exercise for improving various outcomes remain unclear.

Objective: To systematically review and synthesize evidence regarding the effectiveness of exercise on muscle mass and physical performance among older adults with sarcopenia.

Material and Methods: A comprehensive search for randomized controlled trials was conducted across several major databases, including PubMed, ScienceDirect, the Cochrane Library, CINAHL, Embase, and Scopus. Two independent reviewers screened the studies, reached a consensus on inclusion, and assessed methodological quality using the PEDro scale.

Results: From 336 identified studies, 16 studies met the inclusion criteria, comprising a total of 820 older adults with sarcopenia. The analysis revealed that exercise interventions, regardless of type, improved muscle mass, strength, and physical performance. In particular, resistance training demonstrated the most significant effects.

Conclusion: Exercise, particularly resistance training, is an effective intervention for improving muscle mass and physical performance in older adults with sarcopenia. It is recommended to perform resistance exercise 3–4 times per week for at least 12 weeks, with an intensity of 40–60% of one-repetition maximum (1RM).

Needs Assessment of Health-Related Quality of Life Among Colorectal Cancer Patients Receiving Chemotherapy

2025-06-30T08:47:22+07:00

Background: The quality of life of colorectal cancer patients receiving chemotherapy is often affected by physical and psychological side effects. Assessing health-related quality of life needs is therefore a crucial foundation for planning appropriate care.

Objective: To assess the needs, prioritize them, and analyze the causal factors of health- related quality of life needs among colorectal cancer patients receiving chemotherapy.

Material and methods: The sample for this descriptive study comprised 220 colorectal cancer patients receiving chemotherapy at a tertiary hospital in Bangkok. A health-related quality of life assessment was used to analyze needs, prioritize them, and examine causal factors through a group process using the Assumption-Based Technique. Data obtained from the group process were analyzed using a content analysis approach adapted from Van Manen’s steps, and the synthesized results were summarized using a fishbone diagram based on Ishikawa’s concept.

Results: The health-related quality of life needs identified in this study, based on the PNI _modified dimensions, ranged from moderate to high levels. These included symptoms affecting health (0.34), followed by biological functioning (0.24), physical functioning (0.23), and perceived health status (0.22), respectively. The causal factors influencing the response to these health-related quality of life needs included limitations of healthcare providers, the healthcare system, and the patients’ families.

Conclusion: Colorectal cancer patients receiving chemotherapy have multidimensional health-related needs. Developing a holistic care model that encompasses all aspects of well-being, enhancing healthcare team competencies, and strengthening family support can effectively improve patient’s health-related quality of life.

Development of an Artificial Intelligence Prototype for Sex Classification Using Lateral Skull Computed Tomography (CT) Images Focused on Supraorbital Ridge and Nuchal Crest in The Thai Population

2025-11-05T16:05:09+07:00

Background: The study of the human skull plays a crucial role in forensic science, particularly in cases where only partial remains, such as cranial fragments, are recovered. Challenges often arise from environmental conditions, time constraints, and religious considerations. Recently, the application of artificial intelligence (AI), especially deep learning algorithms, has shown promise in supporting sex estimation from cranial morphology with high accuracy.

Objective: This study aimed to develop a prototype AI model for sex classification using lateral cranial computed tomography (CT) images, with a focus on two anatomical landmarks: the supraorbital ridge and the nuchal crest, specifically within the Thai population.

Material and methods: A total of 190 lateral skull CT images were collected, divided into 150 training samples and 40 test samples. The Roboflow 3.0 Object Detection (Accurate) model, a deep Learning architecture (YOLOv8-compatible) was used to train two AI models: one with data augmentation and one without. Model performance was evaluated using mAP@50, precision, and recall metrics. In addition, results were compared with sex estimation accuracy derived from conventional anthropometric parameters: Maximum Cranial Length (MCL) and Lambda-opisthion Chord (OCC).

Results: The augmented model achieved a higher precision (98.1%) and recall (99.9%) compared to the non-augmented model, while both models yielded an identical mAP@50 of 99.5%. In the unknown dataset, the augmented model successfully detected 39 out of 40 cases, with high confidence scores, particularly in male subjects (up to 95%). In contrast, traditional anthropometric methods based on MCL and OCC measurements yielded lower accuracy at 76.31% and 52.65%, respectively.

Conclusion: The AI model developed in this study demonstrated high accuracy and stability in sex estimation from lateral skull images, especially when enhanced by data augmentation. This approach shows significant potential for application in forensic science, particularly within Thai forensic contexts where limited biological samples and time constraints are often encountered.

Relationship Between Pregnancy-Related Anxiety, Social Support, and Health-related Quality of Life Among Pregnant Women with Post-COVID-19 Conditions

2025-11-18T15:18:03+07:00

Background: Pregnant women with post-COVID-19 conditions face physical and psychological challenges that may affect their health-related quality of life, yet knowledge of the relationships between pregnancy-related anxiety, social support, and quality of life in this population remains limited.

Objective: This study aimed to examine the levels and relationships between pregnancy-related anxiety, social support, and health-related quality of life among pregnant women with post COVID-19 conditions.

Materials and methods: This study employed a descriptive correlational design. The participants were selected following the inclusion criteria and consisted of 90 pregnant women with post COVID-19 conditions who received antenatal care at Phrae Hospital and Lampang Hospital. The research instruments consisted of a demographic data record form, the pregnancy-related anxiety questionnaire, the social support of high-risk pregnant women questionnaire, and the short-form health survey 36. Reliability was demonstrated with Cronbach’s alpha coefficients of .84, .96, and .83, respectively. Descriptive statistics, Spearman’s rank-order correlation, and Pearson's correlation coefficient were used to analyze the data.

Results: The participants had a moderate level of pregnancy-related anxiety (Median = 21.00, IQR = 6.00), high perceived social support (𝑥̅ = 94.99, SD = 11.83), and good health-related quality of life (𝑥̅ = 53.77, SD = 14.85). Pregnancy-related anxiety had a low, statistically significant negative correlation with health-related quality of life (r = -.23, p < .05), and social support had a moderate, statistically significant positive correlation with health-related quality of life (r = .35, p < .05).

Conclusion: Nurse-midwives should assess pregnancy-related anxiety, social support, and health-related quality of life among pregnant women with post COVID-19 conditions. This information should be used as a basis for providing appropriate further care and support for them.

Effects of Memory Bingo Games on Preventing Dementia in the Elderly in Thung Saliam District Sukhothai Province

2025-09-17T11:56:58+07:00

Background: Currently, more than 55 million people worldwide live with dementia. The number of dementia patients is steadily increasing, causing significant impacts on both the economy and quality of life. Therefore, preventing and slowing down brain degeneration is essential. Using non-drug activities, such as a brain-training game, is an alternative that helps stimulate brain function, enhance brain performance, and reduce the risk of dementia among older adults.

Objective: To compare brain function scores before and after playing the Memory Bingo game among older adults within the experimental group and between the experimental and control groups.

Material and methods: This quasi-experimental study used a two-group pretest–posttest design. The sample consisted of 68 older adults living in Thung Saliam District, Sukhothai Province. Multi-stage random sampling, divided into an experimental group (n = 34) and a control group (n = 34). The research instruments consisted of (1) The Memory Bingo game and (2) The Thai version of the Mini-Mental State Examination (MMSE-Thai 2002). The experimental group participated in the Memory Bingo game for six weeks, three days
a week, for 30–40 minutes per session, while the control group maintained their usual lifestyle. Data were analyzed using descriptive statistics and t-tests.

Results: The experimental group had a statistically significant increase in the mean brain function scores after the intervention (p-value < 0.05), improving from 20.53 (SD = 1.6) to 24.91 (SD = 1.9) after the experiment. When comparing the experimental group and the control group at week 6, it was found that the experimental group had a significantly higher mean brain function score than the control group (t =9.967, p-value < 0.05).

Conclusion: Memory Bingo games have been shown to stimulate and enhance brain function in older adults. It can be recommended as an activity to prevent and delay
the onset of dementia.

Oral Health Care for Dependent Elderly: A Qualitative Study in a Subdistrict of Suphan Buri Province

2025-09-11T09:20:46+07:00

Background: Dependent elderly individuals face significant limitations in mobility and self-care abilities, placing them at high risk for oral health problems, including tooth loss, dental caries, and periodontal disease. These problems result from inadequate oral health care. Qualitative research can provide an in-depth understanding of oral health care practices among dependent elderly individuals, family caregivers, and relevant stakeholders. Such findings are essential for developing appropriate oral health care systems tailored to this vulnerable population.

Objective: To investigate oral health status, oral health care behaviors among dependent elderly individuals, caregiving behaviors of family members, and the roles of stakeholders involved in oral health care for dependent elderly.

Methods: A qualitative research study was conducted using in-depth interviews and oral health examinations. Primary informants included 11 dependent elderly individuals and family caregivers. Secondary informants consisted of 10 stakeholders, including professional caregivers, care managers, village health volunteers, and Long-Term Care committee members. Purposive sampling was used for participant selection. Data were verified using triangulation methods and analyzed using thematic analysis.

Results: Most dependent elderly individuals had significant oral health problems, particularly insufficient teeth for proper mastication, periodontitis, and poor oral hygiene. Both dependent elderly individuals and family caregivers lacked adequate knowledge and held misconceptions about oral health care. Long-term care system managers and caregivers primarily provided guidance without involving dental personnel in the multidisciplinary care team. Major limitations included a shortage of dental staff, inadequate knowledge and skills among caregivers, difficulties in transporting dependent elderly to access dental services, and the absence of clear policies regarding oral health care at all administrative levels.

Conclusion: Dependent elderly individuals have significant oral health problems with inadequate self-care and caregiver-provided oral health care, and lack systematic care from relevant organizations. Therefore, comprehensive training programs should be implemented to enhance the knowledge and skills of family caregivers and professional care providers. Additionally, integrated oral health care systems requiring coordination among all stakeholders at every administrative level are urgently needed.

Patterns of Drug Abuse and Spatial Distribution of Drug-Related Deaths in Nonthaburi and Pathum Thani Provinces: A Retrospective Descriptive Study, 2023

2025-10-20T15:09:07+07:00

Background: Over the past decade, drug abuse has remained a critical public health concern in Thailand. However, a pattern of drug use and the geographic distribution of drug-related deaths have not been well studied, particularly in Nonthaburi and Pathum Thani provinces. These provinces have shown a high prevalence of drug distribution.

Objective: This study aimed to determine the patterns of drug abuse and spatial distribution among drug-related deaths in Nonthaburi Province and selected areas of Pathum Thani Province during 2023.

Material and methods : This study employed a retrospective descriptive design. A total of 205 cases were systematically sampled from autopsy records and forensic toxicology results obtained from the Central Institute of Forensic Science, Ministry of Justice, between January 1 and December 31, 2023.

Results: The majority of the deceased were male (80.5%), with a mean age of 40.9 years. Most of them were employed as laborers (58.5%). Benzodiazepines were the most frequently detected drugs (54.1%), followed by methamphetamines (32.7%), with 19.9% showing polydrug use. Urban districts such as Mueang Pathum Thani, Mueang Nonthaburi, and Pak Kret exhibited the highest rates of drug-related deaths involving benzodiazepines, along with more complex patterns of poly-drug use. In contrast, suburban areas like Sam Khok, Lat Lum Kaeo, and Sai Noi more commonly showed cases involving single-substance methamphetamines use.

Conclusion: This study highlights the differences in patterns of drug use across areas. These findings emphasize the need for area-specific drug surveillance and targeted prevention strategies.

Effects of a supportive-educative program on self-care behaviors and flatulence among mothers with cesarean section

2025-12-01T12:36:49+07:00

Background: Postoperative flatulence after a cesarean section causes discomfort to mothers, affecting their ability to care for themselves and their newborns. Applying Orem's supportive-educative nursing system in postpartum care reduces flatulence and enables mothers to fully perform their maternal role in caring for their children.

Objective: To study the effects of a supportive and educative program on self-care behaviors and flatulence in mothers after cesarean section.

Material and methods: This is a quasi-experimental study. The sample group consisted of mothers undergoing their first planned cesarean section at Thammasat University Hospital, totaling 50 cases. At the end of the study, 47 cases remained, with 23 in the experimental group and 24 in the control group. The research instruments included: (1) A supportive and educative program to prevent post-cesarean flatulence, (2) A personal data recording form, (3) a self-care behavior questionnaire for preventing flatulence (CVI = 0.86), and (4) A post-cesarean flatulence symptom assessment form (CVI = 0.93). Data were analyzed using descriptive statistics, Chi-square test, Fisher's exact test, and independent t-test statistics.

Result: It was found that 1) at 24 and 48 hours after cesarean, mothers in the experimental cesarean section group had significantly higher average scores for self-care behaviors to prevent postoperative flatulence compared to the control group (p < .001), and 2) at 24 and 48 hours after cesarean, mothers in the experimental cesarean section group had significantly lower average scores for postoperative flatulence compared to the control group (p < .001).

Conclusion: The study found that this support and educational program can help post-cesarean mothers adopt self-care behaviors to prevent flatulence, thereby reducing the incidence of post-cesarean flatulence. Nurses should be encouraged to apply this program with post-cesarean mothers to promote proper self-care behaviors, preventing and alleviating flatulence.

Determination of Glycemic Index of RD43 Rice and Thai Hom Mali Rice and Effects on Postprandial Glucose and Insulin Responses in Healthy Participants: A Crossover Study

2025-10-15T12:04:12+07:00

Background: A large portion of the world, particularly in Asia, relies on rice as a staple diet. This kind of cereal grain contains numerous nutritional components including carbohydrates, proteins, certain fatty acids, and micronutrients. This study aimed to determine the glycemic index (GI) of and “RD43” rice and Thai Hom Mali (THM) rice in healthy subjects, and also the postprandial glycemic and insulin responses after consumption.

Method: In a single-sequence, open-label, 3-period, crossover study, each participant orderly received RD43 rice, THM rice and glucose solution which were separated by 1-week washout. Each test meal provided 50 g of available carbohydrates, corresponding to approximately 150 g of cooked rice. Blood collections were taken in the fasting state and at 15, 30, 45, 60, 90, and 120 min after consumption.

Results: Sixteen healthy participants (5 men and 11 women) completed the study. After excluding subjects whose GI values fell outside the range of mean ± 2SD, data from the remaining 11 participants were analyzed. Consumption of RD43 rice resulted in significantly lower postprandial plasma glucose and insulin levels from 30 minutes after eating throughout the 120-minute test when compared to THM rice. In comparison with 50 g of glucose, as a reference, the GI of RD43 and THM rice was 56.9 ± 11.3 and 80.1 ± 15.8 respectively. RD43 group resulted in a 28.8% lower glycemic area under the curve (AUC) response than THM rice (p < 0.05). The insulinemic response to RD43 rice was 19.1% lower than THM rice, though this difference did not reach statistical significance (p =0.19).

Conclusion: The results indicate that RD43 has a lower GI and can be an option for rice which reduced glycemic response in healthy subjects. (TCTR20210524005)

Development of a Proactive Holistic Nutrition Care Service to Enhance Quality of Life in Patients with End-Stage Renal Disease

2026-03-30T10:05:50+07:00

This project aimed to develop an integrated, proactive nutrition care service model for patients with End-Stage Renal Disease (ESRD) undergoing dialysis, with a focus on improving quality of life rather than disease control alone. The service model integrates nutrition therapy, physical rehabilitation, and multidisciplinary collaboration under a person-centered care approach, emphasizing patient and family engagement in goal setting and care planning.

The outcomes demonstrate that this integrated service model effectively supports adequate nutritional intake, enhances muscle mass and physical function, and improves patients’ quality of life and satisfaction. By aligning clinical care with patients’ individual goals and daily living contexts, the service fosters meaningful care experiences beyond conventional fragmented approaches.

This proactive, holistic nutrition service represents a model of service excellence that can be embedded within routine clinical practice and has the potential to be adapted and scaled to other patient populations at risk of malnutrition and functional decline.

Geriatric Hip Fracture: Fast track Surgery Care

2026-03-30T10:13:40+07:00

Surgical treatment of hip fractures in older adults within 48–72 hours is a crucial factor in reducing complications, disability, and mortality. The TU-GHF team has therefore developed a care pathway incorporating Fast Track Surgery together with Fast Track Rehabilitation to expedite both surgical management and postoperative recovery. The goal is to shorten the time to surgery from the previous 48–72 hours to within 24–48 hours, initiate early mobilization within 24 hours, and implement a postoperative physical therapy program to encourage ambulation with a walker or movement via wheelchair within 48 hours.

Performance outcomes in 2024–2025 (2567–2568 BE) showed that, in 2024, the proportion of patients receiving surgery within 24, 48, and 72 hours after admission was 41.01%, 62.14%, and 85.95%, respectively. In 2025, the corresponding percentages were 32.15%, 64.27%, and 88.36%. In terms of rehabilitation, the proportion of patients able to sit or mobilize within 24 hours increased from 60.13% in 2024 to 94.07% in 2025. Those able to ambulate with a walker or wheelchair within 48 hours increased from 74.05% to 91.39%, and the rate of discharge within 10 days increased from 79.70% to 87.06% in 2025.

In summary, accelerated surgery and rapid rehabilitation significantly contribute to earlier mobilization, reduced complications, increased patient safety, shortened hospital stays, and lower overall treatment costs.

Effects of a 7-Week Empowerment Program on Health Behaviors and Body Mass Index in Mueang Yala District

2026-03-30T10:18:01+07:00

Background: Overweight and obesity are major public health issues leading to Non-communicable diseases (NCDs). Enhancing health behavior modification is urgently needed for future chronic disease prevention.

Objective: To study the effects of a 7-week empowerment program on health behavior modification among overweight populations in Mueang Yala District, Yala Province.

Material and Methods: This quasi-experimental study employed a two-group design. Seventy participants were purposively recruited and randomly allocated to either an experimental group (n = 35), which received the empowerment program, or a control group (n = 35), which received routine care. Research instruments included the empowerment program, assessments of knowledge and health behaviors, 3E2S records, and physical measurements. Data were analyzed using descriptive statistics, paired t-tests, and independent t-tests.

Result: Post-intervention, the experimental group showed significantly higher mean scores for knowledge and health behaviors compared to pre-intervention (p < .01) and the control group (p < .05). Regarding physical outcomes, the experimental group achieved a significant reduction in weight and waist circumference compared to pre-intervention and the control group (p < .01), with an average weight loss of 1.82 kg and a 5.5 cm reduction in waist circumference.

Conclusion: The 7-week empowerment program effectively improved health behaviors and promoted weight loss and waist reduction. It should be integrated into Dutchie Prevention and Control (DPAC) clinics and health promotion services for sustainable obesity management.

Development of a Neonatal Care System to Reduce Medication Errors

2026-03-30T10:23:15+07:00

Background: Neonates, particularly preterm infants, represent a highly vulnerable population at increased risk for medication errors due to immature organ systems, narrow therapeutic ranges, and the requirement for weight- and age-based dosing. Medication management in neonatal intensive care units (NICUs) frequently involves small-dose preparations, complex calculations, and multiple handoffs among healthcare professionals. Errors may occur at any stage of the medication-use process, including prescribing, preparation, dispensing, and administration, and even minor inaccuracies can result in serious adverse drug events, prolonged hospitalization, or mortality. Therefore, improving medication safety in NICUs is a critical patient safety priority and requires a system-based approach that addresses both clinical complexity and human factors influencing nursing practice.

Objective: To reduce medication administration errors in neonatal patients, targeting a category C–I error rate of less than 0.3 per 1,000 patient-days and eliminating category E errors.

Methods: This quality improvement study applied Continuous Quality Improvement (CQI) principles using Plan–Do–Study–Act (PDSA) cycles and Human Factors Engineering. A multidisciplinary team implemented a web-based neonatal drug application to support medication prescribing and administration. Additional interventions included simplification of medication guidelines, use of visual controls, expansion of medication error reporting channels, and ongoing staff education. Medication error rates were monitored using standardized severity classifications per 1,000 patient-days.

Results: Following implementation, medication errors classified as categories C–I decreased to fewer than 0.3 per 1,000 patient-days, with no category E or higher errors identified. Reporting of near-miss events increased, reflecting improved medication safety awareness and a strengthened patient safety culture among NICU nursing staff.

Conclusion: Integrating CQI methodology, Human Factors Engineering, and health information technology effectively reduced medication errors in neonatal care. System designs that support nursing workflow can enhance medication safety and promote sustainable quality improvement in NICUs.