SELECTION OF OPPRTUNITIES FOR IMPROVEMENT:

In 2016, there were 27% from total patient (N=122,275) admitted into yellow zone (YZ), ED HSDG. The large amount of patients with limited beds available in wards leads to access block at YZ, with mean pending time of 3 days. Crowded environment, understaffing with high workload and semi-IT system resulted in high incidence of MOE.

KEY MEASURES FOR IMPROVEMENT:

The indicator for this project is the percentage of omission errors in YZ, ED HSDG which is measured by the total number of medications with omission errors divided by the total number of medications intended. Target standard was set based on Dabaghzadeh F et al study where MOE detected at ED was 29.6% and lower than 25% target was set based on consensus in ED Pharmacy Clinical Meeting.

PROCESS OF GATHERING INFORMATION:

This is cross-sectional study using universal sampling with calculated sample size of 450 in verification study. We use data collection forms and questionnaires which targeted on health care professionals and the patients.

ANALYSIS AND INTERPRETATION:

From verification study (N=450), 53.8% (n=242) of them encountered MOE. From the questionnaires, we identified 5 key barriers that contributed to the MOE which includes high number of medications not ordered in system (92%), difficulty tracing patients medication history (86%), lack of awareness among patients on their own medications (80%) increasing workload among nurses (76%) and different format of medication chart used (68%).

STRATEGIES FOR CHANGE:

Strategies includes the improvisation on the manual medications charts, centralization on ED medication supply system, inclusions of 2 clinical pharmacists in ED to improve ED medication safety, increase awareness on POMs by strengthening promotional efforts on POMs in ED. Further strategies includes collaboration with multiple Quality Project in Pharmacy department and Hospital Serdang (Lean, KIK & QA) to improve patient pending time in YZ ED.

EFFECT OF CHANGE:

Improvement was shown in medication ordering and administration contributing to the percentage of MOE reduced from 53.8% to 22.7% in Cycle 1 and further reduce to 12.9% in Cycle 2. Achievable Benefit Not Achieve (ABNA) was reduced from 28.8% to -2.3% then further reduced to -12.1% in Cycle 2. From the results, we managed to reduce the percentage of omission error in YZ, ED HSDG.

THE NEXT STEP:

Continuous education should be carried out to sustain the proper process of care. Promotion on POMs program should be extended to public to increase awareness about the importance of bringing their own medications to the hospital.