Selection of Opportunities for Improvement: Stress Test MPI is a non-invasive pharmacological diagnostic method used to assess the functional or physiological consequences of coronary artery disease (CAD). Tc-99m Tetrofosmin for Stress Test MPI is prepared by Nuclear Pharmacy based on patients’ schedule. Unutilized doses lead to wastage of radiopharmaceuticals. In 2017, it was found that under-utilisation led to a wastage of about RM8200/month.
Key Measures for Improvement: Utilised dose was defined as number of prepared doses given to scheduled patients. This study aims to increase the percentage of Tc-99m Tetrofosmin dose utilized for patients in Stress Test MPI. The standard was set at 80% based on 2017 Departmental Statistics.

Process of Gathering Information: A cross-sectional study was conducted from October to December 2017 involving all patients scheduled for Stress Test MPI to verify the percentage of doses not supplied and to identify the contributing factors using data collection form. Implementation of remedial measures was carried out in 2 phases from April to August 2018. Post-remedial action was reassessed accordingly.
Analysis and Interpretation: Pre-remedial study showed that only 55% of dose prepared for Stress Test MPI was utilised. Contributing factors include patients non-turn up and patients non-adherence to preparations as counselled by pharmacist. The ABNA was 24.79%

Strategy for Change: Two phases of change were carried out. Firstly, a phone reminder was given to the patients two days before appointment date. Secondly, an additional simplified leaflet was provided during counselling, which comprised of pictures and step-by-step instructables, enabling patients to adhere to the preparations easily.

Effect of Change: The percentage of utilized dose increased from 55.21% to 61.2% after first cycle. It was further increased to 75.89% following second cycle. ABNA reduced from 18.8% to 4.11%. Secondary outcomes included a slight improvement in patients’ waiting time to appointment (128 days to 120 days) as well as a reduction in wastage of radiopharmaceuticals, from RM8200/month to RM6700/month and subsequently RM 3100/month.

The Next Step: These tools can be expanded to other Nuclear Medicine facilities conducting Stress Test MPI which are also facing the same issue of under-utilisation of Tc-99m Tetrofosmin.