Selection of opportunities for improvement
Increasing trend of non-compliance to prescriptions writing requirement was highlighted in Muar Health Clinics according to ISO Non-Conformance Report (NCR). Prescribing error can harm patient if major error was not detected and reached patient.

Key Measures for improvement
This study aimed to get 90% of Good Prescription Rate (GPR). Good prescription was defined as prescription without error. Target set was based on consensus in Drug Committee Meeting 1/2016.

Process of gathering information
This is a cross-sectional study with retrospective data which involved all 11 Muar health clinics. Baseline of GPR was assessed from December 2015 to June 2016. Types and prevalence of prescribing errors were identified and recorded in data collection form. Remedial actions implemented from Jun to September 2016. Post remedial GPR was reassessed from October to December 2016. The study was repeated in 2018 and second cycle remedial actions were implemented from November 2018. GPR was reassessed again from Mac to May 2019.

Analysis and Interpretation
GPR before remedial actions was 10.5% and only 0.55% was intervened by pharmacist. Type of errors detected were usage of brand name (72.9%), usage of unapproved abbreviation (67%), incomplete details of medicine (48.4%), polypharmacy (24.5%), incomplete patient’s details and diagnosis (23%), unauthorized prescribing (7.7%), illegible hand handwriting (0.8%), no prescriber’s name, chop or signature (0.5%) and inappropriate dose & frequency (0.5%)

Strategy for Change
In 1st cycle, role of PKD Muar Drug Committee Board was strengthened. Proper member appointment and improvement in frequency of meetings held per year were done. Efficient meeting held leads to important decisions made on issues relating medicine example polypharmacy and unauthorized prescribing. To enhance knowledge among prescribers, workshops and CME were conducted and open access of Online MimsGateway was done. Pharmacists were strictly emphasized on active feedback control systems and immediate review of prescriptions to prescribers. In 2nd cycle, Quick Prescribing Guide was developed for easy access on relevant information regarding prescribing

Effects of change
The GPR increased from 10.5% to 26.3% (2016) and to 61.36% (2019). ABNA was improved from 79.5% to 28.6%.

The next step
Our next step is development of Prescriber Kit to tackle the issue of new prescribers. This study also suggests the usage of automated prescribing systems should be the way forward to reduce prescribing errors.