1. Selection of opportunities for improvement (Outline for problem)
Study in Pharmacy Outpatient Department of Temerloh District shows low prescriptions utilized value added services (VAS) in repeat prescription for 2015 (6.2%) and 2016 (11.2%).

2. Key Measures for improvement
Our indicator is percentage of repeat prescription offered with VAS dispensed; the standard is set at 20%

3. Process of gathering information
A retrospective study was done in January 2017 to determine magnitude of usage of VAS offered by using data collection form. Besides, questionnaires were distributed to patient and staffs from 9th to 20th January 2017 to determine the contributing factors. First cycle (June 2017) and second cycle (Mac 2018) of study was carried out to study the effectiveness of remedial actions.

4. Analysis and Interpretation
KK Bandar Mentakab and KK Temerloh have high repeat prescriptions with 35,234 (30.3%) and 22,163 (46%) respectively. ‘Leave & Take’ shows the highest usage with 4283 prescriptions (50.9%), followed by ‘Appointment Card’ with 2588 prescriptions (30.7%).
Patients worried of prepayment (66.9%) upon using VAS and lack of detail information (80.3%).
25 staffs (65.8%) agree that procedure of VAS is complex. Lack of organized system for searching (92.1%) and limited space (89.5%) causes low VAS offered. While offering VAS, staffs find difficulty to explain terms and conditions (94.7%).

5. Strategy for Change
We formulate a new VAS, known as Easy-Drop. Second, a poster that contains all the VAS provided in pharmacy department in Temerloh District was prepared. Thirdly, we prepared brochures that contain flow of using VAS in pictures. Also, personal training by QA group members is given to staff.

6. Effects of change
The percentage of prescription offered with VAS is increased from 11.2% to 13.5% (Post study 1) and 14.8% (Post study 2) even though it is lower than standard of 20%. The ABNA has also been reduced by 3.6%.

7. The next step
We aim to design a mobile apps that contains VAS available, guide to choose the most suitable VAS for patient and procedure to use the particular VAS.