R16: Reducing Percentage of Polypharmacy Error Among Patients With Multiple Follow-Ups in Outpatient Pharmacy Department (OPD) Hospital Banting (HB)

1. Selection of opportunities for improvement (Outline for problem)
Polypharmacy error leads to adverse drug reactions, hospitalizations and death1,2.102 chronic patients/month which came to Hospital Banting Outpatient Pharmacy Department (OPD) had multiple prescriptions from different healthcare facilities or units and n=38 had polypharmacy error. There was hospitalization reported due to double dose of amlodipine taken from different facilities.

R2: Reducing Inappropriate Usage of Acid Suppression Therapy (AST) as Stress Ulcer Prophylaxis (SUP) in General Medical Wards in District Specialist Hospital Kulim

Selection of opportunities for improvement (Outline for problem)
Concerns have been raised with regards to the overutilization of AST as SUP where studies have emerged with reports claiming that AST usage without proper indication is common. Inappropriate AST such as ranitidine and Proton Pump (esomeprazole, pantoprazole and omeprazole) inhibitor usage were observe among hospitalized patients in general wards Hospital Kulim and upon discharged. The overutilization of AST accounts for a significant increase in cost expenditure.

R3: Meningkatkan Peratus Kepatuhan Pesakit Antenatal Terhadap Zat Besi Di Klinik Kesihatan Daerah Kota Bharu

Bilangan kejadian anemia dikalangan ibu hamil pada 36 minggu tahun 2017 di Klinik Kesihatan Daerah Kota Bharu (KKDKB) adalah seramai 267 orang. Kepatuhan pengambilan zat besi pesakit antenatal adalah rendah iaitu 34%. Ketidakpatuhan mengancam kesihatan ibu dan bayi yang membawa kepada komplikasi dan kematian, menyebabkan kekerapan penukaran dos dan alternatif yang lebih mahal dan peningkatan kos akibat pembaziran.

R4: Optimisation of stock management in klinik komuniti PKD Seberang Perai Selatan

Selection of Opportunities for Improvement (Outline for Problem)
Poor management of stock will lead to either shortage of medication or stock overload. Based on supervisory visit in 2017, an evaluation of community clinic’s stock management performance in PKD Seberang Perai Selatan was 62% on average as compared to standard 100%. A huge number of items were found kept overstock in KKom Nibong Tebal, costs nearly RM 5000. Hence, it is vital to identify and overcome the factors leading to poor stock management.

R5: To Reduce The Incidence Of Error In Galenical External Preparation, Hospital Sungai Bakap (HSB) Pulau Pinang

Outline of Problem
Galenical external preparations are referred to creams and lotions unavailable commercially. In Hospital Sungai Bakap, 67.5% of galenical preparations were detected with errors in preparation name, raw material, expiry date, packaging size, strength and batch number. These will lead to medication error, wastage and reduce efficacy.

Key Measure for Improvement
The objective is to reduce the incidence of error in the preparation to 0%.

R6: Reducing Ceftriaxone Usage In Hospital Tuanku Ampuan Najihah (HTAN)

1. Selection of opportunities for improvement (Outline for problem)
HTAN was the highest ceftriaxone user in Malaysia from 2012 to 2014. Ceftriaxone is a third generation cephalosporin, where increased usage will result in increasing resistance rate towards it, leading to the emergence of multidrug-resistant organisms (e.g. extended spectrum beta lactamase, ESBL). Hence, we aimed to reduce ceftriaxone usage in HTAN.

R7: Increasing Utilisation of Tc-99m Tetrofosmin Prepared for Stress Test Myocardial Perfusion Imaging (MPI)

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.

R8: Increasing Good Prescriptions Rate In Muar Health Clinics

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.

R10: To Empower The Usage Of Value-Added Service Offered In Health Clinics, Temerloh District

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%