R1: Improving Anticoagulation Therapy Monitoring in Surgical Wards of Kuala Lumpur Hospital

Selection of opportunities for improvement
Incompleteness of anticoagulation therapy monitoring form may result in inappropriate
adjustment of anticoagulation dosage regime and lead to undesirable side effects or
under treatment. This study aimed at improving the documentation of heparin and
warfarin monitoring forms in surgical wards of Kuala Lumpur Hospital (KLH).

R15: Improving appropriateness of carbapenem prescribed in Hospital Serdang

Selection of opportunities for improvement:
Carbapenem –resistance enterobacteriacease (CRE) incidence was persistently high in Hospital Serdang in the past two years (21 cases). Studies showed inappropriate use of carbapenem leads to emergence of CRE. An audit done in year 2017 showed 84.6% carbapenem prescribed in Hospital Serdang was inappropriate. Thus, this study aim to improve the appropriateness of carbapenem prescribed in Hospital Serdang.

R14: Improving Safe Handling of Oral Antineoplastic Agents among Outpatient Pharmacy Staff at Pharmacy Department, Hospital Tengku Ampuan Rahimah Klang (HTAR)

1. Selection of opportunities for improvement (outline for problem)
Similar to intravenous formulations, oral chemotherapy has the same exposure risks leading to adverse events such as cancer, fertility problems and fetal abnormalities. To minimize occupational safety hazard, we aim to improve safe handling of oral antineoplastic agents among outpatient pharmacy department (OPD) staff at HTAR.

R12: Increasing Percentage of Correct Intravenous Drug Administration in Medical Ward Hospital Kajang

1. Selection of opportunities for improvement (Outline for problem)
In 2017, 175 cases of medication errors that caused harm to patient was reported to Pharmaceutical Services Division. 22% of the reported cases involved intravenous (IV) drug administration. In the same year, one case of intravenous drug administration errors was reported in Hospital Kajang which cause very serious harm to patient that required Intensive Care Unit admission and prolong hospitalization.

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%

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.

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.

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.