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    ACTIVITIES & ACHIVEMENT OF PATIENT SAFETY COUNCIL MALAYSIA 2009

    The Malaysian Patient Safety agenda follows closely the World Health Organisations World

    Alliance for Patient Safetysrecommendation on Patient Safety Strategies and programs.

    Recently WHO has grouped the activities into 13 Patient Safety Program Areas. These are beingsupported by the Patient Safety Council of Malaysia.

    WHO PATIENT SAFETY PROGRAM AREAS

    Action Area 1 (Global Patient Safety Challenge)

    2005-2006: Clean Care Is Safer Care

    2007-2008: Safe Surgery Saves Lives

    2009-2010: Tackling Antimicrobial Resistance

    Action Area 2- Patients For Patient Safety

    Action Area 3- Research For Patient Safety

    Action Area 4- Taxonomy - International Patient Safety Classification

    Action Area 5- Reporting And Learning

    Action Area 6- Solutions For Patient Safety

    Action Area 7- High 5s

    Action Area 8- Technology For Patient Safety

    Action Area 9- Knowledge Management

    Action Area 10- Eliminating Central Line-associated Bloodstream Infections

    Action Area 11- Education For Safer Care

    Action Area 12- Safety Prize

    Action Area 13- Medical Checklist

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    Graph 1- MOH Hospitals Hand Hygine Compliance Rate 2009

    Most recent assessment of compliance which was conducted in October 2009 showedthat community nurse showed highest professional compliance followed by specialist,

    staff nurses and medical officers. Students and house officers had the lowest

    compliance rate. (Refer Graph 2b)

    Paediatrics Department persistently showed high compliance. Other departments have

    shown increasing compliance. (Refer Graph 3a & b)

    56 6268.4

    66.7 65.9

    0

    20

    40

    6080

    Jun,08 Jan,09 Apr,09 Jul,09 Oct,09

    Percentage

    Ministry of Health Hospital

    Hand Hygiene Compliance Rate 2009

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    Graph 2aProfessional Compliance On Hand Hygiene (May-June 2008)

    Graph 2bProfessional Compliance On Hand Hygiene (October 2009)

    63%

    48%

    58%51%

    0%

    25%

    50%

    75%

    100%

    Nurses/Midwife Med Dr Auxiliary nurses Others

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    Graph 3aDepartment Compliance On Hand Hygiene (May-June 2008)

    Graph 3bDepartment Compliance On Hand Hygiene (Oct 2009)

    *OT: In recovery bay only

    61%

    55%

    74%

    54%

    23%

    66%

    52%

    0% 25% 50% 75% 100%

    Obstetric

    ICU

    Paediatric

    Medicine

    A&E

    OPD

    Surgery Obstetric

    ICU

    Paediatric

    Medicine

    A&E

    OPD

    Surgery

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    a)

    Safe Surgery Saves Lives (2007=2008)

    Second Global Patient Safety Challenge

    To improve safety of surgical care by ensuring adherence to proven standards of care

    Malaysia theme is Safer Surgery Through Better Communication

    In Ministry of Health it is spear-headed by the MOHs Safe Surgery Saves Lives Steering

    Committee which is led by Dato Dr. Abdul Jamil Abdullah, Consultant and Head of Surgery,

    Hospital Sultanah Nurzahirah, Kuala Trengganu.

    Malaysian version of Peri Operative Check List was established in 2009 based from WHO

    Check List. Pilot project using this check list had been successfully carried out in 6 MOHhospitals:

    H. Pulau Pinang; H. Raja Permaisuri Bainun, Ipoh, HRPZII, Kota Bharu; H. Kemaman,

    Terengganu; H. Teluk Intan, Perak; H. Duchess of Kent, Sandakan

    Initiative was endorsed in Mesyuarat KPK Khas 24th

    Oct 2009, to be implemented nation wide

    by 1stJanuary 2010.

    Pekeliling Ketua Pengarah Kesihatan Malaysia Bil 23/Tahun 2009 on Safe Surgery Saves Lives

    initiative was signed on the 12thNov 2009 .

    Safe Surgery Saves Lives Initiative & Implementation Guideline was launched on the 15th

    Nov

    2009.

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    State hospitals have been training other hospitals with OT in their respective states

    A follow up meeting to evaluate the implementation and performance of hospitals is going to

    be conducted in April/May 2010.

    c) Tackling Antimicrobial Resistance(2009-2010)

    Third Global Patient Safety Challenge

    Antimicrobial resistance poses a growing threat to the treatment and control of infectious

    diseases.

    Annual Scientific Meeting on Antimicrobial Resistance has been organized regularly by the

    Infection Control Unit, Quality in Medical Care Section, Medical Development Division MOH

    National Antibiotic Guidelines was launched at the Annual Scientific Meeting on AntimicrobialResistance held on 21

    stJuly 2008 by the Director-General of Health Malaysia, as Chairman of the

    National Steering Committee for Infection and Antibiotic Control.

    Infection Control Policy and Procedure will be launched in the 3rd

    Annual Scientific Meeting on

    Antimicrobial Resistance , 5th

    May 2010.

    Action Area 2- Patients for Patient Safety

    Patients for Patient Safety is an international network which comprised of patients/family,

    members who have experienced preventable medical error, patient advocates, policy-makers,

    health-care workers, others dedicated to improve patient safety through partnership.

    The concept is patients and consumers act as partners in improving the quality and safety of

    health care.

    This is an area for future action by the Patient Safety Council.

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    Action Areas 3- Research for Patient Safety

    Operational intervention research projects under the EVIPNet (Evidence-informed policy

    network) have been conducted by the Institute for Health Systems Research (IHSR) .

    Policy briefs and research highlights have been published to facilitate the use of research

    evidence in policy and practice. The research highlights are:

    i.

    Patients unvoiced needs

    Doctor, lend me your ears

    Help patients voice their needs

    ii.

    Handoff communication

    Handoff communication process in MOH hospitals

    Improving discharge communication

    Inadequate discharge communication

    Patient empowerment : The doctors perspective

    iii.

    Inpatient medical error

    Medical discipline, MOH specialist hospitals Adverse events & near misses

    MOH Non-specialist hospitals: Adverse events & near misses

    Action Areas 4-Taxonomy - International Patient Safety Classification

    Aims to define, harmonize and group patient safety concepts into an internationally

    standardized classification.

    Easier to capture and analyse factors relevant to patient safety, for learning and system

    improvement.

    Taxonomy has been used in patient safety research, in the training of Root Cause Analysis and in

    the new format of Incident Reporting.

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    Action Areas 5- Reporting and Learning

    To generate best practice guidelines for reporting systems & learning from information

    available.

    Incident Reporting followed by Root Cause Analysis (RCA) are used to capture incidents related

    to patient safety in government hospitals. A new Incident Reporting System called Medical

    Incident Reporting System is in the process of development, in collaboration with WHO

    Consultant, Mr Stuart Emsley.

    RCA Courses for State/Hospital directors/deputy directors, doctors, paramedics have been

    conducted since 2005 to 2009 in collaboration with WHO Consultant, Mr Stuart Emsley. Total of

    665 participants attended the course (Refer Table 1)

    TABLE 1PARTICIPANTS OF ROOT CAUSE ANALYSIS COURSE

    ORGANIZED BY QUALITY IN MEDICAL CARE SECTION MINISTRY OF HEALTH (2005-2009)

    STATE NUMBER OF PARTICIPANTS

    Pulau Pinang 50

    Sabah 50

    Sarawak 50

    Johor Bahru 40

    Other states 475

    TOTAL 665

    Root Cause Analysis Application Guideline to guide health care professionals investigate the

    causal factors for adverse events will be produced in 2010.

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    Managing Concentrated Injectable Medicines

    Assuring Medication Accuracy at Transitions in Care

    Action Areas 8-Technology for Patient Safety

    Malaysian Health Technology Assessment Section (MaHTAS) was established in August 1995

    under Medical Program, Ministry of Health

    MaHTAS has been conducting many health technology assessment for new equipment to

    ensure safety and cost-effectiveness of the technology before it is used widely.

    MaHTAS also produce various Clinical Practice Guidelines to ensure management of patient is

    safe and evidence-based

    In 2009, Seminar & Launching on Management of Dengue Infection In Adults (2ndEdition) was

    conducted.

    Recent technology assessment which have been conducted are for circumcision clamps,

    cytotoron (in the treatment of arthritis and cancer) and sonotron therapy for musculoskeletal

    problem.

    Action Areas 9- Knowledge Management

    To gather and share knowledge on patient safety developments globally.

    Ministry of Health Malaysia has been sharing experience in patient safety programs with WHO

    and other countries. Hand hygiene, safe surgery program.

    WHO consultant shares knowledge on Clinical GovernanceFramework for Integrated Quality,

    Safety and Risk Management, Root Cause Analysis and Incident Reporting System with Malaysia.

    Organized and participated in conferences:

    o Y. Bhg Tan Sri Dato Seri KPK was invited to present a 45 minute paper at The APHM

    International Health Care Conference and Exhibition 2009, held on 21stto 23rdJuly 2009

    . The theme for the Conference is Applying Best Practices in Health Care Delivery.

    o Y. Bhg. Tan Sri Dato Seri Dr. Hj. Mohd Ismail Merican delivered the key note address at

    Ministry of Health- Academy of Medicine Malaysia Conference in August 2009. Thetheme is Building a Safety Culture through Accountability.

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    Other Activities

    a) Patient Safety Council Web-site

    This was developed in-house by the Section on Quality in Medical Care, Medical Development Division,

    Ministry of Health Malaysia as the Patient Safety Council Secretariat. It is already on-line (front-page link

    at MOH web-site).

    b) MOH Patient Safety Project 2009Improving the Management of Extra-dural Hematoma (EDH) in

    Specialist Hospitals with CT Scans

    The Section on Quality has been working on an important patient safety project to enable General

    Surgeons to manage certain types of EDH at their hospitals.

    The first meeting took place in HSA JB and a committee was set up, under the auspices of thePOMR Committee to implement training in selected centres for general surgeons.

    The first national training was held in Johor Bahru in December 2009.Future plan is to arrange

    attachment program for general surgeon in neurosurgical unit

    c) Patient and Staff Fall Prevention Program In Hospital

    To prevent incidence of fall among patients and staffs in hospital

    Workshop was conducted in December 2009 to discuss the initiative


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