mjphm supplement 5 (2011)

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Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 5) 2011 The 6th

National QA Convention 18th

-21st

October 2011

Official Journal of Malaysian

Public Health PhysiciansAssociation

Volume 11(Suppl 5) 2011

MJPHM

EDITORIAL BOARD

Chief Editor

Prof. Dato Dr. Syed Mohamed Aljunid(United Nations UniversityInternational Institute for Global Health)

Deputy Chief Editor

Assoc. Prof. Dr. Sharifa Ezat Wan Puteh

(Universiti Kebangsaan Malaysia)

Members:

Assoc. Prof. Sharifah Zainiyah Syed Yahya University Putra MalaysiaDr. Lokman Hakim Sulaiman Ministry of Health MalaysiaAssoc. Prof. Dr Retneswari Masilamani University Malaya

Assoc Prof. Dr. Mohamed Rusli Abdullah University Sains MalaysiaAssc. Prof. Dr Saperi Sulong University Kebangsaan Malaysia

Assc. Prof. Dr Maznah Dahlui University MalayaDr. Roslan Johari Ministry of Health MalaysiaDr. Othman WarijoDr. Norfazilah Ahmad

Ministry of Health MalaysiaUniversity Kebangsaan Malaysia

Dr. Amrizal Muhd Nur United Nations University

InternationalInstitute for Global Health (UNU-IIGH)

Chief EditorMalaysian Journal of Public Health Medicine (MJPHM)

United Nations University - International Institute for Global Health (UNU-IIGH)

Universiti Kebangsaan Malaysia Medical Centre (UKMMC)Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur

Malaysia

ISSN: 16750306

The Malaysian Journal of Public Health Medicine ispublished twice a yearCopyright reserved @ 2001

Malaysian Public Health Physicians Association

Secretariate Address:

The SecretariateUnited Nations University - International Institute for Global Health (UNU-IIGH)

Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

Jalan Yaacob Latif, 56000 Cheras, Kuala LumpurMalaysia

Tel: 03-91715394 Faks: 03-91715402 Email:[email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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Official Journal of Malaysian

Public Health PhysiciansAssociation

Volume 11(Suppl 5) 2011

MJPHM

6th

NATIONAL QUALITY ASSURANCE CONVENTION 2011

18-21 OCT 2011

DEWAN WAWASAN 2020, KANGAR, PERLIS

EDITORIAL BOARD

Chairman: Ms Haniza Mohd Anuar

Secretary: Ms Samsiah Awang

Members: Dr Nur Ezdiani Mohamed

Datin Dr Siti Haniza MahmudDr Roslinah AliMr Ramli Zainal

Ms Look Chai Hong

In Cooperation with

Perlis State Health Department

Organised by

Ministry of Health


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CONTENTS

ORAL PRESENTATION

OP-01 OPEN ACCESS ENDOSCOPY SERVICE REDUCES WAITING TIME ANDINCREASES GASTROINTESTINAL CANCER DETECTIONMahadevan D, Dharmendran R, Azrina A, Vijaya S, Kandasami P,Ramesh G, Jasiah Z.

1

OP-02 MENINGKATKAN TAHAP PENGLIHATAN PESAKIT AMBLIOPIA DIKLINIK OFTALMOLOGIFarawahida Kasmira F, Nur Liyana I, Nurul Ain MZ, Abdul MutalibO, Mazliana A, Maizun MZ, Laila A.

2

OP-03 MENINGKATKAN KOMPETENSI PELATIH PROGRAM DIPLOMAPEMBANTU PERUBATAN MELALUI INTERVENSI SIMULASI KLINIKALElengovan V, Nazri A, Yong KK, Zafri Y, Liew CF.

3

OP-04 MENINGKATKAN KEHADIRAN IBU MENGANDUNG KE KLINIKPERGIGIANNor Sarah A, Suhaila AK, Nur Arliza P, Wan Mohd Ridzuan WJ.

4

OP-05 REDUCING E-PRESCRIPTION ERROR IN A HOSPITAL INPATIENTPHARMACYWan Najbah NN, Ngan YS, Muhd Nor Hazli N, Ng KY, Ching MW, TanHF.

5

OP-06 RE-ENGINEERING THE PROCESS OF OBTAINING SPECIALFORMULARY DRUGS BY ONCOLOGY PATIENTSTan PL, Azhari Wasi NA, Dhillon HK, Buang A, Sulaiman CZ, MohdZakaria IE, Tan WC, Poopaladurai D.

6

OP-07 MENURUNKAN KEJADIAN ANEMIA DI KALANGAN IBU HAMIL PADAUSIA KANDUNGAN 36 MINGGUNorasikin M, Zaitun I, Roslenda M, Mazliza M, Rubiah L, Masriah M.

7

OP-08 IMPROVING ADHERENCE TO BLOOD SAMPLING TIME FORTHERAPEUTIC DRUG MONITORING IN A GOVERNMENT HOSPITAL

Rosdi MZ, Dang CC, Ku SC, Norshazareen AM, Lim CW, Tan BL.

8

OP-09 THE BRAINWAVES SYSTEM: DEVELOPMENT OF A MINDSTIMULATING SYSTEM TO IMPROVE NEUROCOGNITIVE HEALTH BYINCREASING ALERTNESS IN THE WORKPLACEZalina I, Wan Asim WA, Idris L, Aida Fadriah M, Wan Raihana WA,Yang SA, Kumar J, AlHindi R, Gisely V.

9


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OP-10 MENINGKATKAN PERATUSAN KEPATUHAN TERHADAP PERAWATANPESAKIT DENGAN INFUSI INTRAVENA DI WAD OBSTETRIK &GYNAECOLOGYNancy B, Sania L, Diviki T, Anita M, Zabidah J, Rusti T, Jockina M.

10

OP-11 IMPROVING TIME INTERVAL FROM DECISION TO CAESAREANDELIVERY FOR FETAL DISTRESS CASESYuzainov A, Nurul Khairiyah K, Norul Akhma AH, Rahmah N,Norraihan H, Suriwati I.

11

OP-12 INCREASING LOWER SEGMENT CAESARIAN SECTION WITHOUT POSTPARTUM HAEMORRHAGENor Jumizah AK, Lim KY, Faridah MY, Wan Mazlina WR, Maziati M,Suhainiza S, Norleeza MN.

12

OP-13 IMPROVING THE PERCENTAGE OF ASTHMATICS RECEIVING

OPTIMAL ASSESSMENT DURING FOLLOW UP IN HEALTH CLINICSNor Azila MI,Shuaita MN, Uthayalaxmi N, Ahmad Nazifi S, Toh LS,Mohd Azrul Z, Nor Izzah AS.

13

OP-14 MENINGKATKAN PENGURUSAN YANG EFEKTIF BAGI IBU HAMILDENGAN ANEMIA DI KLINIK KESIHATANSuzaini MD, Junaidah I, Norhayati S, Nur Hazwani R, Rosnani R.

14

OP-15 MENGURANGKAN KEKERAPAN PESANAN LUAR JANGKA DARI UNITPEMESAN BAGI ITEM BUKAN UBAT DI UNIT PEROLEHAN DANPEMBEKALAN

Noor Mariati O, Siti Masyitah MT, Noorulhuda S, Lee LG, Azizah M,Khairul Anuar M, Norsiah MN.

15

OP-16 ROLE OF THE PHARMACIST IN IMPROVING TARGETEDINTERNATIONAL NORMALISED RATIO VALUE OF PATIENTS ONWARFARIN THERAPYShakirin SR, Izrul Azwa ML, Tan SY, Cheah SY, Wong MK, Chiew CW.

16

OP-17 REDUCING THE INCIDENCE OF VENTILATOR ASSOCIATEDPNEUMONIA AMONG ICU PATIENTSRozaidah AK, Norlida AB, Fatimah A, Nor Azuwa J, Che Zakiah O,

Dominica Rose JS Daniel.

17

OP-18 MENINGKATKAN PERATUS BRONKIAL ASMA TERKAWALJayashree M, Shahrul Bariyah A, Norsiah MN, Ruzita S.

18

OP-19 REDUCINGINCIDENCEOFSEVERENEONATALJAUNDICEGadung A, Christina BL, Adeline WSF, Juliana H, Hilda B, Iya R.

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OP-20 ACHIEVING INTERNATIONAL NORMALISED RATIO TARGETS ANDSATISFACTION OF WARFARINISED PATIENTSSubramaniam T, Fudziah A, Jeyaindran S, Suliyana Y, Lim SC, ChongMF, Cheng PL, Teng SC.

20

POSTER PRESENTATIONPP-01 REDUCING THE PERCENTAGE OF CLINICAL PROGRESSION OF

SEVERE NON- PROLIFERATIVE DIABETIC RETINOPATHY CASES TOPROLIFERATIVE DIABETIC RETINOPATHY STAGE OVER 1 YEAR IN ANOPHTHALMOLOGY DEPARTMENT

Adeline ML Khaw, Chariya Eh Chot, SL Ng, A Rosli

21

PP-02 MENGURANGKAN PENCEMARAN LONGKANG DAN SALIRAN AWAMOLEH SISA MINYAK TERPAKAI

Azraei R, Ganggaraj A, Abdul Hamid MD.

22

PP-03 REDUCING THE NUMBER OF MEDICATION ADMINISTRATION ERRORSIN A GENERAL PAEDIATRIC WARDHiew CY, Lee ML.

23

PP-04 IMPROVING PROPER USAGE OF FETAL MOVEMENT CHART AMONGPREGNANT WOMENM Nazari J, Maskinah A, Haizuna MY, Saruah B, Aishah B, Ismail A,

Adinegara.

24

PP-05 REDUCING FREQUENCY OF READMISSION OF PATIENTS WITH

SCHIZOPHRENIA AFTER LAST DISCHARGERuzita J, Dandaithapani T, Muslim AR, Rasidi D, Rozali I, Basiah A,Afidayati A.

25

PP-06 MENINGKATKAN AKTIVITI PENYUSUAN DI KALANGAN JURURAWATDI TEMPAT KERJANorbaizora M, Ruzita MY, Sapinah MK, Kalsom M, Rohani H, W MohdFaizal A, Ahmad Syahir S, Norhasriza Z, Nor Syarahani J.

26

PP-07 INCREASING THE SUCCESS RATE OF QUIT SMOKING CLINIC AMONGADOLESCENTS

Arbaiah O, Marina MS, Zaleha J, Zainal AR, HariyatonR.

27

PP-08 MENINGKATKAN PENGESANAN KOMPLIKASI PESAKIT DIABETESYANG LENGKAP DI KLINIK KESIHATANNorhana Y, Fatimah M, Mazlinah M, Kamilah M, Che Azizah A.

28

PP-09 REDUCING REJECTION RATE OF BLOOD FILM MALARIA PARASITESAMPLE DUE TO UNSATISFACTORY SMEAR FROM EMERGENCY AND

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TRAUMA DEPARTMENTTchong FL, Nadiah AR, Noriah Y, Timothy B, Marilyn AA.

PP-10 IMPROVING THE PASSING RATE OF NURSING STUDENTS INANATOMY AND PHYSIOLOGY SUBJECTS

Tan SC, Chin SK, Khaw ES, Rogayah I, Lim JK.

30

PP-11 MENGURANGKAN PERATUS ANAEMIA SEDERHANA DI KALANGAN IBUHAMIL PADA MINGGU 36Norazlina MN, Aida Rahayu AG, Shaebah MJ, Asma I, Noor Azhan A.

31

PP-12 REDUCING CENTRAL VENOUS LINE RELATED BLOOD STREAMINFECTIONS AMONG PAEDIATRIC ONCOLOGY PATIENTSYeoh SL, Tan PY, Suhaila R, Azimah A, Nor Hafiza R.

32

PP-13 OPTIMISATION OF PHARMCARE SERVICE IN A TERTIARY HOSPITAL

Giam WL, Azhari Wasi NA, Buang A, Dhillon HK, Mohd Zakaria IE,Lee CE, Jinan Taib JT, Ismail NS, Syed Othman SR, Abdul Wahab AR.

33

PP-14 IMPROVING ADMISSION TIME AT A MATERNITY PATIENTASSESSMENT CENTREMohd Azri MS, Lim GL, Puziah Y, Mohd Nasir O, Mohammad FaidzolT.

34

PP-15 MENGURANGKAN PERATUS X-RAY BERULANG YANG TINGGI DIKLINIK PERGIGIANMorni AR, Siti FJ, Amran MY, Hasniza J, Irdawaty M.

35

PP-16 MENGURANGKAN KETIDAKSEIMBANGAN BADAN DI KALANGANPESAKIT WARGA TUA DI WAD KRONIKMike C, Fung Z, Tay LH, Nandi Dewi R, Mariani A.

36

PP-17 MINIMISING THE FILLING ERRORS IN A SPECIALIST CLINICPHARMACYSiow CC, Menaga K, Noor Shafizah J, Muhd Redhuan N.

37

PP-18 RE-ENGINEERING THE CATARACT SURGERY WAIT-TIME STRATEGYShubhashini Y, Poh EP, Gong VHM, Kogilavaani J, Kasturi R, Che Sam

AK, Normadiniatul SMH, Nur Fazlina MN.

38

PP-19 MENURUNKAN PERATUSAN PENOLAKAN KES PEMBEDAHAN DEWANBEDAHNurul Atikah H, Mohd Zahidi H, Kartini M, Sahaimi M, Nik Abdul AzizRS.

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PP-20 REDUCING THE INCIDENCE OF THIRD DEGREE TEAR IN OBSTETRICS& GYNAECOLOGY DEPARTMENTMolen A, Myat SY, Lily D, Chanic B., Landsee DM, Juliana DJ, AbbyB.

40

PP-21 IMPROVING TURN-AROUND-TIME OF CULTURE & SENSITIVITYTESTINGWong MK, Abdullah A, Justin F.

41

PP-22 CLINICAL AND ECONOMIC IMPACT OF PHARMACIST-RUNMEDICATION THERAPY ADHERENCE CLINIC SERVICE ON PATIENTSWITH TYPE 2 DIABETESNavin Kumar L, Chin ST, Rachel T, Lim KY, Fudziah A.

42

PP-23 INCREASING RETENTION RATE OF FISSURE SEALANT AMONGPRIMARY SCHOOL CHILDRENHajar HR, Vijayamanohar K, Wan Aini WY, Nadia DB, Umi A.

43

PP-24 INCREASING PERCENTAGE OF ASTHMA CONTROL MONITORING ATDISTRICT HEALTH CLINICSMohd Fozi K, Junaidah I, Azirah Y, Nurul Azlyn MY, Mahani K, AliO, Mardiana A, Hamiza H.

44

PP-25 IMPROVING DETECTION RATE OF DIABETIC FOOT AMONG PATIENTSWITH DIABETESSamurah AR, Ganespathy P, Ibrahim AF, Molina J.

45

PP-26 MENINGKATKAN PERATUS PREMIS BERSIH KANTIN SEKOLAH

MENENGAHNorazema AA, Samsir Asuwat S, Mohd Zulfadhli MS, Mohd ZahariY, Md Kamal Ariffin AG, Zainal Abidin I, Azmi A, Jamaliah J.

46

PP-27 MENURUNKAN KEJADIAN ANEMIA SEDERHANA DI KALANGAN IBUHAMILM. Adam MA, Nini Shuhaida MH, Rohanita N, Badariah S, BadariahM,Wan Hafizah WM.

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PP-28 DELAY IN INDUCTION OF LABOUR WITH OXYTOCINNik Azi Azuha NH, Norhayati A, Norizah M, Saluwani AH, Nuraini M.

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PP-29 MENINGKATKAN PENGETAHUAN PESAKIT TENTANG PERUBAHANRUPA UBAT DI FARMASI PESAKIT LUAR Norhasmani M, Abby Ang SY,Rashidah AR, Omar O, Norfajariah I, Arzarizah A.

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PP-30 MENGURANGKAN KADAR KEJADIAN LSCS WOUND BREAKDOWNAnna T, Masni L, Lena C, Chua YL, Jeanyfer L, Mohd FA, Lucina L.

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PP-31 MENINGKATKAN AKTIVITI FIZIKAL MELALUI KEMPEN 10,000LANGKAH DI KALANGAN MASYARAKATNorasikin M, Rubiah L, Masriah M, Zaitun I, Masliza M, Roslenda M.

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PP-32 ADHERENCE PROGRAMME TO IMPROVE TREATMENT RESPONSE IN

HIV TREATMENT-NAVE PATIENTS AT INFECTIOUS DISEASE CLINICChow TS, Low LL, Zuhaila MI, Cheang LF, Asma A, Zakiah K,Norlizawati S.

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Farawahida Kasmira F, Nur Liyana I, Nurul Ain MZ, Abdul Mutalib O, Mazliana A, Maizun MZ, Laila A.Jabatan Oftalmologi, Hospital Kuala Krai, Kelantan.

Pemilihan Peluang untuk Penambahbaikan

Ambliopia boleh berlaku pada pelbagai peringkat umur dan jika tidak dirawat awal boleh menyebabkan kebutaankekal. Peningkatan tahap penglihatan (VA) di kalangan pesakit Ambliopia yang komplians terhadap rawatanpengatupan boleh mencapai 77%. Seterusnya, meningkatkan komplians terhadap rawatan pengatupan akanmeningkatkan VApesakit Ambliopia.

Pengukuran Utama Penambahbaikan

Untuk menilai VA dan mengenalpasti faktor yang menyumbang kepada VA di kalangan pesakit Ambliopia yangmenjalani rawatan dan seterusnya menjalankan tindakan penambahbaikan bagi meningkatkan VA kepada 77%.Komplians dinilai dengan memakai kaca mata beralat refraksi terkini, membuat rawatan pengatupan 2 jam seharidan menghadiri temujanji.

Proses Pengumpulan Maklumat

Kajian bermula Jun 2009 hingga Mac 2011. Maklumat diperolehi dengan menggunakan borang soal selidik, bukutemujanji pesakit dan kad rawatan pesakit. Kajian penilaian keberkesanan tindakan penambahbaikan dijalankanterhadap pesakit dan kakitangan klinik.

Analisa dan Interpretasi

Peningkatan VA ialah 12% manakala faktor penyumbang kepada VA pesakit Ambliopia ialah kurang pengetahuantentang rawatan, waktu sekolah yang panjang (lebih 7 jam), tidak faham arahan pengatupan, tidak yakin kepadarawatan pengatupan, tidak memakai kaca mata dengan ralat refraksi terkini dan gagal menghadiri temujanji yangditetapkan.

Strategi Penambahbaikan

Menyediakan Prosedur Operasi Terpiawai (SOP) pengendalian pesakit Ambliopia, menjalankan aktiviti pendidikankesihatan dan meningkatkan kemudahan sistem temujanji.

Kesan Perubahan

Kajian menunjukkan VApesakit Ambliopia telah meningkat kepada 78% dengan peningkatan komplians terhadaprawatan pengatupan.

Langkah Seterusnya

Memastikan pengendalian semua pesakit Ambliopia mengikut Prosedur Operasi Terpiawai (SOP) sertamempertingkatkan aktiviti pendidikan kesihatan dan program saringan penglihatan di peringkat tadika, sekolahrendah serta projek komuniti sebagai langkah pencegahan Ambliopia.

OP-02Meningkatkan Tahap Penglihatan Pesakit Ambliopia diKlinik Oftalmologi


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Elengovan V, Nazri A, Yong KK, Zafri Y, Liew CF.

Bahagian Pengurusan Latihan, Kementerian Kesihatan Malaysia, Wilayah Persemutuan Putrajaya.


Hasrat Institusi Latihan Kementerian Kesihatan Malaysia adalah untuk melahirkan anggota kesihatan yang berilmu,kompeten dan pengamal selamat bagi merealisasikan dasar dan wawasan kesihatan Negara. Walaubagaimanapun,kemampuan dan kualiti graduan yang dihasilkan sering dipersoalkan. Isu kurang kompetens serta faktor sepertipeluang pendedahan, suasana pembelajaran, penyeliaan, kerelaan pesakit, isu keselamatan pesakit danperundangan membawa kepada theory-practice gapdi unit klinikal.


Kajian ini bertumpu ke arah meningkatkan kompetensi pelatih ke paras piawai 85%. Model of Skills Acquisition(Dreyfus & Dreyfus, 1980) digunakan sebagai indikator bagi mengukur kombinasi kemahiran, pengetahuan, sikap,nilai dan keupayaan pada peringkat kompetens dalam pengendalian kes klinikal.


Kajian ini dijalankan dari 4 hingga 30 Julai 2010 dan melibatkan sampel seramai 50 orang pelatih dari KolejPembantu Perubatan Ulu Kinta, Alor Setar, Seremban dan Kuching. Ujian Objective Structured ClinicalExamination (OSCE) berasaskan senario klinikal digunakan untuk mengukur komponen kompetensi sebelum danselepas intervensi simulasi.

Analisis dan Interpretasi

Hasil kajian sebelum intervensi menunjukkan bahawa pelajar hanya mampu memperolehi min skor 51.19% dengansisihan piawai 10.89. Prestasi ini tidak memenuhi piawai latihan.


Sebagai langkah penambahbaikan, Kolej Pembantu Perubatan telah memperkenalkan pendekatan IntervensiSimulasi Klinikal dalam Meningkatkan Kompetensi Pelatih. Integrasi simulasi dalam pedagogi latihan menggunakansenario kes klinikal sebagai stimulus pembelajaran dan dibantu oleh pelakon, manikin, peralatan ICT sertapengajar sebagai fasilitator dalam pengendalian kes klinikal.

Kesan Penambahbaikan

Kajian keberkesanan menunjukkan bahawa gabungan program simulasi dan penempatan klinikal (Study Group)dapat menganjakkan prestasi dan kompetensi pelatih dari paras 51.2 % ke paras 77.3 % (Pre-test- x: 51.19; sd:10.89; Post-test- x: 77.30, sd: 6.90)berbanding dengan pelajar yang hanya mengikuti program penempatan klinikaldi Hospital (Control Group Pre-test- x: 43.72; sd: 12.09; Post-test- x: 55.09, sd: 14.72). Walaupun piawai yangditetapkan adalah 85.0%, intervensi ini telah memberi impak dan kejayaan dalam meningkatkan prestasi,kompetensi dan keyakinan pelatih.

Langkah Seterusnya

Aktiviti pengajaran dan pembelajaran yang menggunakan pendekatan simulasi klinikal dapat membangunkankompetensi klinikal disamping memudahcarakan pemindahan ilmu kepada situasi klinikal sebenar. Impak dankejayaan projek ini memberi ruang dan peluang bagi memperluaskan dan mengintegrasikan konsep simulasi klinikaldalam kurikulum serta membangunkan konsep makmal simulasi.

OP-03Meningkatkan Kompetensi Pelatih Program DiplomaPembantu Perubatan melalui Intervensi Simulasi Klinikal


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Nor Sarah A, Suhaila AK, Nur Arliza P, Wan Mohd Ridzuan WJ.Klinik Pergigian Peringgit, Melaka.


Ibu mengandung, selain mengalami masalah karies, cenderung mendapat penyakit gusi (periodontium) keranaperubahan hormon semasa hamil. Jika dibiarkan, penyakit periodontium mendedahkan ibu mengandung kepadarisiko mendapat kelahiran pramatang dan bayi dilahirkan kurang berat badan. Sejak tahun 2004 hingga 2009didapati kehadiran ibu mengandung ke Klinik Pergigian Peringgit sekitar 30% sahaja.


Peratusan kehadiran baru ibu mengandung ke klinik pergigian berbanding kehadiran baru ibu mengandung ke KKIAadalah indikator District Specific Approach (DSA)yang ditetapkan dengan piawaian lebih dari 50%.


Kajian irisan lintang dijalankan pada Januari dan Februari 2010 bagi mengenalpasti faktor ibu mengandung kurangmembuat pemeriksaan gigi. Dua set borang soal selidik melibatkan 40 orang ibu mengandung dan 22 orang anggotapergigian dan Klinik Kesihatan Ibu dan Anak (KKIA) digunakan.

Analisis dan Intepretasi

Majoriti ibu mengandung tahu mengenai penyakit pergigian (71.1%) dan pernah diberitahu agar membuatpemeriksaan gigi (68.4%). 57.9% menyatakan mereka telah membuat pemeriksaan gigi. Majoriti (73.7%) tidakpernah diberi ceramah mengenai kesihatan pergigian. 92.1% menyatakan tiada masalah untuk pergi membuatpemeriksaan di klinik gigi di tingkat atas. Majoriti dari anggota pergigian dan KKIA (68.2%) menyatakan bahawamaklumat kesihatan pergigian di KKIA tidak mencukupi.


Beberapa langkah penambahbaikan telah dilaksanakan termasuklah menempatkan Pegawai Pergigian di KKIA,mewujudkan borang pemeriksaan dan rujukan untuk rawatan pergigian yang akan dikepilkan ke dalam bukuantenatal bagi tujuan peringatan serta mengelakkan dari keciciran ibu mengandung mendapatkan pemeriksaanpergigian. Selain itu, pamplet dan poster kesihatan pergigian diedarkan di KKIA sebagai bahan bacaan ibumengandung dan Fast lane bagi ibu mengandung yang datang mendaftar di klinik pergigian.


Peratusan kehadiran baru ibu mengandung meningkat kepada 60.5% (Jan-Dis 2010).

Langkah Seterusnya

Kerjasama berterusan antara pihak pergigian dan KKIA akan dipertingkatkan. Laporan kehadiran ibu mengandungke klinik pergigian akan dihantar ke KKIA & Pegawai Perubatan Daerah (PPD) untuk makluman dan pemerhatian.Ibu mengandung yang tercicir akan dihubungi melalui telefon untuk temujanji pemeriksaan pergigian.

OP-04Meningkatkan Kehadiran Ibu Mengandung ke KlinikPergigian


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Wan Najbah NN, Ngan YS, Muhd Nor Hazli N, Ng KY, Ching MW, Tan HF.Pharmacy Department, Putrajaya Hospital, Wilayah Persekutuan Putrajaya.

Selection of Opportunities for Improvement

The Computer-based Physician Order Entry (CPOE) system has been shown to reduce the number of prescriptionerrors. However, it may also lead to new kinds of prescription errors. A study in 2009 in Putrajaya Hospitaldemonstrated that the percentage of prescription errors in in-patient pharmacy was 5.32%. This project aimed toreduce the percentage of prescription errors in in-patient pharmacy, Putrajaya Hospital (HPJ).

Key Measures for Improvement

The proposed standard for percentage of prescription errors in Putrajaya Hospital (HPJ) was 0%.

Process of Gathering Information

All in-patient prescriptions were sampled from 18 till 24 October 2010. During this phase, doctors were asked the

reasons for occurrence of errors. The contributing factors for errors were determined by distributing self-administered questionnaires to all doctors in wards. Following remedial measures, two more phases of datacollection were carried out to evaluate its effectiveness.

Analysis and Interpretation

First phase data collection detected 69 prescription errors out of 962 prescriptions (7.17%). Most (88%) prescriptionerrors involved houseman doctors and generally involved antibiotics (31.8%). Surveys revealed that the mostcommon problem faced by doctors was unsure of dosage regime (42.4%).

Strategies for Improvement

Remedial actions carried out included promotion of Drug Information Services, distribution of dosage mini cards towards, presentation of project findings to the Head of Departments and also the distribution of pocket sizereference dosage cards to houseman doctors.

Effects of Change

Following remedial actions, the percentage of prescription error dropped from 7.17% to 2.25% and later slightlyincreased to 2.94%.

The Next Step

Medication ordering training needs to be incorporated during IT orientation for new doctors. Also, defaultdosing for commonly prescribed drugs was proposed. Although CPOE reduced the number of prescription errors,more human effort and IT intelligence will be needed to prevent prescription errors.

OP-05Reducing E-Prescription Error in a Hospital In-patientPharmacy


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Tan PL, Azhari Wasi NA, Dhillon HK, Buang A, Sulaiman CZ, Mohd Zakaria IE, Tan WC, Poopaladurai D.Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur.


Oncology patients and/or their caregivers were subject to the inconvenient process of obtaining special formularycytotoxic drugs due to the different locations of cytotoxic drugs in University Malaya Medical Centre (UMMC). Theprocess also caused delays in reconstitution of drugs and thus, administration time. Therefore, the aim of thisproject was to re-engineer the current process to increase patients satisfaction.


Reduction in time spent by patients to obtain cytotoxic drugs (


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October 2011

7

Norasikin M, Zaitun I, Roslenda M, Mazliza M, Rubiah L, Masriah M.Pejabat Kesihatan Pontian, Johor.


Anemia semasa hamil boleh menyebabkan morbiditi dan mortaliti kepada ibu hamil dan anak yang dikandung.Prevalens anemia di kalangan ibu hamil Daerah Pontian masih tinggi iaitu di antara 25% hingga 33% dari tahun 2001hingga tahun 2003.


Menurunkan prevalens anemia di kalangan ibu hamil pada usia kandungan 36 minggu. Standard yang ditetapkanadalah kurang dari 10 %.


Kajian irisan lintang telah dijalankan pada bulan Januari hingga Disember 2004. Seramai 671 ibu hamil telah dipilihsecara rawak di kalangan yang bersalin pada tahun 2003.Borang soal selidik dan kad ibu hamil digunakan untukmengetahui faktor yang mempengaruhi anemia di kalangan ibu hamil.


Hasil kajian menunjukkan daripada 671 responden, seramai 224 (33.4%) mengalami anemia bagi tempoh satutahun. Hanya faktor klinik kesihatan, status pekerjaan, cara kelahiran dan cara pengambilan bersama hematinikmempengaruhi status anemia di kalangan ibu hamil (p


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October 2011

8

Rosdi MZ, Dang CC, Ku SC, Norshazareen AM, Lim CW, Tan BL.Pharmacy Department, Melaka Hospital, Melaka.


Non-adherence to blood sampling time may lead to inaccurate recommendation of drug dosage or frequency givenby the pharmacist and this may then lead to drug toxicity or inadequate therapeutic response.


Adherence to blood sampling time was defined as blood samples that are taken according to the Therapeutic DrugMonitoring (TDM) Guidelines on Blood Sampling Time. The Standard of Good Care was set with the target ofadherence to blood sampling time being more than 90%.


A data collection sheet was prepared and TDM forms were screened. TDM forms received from all the wards ofMelaka Hospital were included except from Psychiatric Wards, Outpatient Clinics and other hospitals or polyclinics.Data needed were transferred from TDM forms to data collection sheet. The same process was done for TDM formsreceived in August 2009, February 2010 and August 2010.


Percentage of adherence to blood sampling time was 45.9% before the remedial measures.

Strategy for Change

A series of talks were given to pharmacists, nurses and doctors. A reminder sticker was introduced to the currentsetting. Besides, TDM Guidelines on Blood Sampling Time was distributed to all the wards in Melaka Hospital.

Effects of Change

The adherence had increased to 61.8% after the first remedial measure and had further improved to 88.6% afterthe second remedial measure.

The Next Step

All remedial measures taken were shown to improve the adherence to blood sampling time for TDM in MelakaHospital. However, the target set in Standard of Good Care has not been achieved yet. More studies will beconducted to further improve the current system.

OP-08Improving Adherence to Blood Sampling Time forTherapeutic Drug Monitoring in a Government Hospital


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October 2011

9

Zalina I, Wan Asim WA, Idris L, Aida Fadriah M, Wan Raihana WA,Yang SA, Kumar J, AlHindi R, Gisely V.BRAINetwork Centre for Neurocognitive Science, School of Health Sciences, Universiti Sains Malaysia, KubangKerian, Kelantan.


There was a daily loss of about 0.9 hours of productivity due to decreased mental alertness. Many nurses utilisedsocial networking sites, tea breaks or personal discussions to refresh their minds and find it difficult to get back totheir job. An opportunity existed for creating a cheap and an effective way of improving alertness withoutsacrificing money, time or productivity.

Key Measures of Improvement

The BRAINwaves System was expected to improve alertness, productivity, focus and wellness by 50%.


The Blue Ocean Strategy and Prashnigs Working styles analysis were used to identify neurocognitive health issuesof 70 administrators and nurses in the Intensive Care Unit and Operating Theatres of Universiti Sains Malaysia(USM) between January and June 2011.


Fifty percent of respondents indicated that decreased alertness was a major neurocognitive problem while lack ofsocialisation, lack of reward and recognition and unsatisfactory facilities scored 20%.

Strategy for Change

The BRAINwaves System was developed and an interventional study was carried out. Respondents were randomlyselected for confirmatory electroencephalography tests. Neurocognitive changes were also assessed by the

Cambridge Neuropsychological Test Automated Battery (CANTAB).

Effects of Change

BRAINwaves improved alertness, productivity, focus and wellness by 85%, lowered costs by 96%, with projectedsavings of RM122 000/ year. Focus group studies indicated that BRAINwaves met current market needs andcreated value innovation by improving mental alertness across five different domains. It is highly specific yetdiverse enough to cut across communities, age groups and cultures.

The Next Step

The BRAINwaves System is highly effective and will be applied to all administrators and nurses in USM as part of amanagement effort to improve productivity in the workplace by improving neurocognitive health.

The BRAINwaves System: Development of a MindStimulating System to Improve Neurocognitive Health byIncreasing Alertness in the Workplace

OP-09


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October 2011

10

Nancy B, Sania L, Diviki T, Anita M, Zabidah J, Rusti T, Jockina M.Hospital Wanita dan Kanak-Kanak, Kota Kinabalu, Sabah.

Pemilihan Peluang Untuk Penambahbaikan

Sebilangan 20-40% pesakit yang dimasukkan ke Wad Obstetriks & Ginekologi (O&G) dan 100% pesakit yangmenjalani pembedahan, dirawat dengan infusi intravena (IV). Hasil audit bagi tiga tahun berturut-turut 2008-2010 menunjukkan pencapaian Wad O&G hanyalah mematuhi StandardOperating Procedure (SOP)sebanyak 65-69%dan tidak mencapai sasaran yang ditetapkan oleh Unit Kejururawatan, Jabatan Kesihatan Negeri Sabah.


Indikator yang dikenalpasti adalah peratusan kepatuhan penjagaan perawatan pesakit dengan infusi IV mengikutSOP dengan standard lebih 80%.


Semua Jururawat U29 di Wad O&G dan pesakit dengan infusi IV diambil sebagai sampel kajian. Kajiandilaksanakan dari 1 hingga15 Disember 2010. Borang soal selidik digunakan untuk mengkaji pengetahuanjururawat berkaitan perawatan pesakit dan menilai keberkesanan pemberian penerangan kepada pesakitsebelum dan semasa pemasangan infusi IV. Senarai semak digunakan untuk menentukan dan memerhaticara perawatan yang diberikan.


Didapati daripada sejumlah 110 jururawat, 20% dikenalpasti kurang pengetahuan berkaitan cara mengira titisaninfusi IV. Faktor lain mempengaruhi ketidakpatuhan terhadap perawatan pesakit infusi IV adalah beban tugasyang tinggi, tiada semakan regim, melayan pesakit, kurang pemantauan, regim kurang jelas dan salah pengiraantitisan/kalibrasi oleh jururawat. 75% pesakit tidak diberikan penerangan sebelum pemasangan infusi IV.


Strategi yang dilaksanakan termasuklah mengadakan sesi ceramah dan pembelajaran berterusan dari wad kewad berkaitan Prosedur Infusi Intravena; bengkel memantap cara pengiraan infusi IV regim; programberstruktur kepada jururawat lantikan baru atau baru pindah dan memantapkan kecekapan pemantauanklinikal. Mesyuarat bersama Ketua Jabatan berkaitan penyediaan regim tepat dan jelas turut diadakan.Memantapkan pemberian penerangan kepada pesakit mengenai penjagaan infusi IV secara tidak langsungmemberikan peranan/kuasa kepada pesakit untuk melibatkan diri bersama jururawat dalam menjaga infusi IV.


Selepas enam bulan, pelan penambahbaikan telah meningkatkan peratusan kepatuhan terhadap perawatanpesakit dengan infusi IV daripada 69% meningkat kepada 87% dan melepasi sasaran yang ditetapkan.

Langkah Seterusnya

Sesi pembelajaran berterusan, pemantauan indikator setiap 6 bulan dan berterusan untuk pengekalan danpeningkatan kepatuhan kepada SOP. Jururawat perlu komited, supaya ia menjadi amalan budaya perawatan.

Meningkatkan Peratusan Kepatuhan Terhadap PerawatanPesakit dengan Infusi Intravena di Wad Obstetriks &Ginekologi

OP-10


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October 2011

11

Yuzainov A, Nurul Khairiyah K, Norul Akhma AH, Rahmah N, Norraihan H, Suriwati I.Hospital Seberang Jaya, Penang.


A retrospective analysis in the Obstetrics and Gynaecological (O&G) Department, Seberang Jaya Hospital revealedthat only 24% of babies with fetal distress were delivered within 30 minutes (via caesarean section) from July toDecember 2007. This can result in an increase in perinatal morbidity and mortality. This study intended to improvethe rate of babies delivered with fetal distress within 30 minutes.


This study aimed to re-engineer the process involved from decision making to delivery of baby. A standard of morethan 70% of babies delivered within 30 minutes was set.


A prospective study (pre-remedial) was carried out from April to May 2008. The staff were assessed on theirknowledge on the urgency to deliver babies with fetal distress using self-administered questionnaires. A data sheeton the time sequence from decision for caesarean section till delivery of baby was designed.


6.25% of babies were delivered within 30 minutes during the pre-remedial study. Delay in preparing and sendingpatient to OT was among the major contributing factors identified.

Strategy for Change

Seminars and drills were carried out to improve staff knowledge on the urgency to prepare patient for caesareansection. Delay in sending patients was attributed to lengthy report writing. Hence a simplified nursing report formwas created to expedite the process. A caesarean section kit was also innovated to expedite preparation of

patient.

Effects of Change

The rate of babies with fetal distress delivered within 30 minutes increased from 6.25% (pre-remedial) to 46.9%(3rdcycle). There was also an improvement on staff knowledge from 18% (pre-remedial) to 95% (3rdcycle). ABNAwas reduced from 63.8% to 23.1%.

The Next Step

The simplified nursing report form and caesarean section kit were adopted for other cases of caesarean section.The improvement in the re-engineering of the work process will also be shared with other hospitals in our country.

Improving Time Interval from Decision to CaesareanDelivery for Fetal Distress CasesOP-11


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October 2011

12

Nor Jumizah AK, Lim KY, Faridah MY, Wan Mazlina WR, Maziati M, Suhainiza S, Norleeza MN.Department of Obstetrics and Gynecology, Kemaman Hospital, Terengganu.


2006-2008 statistics had shown that post partum haemorrhage (PPH) was one of the major problems faced by theObstetrics and Gynaecology Department in Hospital Kemaman, which contributed towards the increased morbidityand mortality rate of pregnant mothers. The aim of this study was to identify the contributing factors and toreduce the incidence of PPH in Lower Segment Caesarian Section (LSCS).


We set a standard of LSCS without PPH at 90%.


A cross sectional clinical study was carried out from July 2008 to December 2009. Data were obtained frommaternal notes and questionaires. The rate of LSCS without PPH were calculated by incident of LSCS without PPHdivided by total LSCS multiplied by 100. The research tool used was self administered questionnaire.


Our verification study showed the incidence of LSCS without PPH was only 83.5%. PPH in LSCS was associated withdelay in calling for help by the junior doctors, surgery related factors, uterine factors and inappropriateness ofmeasures taken to prevent PPH as well as lack of staff knowledge and urgency.

Strategy for Change

The remedial measures taken were training module on LSCS for medical officers, emphasis on early call for help bymedical officers, LSCS training module, CME sessions for doctors and paramedics and application of safe surgeryprotocol. Patients were prepared for surgery in accordance to their risk factors and cases were delegated to

surgeons based on risk, seniority and experience of the surgeon.

Effects of Change

The incidence of LSCS without PPH increased from 83.5% to 92.5 %.There was an increased in awareness of callingfor help early and knowledge of staff had also improved .

The Next Step

The remedial measures carried out had been effective, thus it shall be applied constantly and improvement will bemade along the way. Our next aim is to carry out an observational study on Surgery relat ed reasons of PPH inLSCS which will assist us in improving the remedial actions implemented in this QA study.

Increasing Lower Segment Caesarian Section without PostPartum HaemorrhageOP-12


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October 2011

14

Suzaini MD, Junaidah I, Norhayati S, Nur Hazwani R, Rosnani R.

PKD Kangar, Perlis.


Di Perlis, peratus ibu hamil dengan anemia pada 36 minggu melebihi standard Kementerian Kesihatan Malaysia.Pengurusan kes yang kurang sistematik dan tidak mengikut Clinical Pactice Guideline dikenalpasti sebagaipenyumbang kepada masalah.


Meningkatkan pengurusan yang efektif (mengikuti kesemua 4 elemen dalam strategi penambahbaikan) danmengurangkan peratus ibu hamil dengan anemia pada 36 minggu kepada kurang dari 26% (mengikut KPIKesihatanKeluarga).


Tiga kajian verifikasi dijalankan pada 2009 menggunakan kad KIK/1(b)/96 melibatkan 151 ibu hamil.


Hasil kajian mendapati pengurusan yang efektif hanya kepada 51 (33.8%) kes. Pemberian zat besi (iron) profilaksissecara oral adalah 9.4% dan terapeutik 24.4% sahaja. Penyiasatan Iron Deficiency Anaemia (IDA)dilakukan untuk47 (31%) kes. Hanya 11 (7.3%) ibu menerima rawatan parenteral. Kajian KAPmendapati 60% anggota kejururawatankurang arif mengenai pengurusan kes anemia


Empat penambahbaikan dilaksanakan bermula April 2010: (i) Mewajibkan pengesahan IDA atas kes anemia (ii)Pemberian profilaksis zat besi secara oral (Ferrous Fumarate 200 mg b.d) kepada ibu dengan Hb normal semasabooking (iii) Memulakan rawatan terapeutik (Ferrous Fumarate 400 mg b.d) serta-merta apabila Hb


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October 2011

15

Noor Mariati O, Siti Masyitah MT, Noorulhuda S, Lee LG, Azizah M, Khairul Anuar M, Norsiah MN.Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang.


Item bukan ubat perlu dipesan sebulan sekali. Peratusan pesanan luar jangka yang tinggi disebabkan olehkelewatan penerimaan barang daripada pembekal, stok dalam stor tidak mencukupi untuk dibekalkan, tiadasenarai alat dan senarai piawai alat dari unit pemesan, tiada sistem pemantauan stok yang sistematik, ruangpenyimpanan yang terhad dan penyusunan barang yang tidak sistematik serta pesanan bulanan tidak mengikutjadual. Objektif kajian ialah mengurangkan kekerapan pesanan luar jangka dengan mengenalpasti kekerapanpemesanan luar jangka, faktor penyumbang dan menentukan langkah penambahbaikan serta menentukankeberkesanan langkah yang diambil.


Indikator kajian ialah peratus pesanan luar jangka yang diterimadengan standard kurang dari 20%


Data pesanan luar jangka diperolehi dari buku daftar pesanan. Maklumat lain diperolehi melalui soal selidik danpemerhatian menggunakan borang pengumpulan data.


Peratus pesanan luar jangka sebelum penambahbaikan dilakukan ialah 60.7%. Faktor penyumbang utama kekerapanpesanan luar jangka ialah senarai piawai minima dan maksima item bukan ubat dari unit pemesan iaitu 90% danpesanan tidak mengikut jadual sebanyak 100%.


Empat strategi telah dilaksanakan iaitu mengadakan taklimat pengurusan stor kepada pegawai yang menjaga

unit/wad terlibat, penguatkuasaan jadual pesanan bulanan, mewujudkan senarai minima dan maksima item bukanubat dan pemantauan stor secara berkala.


Hasil langkah penambahbaikan yang telah diambil adalahpenurunan pesanan luar jangka dari 60.7% ke 33.3%. Inimasih tidak mencapai standard yang ditetapkan iaitu 20%.

Langkah Seterusnya

Kajian lanjutan akan diteruskan untuk mengenalpasti faktor lain yang boleh menyebabkan peratusan pesanan luarjangka yang tinggi serta langkah penambahbaikan yang perlu diambil untuk mengatasinya.

Mengurangkan Kekerapan Pesanan Luar Jangka dari UnitPemesan bagi Item Bukan Ubat di Unit Perolehan danPembekalan

OP-15


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October 2011

16

Shakirin SR, Izrul Azwa ML, Tan SY, Cheah SY, Wong MK, Chiew CW.

Department of Pharmacy, Labuan Hospital,Wilayah Persekutuan Labuan.


Inappropriate Warfarin dose was associated with higher bleeding events. Only 38.7% individual InternationalNormalised Ratio (INR) values of Warfarin patient are within targeted INR range. Collaboration between physiciansand pharmacists, who managed Warfarin Medication Therapy Adherence Clinic (MTAC), was introduced to closelymonitor INR and counsel regarding drug-drug interactions, dietary intakes and lifestyle. This study aimed toimprove targeted INR value of Warfarin patients with increased involvement of pharmacists.


Warfarin MTAC pharmacists in Labuan Hospital decided to set standard percentage of individual INR reading withinthe targeted therapeutic range of at least 50%.


23 patients were involved in this study. Their INR readings from June to November 2009 were obtained from theirBed Head Ticket (BHT). Pre intervention investigation found that lack of pharmacist involvement contributed tothe non achievement of targeted INR value of Warfarin patients.


Of the 191 individual INR values from the 23 patients, only 38.7% were categorised as good.Good is defined asvalues within the target. Prior to Warfarin MTAC, the following flaws were observed: there was no record ofWarfarin counseling, proper documentation of INR reading in the BHT nor was there any standard Warfarin bookletgiven to patients. Supply of warfarin was obtained from the FarmasiKlinik Pakar.

Strategy for Change

We have implemented a one-stop service centre of Warfarin MTAC. The patients blood samples were taken by thepharmacist using Point-of-care (POC) instrument and Warfarin was supplied during the Warfarin MTAC session.Patients also received standard Warfarin booklets where INR values and Warfarin doses were recorded. Warfarinpatients also received continuous individual counseling sessions.

Effects of Change

After implementation, the number of individual INR readings within target range increased from 38.7% to 55.9%.

The Next Step

The Warfarin MTAC pharmacists now aims to achieve improved patients INR reading targeted above 70% in thepharmacy practice with regular assessments.

Role of the Pharmacist in Improving Targeted InternationalNormalised Ratio Value of Patients on Warfarin TherapyOP-16


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October 2011

19

Gadung A, Christina BL, Adeline WSF, Juliana H, Hilda B, Iya R.Kuching Divisional Health Office, Sarawak.


The incidence of Severe Neonatal Jaundice (SNNJ) in Kuching District increased from 119.3 per 10,000 live births in2005 to 123.3 per 10,000 live births in 2008, which was above the standard of the National QAP Indicator of 100per 10,000 live births.


The objective of this study was to reduce the incidence of SNNJ in Kuching District from 121.34/10,000 ExpectedLive Birth (ELB) to below 100/10,000 Expected Live Birth (ELB).


This study used a cross sectional design covering a period of six months. The sample comprised 113 nurses of all

categories working in urban and rural maternal and child health clinics in Kuching District. Tools used in the studywere self-administered questionnaires in English and Bahasa Malaysia.


The pre-intervention survey on nurses showed that only 56.6% were able to identify the risk factors for jaundice;94.6% were able to define jaundice; 41.5% were able to detect jaundice while 70.8% knew sign of kernicterus. Asfor normal post natal nursing schedule (Day 1,2,3,4,6,8,10 and day 20 post natal), only 40.7% were able to practicethe schedule while only 69.0% were able to give advice on management of jaundice.

Strategy for Change

The interventions were Continuing Nursing Education sessions which included new nursing formats and newreporting procedures. Vehicles were also provided for home nursing.

Effects of Change

Post intervention; 63.2% of nurses were able to identify the risk factors causing jaundice; 97.2% were able todefine jaundice while 97.2% were able to detect jaundice and 88.6% know sign of kernicterus. In term of practisingrecommended post natal nursing schedule, it had increased to 49.9 % while 92.0% were able to give advice tomother on management of jaundice. Second day postnatal nursing increased from 16.7% to 65%. The incidence ofSNNJ dropped to 78 per 10,000 live births in 2010.

The Next Step

The interventions helped to improve the knowledge and practice of recommended measures to detect neonataljaundice early. Stronger emphasis will be placed on using the new reporting procedures and new nursing sheets.Continuous monitoring through regular nursing audits is also essential to reduce the incidence of SNNJ. Provision ofvehicles for all busy maternal and child health clinics for home nursing care is to be continued.

Value Added Features

The interventions undertaken is effective and to be included for National Indicator Approach (NIA).

OP-19 Reducing Incidence of Severe Neonatal Jaundice


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October 2011

20

Subramaniam T1,Fudziah A1, Jeyaindran S2, Suliyana Y1, Lim SC1, Chong MF1, Cheng PL1, Teng SC1.1Department of Pharmacy, Kuala Lumpur Hospital.2Department of General Medicine, Kuala Lumpur Hospital, Wilayah Persekutuan Kuala Lumpur.


Non-achievement of International Normalised Ratio (INR) among warfarinised patients results in poor clinicaloutcomes and increased healthcare cost.


The key measures for improvement were percentage of INR readings within target range (2 - 3), patients warfarintherapy knowledge and clinic waiting time.


The selected measures were assessed both in the pre and post-remedial actions phase. Five INR levels of 331patients were collected. A survey was conducted to assess the clinic waiting time and a questionnaire wasadministered to assess patientsknowledge of warfarin therapy.


Almost 50% (827 readings) of the INR levels did not meet the INR target. The average clinic waiting time perpatient among 100 patients was 202 minutes and these patients were only able to answer on average 10 out of 18questions correctly.

Strategy for Change

The implementation of the remedial action is an on-going process and the remedial actions were implemented inthree phases based on process, knowledge and attitude. The process in terms of blood taking method and clinicappointment was improved. Education sessions for both patients and healthcare personnel were provided to

improve their knowledge on warfarin therapy. A drug consumption calendar was given to every patient toencourage positive attitude towards warfarin therapy. Improved dosing method was used in Phase 2 whereaspatients reminders were used in Phase 3.

Effects of Change

The percentage of INR levels within target range increased by 16 % upon the implementation of the remedialactions. The average clinic waiting time was reduced by 51.5% to 98 minutes. Average warfarin therapy knowledgequestions answered correctly improved by 40%. In terms of the satisfaction, 90% of the patients were satisfied withthe time, information provision and overall clinic management. In Phase 2, the percentage of INR reading withinrange for the selected patients improved from 60% to 72%. Phase 3 is in progress.

The Next Step

Quality improvement in managing warfarinised patients is a continuous, multi disciplinary, patient oriented

approach. These clinic-based remedial actions will be expanded to Fridays. We will explore the possibility ofconducting a pharmacoeconomic study.

Achieving International Normalised Ratio Targets andSatisfaction of Warfarinised PatientsOP-20


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October 2011

21

Adeline ML Khaw, Chariya Eh Chot, Ng SL, Rosli A.Department of Ophthalmology, Hospital Taiping, Perak.


Diabetic Retinopathy (DR) is a microvascular complication of patients with diabetes. Those who have Severe Non-Proliferative DR (Severe NPDR) are at high risk (one year risk of 50.2%) of progressing to Proliferative DR (PDR)with subsequent poor visual outcome due to vitreous haemorrhage and/or retinal detachment. This study wascarried out to identify the contributing factors, develop effective remedial measures and thus, delay theprogression of this potentially blinding complication.


We aimed to reduce the above percentage of 50.2% to 20%, based on the target set by our department.


This project was divided into 4 parts. A retrospective analysis was done over a 2 year period (January 2007 toDecember 2008) to identify contributing factors (n=12). Remedial measures have been carried out since January2009. Evaluation on its effectiveness was carried out from March 2009 to April 2010 (n=20). A sustainability reviewwas held from June 2009 to July 2010 (Part 1, n=20) and August 2010 to April 2011 (Part 2, n=15).


Four contributing factors were identified namely, long waiting time for new cases, poor glycemic control, lownumber of referrals to nearest clinics for better glycemic control and delay in initiating Laser Treatment.

Strategy for Change

Remedial measures included starting Laser Treatment at Severe NPDR stage, strict supervision of learning doctors

during Laser Treatment, giving appointment to new patients with diabetes within 6 weeks, lifestyle modificationcounselling and referring of patients with poor glycemic control (FBS > 10mmol/l) to the nearest clinic. Thesemeasures involved all doctors and paramedics in our department.

Effects of Change

There was a significant reduction in the percentage of clinical progression of Severe NPDR cases to PDR stage from67% in 2007, 70% in 2008 to 10% in March 2009 until April 2010. A lower percentage of 5% was recorded in ourSustainability Review period (Part 1) and similarly 6% in Part 2.

The Next Step

This project had raised awareness among our doctors to be more vigilant in DR cases. We had started introducingmonthly Fundus Camera screening programme in nearby government clinics.

PP-01

Reducing the Percentage of Clinical Progression of SevereNon-Proliferative Diabetic Retinopathy Cases toProliferative Diabetic Retinopathy Stage Over 1 Year in anOphthalmology Department


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October 2011

22

Azraei R, Ganggaraj A, Abdul Hamid MD.

Jabatan Kesihatan & Alam Sekitar, Dewan Bandaraya Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur.

Pemilihan Peluang Untuk Penambahbaikan

Tinjauan yang telah dijalankan mendapati kebanyakan pengusaha premis makanan di Wilayah Persekutuan KualaLumpur telah membuang sisa minyak masak terpakai ke dalam longkang dan saliran awam. Senario ini akanmengundang banyak implikasi negatif terhadap kesihatan persekitaran.


Objektif program adalah mengurangkan pencemaran sisa minyak masak dan lemak di dalam longkang dan saliranawam serta membantu pengusaha restoran dan kedai makan melupuskan sisa minyak masak terpakai dengansempurna. Indikator yang dikenalpasti adalah tiada lagi aduan awam yang berkaitan dengan pencemaran longkangatau saliran dan peningkatan isipadu kutipan sisa minyak masak oleh pengusaha kedai makan. Piawaian yangdikenalpasti adalah berdasarkan pemerhatian fizikal iaitu kehadiran lapisan filem minyak dan lemak atas

permukaan air dan di tepi dinding longkang.


Kajian verifikasi data dibuat dari bulan Januari hingga Jun 2011. Lokaliti data merangkumi kawasan di sekitar JalanBukit Bintang, Jalan Alor, Kepong, Jalan Kelang Lama, Mont Kiara, dan Bangsar. Pengumpulan data adalah melaluirekod dan laporan kutipan sisa minyak masak terpakai dari premis makanan oleh kakitangan Dewan BandarayaKaula Lumpur dan panel swasta yang dilantik.


Pada tahun 2010 (Januari hingga Jun) 19, 212kg sisa minyak telah dikutip. Manakala pada tahun 2011 (Januarihingga Jun) 27, 446kg sisa minyak telah dikutip. Kadar peningkatan peratusan jumlah kutipan (kg) adalah sebanyak42%. Peningkatan sebanyak 42% ini menunjukkan tahap keberkesanan program telah diyakini sepenuhnya.


Suatu inovasi telah dikenalpasti bagi mengatasi masalah ini berserta peluang penambahbaikan yang berterusan.Bagi memastikan keberkesanan usaha ini, Dewan Bandaraya Kuala Lumpur (agensi kerajaan) akan menjalinkanusahasama secara 3 hala dengan kontraktor kutipan (agensi swasta) dan pengusaha kedai makan (komuniti). Selainitu, khidmat nasihat juga diberikan dari semasa ke semasa kepada para pengusaha kedai makan yang belum lagimempraktikkan kaedah ini.


Impak positif program ini adalah tiada lagi pembuangan sisa minyak ke dalam longkang dan saliran awam olehpengusaha kedai makan. Walaubagaimanapun, apa yang paling penting ialah program ini mampu membantu parapengusaha kedai makan/pusat penjaja untuk melupuskan sisa minyak masak dengan sempurna dan terurus.

Langkah SeterusnyaPencemaran longkang dan saliran awam dapat diatasi dengan lebih baik dan mampu menjanjikan pulangan yangbersih terhadap persekitaran alam semulajadi khususnya. Di samping itu, suatu keseimbangan ekologi antaramanusia dan alam sekitar juga mampu diperolehi kerana sisa minyak masak yang terpakai boleh dikitar semulauntuk penghasilan biodiesel yang berguna untuk keperluan manusia amnya.

PP-02Mengurangkan Pencemaran Longkang dan Saliran Awamoleh Sisa Minyak Terpakai


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October 2011

23

Hiew CY, Lee ML.Department of Pharmacy and Department of Paediatrics, Tuanku Jaafar Hospital, Seremban, Negeri Sembilan.


Medication administration errors are common occurrences in any hospital setting especially in a paediatric ward.This is because of the different doses required by the paediatric patients due to the differences in their weightand age. This study aimed to identify the common medication errors that occur in a general paediatric ward andmeasures that can be implemented to reduce these errors.


The Pharmacy Department had targeted to reduce any type of medication errors to 0%.


An audit was done in the general paediatric ward of Tuanku Jaafar Hospital, Seremban from November 2008 toNovember 2009. The audit was done using a pre-prepared checklist produced by the Pharmacy Department. Apharmacist observed nurses when they prepared and administered medications. There were 3 cycles in this audit.100 medications consisting of 50 oral and 50 intravenous, were conveniently chosen for each cycle. Interventionswere done after cycle 1.


The percentage of errors for intravenous drug administration was 34% while for oral drug administration was 38%.

Strategy for Change

Periodical briefings about medication administration were given to new staff nurses and a pharmacist wouldrandomly countercheck medication administration by selected nurses.

Effect of Change

Both of the intravenous arm and oral arm of the study showed a remarkable reduction in the number of nearmisses.The percentage of errors for intravenous drug administration was reduced from 34% to 16% while for theoral drug administration was reduced from 38% to 12%.

The Next Step

This system has been shown to be effective in reducing the number of medication administration errors in thegeneral paediatric ward. It should be applied in the normal practice during medication administration inconjunction with other measures as well.

PP-03Reducing the Number of Medication Administration Errorsin a General Paediatric Ward


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October 2011

25

Ruzita J, Dandaithapani T, Muslim AR, Rasidi D, Rozali I, Basiah A, Afidayati A.Department of Psychiatry, Tuanku Fauziah Hospital, Kangar, Perlis.


Readmission is commonly used as an outcome and quality indicator for inpatient services. Schizophrenia was foundto be the most commonly diagnosed mental illness among those readmitted into the psychiatric ward. The aims ofthis study were to reduce the frequency of readmission of patients with schizophrenia after last discharge from thepsychiatric ward, Tuanku Fauziah Hospital (HTF) and to look for factors that may contribute to this problem.


We decided to set the standard of rate of readmission of patients with schizophrenia within 6 months of lastdischarge to less than 25% in keeping with our national indicator for psychiatry.


All the psychiatric cases that were admitted into the psychiatric ward from 2008-2009 were identified and theircase notes were traced and reviewed. Eighty patients with schizophrenia admitted to the psychiatric ward fromJanuary-June 2010 that fulfilled the inclusion criteria were interviewed using a guided questionnaire.


There were 390 psychiatric cases admitted into the psychiatric ward in 2008 and 386 cases in 2009. Of these, 246cases (63.08%) were schizophrenia cases in 2008 and 277 (71.80%) in 2009. Of the 246 schizophrenia cases admittedin 2008, 93 (37.80%) of them were readmitted within 6 months of previous discharge. Of the 277 schizophreniacases admitted in 2009, 97 of them (35.02%) were readmitted within 6 months of previous discharge. The rate ofreadmission of the schizophrenia patients from 2008 to 2009 ranged from 10.02% to 12.80% higher than thestandard.

Strategy for Change

In this study, medication non-adherence and multiple social problems were the most important factors related tofrequency of readmission. Psychoeducation was given to improve their knowledge and reduce treatment non-adherence. Home visit services were strengthened to ensure the continuity of treatment and to empower supportfrom the caregivers.

Effects of Change

There was a reduction in the rate of readmission of schizophrenia patients after last discharge from 35.02% to25.61% post intervention. Providing psychoeducation and psychosocial care reduced the readmission rates amongschizophrenia patients.

The Next Step

More studies are needed in this field as it will help in the provision of care in our mental health patients

particularly schizophrenia and also those caring for them.

PP-05Reducing Frequency of Readmission of Patients withSchizophrenia after Last Discharge


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October 2011

27

Arbaiah O, Marina MS, Zaleha J, Zainal AR, Hariyaton R.Batu Pahat Health Clinic, Johor.


Adolescents, target of tobacco industries, had smoking prevalence of 14.7%. Young smokers are future statistics ofstrokes, heart diseases and cancers. Factors contributing to the poor performance of Quit Smoking Clinic (QSC)among adolescents need to be identified.


To increase percentage of quit smoking among adolescents attending QSC in Batu Pahat to 80%.


Four cross-sectional studies were done between January and March 2009. Secondary data of clinic-based QSC

performance were collected and followed by interviews of adolescents identified as failed to quit for year 2008.Providers factors contributing to the quitting were obtained through self administered questionnaires on 26Medical Assistants (MA) who run the clinic- based QSC. Adolescents from nine selected schools answered thequestionnaires distributed.


Data from 2008 showed that only 2(16.7%) of 12 adolescents quit smoking. Of 10 adolescents who failed to quit,7(70%) had high Fagerstrom score, 9(90%) did not have time and transport convenience to attend clinic-based QSCand 7(70%) revealed no intention of quitting. 61.5% of MAs responded that heavy outpatient workload,uninterested clients (65.4%) and insufficient training in running QSC (53.8%) were factors contributing to lowperformance of QSC. There were 204(16.5%) smokers from a total of 1231 students who answered thequestionnaire. Transport and time inconvenience of the adolescents combined with high workload of MAsprompted the team to look for alternatives for QSC.

Strategy for Change

Smokers enrolled were introduced to the newly developed school-based module, conducted by trained teachersand monitored by trained staff nurses. It was a 1-2 hour session per week for 8 consecutive weeks within theschool hours. Factors contributing to smoking and quitting were compared pre and post intervention.

Effects of Change

125(61.3%) of 204 students successfully quit smoking compared to 16.7% quit rate in 2008. Quit smoking activitieswithin school compound and hours resulted in higher success rate.

The Next Step

School-based quit smoking clinics were extended to 21 schools. Continuous improvement of the module andapproach is planned with the education department.

PP-07Increasing the Success Rate of Quit Smoking Clinic amongAdolescents


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October 2011

28

Norhana Y, Fatimah M, Mazlinah M, Kamilah M, Che Azizah A.

Klinik Kesihatan Negeri Terengganu.

Pemilihan Peluang untuk Penambaikan

Pengesanan komplikasi Diabetes Mellitus (DM) yang lengkap di klinik kesihatan perlu dilakukan di peringkat awalbagi mengurangkan kadar morbiditi dan mortaliti. Hasil kajian verifikasi menunjukkan pengesanan komplikasidiabetes yang lengkap sangat rendah iaitu 2.8%.


Unit Kawalan Penyakit Tidak Berjangkit Jabatan Kesihatan Negeri Terengganu telah menjalankan kajian denganobjektif untuk meningkatkan peratus pengesanan komplikasi diabetes yang lengkap dimana indikator adalahperatus kes menjalani pengesanan komplikasi Diabetes yang lengkap dan standard yang ditetapkan adalah 60%.Pemeriksaan Lengkap bermaksud setiap pesakit menjalani kesemua pemeriksaan seperti kaki, neurologi, sistemvaskular periferi, pemeriksaan mata termasuk fundus serta electrocardiogram dan ujian makmal seperti urine

microalbumin/albumin, blood urea serum electrolytedan creatinine.


Kajian telah dijalankan di dua buah klinik yang terpilih di setiap daerah Negeri Terengganu untuk mengenalpastifaktor penyumbang kepada masalah tersebut. Kajian pengetahuan pengesanan komplikasi diabetes telahdijalankan pada 4 hingga 28 Februari 2007. Borang soalselidik telah digunakan dan melibatkan pesakit dan anggotayang terpilih. Selain dari itu audit peralatan dibuat untuk memastikan peralatan mencukupi. Audit sistempenyeliaan dilakukan untuk memastikan adanya sistem yang teratur dalam pengesanan komplikasi diabetes. Kajiansemula setelah intervensi dilakukan pada 15 hingga 25 Februari 2009 dan 12 hingga 22 Disember 2010,menggunakan format yang sama.


Peratus pengetahuan baik bagi pesakit adalah sebanyak 15% manakala bagi anggota adalah 7%. Audit teknikal

peralatan menunjukkkan 78.6% peralatan mencukupi. Pengesanan komplikasi diabetes yang lengkap ialah 2.8%.


Kursus pengendalian Klinik Diabetes peringkat negeri termasuk demonstrasi pemeriksaan kaki, Kursus FundusPhoto Grading untuk Pegawai Perubatan dan paramedik telah diadakan. Audit klinikal dan teknikal berkaladilaksanakan untuk memastikan pengesanan komplikasi dibuat secara lengkap dan penyeliaan dilakukan secaraberkala.


Kajian semula menunjukkan pengetahuan yang baik bagi pesakit meningkat ke 25.9% manakala bagi anggotameningkat ke 22.6%. Audit teknikal peralatan menunjukkkan 92.9% peralatan mencukupi. Sistem penyeliaanpengurusan diabetes telah diwujudkan. Pengesanan komplikasi diabetes yang lengkap telah meningkat dari 2.8% ke22.9% pada Februari 2009 dan 27.8% pada Disember 2010.

Langkah Seterusnya

Memantapkan sistem penyeliaan dan memberi latihan dan kesedaran secara berterusan kepada anggota kesihatan.

PP-08Meningkatkan Pengesanan Komplikasi Pesakit Diabetesyang Lengkap di Klinik Kesihatan


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October 2011

29

Tchong FL, Nadiah AR, Noriah Y, Timothy B, Marilyn AA.Department of Pathology, Sarawak General Hospital, Sarawak.


Blood Film Malaria Parasite (BFMP) is a screening test used to differentiate the malaria parasite species. A goodquality BFMP slide is important for the correct identification of malaria species; therefore unsatisfactory BFMPslides will be rejected.


This study aimed to reduce the rejection rate of BFMP sample from ETD, SGH to less than 5% by conductingappropriate remedial action.


Retrospective record review of 500 samples was carried out from 1 March 2010 until 30 June 2010 to identify thefactors for sample rejection. After the remedial actions were taken, a cross sectional study was done from1 September 2010 until 31 December 2010. Data were collected from from the Laboratory Information System (LIS)and Notification of Specimen Rejection Record.


The data showed 18% of the sample reviewed was rejected due to multiple factors. Unsatisfactory smear receivedcontributed as the main factor for the most sample rejection due to poor preparation technique of BFMP slides.Regular change of staff and lack of supervision were the perceived factors which contributed to the existence ofthis problem.

Strategy for Change

Five sessions of hands-on training on proper technique of BFMP slide preparation and Continuous Medical Education

(CME) was conducted to ETD, SGH staff of all categories, involved in preparing BFMP slides. Experienced personnelfrom the Vector Unit, Sarawak State Health Department, were invited to be the trainers. Useful tools such as slidespreader and handy guideline were also given to all participants. A short demonstration on proper BFMP slidepreparation to all housemen attached to the laboratory was also provided.

Effects of Change

Post intervention data showed the number of BFMP sample rejected was successfully reduced from 18% to 2% (total500 samples). Re-evaluation carried out in January to April 2011 showed the rejection rate from ETD,SGH wasmaintained at less than 5%.

The Next Step

To meet the standard, continuous education on sample preparation shall be given to the staff. The remedialactions will be expanded to other departments in SGH for continuous quality improvement.

PP-09

Reducing Rejection Rate of Blood Film Malaria ParasiteSample Due to Unsatisfactory Smear from Emergency andTrauma Department


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October 2011

30

Tan SC, Chin SK, Khaw ES, Rogayah I, Lim JK.College of Nursing Penang, Taiping, Kuantan & Kuching.


Anatomy and Physiology subjects are the foundations of knowledge and generic skills that will influence studentssuccess throughout the three years course. Without Anatomy and Physiology, nurses would not know what to watchfor in patients with medications reactions, or how these patients are responding to care. Therefore, if the nursehas a thorough understanding of how the body works, she will be better prepared to give safe and quality patientcare. The study aimed to identify effective teaching and learning strategy to increase the passing rate of Anatomyand Physiology among student nurses of Year I Semester II.


The four nursing colleges in the Training Division Ministry of Health had decided to set the standard of increasingthe passing rate from 70% to 90%.


Retrospective record review from January 2008 to June 2010 showed an increase in the failure rate. Interventionalstudy was conducted from 1 July to 31 December 2010. Remedial measures were evaluated by monitoring theresults of summative examinations.


A total of 350 students took part in this study. The result of Summative Examination in November 2010 showedthere is an improvement in the passing rate of the subject, Anatomy and Physiology. 51% of the respondents weresatisfied with this methodology because it encouraged group interaction and 52% reported that their workload anddifficulty in studying Anatomy and Physiology was reduced.

Strategy for Change

We introduced Cooperative Learning and the use of log book to enhance students learning and retention power instudying Anatomy and Physiology.

Effects of Change

Retrospective summative examinations of 2 years (2008 -2010) showed about 70% of the students passed thesubject on Anatomy and Physiology. The new teaching methodology was implemented for a period of 2 months(July August). After the implementation the passing rate had increased by 20%, that is from 70% to 90%.

The Next Step

The use of Cooperative Learning and Computeraided Learning is effective and will be used continuously whenteaching Anatomy and Physiology in all nursing colleges.

PP-10Improving the Passing Rate of Nursing Students in Anatomyand Physiology Subjects


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October 2011

31

Norazlina MN, Aida Rahayu AG, Shaebah MJ, Asma I, Noor Azhan A.Pejabat Kesihatan Daerah Kubang Pasu, Kedah.


Anemia di kalangan ibu hamil boleh membawa kepada kejadian post-partum hemorrhage, intrauterine death, dansmall gestational age. Walau bagaimanapun, kejadian anemia sederhana didapati semakin meningkat di DaerahKubang Pasu pada tahun 2008. Kajian ini bertujuan untuk mengurangkan peratus anemia sederhana di kalanganibu hamil pada usia kandungan 36/52 minggu.


Standard yang ditetapkan adalah 18%.


Kajian verifikasi dilakukan dari Februari hingga Mac 2009 melalui semakan kad antenatal, kajian tahappengetahuan dan sikap ibu hamil serta anggota kesihatan dilakukan dari Apr hingga Mei 2009 dengan menggunakanborang soal selidik. Begitu juga dengan semakan pengendalian kes di klinik juga telah dilakukan melalui semakankad antenatal dan audit data dari Clinical Practise Guideline(CPG) dan borang semakan.


Kejadian anemia sederhana di kalangan ibu hamil pada 36/52 minggu pada tahun 2007 dan 2008 adalah 15% dan23%. Tahap pengetahuan dan sikap ibu mengenai anemia adalah 56%, manakala tahap pengetahuan anggotakesihatan adalah 76%. Kesemua anggota kesihatan tidak pernah menghadiri sebarang CME atau kursus mengenaianemia. Semakan kad antenatal mendapati pengendalian kes yang kurang berkesan di mana ibu hamil lewat diberirawatan hematinik dan ketiadaan defaulter tracingbagi kes yang tidak hadir ke klinik.


Tindakan penambahbaikan dijalankan dengan mengadakan kaunseling dan ceramah berkumpulan kepada ibu hamilbagi meningkatkan tahap pengetahuan dan komplian terhadap rawatan. Anggota kesihatan diberi latihan dankursus bagi meningkatkan pengetahuan dan pengendalian kes anaemia. Promosi kesihatan di komuniti diadakanbagi meningkatkan kesedaran umum berkaitan anemia seperti ceramah pemakanan di sekolah menengah, sertaceramah ringkas semasa kursus pra perkahwinan.


Berlaku penurunan peratus anemia sederhana di kalangan ibu hamil iaitu 15.6% untuk tahun 2009 dan 12.5% untuktahun 2010.

Langkah Seterusnya

Pengetahuan ibu dan pengendalian kes yang berkesan di kalangan anggota kesihatan amat penting untukmengurangkan kejadian anemia di kalangan ibu hamil.

PP-11Mengurangkan Peratus Anemia Sederhana di Kalangan IbuHamil Pada Minggu 36


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October 2011

32

Yeoh SL, Tan PY, Suhaila R, Azimah A, Nor Hafiza R.Paediatric Oncology Unit, Paediatric Department, Hospital Pulau Pinang, Penang.


A high rate of catheter related blood stream infection (CR-BSI) in paediatric oncology patients may lead toincreased mortality, morbidity, patient dissatisfaction and higher financial cost.


To educate caretaker on central venous line (CVL) care and ensure that staff follow the MOGC. A target to reduceour CR-BSI rate to


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October 2011

33

Giam WL, Azhari Wasi NA, Buang A, Dhillon HK, Mohd Zakaria IE, Lee CE, Jinan Taib JT, Ismail NS, Syed OthmanSR, Abdul Wahab AR.Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur.


Pharmacy UMMC has PharmCARE services for patients with long term prescriptions where advance preparation ofmedicines can be requested. Despite the availability of this service, a large number of patients still come to themain outpatient pharmacy (OP) for supplies, resulting in under-utilisation of PharmCARE. With the availableresources, PharmCARE should be able to serve 400 patients per day.


Reduction in achievable benefit not achieved (ABNA) of PharmCARE patients per day to more than 30% afterimprovement, without compromising waiting time and patients satisfaction.

Process of Gathering InformationRetrospective analysis of the average number of patients was collected from January to December 2009 asverification. The reasons for under-utilisation of PharmCARE were identified using a questionnaire from 11-22January 2010 in OP pharmacy.


From the study, PharmCARE was only able to serve 90 patients/day compared to 400 patients/day. Thus the ABNAis 77.5%. A total of 250 questionnaires were returned, with the main reason for under-utilisation as lack ofPharmCARE awareness (65.6%). Most patients (66%) were interested in courier service for medicine collection.

Strategy for Change

Promotion to create awareness was initiated and a new service called BY-POST was introduced in May 2010 to

further attract patients to use PharmCARE services.

Effects of Change

PharmCARE promotion and implementation of the BY-POST service had succeeded in increasing the averagenumber of patients from 90 to 162 patients/day by September without compromising the waiting time andpatients satisfaction. It had resulted in 18% ABNA reduction from 77.5% to 59.5%. Failure to achieve the targetedstandard was due to unexpected workload for BY-POST service and increase in medication counseling sessions thatlimited the process of patients recruitment.

The Next Step

Ensuring the continuity and expansion of PharmCARE for all patients with repeat prescriptions will continue toimprove the OP pharmacy service.

PP-13 Optimisation of Pharmcare Service in a Tertiary Hospital


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October 2011

34

Mohd Azri MS, Lim GL, Puziah Y, Mohd Nasir O, Mohammad Faidzol T.

Sultan Abdul Halim Hospital, Sungai Petani, Kedah.


Admission of obstetrics patients through the Patient Assessment Centre (PAC) becomes a major workload to theObstetrics and gynaecological (O&G) Department, Sultan Abdul Halim Hospital (HSAH). A preliminary study on themagnitude of this issue revealed that only 6% of obstetric patients were admitted to the wards within one hour,another 94% of patients were stranded in PAC for up to more than 2 hours. The aim of this study was to identifythe contributing factors that cause long admission time at PAC and to formulate appropriate remedial measures toovercome it.


Our aim was to achieve 75% of patients sent to the Antenatal Ward within one hour.


The data were collected for pre and post remedial period, mainly the time started and time finished at everystage of care at PAC and the time interval between each stage and the stage before it.


During the pre remedial study period, only 8.4% of patients managed to be transferred to the Antenatal ward fromPAC within 1 hour. Registration process and lengthy clerking were the two main factors for long admission time.

Strategy for Change

Several strategies had been planned to overcome each problem. Continual meetings and orientation of the staff atPAC were carried out.

Effects of Change

After the first reevaluation period, 67.2% of patients in PAC managed to be transferred to their respective wardswithin 1 hour. Greater improvement was observed during the 4thre-evaluation period where we achieved 71.6%.The time intervals for all stages were also reduced.

The Next Step

We hope to achieve the target of 75% of patients admitted to the Antenatal Ward from PAC within 1 hour.Although the target has not been achieved, there is promising result from the measures implemented and the nextstep is to sustain current achievement and formulate new strategies to achieve the target.

PP-14Improving Admission Time at a Maternity PatientAssessment Centre


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October 2011

35

Morni AR, Siti FJ, Amran MY, Hasniza J, Irdawaty M.

Pejabat Kesihatan Pergigian Daerah Hulu Selangor, Selangor.


Pengambilan x-ray adalah salah satu langkah penting dalam pengendalian penyakit pergigian. Imej x-ray yangterang dan jelas amat penting untuk mendapatkan diagnosis yang tepat. Di Klinik Pergigian daerah Hulu Selangor,pengambilan x-ray yang berulang adalah tinggi iaitu 18.1% pada tahun 2008. Ini telah memberi impak negatifterhadap kualiti perkhidmatan dengan meningkatkan pembaziran bahan dan kos. Ia juga menyebabkan peningkatanpendedahan radiasi kepada pesakit dan menyebabkan pesakit bimbang dan cemas, serta melambatkan diagnosispenyakit dengan mempengaruhi keberkesanan dan ketepatan rawatan.


Objektif kajian adalah untuk mengurangkan peratus x-ray berulang di Klinik Pergigian daerah Hulu Selangor dari18.1% kepada < 10% (Objektif Kualiti MS ISO 9001: 2008). Tindakan penambahbaikan diambil untuk mengatasi

masaalah ini dengan mengenalpasti faktor penyumbang kepada x-ray perlu diulang.


Empat sebab utama x-ray berulang adalah teknik pengambilan dan pemprosesan x-ray yang tidak tepat, kualitibahan yang kurang memuaskan dan masalah teknikal mesin x-ray. Kajian yang dijalankan adalah kajian irisanlintang. Manakala maklumat diperolehi menggunakan borang daftar pengambilan x-ray, jadual penyemakanbekalan, senarai semak prosedur pengambilan x-ray dan borang kajiselidek.


Peratus filem x-ray berulang tahun 2008 adalah 18.1%. Faktor penyumbang utama filem x-ray berulang adalahteknik pengambilan x-ray yang salah dan kurangnya pengetahuan dalam pengambilan dan pemprosesan x-ray olehPembantu Pembedahan Pergigian (PPP) yang merangkap juru x-ray.


Penggunaan film holder semasa mengambil x-ray. Memberi taklimat dan demonstrasi prosedur pengambilan danpemprosesan filem x-ray kepada semua PPP. Carta aliran pengambilan x-ray disediakan dalan bahasa Melayu untukdifahami. Manakala senarai semak pengambilan x-ray diperbaiki.


Setelah penambahbaikan diambil, peratus x-ray berulang telah berkurang dari 18.1% (2008) ke 5.4% pada tahun2009 dan terus menurun ke 4.6% pada tahun 2010.

Langkah Seterusnya

Pemantauan berterusan ke atas senarai semak dan rekod pengambilan x-ray. Mesin x-ray dikalibrasi serta kualiti

filem dan larutan x-ray dipantau secara berkala.

PP-15Mengurangkan Peratus X-Ray Berulang yang Tinggi diKlinik Pergigian


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October 2011

36

Mike C, Fung Z, Tay LH, Nandi Dewi R, Mariani A.

Unit Fisioterapi, Hospital Mesra Bukit Padang, Sabah.


Penurunan kefungsian diramal pada kadar penurunan 5% - 10% untuk setiap dekad hidup setelah usia 30 (Sanders,1995).Kementerian Kesihatan Malaysia menetapkan warga tua adalah berumur 60 tahun ke atas. Di Hospital ini,terdapat 40 orang pesakit geriatrik yang ditempatkan di dua wad kronik. Terdapat 22 orang pesakit geriatrikberada dalam program Fisioterapi. Statistiks hospital menunjukkan, terdapat peningkatan terhadap pesakit jatuhdisebabkan masalah keseimbangan badan (balance) di kalangan pesakit geriatrik. Sehingga Mei 2010 sahaja, telahterdapat 5 kes jatuh berlaku di Hospital Mesra Bukit Padang. Projek ini dijalankan bagi mengenalpasti puncamasalah

mjphm supplement 5 (2011)

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