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Volume 11(Suppl 5) 2011
MJPHM Official Journal of Malaysian Public Health Physicians’Association EDITORIAL BOARD Chief Editor Prof. Dato’ Dr. Syed Mohamed Aljunid (United Nations University – International Institute for Global Health) Deputy Chief Editor Assoc. Prof. Dr. Sharifa Ezat Wan Puteh (Universiti Kebangsaan Malaysia) Members: Assoc. Prof. Sharifah Zainiyah Syed Yahya Dr. Lokman Hakim Sulaiman Assoc. Prof. Dr Retneswari Masilamani Assoc Prof. Dr. Mohamed Rusli Abdullah Assc. Prof. Dr Saperi Sulong Assc. Prof. Dr Maznah Dahlui Dr. Roslan Johari Dr. Othman Warijo Dr. Norfazilah Ahmad Dr. Amrizal Muhd Nur
University Putra Malaysia Ministry of Health Malaysia University Malaya University Sains Malaysia University Kebangsaan Malaysia University Malaya Ministry of Health Malaysia Ministry of Health Malaysia University Kebangsaan Malaysia United Nations University–International Institute for Global Health (UNU-IIGH)
Chief Editor Malaysian 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: 1675–0306 The Malaysian Journal of Public Health Medicine is published twice a year Copyright reserved @ 2001 Malaysian Public Health Physicians’ Association Secretariate Address: The Secretariate United Nations University - International Institute for Global Health (UNU-IIGH) Universiti Kebangsaan Malaysia Medical Centre (UKMMC) Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur Malaysia Tel: 03-91715394 Faks: 03-91715402 Email:
[email protected]
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 5) 2011
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MJPHM Official Journal of Malaysian Public Health Physicians’Association 6th NATIONAL QUALITY ASSURANCE CONVENTION 2011 18-21 OCT 2011 DEWAN WAWASAN 2020, KANGAR, PERLIS Organised by Ministry of Health Persatuan PakarIn Perubatan Kesihatan Cooperation with Awam Malaysia Perlis State Health Department
EDITORIAL BOARD Chairman:
Ms Haniza Mohd Anuar
Secretary:
Ms Samsiah Awang
Members:
Dr Nur Ezdiani Mohamed Datin Dr Siti Haniza Mahmud Dr Roslinah Ali Mr Ramli Zainal Ms Look Chai Hong
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CONTENTS ORAL PRESENTATION OP-01
OPEN ACCESS ENDOSCOPY SERVICE REDUCES WAITING TIME AND INCREASES GASTROINTESTINAL CANCER DETECTION Mahadevan D, Dharmendran R, Azrina A, Vijaya S, Kandasami P, Ramesh G, Jasiah Z.
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OP-02
MENINGKATKAN TAHAP PENGLIHATAN PESAKIT AMBLIOPIA DI KLINIK OFTALMOLOGI Farawahida Kasmira F, Nur Liyana I, Nurul Ain MZ, Abdul Mutalib O, Mazliana A, Maizun MZ, Laila A.
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OP-03
MENINGKATKAN KOMPETENSI PELATIH PROGRAM DIPLOMA PEMBANTU PERUBATAN MELALUI INTERVENSI SIMULASI KLINIKAL Elengovan V, Nazri A, Yong KK, Zafri Y, Liew CF.
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OP-04
MENINGKATKAN KEHADIRAN IBU MENGANDUNG KE KLINIK PERGIGIAN Nor Sarah A, Suhaila AK, Nur Arliza P, Wan Mohd Ridzuan WJ.
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OP-05
REDUCING E-PRESCRIPTION ERROR IN A HOSPITAL INPATIENT PHARMACY Wan Najbah NN, Ngan YS, Muhd Nor Hazli N, Ng KY, Ching MW, Tan HF.
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OP-06
RE-ENGINEERING THE PROCESS OF OBTAINING SPECIAL FORMULARY DRUGS BY ONCOLOGY PATIENTS Tan PL, Azhari Wasi NA, Dhillon HK, Buang A, Sulaiman CZ, Mohd Zakaria IE, Tan WC, Poopaladurai D.
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OP-07
MENURUNKAN KEJADIAN ANEMIA DI KALANGAN IBU HAMIL PADA USIA KANDUNGAN 36 MINGGU Norasikin M, Zaitun I, Roslenda M, Mazliza M, Rubiah L, Masriah M.
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IMPROVING ADHERENCE TO BLOOD SAMPLING TIME FOR THERAPEUTIC DRUG MONITORING IN A GOVERNMENT HOSPITAL Rosdi MZ, Dang CC, Ku SC, Norshazareen AM, Lim CW, Tan BL.
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THE BRAINWAVES SYSTEM: DEVELOPMENT OF A MIND STIMULATING SYSTEM TO IMPROVE NEUROCOGNITIVE HEALTH BY INCREASING ALERTNESS IN THE WORKPLACE Zalina I, Wan Asim WA, Idris L, Aida Fadriah M, Wan Raihana WA, Yang SA, Kumar J, AlHindi R, Gisely V.
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OP-10
MENINGKATKAN PERATUSAN KEPATUHAN TERHADAP PERAWATAN PESAKIT DENGAN INFUSI INTRAVENA DI WAD OBSTETRIK & GYNAECOLOGY Nancy B, Sania L, Diviki T, Anita M, Zabidah J, Rusti T, Jockina M.
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OP-11
IMPROVING TIME INTERVAL FROM DECISION TO CAESAREAN DELIVERY FOR FETAL DISTRESS CASES Yuzainov A, Nurul Khairiyah K, Norul Akhma AH, Rahmah N, Norraihan H, Suriwati I.
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INCREASING LOWER SEGMENT CAESARIAN SECTION WITHOUT POST PARTUM HAEMORRHAGE Nor Jumizah AK, Lim KY, Faridah MY, Wan Mazlina WR, Maziati M, Suhainiza S, Norleeza MN.
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IMPROVING THE PERCENTAGE OF ASTHMATICS RECEIVING OPTIMAL ASSESSMENT DURING FOLLOW UP IN HEALTH CLINICS Nor Azila MI, Shuaita MN, Uthayalaxmi N, Ahmad Nazifi S, Toh LS, Mohd Azrul Z, Nor Izzah AS.
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MENINGKATKAN PENGURUSAN YANG EFEKTIF BAGI IBU HAMIL DENGAN ANEMIA DI KLINIK KESIHATAN Suzaini MD, Junaidah I, Norhayati S, Nur Hazwani R, Rosnani R.
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MENGURANGKAN KEKERAPAN PESANAN LUAR JANGKA DARI UNIT PEMESAN BAGI ITEM BUKAN UBAT DI UNIT PEROLEHAN DAN PEMBEKALAN Noor Mariati O, Siti Masyitah MT, Noorulhuda S, Lee LG, Azizah M, Khairul Anuar M, Norsiah MN.
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ROLE OF THE PHARMACIST IN IMPROVING TARGETED INTERNATIONAL NORMALISED RATIO VALUE OF PATIENTS ON WARFARIN THERAPY Shakirin SR, Izrul Azwa ML, Tan SY, Cheah SY, Wong MK, Chiew CW.
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REDUCING THE INCIDENCE OF VENTILATOR ASSOCIATED PNEUMONIA AMONG ICU PATIENTS Rozaidah AK, Norlida AB, Fatimah A, Nor Azuwa J, Che Zakiah O, Dominica Rose JS Daniel.
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MENINGKATKAN PERATUS BRONKIAL ASMA TERKAWAL Jayashree M, Shahrul Bariyah A, Norsiah MN, Ruzita S.
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REDUCING INCIDENCE OF SEVERE NEONATAL JAUNDICE Gadung A, Christina BL, Adeline WSF, Juliana H, Hilda B, Iya R.
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ACHIEVING INTERNATIONAL NORMALISED RATIO TARGETS AND SATISFACTION OF WARFARINISED PATIENTS Subramaniam T, Fudziah A, Jeyaindran S, Suliyana Y, Lim SC, Chong MF, Cheng PL, Teng SC.
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POSTER PRESENTATION PP-01
REDUCING THE PERCENTAGE OF CLINICAL PROGRESSION OF SEVERE NON- PROLIFERATIVE DIABETIC RETINOPATHY CASES TO PROLIFERATIVE DIABETIC RETINOPATHY STAGE OVER 1 YEAR IN AN OPHTHALMOLOGY DEPARTMENT Adeline ML Khaw, Chariya Eh Chot, SL Ng, A Rosli
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PP-02
MENGURANGKAN PENCEMARAN LONGKANG DAN SALIRAN AWAM OLEH SISA MINYAK TERPAKAI Azraei R, Ganggaraj A, Abdul Hamid MD.
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PP-03
REDUCING THE NUMBER OF MEDICATION ADMINISTRATION ERRORS IN A GENERAL PAEDIATRIC WARD Hiew CY, Lee ML.
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PP-04
IMPROVING PROPER USAGE OF FETAL MOVEMENT CHART AMONG PREGNANT WOMEN M Nazari J, Maskinah A, Haizuna MY, Saruah B, Aishah B, Ismail A, Adinegara.
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PP-05
REDUCING FREQUENCY OF READMISSION OF PATIENTS WITH SCHIZOPHRENIA AFTER LAST DISCHARGE Ruzita J, Dandaithapani T, Muslim AR, Rasidi D, Rozali I, Basiah A, Afidayati A.
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PP-06
MENINGKATKAN AKTIVITI PENYUSUAN DI KALANGAN JURURAWAT DI TEMPAT KERJA Norbaizora M, Ruzita MY, Sapinah MK, Kalsom M, Rohani H, W Mohd Faizal A, Ahmad Syahir S, Norhasriza Z, Nor Syarahani J.
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INCREASING THE SUCCESS RATE OF QUIT SMOKING CLINIC AMONG ADOLESCENTS Arbaiah O, Marina MS, Zaleha J, Zainal AR, Hariyaton R.
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PP-08
MENINGKATKAN PENGESANAN KOMPLIKASI PESAKIT DIABETES YANG LENGKAP DI KLINIK KESIHATAN Norhana Y, Fatimah M, Mazlinah M, Kamilah M, Che Azizah A.
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PP-09
REDUCING REJECTION RATE OF BLOOD FILM MALARIA PARASITE SAMPLE DUE TO UNSATISFACTORY SMEAR FROM EMERGENCY AND
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TRAUMA DEPARTMENT Tchong FL, Nadiah AR, Noriah Y, Timothy B, Marilyn AA. PP-10
IMPROVING THE PASSING RATE OF NURSING STUDENTS IN ANATOMY AND PHYSIOLOGY SUBJECTS Tan SC, Chin SK, Khaw ES, Rogayah I, Lim JK.
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PP-11
MENGURANGKAN PERATUS ANAEMIA SEDERHANA DI KALANGAN IBU HAMIL PADA MINGGU 36 Norazlina MN, Aida Rahayu AG, Shaebah MJ, Asma I, Noor Azhan A.
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PP-12
REDUCING CENTRAL VENOUS LINE RELATED BLOOD STREAM INFECTIONS AMONG PAEDIATRIC ONCOLOGY PATIENTS Yeoh SL, Tan PY, Suhaila R, Azimah A, Nor Hafiza R.
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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.
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PP-14
IMPROVING ADMISSION TIME AT A MATERNITY PATIENT ASSESSMENT CENTRE Mohd Azri MS, Lim GL, Puziah Y, Mohd Nasir O, Mohammad Faidzol T.
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PP-15
MENGURANGKAN PERATUS X-RAY BERULANG YANG TINGGI DI KLINIK PERGIGIAN Morni AR, Siti FJ, Amran MY, Hasniza J, Irdawaty M.
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PP-16
MENGURANGKAN KETIDAKSEIMBANGAN BADAN DI KALANGAN PESAKIT WARGA TUA DI WAD KRONIK Mike C, Fung Z, Tay LH, Nandi Dewi R, Mariani A.
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PP-17
MINIMISING THE FILLING ERRORS IN A SPECIALIST CLINIC PHARMACY Siow CC, Menaga K, Noor Shafizah J, Muhd Redhuan N.
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PP-18
RE-ENGINEERING THE CATARACT SURGERY WAIT-TIME STRATEGY Shubhashini Y, Poh EP, Gong VHM, Kogilavaani J, Kasturi R, Che Sam AK, Normadiniatul SMH, Nur Fazlina MN.
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PP-19
MENURUNKAN PERATUSAN PENOLAKAN KES PEMBEDAHAN DEWAN BEDAH Nurul Atikah H, Mohd Zahidi H, Kartini M, Sahaimi M, Nik Abdul Aziz RS.
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PP-20
REDUCING THE INCIDENCE OF THIRD DEGREE TEAR IN OBSTETRICS & GYNAECOLOGY DEPARTMENT Molen A, Myat SY, Lily D, Chanic B., Landsee DM, Juliana DJ, Abby B.
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PP-21
IMPROVING TURN-AROUND-TIME OF CULTURE & SENSITIVITY TESTING Wong MK, Abdullah A, Justin F.
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PP-22
CLINICAL AND ECONOMIC IMPACT OF PHARMACIST-RUN MEDICATION THERAPY ADHERENCE CLINIC SERVICE ON PATIENTS WITH TYPE 2 DIABETES Navin Kumar L, Chin ST, Rachel T, Lim KY, Fudziah A.
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PP-23
INCREASING RETENTION RATE OF FISSURE SEALANT AMONG PRIMARY SCHOOL CHILDREN Hajar HR, Vijayamanohar K, Wan Aini WY, Nadia DB, Umi A.
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PP-24
INCREASING PERCENTAGE OF ASTHMA CONTROL MONITORING AT DISTRICT HEALTH CLINICS Mohd Fozi K, Junaidah I, Azirah Y, Nurul Azlyn MY, Mahani K, Ali O, Mardiana A, Hamiza H.
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PP-25
IMPROVING DETECTION RATE OF DIABETIC FOOT AMONG PATIENTS WITH DIABETES Samurah AR, Ganespathy P, Ibrahim AF, Molina J.
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PP-26
MENINGKATKAN PERATUS “PREMIS BERSIH” KANTIN SEKOLAH MENENGAH Norazema AA, Samsir Asuwat S, Mohd Zulfadhli MS, Mohd Zahari Y, Md Kamal Ariffin AG, Zainal Abidin I, Azmi A, Jamaliah J.
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PP-27
MENURUNKAN KEJADIAN ANEMIA SEDERHANA DI KALANGAN IBU HAMIL M. Adam MA, Nini Shuhaida MH, Rohanita N, Badariah S, Badariah M,Wan Hafizah WM.
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PP-28
DELAY IN INDUCTION OF LABOUR WITH OXYTOCIN Nik Azi Azuha NH, Norhayati A, Norizah M, Saluwani AH, Nuraini M.
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PP-29
MENINGKATKAN PENGETAHUAN PESAKIT TENTANG PERUBAHAN RUPA 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 BREAKDOWN’ Anna T, Masni L, Lena C, Chua YL, Jeanyfer L, Mohd FA, Lucina L.
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PP-31
MENINGKATKAN AKTIVITI FIZIKAL MELALUI KEMPEN 10,000 LANGKAH DI KALANGAN MASYARAKAT Norasikin 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-NAÏVE PATIENTS AT INFECTIOUS DISEASE CLINIC Chow TS, Low LL, Zuhaila MI, Cheang LF, Asma A, Zakiah K, Norlizawati S.
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Open Access Endoscopy Service Reduces Waiting Time and Increases Gastrointestinal Cancer Detection
Mahadevan D, Dharmendran R, Azrina A, Vijaya S, Kandasami P, Ramesh G, Jasiah Z. Department of Surgery, Tuanku Ja’afar Hospital, Seremban, Negeri Sembilan. Selection of Opportunities for Improvement In Malaysia, gastrointestinal cancer patients present late. There is no guideline to identify high risk patients. Thus appointments are given without urgency, leaving some patients with late appointments for specialist consultation. Failure to identify high risk patients in the health centre, followed by delay in diagnostic endoscope procedure, is the reason for the delay in diagnosis, thus narrowing the treatment options to palliation. Key Measures for Improvement Time from presentation to health centre to endoscopic procedure is the direct indicator with the standard of two weeks and cancer detection rate due to introduction of Open Access Endoscopy (OAE) service compared to routine referral is the proxy indicator. Process of Gathering Information A three-pronged approach was undertaken. 1)Phase 1(2006): Development of the weighted scoring system using cancer database and multivariate logistic regression model, 2)Phase 2(2007-2008): Estimating positive predicting value, 3)Phase 3(2008-2010): Comparison of OAE to conventional referral system. This is a cross sectional study to determine diagnostic yield of both systems. Analysis and Interpretation From January 2004 till July 2006, a total of 59 stomach and 20 oesophageal cancers were studied, with more than 90% of these being advanced disease. Mean time taken in the conventional referral system, from the first appearance of cancer symptoms to the time of endoscopic procedure was 34 weeks. The delay in colonoscope appointment was 12-20 weeks. Strategy for Change We reduced the work process for referral and getting appointment for endoscope service by introducing OAE. Medical officers in health centres could order endoscope appointment for high risk patients directly without prior specialist consultation. OAE service in Negeri Sembilan is the first OPEN ACCESS programme in Malaysia. Effect of Change After the implementation of strategies, all referral via OAE were done within 2 weeks, more stomach cancers were diagnosed early and there was high yield of endoscope procedure. By identifying high risk patients and reducing the endoscope appointment time, the cancer detection could be increased and treatment hastened. Without this, high risk patients were not identified and consequently, their cancers diagnosed late. The Next Step Consolidate and publish the findings, implement OAE nationwide.
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Meningkatkan Tahap Penglihatan Pesakit Ambliopia di Klinik Oftalmologi
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 kebutaan kekal. Peningkatan tahap penglihatan (VA) di kalangan pesakit Ambliopia yang komplians terhadap rawatan pengatupan boleh mencapai 77%. Seterusnya, meningkatkan komplians terhadap rawatan pengatupan akan meningkatkan VA pesakit Ambliopia. Pengukuran Utama Penambahbaikan Untuk menilai VA dan mengenalpasti faktor yang menyumbang kepada VA di kalangan pesakit Ambliopia yang menjalani 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 sehari dan menghadiri temujanji. Proses Pengumpulan Maklumat Kajian bermula Jun 2009 hingga Mac 2011. Maklumat diperolehi dengan menggunakan borang soal selidik, buku temujanji pesakit dan kad rawatan pesakit. Kajian penilaian keberkesanan tindakan penambahbaikan dijalankan terhadap pesakit dan kakitangan klinik. Analisa dan Interpretasi Peningkatan VA ialah 12% manakala faktor penyumbang kepada VA pesakit Ambliopia ialah kurang pengetahuan tentang rawatan, waktu sekolah yang panjang (lebih 7 jam), tidak faham arahan pengatupan, tidak yakin kepada rawatan pengatupan, tidak memakai kaca mata dengan ralat refraksi terkini dan gagal menghadiri temujanji yang ditetapkan. Strategi Penambahbaikan Menyediakan Prosedur Operasi Terpiawai (SOP) pengendalian pesakit Ambliopia, menjalankan aktiviti pendidikan kesihatan dan meningkatkan kemudahan sistem temujanji. Kesan Perubahan Kajian menunjukkan VA pesakit Ambliopia telah meningkat kepada 78% dengan peningkatan komplians terhadap rawatan pengatupan. Langkah Seterusnya Memastikan pengendalian semua pesakit Ambliopia mengikut Prosedur Operasi Terpiawai (SOP) serta mempertingkatkan aktiviti pendidikan kesihatan dan program saringan penglihatan di peringkat tadika, sekolah rendah serta projek komuniti sebagai langkah pencegahan Ambliopia.
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Meningkatkan Kompetensi Pelatih Program Diploma Pembantu Perubatan melalui Intervensi Simulasi Klinikal
Elengovan V, Nazri A, Yong KK, Zafri Y, Liew CF. Bahagian Pengurusan Latihan, Kementerian Kesihatan Malaysia, Wilayah Persemutuan Putrajaya. Pemilihan Peluang untuk Penambahbaikan 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 seperti peluang pendedahan, suasana pembelajaran, penyeliaan, kerelaan pesakit, isu keselamatan pesakit dan perundangan membawa kepada theory-practice gap di unit klinikal. Pengukuran Utama Penambahbaikan 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. Proses Pengumpulan Maklumat Kajian ini dijalankan dari 4 hingga 30 Julai 2010 dan melibatkan sampel seramai 50 orang pelatih dari Kolej Pembantu Perubatan Ulu Kinta, Alor Setar, Seremban dan Kuching. Ujian Objective Structured Clinical Examination (OSCE) berasaskan senario klinikal digunakan untuk mengukur komponen kompetensi sebelum dan selepas intervensi simulasi. Analisis dan Interpretasi Hasil kajian sebelum intervensi menunjukkan bahawa pelajar hanya mampu memperolehi min skor 51.19% dengan sisihan piawai 10.89. Prestasi ini tidak memenuhi piawai latihan. Strategi Penambahbaikan Sebagai langkah penambahbaikan, Kolej Pembantu Perubatan telah memperkenalkan pendekatan „Intervensi Simulasi Klinikal dalam Meningkatkan Kompetensi Pelatih‟. Integrasi simulasi dalam pedagogi latihan menggunakan senario kes klinikal sebagai stimulus pembelajaran dan dibantu oleh pelakon, manikin, peralatan ICT serta pengajar 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 klinikal di Hospital (Control Group Pre-test- x: 43.72; sd: 12.09; Post-test- x: 55.09, sd: 14.72). Walaupun piawai yang ditetapkan 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 membangunkan kompetensi klinikal disamping memudahcarakan pemindahan ilmu kepada situasi klinikal sebenar. Impak dan kejayaan projek ini memberi ruang dan peluang bagi memperluaskan dan mengintegrasikan konsep simulasi klinikal dalam kurikulum serta membangunkan konsep makmal simulasi.
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The 6 National QA Convention 18 -21 October 2011
Meningkatkan Kehadiran Ibu Mengandung ke Klinik Pergigian
Nor Sarah A, Suhaila AK, Nur Arliza P, Wan Mohd Ridzuan WJ. Klinik Pergigian Peringgit, Melaka. Pemilihan Peluang untuk Penambahbaikan Ibu mengandung, selain mengalami masalah karies, cenderung mendapat penyakit gusi (periodontium) kerana perubahan hormon semasa hamil. Jika dibiarkan, penyakit periodontium mendedahkan ibu mengandung kepada risiko mendapat kelahiran pramatang dan bayi dilahirkan kurang berat badan. Sejak tahun 2004 hingga 2009 didapati kehadiran ibu mengandung ke Klinik Pergigian Peringgit sekitar 30% sahaja. Pengukuran Utama Penambahbaikan Peratusan kehadiran baru ibu mengandung ke klinik pergigian berbanding kehadiran baru ibu mengandung ke KKIA adalah indikator District Specific Approach (DSA) yang ditetapkan dengan piawaian lebih dari 50%. Proses Pengumpulan Maklumat Kajian irisan lintang dijalankan pada Januari dan Februari 2010 bagi mengenalpasti faktor ibu mengandung kurang membuat pemeriksaan gigi. Dua set borang soal selidik melibatkan 40 orang ibu mengandung dan 22 orang anggota pergigian dan Klinik Kesihatan Ibu dan Anak (KKIA) digunakan. Analisis dan Intepretasi Majoriti ibu mengandung tahu mengenai penyakit pergigian (71.1%) dan pernah diberitahu agar membuat pemeriksaan gigi (68.4%). 57.9% menyatakan mereka telah membuat pemeriksaan gigi. Majoriti (73.7%) tidak pernah diberi ceramah mengenai kesihatan pergigian. 92.1% menyatakan tiada masalah untuk pergi membuat pemeriksaan di klinik gigi di tingkat atas. Majoriti dari anggota pergigian dan KKIA (68.2%) menyatakan bahawa maklumat kesihatan pergigian di KKIA tidak mencukupi. Strategi Penambahbaikan Beberapa langkah penambahbaikan telah dilaksanakan termasuklah menempatkan Pegawai Pergigian di KKIA, mewujudkan borang pemeriksaan dan rujukan untuk rawatan pergigian yang akan dikepilkan ke dalam buku antenatal bagi tujuan peringatan serta mengelakkan dari keciciran ibu mengandung mendapatkan pemeriksaan pergigian. Selain itu, pamplet dan poster kesihatan pergigian diedarkan di KKIA sebagai bahan bacaan ibu mengandung dan ‟Fast lane‟ bagi ibu mengandung yang datang mendaftar di klinik pergigian. Kesan Penambahbaikan 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 mengandung ke 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.
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Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 5) 2011
OP-05
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The 6 National QA Convention 18 -21 October 2011
Reducing E-Prescription Error in a Hospital In-patient Pharmacy
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 prescription errors. However, it may also lead to new kinds of prescription errors. A study in 2009 in Putrajaya Hospital demonstrated that the percentage of prescription errors in in-patient pharmacy was 5.32%. This project aimed to reduce 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 selfadministered questionnaires to all doctors in wards. Following remedial measures, two more phases of data collection 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%) prescription errors involved houseman doctors and generally involved antibiotics (31.8%). Surveys revealed that the most common 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 to wards, presentation of project findings to the Head of Departments and also the distribution of pocket size reference 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 slightly increased to 2.94%. The Next Step “Medication ordering training” needs to be incorporated during IT orientation for new doctors. Also, “default dosing 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.
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Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 5) 2011
OP-06
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The 6 National QA Convention 18 -21 October 2011
Re-Engineering the Process of Obtaining Special Formulary Drugs by Oncology Patients
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. Selection of Opportunities for Improvement Oncology patients and/or their caregivers were subject to the inconvenient process of obtaining special formulary cytotoxic drugs due to the different locations of cytotoxic drugs in University Malaya Medical Centre (UMMC). The process also caused delays in reconstitution of drugs and thus, administration time. Therefore, the aim of this project was to re-engineer the current process to increase patients‟ satisfaction. Key Measures for Improvement
Reduction in time spent by patients to obtain cytotoxic drugs (