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Q Bulletin, Volume 1, No. 32 (Supplement 1), Jan - Dec 202412th National QA Convention, 8 %u2013 10 October 2024PP-01Reducing the Percentage of Suboptimal Skull Radiograph among Paediatric Patientsin Department of Radiology, Hospital MelakaNur Alfalailah, Quek CY, Livania, Iffah Syafiqah, Mohd NizamuddinDepartment of Radiology, Hospital Melaka.SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:Skull radiograph is an integral part of paediatric management in health care centres. Suboptimal paediatricskull radiograph provides insufficient information, requiring repeat and retake, which unfortunately willincrease the risk of radiation exposure. These may have significant patient safety and economicimplications. The aim of this study is to reduce the percentage of suboptimal skull radiograph consistentwith As Low As Reasonably Achievable (ALARA) level.KEY MEASURES FOR IMPROVEMENT:The key indicator for the study was measured using the percentage of suboptimal skull radiograph amongpaediatric patients. The standard was aimed to be <30% based on reference (An Exploration ofRadiographer Decision-Making Regarding Rejected or Sub-Optimal Plain X-Ray, Images School ofClinical Sciences Faculty of Health, Queensland University of Technology 2023).PROCESS OF GATHERING INFORMATION:A quality improvement study (from June 2022 till December 2023) was conducted in the RadiologyDepartment, Hospital Melaka that included all paediatric cases <7 years old which required skullradiograph. An observational checklist was used to assess the acceptability criteria for the skullradiograph images in both anteroposterior (AP) and lateral views.ANALYSIS AND INTERPRETATION:Pre-remedial study showed 85.2% of skull radiographs were suboptimal. The main contributing factorswere improper positioning (70.3%) and the presence of external artefact (48.1%).STRATEGIES FOR CHANGE:The strategies implemented include application of innovative paediatric skull aid (immobiliser) tominimise the head movement and patient preparation improvement prior to and during the skullradiograph examination. Other strategies included development of a user manual for the innovative deviceand enhancing user training sessions among the radiographers for skill reinforcement.EFFECT OF CHANGE:The percentage of suboptimal paediatric skull radiographs (including AP and Lateral view) was reducedfrom 85.2% to 49.1% in post-remedial measures. The ABNA was narrowed down from 55.2% to 19.1%.THE NEXT STEP:To widen the implementation of remedial measures to all district or cluster hospitals in Melaka (HospitalAlor Gajah and Hospital Jasin). Further efforts are aimed to apply to other primary health care centres.52 | Page