Page 22 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
th
11 National QA Convention, 4 – 6 October 2022
OP-08

Reducing the Percentage of Returned Analgesic Medications in the Outpatient Pharmacy
Department (OPD) of Institut Kanser Negara (IKN)

Muhammad Aiman M, Kirubaa N, Nurnaqiah A, Akmal S, Hafiz AR, Dharishiny S
Institut Kanser Negara, Putrajaya

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Chronic pain is highly prevalent among IKN cancer patients. However, RM52,847.18 worth of analgesic
medications provided to these patients was returned to OPD unused in 2018, which had to be disposed of for
concern of safety and efficacy.

KEY MEASURES FOR IMPROVEMENT:
The indicator was the percentage of returned analgesic medications over the total of analgesic medications
dispensed. The standard is a 30% reduction, according to Bekker et al., 2018.

PROCESS OF GATHERING INFORMATION:
A verification study was done from 01/01/2019 till 30/04/2019 to determine the percentage of returned
analgesics and identify the contributing factors. A data collection form was used to record the quantity and
reason for return. Implementations of remedial measures were conducted from 01/10/2019 till 31/01/2020. The
returned analgesic medications were reassessed from 01/02/2020 till 31/05/2020.

ANALYSIS AND INTERPRETATION:
Pre-remedial returned analgesic medications were RM27,630.09 and the reasons were unused medications
(60%), discontinued medications (24%), side effects (8%), non-compliance (4%), patient deceased (2%) and
others (2%). Only 36% of patients knew that returned medications couldn’t be reused for another patient. The
ABNA was 1.87%.

STRATEGIES FOR CHANGE:
An awareness campaign was held in OPD. A replica of returned medications was put together with a poster
exhibition. Pharmacists were stationed at the campaign booth to engage with the patients actively. A pledge
board was put up for patients to pledge to check their medications before leaving the pharmacy. Pharmacists
in OPD were reemphasised to check the patient’s medications’ balance and dispense accordingly. Medication
reconciliation was done to ensure patients comply with taking their medications.

EFFECT OF CHANGE:
Returned analgesic medications were reduced from RM27,630.09 (6.24%) to RM21,559.48 (5.45%). The
ABNA was 1.08% at the end of the study.

THE NEXT STEP:
More out-of-the-box solutions such as utilising a mobile app to track the balance of patients’ medications can be
used to complement the conventional solutions to achieve a lesser number of returned analgesic medications.

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