Page 23 - 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
11 National QA Convention, 4 – 6 October 2022
th
OP-09

Reducing the Heavy Usage of Controlled Antibiotics in Hospital Seberang Jaya

Ann Lisa A , Gaiyathri S , Lim MC , Elsie TYL , Mohd Ashraf M , Lim CH , Cheng JT , Siti Hawa H , Woo
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4
1
1
1
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1
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YY , Adawiyah B 5
4
1 Pharmacy Department, Hospital Seberang Jaya, Pulau Pinang
2 Infection Control Unit, Hospital Seberang Jaya, Pulau Pinang
3 Medical Department, Hospital Seberang Jaya, Pulau Pinang
4 Microbiology Unit, Hospital Seberang Jaya, Pulau Pinang
5 Aneasthesiology Department, Hospital Seberang Jaya, Pulau Pinang
SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Hospital Seberang Jaya (HSJ) was listed as the highest user of antibiotics in Penang since 2018. It has led to a
prevalence of resistant microorganisms and increased antibiotics expenditures. Therefore, it was an attempt to
improve the antibiogram and cost savings by reducing the heavy usage of controlled antibiotics.
KEY MEASURES FOR IMPROVEMENT:
The standard was to reduce the defined daily dose (DDD) by more than 30% from the upper limit (UL). The
percentage was computed by dividing the average UL and the DDD by the average UL.

PROCESS OF GATHERING INFORMATION:
The study was conducted from July 2019-December 2021 through convenience sampling. A total of 3 cycles
were performed. The sampling tools were controlled antibiotic order form, antimicrobial stewardship database
and knowledge assessment questionnaires.

ANALYSIS AND INTERPRETATION:
The DDD was above the UL (~17%). The contributing factors were an incomplete review of antibiotics after
72 hours (84%), inappropriate selection of antibiotics during initial therapy (61%) and after review (88%),
pending relevant culture results (36%) and unclear SOP in supplying the antibiotics (49%). The ABNA was
25.5%.

STRATEGIES FOR CHANGE:
Besides continuously educating the healthcare professionals, formulation of new antibiotic guidelines and
formulary restrictions development of electronic antibiotic applications were among the strategies developed.

EFFECT OF CHANGE:
The ABNA reduced from 25.5% to below 0% (up to 37% reduction of DDD from the UL). Improvement in
MOGC seen as appropriate selection of antibiotics during initial therapy from 39% to 99%, and after review
from 12% to 82%, active tracing of relevant results from 64% to 100%, active review of antibiotics from 16%
to 100% and proper supply of antibiotics as SOP from 51% to 87%. Approximately RM 165,000.00 of cost
savings were accomplished. The antibiogram had shown an increase in sensitivity rate.

THE NEXT STEP:
Several strategies will be expanded to other hospitals, like electronic antibiotic application, which will be
extrapolated to other drugs requiring local purchase (LP) form.

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