Page 27 - 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-13

Improving the Appropriate Use of Clopidogrel in Primary Care Setting

Simran Kaur LS, Cheang CY, Khoo CC, Noor Harzana H.
Pejabat Kesihatan Daerah Klang, Selangor

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
43% of clopidogrel was inappropriately prescribed in primary care setting, PKD Klang, wherein 31.6% of this
was without appropriate documentation of diagnosis and duration. This resulted in long-term side effects and
high purchasing costs.

KEY MEASURES FOR IMPROVEMENT:
The indicator was the percentage of patients with appropriate use of clopidogrel with a standard of 90%.
Appropriate use was defined as clopidogrel prescribed according to recommended indications and duration.

PROCESS OF GATHERING INFORMATION:
A quality improvement study involving a verification study and two post-interventional cycles using a universal
sampling method were conducted. A pre/post-test was used to explore knowledge amongst healthcare providers.
A validated questionnaire and audit checklist helped establish the factors of inappropriate use and rate of the
appropriate use of clopidogrel, respectively.

ANALYSIS AND INTERPRETATION:
Verification study disclosed that 57% of clopidogrel was appropriately prescribed. The contributing factors
included lack of review and interventions by doctors (94%) and pharmacists (84%), incomplete clopidogrel
indication on discharge letters (74%) and demand from patients (58%).

STRATEGIES FOR CHANGE:
Clinical audit findings regarding incomplete clopidogrel discharge letters were shared with discharging tertiary
hospitals. An in-house clopidogrel guideline, assessment and counselling checklist with leaflets were developed
to assess patients, improve communication between healthcare providers, and enhance patients’ understanding
of the importance of appropriate clopidogrel duration. Documents containing diagnosis, initiation date, and
duration were made accessible to relevant healthcare providers via a QR code and patients via a record book.
These helped shorten assessment and prescription screening time.

EFFECT OF CHANGE:
The appropriate use of clopidogrel increased from 57% to 87% in cycle 1 and 94% in cycle 2. Achievable
benefit not achieved was improved from 43% to 13% and 6% in cycle 2. The cost of clopidogrel purchased was
reduced from RM63,874.00 (2018) to RM 13,284.00 (2019) and RM 1,404.00 (2020).

THE NEXT STEP:
To empower the sustainability of appropriate clopidogrel use in primary care by ensuring all disciplines adhere
to algorithms and guidelines.

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