Page 28 - 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-14

Reducing the Percentage of Adult Patients Experiencing Moderate and Severe Pain
during Local Anaesthesia Administration in Klinik Pergigian Chemor

Yusraa A , Ng WV , Khairul Fikri H , Nur Maziah M , Wan Nur Nadia WM 2
2
2
1
2
¹ Klinik Pergigian 1 Malaysia UTC, Perak
² Klinik Pergigian Chemor, Perak
SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
An audit conducted at Klinik Pergigian Chemor in 2019 showed that 77.5% of adult patients experienced
moderate and severe pain during local anaesthesia administration. Pain during the procedure may significantly
impact patient satisfaction and delay patients seeking dental treatment, leading to poor oral health care. The
aim was to reduce the percentage of adult patients experiencing pain during local anaesthesia administration
in Klinik Pergigian Chemor.

KEY MEASURES FOR IMPROVEMENT:
The key indicator for improvement was measured using the percentage of patients with moderate and severe
pain during local anaesthesia administration. The standard is ≤20% based on the consensus of Oral Maxillofacial
Surgeon Hospital Taiping.

PROCESS OF GATHERING INFORMATION:
A cross-sectional study was conducted from 1 November to 31 December 2019. A convenient sampling
st
st
method was used. The data were collected from patient records, questionnaires and interviews to identify the
contributing factors and daily pain assessment reports using pain as a fifth vital sign (P5VS) scale.

ANALYSIS AND INTERPRETATION:
The pre-remedial study showed only 22.5% of patients experienced pain-free during local anaesthesia
administration. The causes included patients not receiving physical comfort before injection (100%), no
standard operating procedure of local anaesthesia administration (100%), speed of injection (83%), and fear
of needles (92%).

STRATEGIES FOR CHANGE:
The remedial measures include introducing ice sticks, providing a clear standard operating procedure of local
anaesthesia administration, training sessions for dental officers to perform local anaesthesia according to the
guidelines, turning on the radio while treating the patient, and indiscreet instruments set-up.

EFFECT OF CHANGE:
The percentage decreased from 77.5% to 18.3% in cycle 1 and dropped to 17.1% in cycle 2. This showed that
the measures were effective and sustainable. All contributing factors had improved, and the model of good care
was up to the standard.

THE NEXT STEP:
We will implement the standard operating procedure of local anaesthesia administration in other health facilities
in the Kinta district to meet the gold standard of care.

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