Page 31 - 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-17

Reducing the Percentage of Metered Dose Inhaler (MDI) Salbutamol Exchange among
Patients with Asthma in Health Clinics under Pejabat Kesihatan Daerah Port Dickson
(PKDPD)

Suraya ME , Muhammad Fuad A , Kaveena G 3
1
2
1 Klinik Kesihatan Pasir Panjang, Negeri Sembilan
2 Klinik Kesihatan Bukit Pelanduk, Negeri Sembilan
3 Klinik Kesihatan Bagan Pinang, Negeri Sembilan

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
In 2019, the percentage of patients who came for an exchange for their MDI Salbutamol was high in the health
clinics in PKDPD (68.27%). This could indicate that the patients overused their reliever inhalers, which may
worsen the progression of the disease. Therefore, this study aimed to reduce the percentage of MDI Salbutamol
exchange to ensure the patient has a good understanding of using MDI to ensure good asthma control.

KEY MEASURES FOR IMPROVEMENT:
The key indicator was measured using the percentage of MDI Salbutamol exchange among patients with MDI
Salbutamol in PKDPD. The standard is to reduce the exchange percentage to 35% based on consensus in the
Asthma Committee Meeting 2018.

PROCESS OF GATHERING INFORMATION:
A cross-sectional study was conducted using random sampling in five health clinics in PKDPD with 158
subjects. Data to identify contributing factors were collected using a validated questionnaire (Test of Adherence
to Inhalers Questionnaire).

ANALYSIS AND INTERPRETATION:
The pre-remedial study showed that the percentage of MDI Salbutamol exchange among patients was 68.27%.
The causes included poor technique (63%) and poor compliance with preventers (37%).

STRATEGIES FOR CHANGE:
The strategies were the establishment of the Modified Inhaler Technique Checklist and Asthma Assessment
Form, adapted from the Respiratory MTAC. In Cycle 1, we looked into improving the inhaler technique. In
cycle 2, we worked on the compliance to preventer inhalers and monitored patients’ asthma control.

EFFECT OF CHANGE:
The patient’s inhaler technique improved from 8.86% to 20.89%. Patients’ compliance with preventer inhalers
increased from 50% to 79.7%. Patients with good asthma control improved from 1.26% to 5.06%. MDI
Salbutamol exchange percentage was reduced from 68.27% to 62.35% in cycle 1 to 45.55% in cycle 2.
Achievable benefit not achieved (ABNA) was narrowed from 33.27% to 27.35% and finally to 10.55%.

THE NEXT STEP:
In cycle 3, we will incorporate a Multilanguage Visual Counselling Aid (Malay, Mandarin, and Tamil) to
ensure better understanding.

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