Page 60 - 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
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11 National QA Convention, 4 – 6 October 2022
PP-22

Increasing the Percentage of Correct Medication Administration via Nasogastric Tube
in Hospital Kajang

Teoh YM ,Ong JJ , Tan KZ , Wan K , Fauziah Hanim AA , Fadtin Fatanah MK , Yuhanisa A , Pavallai R 2
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1 Pharmacy Department, Hospital Kajang, Selangor
2 Medical Department, Hospital Kajang, Selangor
SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Incorrect medication administration reduces medication effectiveness, increases adverse effects, causing
various interactions and clogging feeding tubes. These subsequently cause increased morbidity, mortality
and hospitalisation cost. The pre-remedial study showed 0% of medication was correctly administered via
nasogastric tube (NGT).

KEY MEASURES FOR IMPROVEMENT:
The study aimed to increase the percentage of correct medication administration via NGT to the standard of
100%. A medication administration is correct only when all the criteria of prescribing, screening, supplying,
preparation and administration in the audit form are fulfilled.

PROCESS OF GATHERING INFORMATION:
A quality improvement study was conducted using universal sampling in ICU. Data on medication administration
was collected using an observational audit form for 210 samples. A validated self-administered questionnaire
was distributed to 158 healthcare professionals to assess their knowledge and identify the barriers.

ANALYSIS AND INTERPRETATION:
The pre-remedial study showed that 93.3% of NGT medications were prescribed correctly, 0% of inpatient
pharmacists screened and supplied the prescriptions by considering NGT status and 0% of medication was
prepared and administered via NGT correctly. From Pareto analysis, 80% of the contributing factors were
unavailability of appropriate equipment, no Standard Operational Procedure (SOP), no local guidelines and
lack of awareness. The mean score of knowledge was 46.9%.

STRATEGIES FOR CHANGE:
NasoCare Integrated Programme was implemented by developing strategies such as NasoMed guidelines with
QR code, M&M kit containing innovative medication crushing equipment, SOP on medication administration
technique, PinkCard to tag NGT patients, daily NGT patient list for inpatient pharmacist and customised
courses.

EFFECT OF CHANGE:
Correct medication administration via NGT was successfully increased from 0% to 92.3%. Achievable benefit
not achieved (ABNA) was reduced from 100% to 7.7%. The mean score of healthcare professional knowledge
increased to 82.3%.

THE NEXT STEP:
This study will be expanded to all wards in Hospital Kajang and shared with other healthcare facilities in
Malaysia. A reference guide will be developed to educate the caretaker on NGT medication administration at
home.

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