Page 63 - 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
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Improving Eye Drop Administration Technique among Glaucoma Patients Referred by
Doctors in Outpatient Pharmacy Department at Hospital Tuanku Ampuan Najihah,
Negeri Sembilan

Ee Li Y , Hemawathi R , Norsuziana H , Siti Sarah Z , Sulochana M
1
2
1
1
1
1 Pharmacy Department, Hospital Tuanku Ampuan Najihah, Negeri Sembilan
2 Ophthalmology Department, Hospital Tuanku Ampuan Najihah, Negeri Sembilan
SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Glaucoma is a chronic eye disease treated with intraocular pressure lowering eye drops. Studies showed that
eye drop administration errors among glaucoma patients could lead to a poor therapeutic outcome, adverse
effects and medication wastage. A verification study showed that only 4.2 % of glaucoma patients performed
good eye drop administration techniques.

KEY MEASURES FOR IMPROVEMENT:
The indicator is the percentage of patients referred who correctly performed all seven critical steps in eye
drop administration one month post-counselling. The steps were selected based on a study by Lampert et al.,
Malaysia Clinical Practice Guideline for Glaucoma and consensus with the Ophthalmology Department (OD).
The standard is 60% according to the Lampert et al. study and in agreement with OD.

PROCESS OF GATHERING INFORMATION:
We conducted a verification study with convenience sampling between March to May 2020. Validated
questionnaires were distributed to glaucoma patients (n=118), doctors in OD (n=13) and pharmacists (n=58)
to verify the percentage of the problem and contributing factors.

ANALYSIS AND INTERPRETATION:
4.2% of glaucoma patients performed all seven critical steps in eye drop administration. 69% of doctors and
21% of pharmacists reported that they would always counsel newly started patients on eye drops. The main
barriers to counselling were time constraints for doctors and a lack of doctor referrals for pharmacists.

STRATEGIES FOR CHANGE:
We implemented a new standard workflow for referral by doctors and eye drop counselling by pharmacists
in the Outpatient Pharmacy Department. Pharmacists would evaluate the patient’s technique by observation.
We developed an assessment checklist form, educational video and chart. In Cycle 2, we improved the video,
produced pamphlets and an eye anatomy chart and simplified the forms.

EFFECT OF CHANGE:
The percentage increased from 4.2% to 36.4% and 72%. The achievable benefit not achieved was reduced from
55.8% to 23.6% and 0%.

THE NEXT STEP:
This study will be expanded to cluster hospitals and, subsequently, all hospitals in Negeri Sembilan with OD.

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