Page 66 - 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 the Appropriateness of Antibiotic Prescriptions in Upper Respiratory Tract
(URTI) Cases in Klinik Kesihatan Kuala Lumpur (KKKL)

Izyan Dhaniah MD , Nur Azlina Y , Nur Atikah B , Narul Aida S , Nagammai T , Yee Yien C , Grace GSY ,
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Murnirah MD 1
1 Outpatient Department, Klinik Kesihatan Kuala Lumpur, Kuala Lumpur
2 Pharmacy Department, Klinik Kesihatan Kuala Lumpur, Kuala Lumpur
SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Inappropriate antibiotic use can lead to antibiotic resistance, unnecessary drug-related side effects, and an
increase in healthcare costs. A 1-day prescription audit done in KKKL in 2019 revealed that almost 90% of
URTI cases were inappropriately treated with antibiotics. The objective of this project was to improve the
appropriateness of antibiotic prescriptions in URTI cases.

KEY MEASURES FOR IMPROVEMENT:
The indicator was the percentage of appropriate antibiotic prescriptions in URTI cases. The standard set was
80 % by BPKK in the Infection Control Audit at the Primary Health Care Facility.

PROCESS OF GATHERING INFORMATION:
In the pre-intervention phase, a cross-sectional study was conducted in KKKL Fever Center from 1 to 30 April
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2021, where about 47 patients’ treatment cards were used as a data collection tool. A focus group discussion
was done among the Medical Officers to determine the contributing factors.

ANALYSIS AND INTERPRETATION:
In the pre-intervention study, only 42.55% of patients have given antibiotics appropriately. Contributing
factors for inappropriate prescription were: incorrect diagnosis by the medical officer, non-adherence to the
latest National Antibiotic Guideline (NAG) 2019, and lack of patient awareness. The Achievable Benefit Not
Achieved (ABNA) was 37.45%.

STRATEGIES FOR CHANGE:
The strategies include talks on appropriate antibiotic prescription, providing a guide/chart in consultation
rooms, mandatory use of Centor Score before prescribing antibiotics, and poster reminder for doctors in their
WhatsApp group. Pamphlets, posters and Antibiotic Awareness Week were arranged for patients.

EFFECT OF CHANGE:
Post-intervention study in June 2021 revealed an improvement in the appropriateness of antibiotic prescription
from 42.55% to 55.10%. The ABNA was narrowed down from 37.45% to 24.90%.

THE NEXT STEP:
In order to achieve the targeted standard, we plan to create virtual learning tools for staff (video viewing
regarding the management of URTI) followed by a questionnaire to reassess the knowledge and improve
documentation.

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