Page 70 - 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 Completeness of Therapeutic Drug Monitoring (TDM) Request Forms in
Hospital Jasin

Fadzilah S , Nurul Atika W , Noor Hidayah M , Khairul Anuar AK , Noriza S 2
1
1
1
2
1 Pharmacy Department, Hospital Jasin, Melaka
2 Pathology Department, Hospital Jasin, Melaka
SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Therapeutic drug monitoring (TDM) is the clinical practice of measuring narrow therapeutic drug concentration
in a patient’s bloodstream for drug individualisation and optimisation. Inadequate mandatory information leads
to misinterpretation that causes severe impacts on patient care such as trauma, toxicity, therapeutic failure
and prolonged hospitalisation. Furthermore, it will increase workload and waste of resources. A retrospective
analysis conducted in 2019 found that only 0.5% (n=1) of TDM request forms were filled completely.

KEY MEASURES FOR IMPROVEMENT:
This study aims to improve the completeness of mandatory information in TDM request forms, with a more
than 75% standard based on consensus among team members.

PROCESS OF GATHERING INFORMATION:
Data collection included all TDM request forms and excluded those from other facilities. The forms were
screened, and the completeness was summarised in a data collection form using Microsoft Excel. Pre- and post-
test questionnaires were used to assess the knowledge of healthcare personnel on therapeutic drug monitoring.
Remedial actions were conducted during the first cycle from April 2020 until March 2021, whereas the second
cycle was from January 2022 to April 2022.

ANALYSIS AND INTERPRETATION:
The main contributing factors to this problem include non-established TDM request procedure in our hospital,
ineffective communication and lack of awareness among healthcare personnel.

STRATEGIES FOR CHANGE:
In the first cycle, the TDM request workflow was updated, and a WhatsApp group consisting of a multidisciplinary
team was created. TDM Champions were appointed to review monthly reports in each unit/ward to assist with
form completion during the second cycle.

EFFECT OF CHANGE:
The outcome from the first cycle slightly increased from 0.5% to 18.4%. However, complete TDM request
forms increased tremendously after the second cycle to 62%.

THE NEXT STEP:
In conclusion, updating the TDM workflow with effective communication skills greatly improved the
completeness of TDM request forms. Continuous close monitoring and sustainable implementation of the
measures are vital as they may affect the clinical interpretation of results.

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