Page 75 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022
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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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Reducing the Percentage of Prescribing Error for Iron Dextran in Obstetrics and
Gynaecology (O&G) Department, Hospital Tengku Ampuan Rahimah, Klang
Low SY , Parimala VI , P’ng XW , Tan HS , Muna AR , Navamani N
2
1
1
1
1
2
1 Pharmacy Department, Hospital Tengku Ampuan Rahimah, Selangor
2 Obstetrics and Gynaecology Department, Hospital Tengku Ampuan Rahimah, Selangor
SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Prescribing errors may threaten patients’ safety, which may cause fatality. It also increases healthcare costs
due to inappropriate indications. A study conducted at the O&G wards from February to July 2019 found that
45.7% of 188 iron dextran prescriptions have prescribing errors.
KEY MEASURES FOR IMPROVEMENT:
The key indicator was measured by screening the percentage of prescribing errors in iron dextran prescriptions.
The standard for this study was set at 0% errors in iron dextran prescriptions.
PROCESS OF GATHERING INFORMATION:
This is a quality improvement study for iron dextran prescriptions from the O&G wards. The verification study
was conducted from August to December 2019, followed by cycle 1 from January to May 2020 and cycle 2
from Jun to November 2020. A knowledge assessment questionnaire for doctors and nurses and a checklist of
prescribing errors were used for data collection.
ANALYSIS AND INTERPRETATION:
A verification study showed that 46.7% of 230 iron dextran prescriptions have prescribing errors. It was shown
that 48.6% was contributed by the wrong dose, followed by 37.1% of incomplete prescriptions, 12.9% of
wrong indications and 1.4% of the wrong route.
STRATEGIES FOR CHANGE:
The iron dextran calculation worksheet with a QR code-linked user guide was introduced to quantify patients’
iron dextran requirement as a part of cycle 1. A customary stamp was implemented in cycle 2 to standardise
the iron dextran prescription. Continuing Medical Education (CME) was conducted to brief doctors on the
implemented plan.
EFFECT OF CHANGE:
The aforementioned strategies reduced the iron dextran prescription errors from 46.7% to 15.3%. This
percentage was further reduced to 9.68 % after cycle 2 implementation.
THE NEXT STEP:
This strategy was also replicated by one of the cluster hospitals. The iron dextran calculation worksheet will be
transformed into a handy electronic version. CME and internal audits will be carried out at scheduled intervals.
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