Page 75 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022
P. 75

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
                                                                                   th
                                                                                 11  National QA Convention, 4 – 6 October 2022
               PP-37

               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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