Page 35 - npqh NATIONAL POLICY FOR QUALITY IN HEALTHCARE : Bridging Silos, Accelerating Improvements 2022-2026
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National Policy for Quality in Healthcare
                                                                                       Bridging Silos, Accelerating Improvements


                 1.3.4.2 Specific QII

                     a)  Improvement in Clinical Care

                   Clinical Audit                                        Improvement in Clinical Care
                    Year Introduced: around 1990

                    »   Clinical  Audit activities at  the hospital  level have grown  rapidly since 2017,  with

                        continuous training conducted for hospitals.
                    »   Guidelines  on Clinical Audit was produced.  At the same time, National  Audit on

                        Dengue, Lymphoma and Chest Tube Injury have been carried out.
                    »   As of 2019, the Oral Health Programme embarked on its clinical monitoring initiative,

                        which includes the conduct of clinical audits at dental clinics/schools and audit of
                        patients’ treatment records/cards.

                   Confidential  Enquiry  into  Maternal  Deaths  (CEMD)  Improvement in Clinical Care
                   Year Introduced: 1991

                    »   Publication on CEMD related materials such as:

                         - National Policy on Administration of Thromboprophylaxis during postnatal
                         - CEMD Report in triennial  since1991;  e.g. CEMD Report for 2009-2011,  2012-
                            2014, 2015–2017
                         - Case Illustrations 1996 -2020
                         - Annual CEMD Bulletin since 2012
                         - Training  Manual  e.g.  Training  Manual  on Management  of Postpartum
                            Haemorrhage 2016, Quick Reference Guide on Postpartum Haemorrhage 2016,
                                                               rd
                            Hypertensive Disorder in Pregnancy 3 Edition 2018, Prevention and Treatment
                                                                              nd
                            of Thromboembolism in Pregnancy and Puerperium 2  Edition 2018
                         - Consensus  Statement e.g. Consensus  Statement on Malaysia Guideline for  the
                            Management of the Placenta Accreta Spectrum 2020, Consensus on Management
                            of Hyperemesis Gravidarum 2020
                   Peri-natal Mortality Review                           Improvement in Clinical Care
                   Year Introduced: 1991

                    »   The  Stillbirth and Under 5  Mortality  Reporting  (SU5MR) System, was fully
                        implemented in July 2013.
                    »   Perinatal mortality rates for the past 5 years were 8.4 (2015), 8.1(2016), 8.4 (2017),
                        8.8 (2018) and 7.7 (2019).
                    »   A National Framework to Reduce the Under-5 Mortality and Support Child Growth
                        & Development, (National Plan of Action for Child Health 2021-2030) was approved
                        in  Mesyuarat KPK Khas on 8 December  2020  and also approved  by  Mesyuarat
                        Jawatankuasa Dasar dan Perancangan KKM (JDPKK) on 23 February 2021.

















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