ACTIVITIES & ACHIVEMENT OF PATIENT SAFETY COUNCIL MALAYSIA 2009

The Malaysian Patient Safety agenda follows closely the World Health Organisations World
Alliance for Patient Safetys recommendation on Patient Safety Strategies and programs.
Recently WHO has grouped the activities into 13 Patient Safety Program Areas. These are being
supported by the Patient Safety Council of Malaysia.




















WHO PATIENT SAFETY PROGRAM AREAS

Action Area 1 (Global Patient Safety Challenge)
2005-2006: Clean Care Is Safer Care
2007-2008: Safe Surgery Saves Lives
2009-2010: Tackling Antimicrobial Resistance
Action Area 2- Patients For Patient Safety
Action Area 3- Research For Patient Safety
Action Area 4- Taxonomy - International Patient Safety Classification
Action Area 5- Reporting And Learning
Action Area 6- Solutions For Patient Safety
Action Area 7- High 5s
Action Area 8- Technology For Patient Safety
Action Area 9- Knowledge Management
Action Area 10- Eliminating Central Line-associated Bloodstream Infections
Action Area 11- Education For Safer Care
Action Area 12- Safety Prize
Action Area 13- Medical Checklist
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Action Area 1 - Global Patient Safety Challenge
a) Clean Care is Safer Care (2005-2006)
First Global Patient Safety Challenge is focused on improving hand hygiene standards (including
compliance to guidelines on hand hygiene) in healthcare and on helping to implement
successful interventions.
This is to ensure that infection control is acknowledged universally and hand hygiene
improvement remains on the national and international health agenda.
Globally the initiative is led by Prof. Didier Pitet.
In Ministry of Health hospitals, the initiative is led by Infection Control Unit, Medical
Development Division.
National guidelines was produced (adopted WHO document) in 2006.
Hand Hygiene Campaigns conducted at national level (2006) and state level (2007) have
contributed to the increasing awareness on the importance of hand hygiene compliance and
practice
Continuous training on hand hygiene in all hospitals is also part of regular activities by the
Infection Control Unit.
Budgetary allocations for Alcohol-based Hand Rub (ABHR):
Budget for hand rub has been distributed to all hospitals since 2006
For 2009, a budget allocation of RM 2 million was distributed to all hospitals which was
for the procurement of patient safety consumables that include alcohol-based hand rub
Monitoring of Hand Hygiene Compliance in hospitals
From 2009, all State hospitals and major hospitals are to monitor their hospitals
performance after the pilot project on hand hygiene compliance was initiated in 2008.
The assessment cycle is conducted three monthly.
The results showed increasing trend of hand hygiene compliance from 56% in May-
June 2008 to 65.9% in Oct 2009 (Refer Graph 1)





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Graph 1- MOH Hospitals Hand Hygine Compliance Rate 2009



Most recent assessment of compliance which was conducted in October 2009 showed
that community nurse showed highest professional compliance followed by specialist,
staff nurses and medical officers. Students and house officers had the lowest
compliance rate. (Refer Graph 2b)

Paediatrics Department persistently showed high compliance. Other departments have
shown increasing compliance. (Refer Graph 3a & b)
















56
62
68.4
66.7 65.9
0
20
40
60
80
Jun,08 Jan,09 Apr,09 Jul,09 Oct,09
P
e
r
c
e
n
t
a
g
e
Ministry of Health Hospital
Hand Hygiene Compliance Rate 2009
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Graph 2a Professional Compliance On Hand Hygiene (May-June 2008)










Graph 2b Professional Compliance On Hand Hygiene (October 2009)






63%
48%
58%
51%
0%
25%
50%
75%
100%
Nurses/Midwife Med Dr Auxiliary nurses Others
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Graph 3a Department Compliance On Hand Hygiene (May-June 2008)








Graph 3b Department Compliance On Hand Hygiene (Oct 2009)

*OT: In recovery bay only
61%
55%
74%
54%
23%
66%
52%
0% 25% 50% 75% 100%
Obstetric
ICU
Paediatric
Medicine
A&E
OPD
Surgery
Obstetric
ICU
Paediatric
Medicine
A&E
OPD
Surgery
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a) Safe Surgery Saves Lives (2007=2008)


Second Global Patient Safety Challenge
To improve safety of surgical care by ensuring adherence to proven standards of care
Malaysia theme is Safer Surgery Through Better Communication
In Ministry of Health it is spear-headed by the MOHs Safe Surgery Saves Lives Steering
Committee which is led by Dato Dr. Abdul Jamil Abdullah, Consultant and Head of Surgery,
Hospital Sultanah Nurzahirah, Kuala Trengganu.
Malaysian version of Peri Operative Check List was established in 2009 based from WHO
Check List. Pilot project using this check list had been successfully carried out in 6 MOH
hospitals:
H. Pulau Pinang; H. Raja Permaisuri Bainun, Ipoh, HRPZII, Kota Bharu; H. Kemaman,
Terengganu; H. Teluk Intan, Perak; H. Duchess of Kent, Sandakan
Initiative was endorsed in Mesyuarat KPK Khas 24
th
Oct 2009, to be implemented nation wide
by 1
st
January 2010.
Pekeliling Ketua Pengarah Kesihatan Malaysia Bil 23/Tahun 2009 on Safe Surgery Saves Lives
initiative was signed on the 12
th
Nov 2009 .
Safe Surgery Saves Lives Initiative & Implementation Guideline was launched on the 15
th
Nov
2009.


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State hospitals have been training other hospitals with OT in their respective states
A follow up meeting to evaluate the implementation and performance of hospitals is going to
be conducted in April/May 2010.

c) Tackling Antimicrobial Resistance(2009-2010)
Third Global Patient Safety Challenge
Antimicrobial resistance poses a growing threat to the treatment and control of infectious
diseases.
Annual Scientific Meeting on Antimicrobial Resistance has been organized regularly by the
Infection Control Unit, Quality in Medical Care Section, Medical Development Division MOH
National Antibiotic Guidelines was launched at the Annual Scientific Meeting on Antimicrobial
Resistance held on 21
st
July 2008 by the Director-General of Health Malaysia, as Chairman of the
National Steering Committee for Infection and Antibiotic Control.
Infection Control Policy and Procedure will be launched in the 3
rd
Annual Scientific Meeting on
Antimicrobial Resistance , 5
th
May 2010.
Action Area 2 - Patients for Patient Safety
Patients for Patient Safety is an international network which comprised of patients/family,
members who have experienced preventable medical error, patient advocates, policy-makers,
health-care workers, others dedicated to improve patient safety through partnership.
The concept is patients and consumers act as partners in improving the quality and safety of
health care.
This is an area for future action by the Patient Safety Council.






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Action Areas 3- Research for Patient Safety
Operational intervention research projects under the EVIPNet (Evidence-informed policy
network) have been conducted by the Institute for Health Systems Research (IHSR) .
Policy briefs and research highlights have been published to facilitate the use of research
evidence in policy and practice. The research highlights are:
i. Patients unvoiced needs
Doctor, lend me your ears
Help patients voice their needs
ii. Handoff communication
Handoff communication process in MOH hospitals
Improving discharge communication
Inadequate discharge communication
Patient empowerment : The doctors perspective
iii. Inpatient medical error
Medical discipline, MOH specialist hospitals Adverse events & near misses
MOH Non-specialist hospitals: Adverse events & near misses

Action Areas 4-Taxonomy - International Patient Safety Classification
Aims to define, harmonize and group patient safety concepts into an internationally
standardized classification.
Easier to capture and analyse factors relevant to patient safety, for learning and system
improvement.
Taxonomy has been used in patient safety research, in the training of Root Cause Analysis and in
the new format of Incident Reporting.



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Action Areas 5- Reporting and Learning
To generate best practice guidelines for reporting systems & learning from information
available.
Incident Reporting followed by Root Cause Analysis (RCA) are used to capture incidents related
to patient safety in government hospitals. A new Incident Reporting System called Medical
Incident Reporting System is in the process of development, in collaboration with WHO
Consultant, Mr Stuart Emsley.
RCA Courses for State/Hospital directors/deputy directors, doctors, paramedics have been
conducted since 2005 to 2009 in collaboration with WHO Consultant, Mr Stuart Emsley. Total of
665 participants attended the course (Refer Table 1)


TABLE 1 PARTICIPANTS OF ROOT CAUSE ANALYSIS COURSE
ORGANIZED BY QUALITY IN MEDICAL CARE SECTION MINISTRY OF HEALTH (2005-2009)
STATE NUMBER OF PARTICIPANTS
Pulau Pinang 50
Sabah 50
Sarawak 50
Johor Bahru 40
Other states 475
TOTAL 665

Root Cause Analysis Application Guideline to guide health care professionals investigate the
causal factors for adverse events will be produced in 2010.




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Action Areas 6- Solutions for Patient Safety
Interventions /actions that improve process of health care and hence prevent patient safety
problems from recurring
Examples are:
a) Ventilator-Associated Pneumonia (VAP) Care Bundle :
Consists of 4 components - elevation of head of bed to 30 degrees, peptic ulcer
prophylaxis, deep vein thrombosis prophylaxis and sedation holidays.
introduced in January 2007 and currently implemented in all the State hospitals
and hospitals with ICU services. Total of 37 hospitals.
b) Wound Care Management
This year, Infection Control Unit, Quality in Medical Care Section, Medical
Development Division has started Wound Care Management
Programme for Ministry of Health Hospitals.
Training of paramedics has been conducted on the 1
st
-5
th
Mac 2010,
followed by a practical session on the 8-19
th
March. The pilot project
involve four hospitals. There are Kuala Lumpur Hospital, Putra Jaya
Hospital, Raja Perempuan Zainab II Hospital and Seremban Hospital.

Action Areas 7- High 5s
Spread best practice for change in organizational, team and clinical practices to improve patient
safety.
WHO High 5s identify 5 evidence-based solutions for patient safety and develop Standard
Operating Protocol (SOP) for each solution. SOP currently is not yet available from WHO for
download. The five solutions are:
Improved Hand Hygiene to Prevent Health Care-Associated Infections Ministry of
Health already in place
Performance of Correct Procedure at Correct Body Sites Part of Safe Surgery Saves
Lives Initiative
Communication During Patient Care Handovers Research project has been conducted
by IHSR
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Managing Concentrated Injectable Medicines
Assuring Medication Accuracy at Transitions in Care
Action Areas 8-Technology for Patient Safety
Malaysian Health Technology Assessment Section (MaHTAS) was established in August 1995
under Medical Program, Ministry of Health
MaHTAS has been conducting many health technology assessment for new equipment to
ensure safety and cost-effectiveness of the technology before it is used widely.
MaHTAS also produce various Clinical Practice Guidelines to ensure management of patient is
safe and evidence-based
In 2009, Seminar & Launching on Management of Dengue Infection In Adults (2
nd
Edition) was
conducted.
Recent technology assessment which have been conducted are for circumcision clamps,
cytotoron (in the treatment of arthritis and cancer) and sonotron therapy for musculoskeletal
problem.
Action Areas 9- Knowledge Management
To gather and share knowledge on patient safety developments globally.
Ministry of Health Malaysia has been sharing experience in patient safety programs with WHO
and other countries. Hand hygiene, safe surgery program.
WHO consultant shares knowledge on Clinical Governance Framework for Integrated Quality,
Safety and Risk Management, Root Cause Analysis and Incident Reporting System with Malaysia.
Organized and participated in conferences:
o Y. Bhg Tan Sri Dato Seri KPK was invited to present a 45 minute paper at The APHM
International Health Care Conference and Exhibition 2009, held on 21
st
to 23
rd
July 2009
. The theme for the Conference is Applying Best Practices in Health Care Delivery.
o Y. Bhg. Tan Sri Dato Seri Dr. Hj. Mohd Ismail Merican delivered the key note address at
Ministry of Health- Academy of Medicine Malaysia Conference in August 2009. The
theme is Building a Safety Culture through Accountability.


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Action Areas 10 - Eliminating Central Line- Associated Bloodstream Infections (CLBSI)
To reduce the incidence of catheter-related bloodstream infections especially on intensive care
patients.
The 5 elements of care include: hand hygiene, maximal barrier, precautions during insertion, use
of chlorhexidine 2% as skin antiseptic, subclavian vein as the preferred route and daily review of
catheter.
]This program is currently implemented in Hospital Kuala Lumpur as a pilot project and is going
to be introduced in all MOH hospitals with ICUs in 2010. A manual has already been prepared
by the expert committee led by Dr. Ng Siew Hian, Consultant Anesthetist of the MOH.
Action Areas 11 - Education for Safer Care
Curricular guide for medical students as well as other resources has been developed by WHO.
Malaysian Medical Association has also developed a framework for medical student education.
Medical Student Education: Awareness lecture on patient safety given to final year medical
students of UNIMAS, Sarawak in June 2009 by Patient Safety Council secretariat member
Patient safety is a relatively recent initiative in medical education. For most universities, there is
no specific lecture for patient safety. Patient safety is incorporated in the curriculum. Ward
rounds, seminars and group discussions are used as venues to discuss patient safety issues.
Examples of topics related to patient safety are rational drug use, evidence-based Clinical
Practice Guideline, transfusion medicine to prevent transfusion error and good communication
skills.
Action Areas 12 - Safety Prize
International award for excellence in the field of patient safety that will act as a driver for
change and improvement.
Malaysian Patient Safety Prize, for Patient Safety Council to consider
Action Areas 13 - Medical Checklists
Following success of Safe Surgery Checklists, WHO Patient Safety is working on checklists in
other areas of medicine
Checklist for health care workers treating patients with pandemic influenza A (H1N1)
(Refer attachment Patient Care Checklist Influenza A (H1N1) )
Safe Childbirth Checklist
Trauma Care Checklist
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Other Activities

a) Patient Safety Council Web-site
This was developed in-house by the Section on Quality in Medical Care, Medical Development Division,
Ministry of Health Malaysia as the Patient Safety Council Secretariat. It is already on-line (front-page link
at MOH web-site).
b) MOH Patient Safety Project 2009 Improving the Management of Extra-dural Hematoma (EDH) in
Specialist Hospitals with CT Scans
The Section on Quality has been working on an important patient safety project to enable General
Surgeons to manage certain types of EDH at their hospitals.
The first meeting took place in HSA JB and a committee was set up, under the auspices of the
POMR Committee to implement training in selected centres for general surgeons.
The first national training was held in Johor Bahru in December 2009.Future plan is to arrange
attachment program for general surgeon in neurosurgical unit
c) Patient and Staff Fall Prevention Program In Hospital
To prevent incidence of fall among patients and staffs in hospital
Workshop was conducted in December 2009 to discuss the initiative