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PHARMACY PRACTICE & DEVELOPMENT

QAP INDICATORS 2010 MANUAL Version 1/2011

PHARMACY PRACTICE AND DEVELOPMENT DIVISION,

QUALITY AND STANDARD SECTION

The Pharmacy Practice & Development QAP Indicators Manual Version 1/2011 Ministry of Health Malaysia Page 1

QAP INDICATOR 1 :

PERCENTAGE OF PRESCRIPTIONS WRONGLY FILLED AND

DETECTED BEFORE DISPENSING

1.0 BACKGROUND The drug dispensing service is an important function of the pharmacy department in

hospitals and health clinics. At all times, accuracy in the drugs dispensed to the

patients must be upheld, as wrong drug given to the patient could result in dire

consequences. This indicator refers to the number of prescriptions that are wrongly

filled and detected on counterchecking before being dispensed to the patient. This

indicator is not meant to be punitive but for remedial action to be taken.

2.0 RATIONALE FOR DEVELOPMENT OF INDICATOR

This indicator is developed to measure and monitor the incidence of errors during the

medication preparation process. It is also to ensure correct dispensing of medications

to the correct patients as prescribed (in terms of types of drugs, quantity, frequency

and dosages).

3.0 OBJECTIVES

3.1 To detect / document each occurrence / incidence of prescription wrongly

filled but detected before dispensing.

3.2 To identify weaknesses in the system and to take remedial action to prevent

its recurrence.

3.3 To instill patients confidence in receiving the right medication.

4.0 STANDARD

0%

5.0 DEFINITION OF TERMS

Prescriptions - All prescriptions received at out-patient, in-patient (unit of use/unit dose) and discharge prescriptions

For all in-patient (unit of use/unit dose) prescriptions, each filling or refill of the same prescription is recorded as a new prescription

Counterchecking - Prescriptions re-checked by a pharmacist or pharmacist assistant.

The Pharmacy Practice & Development QAP Indicators Manual Version 1/2011 Ministry of Health Malaysia Page 2

Yes No

Wrongly filled prescriptions

- Incorrect data/information of patient on the label Incorrect medication instructions on the label Incorrect medication filled in terms of type of

medications, quantity and dosage.

6.0 MODEL OF GOOD CARE 6.1 FLOW CHART - WORK PROCESS

Receive Prescription

Screen the prescription

Prescription

Error

Detected?

Contact the Prescriber

Problem solved Fill & Label prescription

Supply medication

to patient

Error

Detected

?

Investigate &

Correct the error

End

No Yes

Countercheck filled & labelled

prescription

Start

Yes No

The Pharmacy Practice & Development QAP Indicators Manual Version 1/2011 Ministry of Health Malaysia Page 3

6.2 WORK PROCEDURE FOR MEDICATION PREPARATION

Activities Responsibility

1. Interpret the prescription carefully.

2. Prepare appropriate label for medication.

3. Identify the correct medication.

4. Fill the correct quantity of medication.

5. Recheck labels and items filled.

6. Counterchecked with regards to:

- drug identification

- strength and dosage

- frequency and method of administration

- total quantity supplied.

7. Initial the prescription and put into the appropriate container

8. Hand over filled prescription to dispensing counter.

9. Countercheck filled prescription upon dispensing. Refer to P1 / PA1

for correction if any discrepancy detected and record in FORM 1A

immediately.

10. Rectify the error and dispense medication

11. Investigate and record error in Form 1B

12. Compile the total records from Form 1A & 1B daily.

13. Send the compiled information to the Pharmacist monthly using

Form 1A & 1B.

14. Summarize the statistics from all counters into Form QAP1.

15. Determine and analyze the percentage of prescriptions wrongly

filled and detected before dispensing.

P1 / PA1

P1 / PA1

P1 / PA1

P1 / PA1

P1 / PA1

P1 / PA1

P1 / PA1

P1 / PA1

P2 / PA2

P / PA

P2 / PA2

PA

PA

P

P

P Pharmacist PA Pharmacist Assistant

The Pharmacy Practice & Development QAP Indicators Manual Version 1/2011 Ministry of Health Malaysia Page 4

7.0 METHODOLOGY 7.1 METHOD OF COLLECTING DATA

- Form QAP 1A - is used to collect data related to any errors detected

while Counter-checking.

- Form QAP 1B - is used to collect data related to factors contributing to

errors detected before dispensing.

- Use the following formula for calculation:

Percentage of prescriptions = wrongly filled and detected before dispensing

Number of prescriptions wrongly filled x 100 % Total prescriptions counterchecked

7.2 SAMPLING

7.2.1 Inclusion criteria

- All prescriptions received at out-patient, in-patient (unit of use / unit of

dose) and discharge prescriptions are considered for this indicator at all

Hospital and Health Clinics

- For all in-patient (unit of use / unit dose) prescriptions, each filling or

refill of the same prescription is recorded as a new prescription.

E.g.:

IV Meropenem 500mg tds x 1/52

If unit of use: 2 prescriptions (If supplied every 3 days)

If unit dose: 7 prescriptions (Supplied daily)

- Prescriptions filled and counterchecked by different pharmacy staffs before

dispensing. (At least 2 pharmacy staff are involved in the dispensing

process)

7.2.2 Exclusion criteria

- All Parenteral Nutrition (PN) cases

- All Cytotoxic Drug Reconstitution (CDR) cases

The Pharmacy Practice & Development QAP Indicators Manual Version 1/2011 Ministry of Health Malaysia Page 5

7.3 DATA COLLECTION / FORMS 7.3.1 HOSPITAL / HEALTH CLINIC LEVEL

- Form QAP 1A Daily Recording Of Errors Detected Before Dispensing

- Form QAP 1B Daily Recording of Factors Contributing to Errors

Detected Before Dispensing

- Form QAP 1 This form is to be filled as a compilation of 3 months data

and submitted by the Hospital / Health Clinic to the State Pharmaceutical

Services Division every 3 months:-

Jan Mac by 7th April

Apr Jun by 7th July

July Sept by 7th Oct

Oct Dec by 7th Jan

- Protocol For Investigation Of Hospital / Health Clinics With

Shortfall In Quality (SIQ) For Indicator Percentage of Prescriptions

Wrongly Filled And Detected Before Dispensing This form is to be

sent every three months to the State Pharmaceutical Services Division with

the Form QAP 1 if the Standard for this Indicator is not achieved.

- SIQ QAP 1(STATE PSD)- is to be sent every 3 months by the State

Pharmaceutical Services Division to the Pharmaceutical Services Division,

Ministry of Health.

7.3.2 STATE PHARMACEUTICAL SERVICES DIVISION

- Data collected from Form QAP1A, Form QAP1B and the SIQ form must

be analysed by the State Pharmaceutical Services Division.

- SIQ QAP 1(STATE PSD)- is a summary of the SIQ analysis of all the

facilities within the jurisdiction of the state and this form is to be sent every

3 months by the State Pharmaceutical Services Division to the

Pharmaceutical Services Division, Ministry of Health. [refer to the

attachment SIQ QAP 1(STATE PSD)]

Jan Mac by 15th April

Apr Jun by 15th July

July Sept by 15th Oct

Oct Dec by 15th Jan

The Pharmacy Practice & Development QAP Indicators Manual Version 1/2011 Ministry of Health Malaysia Page 6

7.4 DATA ANALYSIS

- Data collected from Form QAP1A is analysed by the Hospital / Health Clinic

Pharmacist and reported in Form QAP 1.

- Data collected from Form QAP1B is analysed by the Hospital / Health Clinic

Pharmacist and reported in the SIQ form in the event of non-conformance.

- Data collected from Form QAP1A, Form QAP1B and the SIQ form is

analysed, summarized and reported by the State Pharmaceutical Services

Division to the Pharmaceutical Services Division, Ministry of Health.

The Pharmacy Practice & Development QAP Indicators Manual Version 2/2010 Ministry of Health Malaysia Page 7

HOSPITAL / HEALTH CLINIC : ______________________________

MONTH / YEAR : ______________________________

Date

Total Number

Of Prescriptions

With Error

(a)

Types of Error Total Number Of

Prescriptions

Counterchecked

(d)

Labelling Error (b) Filling Error (c)

(c)

Wrong Quantity

Unfilled Drug

Wrong Drug

Wrong Strength

Wrong Quantity Patient

name

Drug data (name,

instruction)

Eg:

6/5/09

llll