EFFICIENT Service

HEALTHY Patient

SITI
AISAH

MOHD AHMAD
ROZALI MUSTAQIM

RAZALLE ROSHILAWANI
 INTRODUCTION DEPARTMENT BACKGROUND

Pharmaceutical
Services Department
Kelantan State
Address :
Lot 125-128, Taman Maktab,
Pengkalan Chepa,16100 Kota Bharu,
Kelantan.
Tel No : Fax No :
09-7730586 09-7730196
http://farmasiklt.moh.gov.my 2
 INTRODUCTION DEPARTMENT BACKGROUND

Organisation Chart
Pharmaceutical Services Division PRACTICE &
Kelantan State health Department DEVELOPMENT
BRANCH

3
 INTRODUCTION DEPARTMENT BACKGROUND

VISION OBJECTIVE CLIENT’S

CHARTER
To lead the quality
management of drugs To ensure all
through a competitive pharmacuetical and
work force, consistent health care products
science and in the market are of
technology, and quality, safe, effective
partnership with all and controlled in
concerned parties accordance with the
concerned laws and
MISSION are used rationally
To ensure quality
drugs for the nation
4
 INTRODUCTION DEPARTMENT BACKGROUND

Dx-Home is also in accordance with

BE AN INTELLIGENT PATIENT
the Malaysian National Medicines PRACTICE
Policy for the Quality Use of Medicines
component which emphasizes the
5R CONCEPT
5Rights (5R) Concept

RIGHT Dose
5R
ASK YOUR PHARMACIST

5
INTRODUCTION DEPARTMENT BACKGROUND

SITI
LEADER AISAH

MOHD AHMAD
ROZALI MUSTAQIM

RAZALLE ROSHILAWANI

Established 3rd January 2017 6

INTRODUCTION DEPARTMENT BACKGROUND

7
 INTRODUCTION DEPARTMENT BACKGROUND

With Deputy Director of Pharmaceutical Services

MOH, Malaysia (Pn Abida Haq) on 15/9/2016 8
INTRODUCTION DEPARTMENT BACKGROUND

9
INTRODUCTION DEPARTMENT BACKGROUND

10
 INTRODUCTION DEPARTMENT BACKGROUND

DUTIES
Note the
Lead the team,
minutes of
data collection Data Handling of
meetings,
NO. MEMBER’S NAME and statistics,
corresponden
collection,
statistics,
Preparation
of book, lead
computer ,
slide
speech text,
collection of
ce, finance documents the team and presentatio
team
management, and presentation n and
documents
refreshments preparation of project preparation
and
and of book of book
presentation
miscellaneous
of project

1 Siti Aisah
Ahmad
2
Mustaqim
3 Mohd Rozali
4 Razalle
5 Roshilawani
Responsible Involvement 11
 INTRODUCTION DEPARTMENT BACKGROUND

TEAM LOGO COLOUR DESCRIPTION

BLUE
Pharmacy Service

RED
Bravery and Fearless

WHITE
Sincerity and Integrity of Members
Achieving Direction
SYMBOL DESCRIPTION
Q = We Prioritise Quality
p = We Are From The Pharmacy Services
RED CIRCLE = Symbolizes Co-operation and
Agreement In Achieving Direction 12
 INTRODUCTION DEPARTMENT BACKGROUND

TEAM MOTTO
COOPERATION, CONSENSUAL AND DETERMINATION
TOWARDS THE PEAK OF SUCCESS

TEAM OBJECTIVE
ENSURE THE PATIENT ALWAYS RECEIVES QUALITY
MEDICINES, SAFE AND EFFECTIVE
TEAM ETHICS
• ACTING TOGETHER TOWARDS SUCCESS
• ALWAYS CONSULT
• TEAM WORK
13
 INTRODUCTION DEPARTMENT BACKGROUND

Action Plan
JUNE 2017 - 1. Team Establishment JAN - MAR 2017
PRESENT 2. Identifying and Selecting
1. Standardization Problem/Project
2. Identifying Side Problems 3. Collecting Early data
and Future Planning 4. Analysis dan Verification
5. Solution Proposal
6. Management Presentation

1. Results Evaluation 1. Project Trial Run

2. Confirmation of Effectiveness 2. Execute Corrective Action
3. Data Collection

Check Do
JUNE - JUNE 2017 APR - MAY 2017
14
 INTRODUCTION DEPARTMENT BACKGROUND

YEAR 2017
TEAM
MONTH JAN FEB MAR APR MAY JUNE JULY AUG SEPT OCT
ACTIVITY WEEK 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
TEAM ESTABLISHMENT
IDENTIFYING AND SELECTING
PROBLEM/PROJECT
P JAN 2017 – MAR 2017
COLLECTING EARLY DATA
P ANALYSIS AND VERIFICATION

SOLUTION PROPOSAL

MANAGEMENT PRESENTATION

PROJECT TRIAL RUN

D EXECUTE CORRECTIVE ACTION D APR 2017 – MAY 2017

DATA COLLECTION

RESULTS EVALUATION
C CONFIRMATION OF EFFECTIVENESS
C JUNE 2017–JUNE 2017

STANDARDIZATION
A IDENTIFYING SIDE PROBLEMS AND A JUNE 2017 - PRESENT
FUTURE PLANNING
PLANNED IMPLEMENTED 15
 INTRODUCTION DEPARTMENT BACKGROUND

Member’s 17 Jan 23 Jan 15 Feb 15 Mar 4 Apr 5 Apr 3 May 8 May 13 June 14 June 3 July
Name 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017
Siti Aisah P P P P P P P P P P P

Ahmad P P P P P P P P P P P
Mustaqim

Mohd P P P P P P P P P P P
Rozali
Razalle P P P P P P P P P P P
Roshilawani P P P P P P A P P P P

P – Present A - Absent MEETING CALL LETTER

Number of Meetings: 11 times

Frequency : 1 @ 2 times/month
Venue : Board Room
Kelantan State’s Pharmaceutical
Services Division, Pengkalan Chepa
Time : 9.00am – 4.30pm
Percentage of Attendence : 98.2%
16
 INTRODUCTION DEPARTMENT BACKGROUND

• Minutes of meetings are circulated via email

• Development / Planning / Implementation of Project / Decisions of Meetings
informed via WhatsApp Application if absent due to attending courses 17
 INTRODUCTION DEPARTMENT BACKGROUND

TABLE OF ASSESSMENT AND RADAR CHART PRE PROJECT

TEAM LEADERSHIP CO-OPERATION INNOVATIVE UNDE RS T ANDING CREATIVITY CONFIDENT COMMUNICATION TOGETHERNESS
MEMBERS PRE PRE PRE PRE PRE PRE PRE PRE
SITI AISAH 4 4 4 3 4 4 4 4
AHMAD MUSTAQIM 3 2 3 3 3 3 3 4
MOHD ROZALI 4 4 4 4 4 4 4 4
RAZALLE 3 4 4 4 4 4 4 4
ROSHILAWANI 3 4 3 4 3 4 3 4
TOTAL 17 18 18 18 18 19 18 20
AVERAGE 3.4 3.6 3.6 3.6 3.6 3.8 3.6 4.0

146 x 100
Pre Achievement 73%
200
SCALE

1 TOO WEAK

2 WEAK

3 MODERATE

4 GOOD

5 EXCELLENT
18
1
 PLAN 1: PROBLEMS, THEMES & GOALS PROBLEM IDENTIFICATION

BRAINSTORMING

PROBLEM IDENTIFICATION

CUSTOMER COMPLAINTS

HEAD OF
DEPARTMENT’S
RECOMENDATION
20 20
 PLAN 1: PROBLEMS, THEMES & GOALS PROBLEM IDENTIFICATION

Qp Team distributed the Problem Survey Questionaires that needed

to be given Priority

Sample :
70 Outpatient Pharmacy Counter staff from the Raja Perempuan
Zainab II Hospital

Method :
Tick (  ) for the 3 problems based on priority that most likely need
to be improved.

21
 PLAN 1 : PROBLEMS, THEMES & GOALS RESULTS

NO PROBLEM SUGGESTION PERCEN

BY TAGE
1 Increasing number of patients who do not contact the Pharmacy 11.4%
via the Telephone and Pickup Service at the Pharmacy Counter.
2 Increasing number of unclaimed medicine by patients who use 12.9%
the Appointment Card Service at the Pharmacy Counter.
3 Difficulty in supplying medicines via HRPZ II Integrated Drug 80%
Dispensing System (IDDS) to the referred facilities.
4 Increasing number of unclaimed medicine by patients who use 14.3%
the Claim Tomorrow Service
5 Value Added Services(VAS) patients of HRPZ II do not comply to 70%
the specified date of appointment.

6 Difficulty in maintaining the Insulin Cold Chain from the 95.7%

Outpatient Pharmacy of Raja Perempuan Zainab II Hospital
(HRPZ II) to the patient’s home
7 Patients using the Value Added Services (VAS) have to wait longer 15.7%
to receive their medicine supplies at the Pharmacy Counter. 22
 PLAN 1 : PROBLEMS, THEMES & GOALS RESULTS

Difficulty in maintaining the Insulin Cold Chain

1 from the Outpatient Pharmacy of Raja

Perempuan Zainab II Hospital (HRPZ II) to the
patient’s home

2
Difficulty in supplying medicines via HRPZ II
Integrated Drug Dispensing System (IDDS) to
the referred facilities

Value Added Services(VAS) patients of HRPZ II

3 do not comply to the specified date of
appointment.

Methodology of data collection :

PROBLEM ANALYSIS i . Data and Statistics
ii . Observations
iii . Questionaires
23
 PLAN 1 : PROBLEMS, THEMES & GOALS 1st PROBLEM ANALYSIS

CONCLUSION of Survey 1-14 Feb 2017

94.4% - agreed to be sent home
62.2% - agreed to be charged
30% - knew the potency of Insulin & other
drugs influenced by temperature

24
 PLAN 1 : PROBLEMS, THEMES & GOALS 1st PROBLEM ANALYSIS
DIFFICULTY IN MAINTAINING THE INSULIN COLD CHAIN
FROM THE OUTPATIENT PHARMACY, HRPZ II TO THE PATIENT’S HOME

MONTH Aug-16 Sept-16 Oct-16 Nov-16 Dec-16 Jan-17 TOTAL Average

Number of Diabetic
Patients Using Insulin at
1014 871 800 618 683 767 4753 792
Outpatient Pharmacy
ACC HRPZ II
Survey 1-14 Feb 2017
CONCLUSION
Only 30% patients
knew the potency of 70% OF PATIENTS FAILED
Insulin & other drugs TO ADHERE TO THE COLD CHAIN
influenced by DEFINATION :
temperature Patients who FAILED TO ADHERE TO THE
COLD CHAIN = refer to Patients who FAILED TO
Prepared by : Mr Ahmad Mustaqim,
STORE the Insulin within 30 minutes OR FAILED
Mr Mohd Rozali and Mdm Siti Aisah
TO ADD ICE CUBES on the way back home
Source :
OPD HRPZ II DATA (office hours only) for the period Aug 2016 – Jan 2017 (Survey Results) 25
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM IDENTIFICATION

SCALE
CRITERIA
1-4 5 6 - 10

Improvements can
Beyond member’s Within member’s
be made with new
capability and capability but
CAPABILITY ideas and within
difficult to produce difficult to produce
member’s
new ideas new ideas
capability

Does not give a Gives impact on

tangible impact on Gives a moderate the service or user
CRITICAL
the service and impact on the service and department’s
department’s image image

26
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM IDENTIFICATION

NO. LIST OF PROBLEMS CAPABILITY CRITICAL TOTAL

Difficulty in maintaining
10 10 20
Insulin Cold Chain from the
1
Outpatient Pharmacy,HRPZ
II to the patient’s home
Difficulty in supplying 0

medicines via HRPZ II

2 Integrated Drug Dispensing 9 9 18
System (IDDS) to the
referred facilities
Value Added Services(VAS)
3
patients of HRPZ II do not
comply to the specified date 7 9 16
of appointment. 27
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM IDENTIFICATION

HIGH CAPABILITY Main

problem
10 1 selected
9 2
8
7 3
LESS VERY
CRITICAL 0 1 2 3 4 6 7 8 9 10 CRITICAL
3
2
1
0

LOW CAPABILITY
28
PLAN 1 : PROBLEMS, THEMES & GOALS

29
 PLAN 1 : PROBLEMS, THEMES & GOALS PROJECT TITLE
PROJECT DEFINITION & TERMINOLOGY

DIFFICULTY :
About
Complications
OR Hardship

Reference: Malay Correspondence Referral Centre / Language Board & Library Latest Edition
30
PLAN 1 : PROBLEMS, THEMES & GOALS PROJECT TITLE
PROJECT DEFINITION & TERMINOLOGY

COLD CHAIN:

Is the medicine supply chain within a

controlled temperature range

Reference: Cold Chain Operation by Juhainun Taha 19th March 2009 31

 PLAN 1 : PROBLEMS, THEMES & GOALS PROJECT TITLE
PROJECT DEFINITION & TERMINOLOGY

INSULIN
Is an injectable form of medicine
to control Diabetes

Reference: Cold Chain Operation by Juhainun Taha 19th March 2009 32

 PLAN 1 : PROBLEMS, THEMES & GOALS PROJECT TITLE
PROJECT DEFINITION & TERMINOLOGY
OUTPATIENT PHARMACY HRPZ II TO THE PATIENT'S HOME

Outpatient Pharmacy at the Ambulatory Care Centre(ACC) Patient’s House

Raja Perempuan Zainab II Hospital(HRPZ II)
33
 PLAN 1 : PROBLEMS, THEMES & GOALS PROJECT TITLE
PROJECT DEFINITION & TERMINOLOGY

Why MAINTAINING THE COLD CHAIN IS

IMPORTANT ?
To controls quality, safety and efficacy of products that
are sensitive to temperature like substances such as :
Pharmaceuticals (eg. Medicines)
Biologicals
Diagnostics
Laboratory samples
Chemicals
Food
Reference: Cold Chain Operation by Juhainun Taha 19th March 2009 34
 PLAN 1 : PROBLEMS, THEMES & GOALS PROJECT TITLE

Rujukan:
http://www.iddt.org/about/living-with-diabetes/storing-insulin

Litreature Review
prepared by :
Rujukan:
Pn Siti Aisah & En Razalle 35
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

Patient receives treatment

at HRPZ II

Doctor prescribes
medication for a duration
exceeding 1 month

36
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

Patient receives medicine

supply for a 1 month
duration from the Pharmacy
(refer Letter from Ministry of
Health dated 26/1/17)

Patient needs to get the

balance supply at the
Outpatient Pharmacy HRPZ II
37
 CAUSING.........

1
Patient need to visit Hospital (HRPZ II) EVERY MONTH
to receive the balance medicine supply 38
 2 Increase
CAUSING......... patient’s
burden
TIME
ENERGY
CONGESTED & DIFFICULT TO GET A PARKING LOT MONEY

NEED TO VISIT THE NEED TO PAY FOR NEED TO PAY SUMMON

HOSPITAL PARKING LOT / COMPOUNDS 39
 CAUSING.........

3
Patients need to wait at the Outpatient Pharmacy, ACC
HRPZ II to get their follow-up balance medicine supply 40
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

Problem
1

Patient has to bring back the

Insulin and ensure it is not
exposed to high temperature
changes in the environment

41
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

Problem
2

Patients are supplied with Ice Cubes &

Insulin
some ice cubes.

Patients need to add ice

cubes while on the way
back home.
Ice Cubes Insulin in the
Refridgerator 42
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

Problem
3

Patients need to hurry

home because insulin
need to be stored in the
fridge at 2-8°Celcius

43
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

ICE CUBE RESISTANCE STUDY

Comment 03017 COLDBOX B
PROOF
Kajian Ketulan Ais
S/N 9134228

Sensor /Temperature Type External NTC MicroLite II®

Low 2
Pre-low
Pre-high
High 8
Ice Cube
External NTC Alarm
Date Time MicroLite II Type
12/2/2017 3:15:00 PM 5.00 Low
12/2/2017 3:25:00 PM 6.10 Low * Temperature
12/2/2017 3:35:00 PM 7.55 Low exceeds 8ºCelcius
12/2/2017 3:45:00 PM 8.72 High
12/2/2017 3:55:00 PM 10.00 High within 30 minutes
12/2/2017 4:05:00 PM 12.50 High
12/2/2017 4:15:00 PM 15.20 High

From the study it is found that for every 200 grams of ice
cubes given to the patient, temperature exceeds 8°Celcius Ice Cube
within 30 minutes & Insulin 44
PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

Monthly Average Maximum Temperature

March 2017
KOTAKOTA
BHARU
BHARU

45
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND
TIME STUDY FOR 1 PATIENT
SCENARIO :
En Ahmad departs from KETEREH (22 km) to Hospital (HRPZ II at
Kota Bharu town) to get his balance Insulin and other medicines

TIME STUDY
TIME DURATION ACTIVITY
(MINUTES)
7.30am - 8.00am 30 minutes Depart from home
8.00am - 8.30am 30 minutes Wait and get medicine
8.30am - 9.00am 30 minutes Breakfast
9.00am - 9.30am 30 minutes Return home
TOTAL TIME 2 HOURS
46
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND
EXPENDITURE STUDY FOR 1 PATIENT
SCENARIO :
En Ahmad departs from KETEREH (22 km) to Hospital (HRPZ II at
Kota Bharu town) to get his balance Insulin and other medicines

EXPENDITURE STUDY EXPENDITURE STUDY

COST OWN PUBLIC COST OWN PUBLIC
TRANSPORT TRANSPORT TRANSPORT TRANSPORT

Petrol USD 2.3 x 2 NONE Petrol RM 8 x 2 NONE

Taxi Fare NONE USD 5.7 x 2 Taxi Fare NONE RM20 x 2

Parking (Out USD 0.6 NONE Parking (Out RM 2 NONE

of HRPZ II) of HRPZ II)
Breakfast USD 1.7 USD 1.7 Breakfast RM 6 RM 6
TOTAL USD 6.9 USD 13.1 TOTAL
COST COST
RM 24 RM 46
47
PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

48 48
PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

IMPACT ON THE PATIENT

Patients receive INSULIN supply

with the potency in doubt
• This will result in the DIABETES
TREATMENT PROCESS
BEING IMPERFECT
• DURATION OF DIABETES TREATMENT
becomes MUCH LONGER
49
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

IMPACT ON THE PATIENT

DIABETIC
COMPLICATIONS

Patients receive INSULIN supply

with the potency in doubt
• Possibility of patients
experiencing a MORE CHRONIC
DIABETIC COMPLICATION
Blindness due to
Diabetes

50
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

IMPACT ON THE
Patients receive PATIENT
INSULIN supply
with the potency in doubt
• It could RESULT IN DEATH
DEATH
Vulnerability
FAILED Blood
Sugar Level SEVERE / CHRONIC
Control Advancement Of
Diabetes
SPOILT
Insulin

51
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

IMPACT ON
THE DEPARTMENT

Diabetes Complication causes

• INCREASE in COST of patient
treatment
• LONGER DURATION of patient
TREATMENT in the ward
• INCREASE in hospital’s TOTAL
EXPENDITURE 52
 PLAN 1 : PROBLEMS, THEMES
& GOALS
PROBLEM BACKGROUND

IMPACT ON
SOCIETY

Produce an unhealthy community.

Failure to achieve the Malaysian Ministry Of
Health’s goal.
COMMUNITY LOSES TRUST towards hospital treatment.
FAILURE in Diabetes patient’s Treatment process.
Patients choose other alternative treatment
 Traditional
 Homeopathy
 Acupunture Traditional
 Shaman Homeopathy
Acupunture
Shaman 53
 PLAN 1 : PROBLEMS,
THEMES & GOALS
PROBLEM DEFINITION TECHNIC

5W + 1H METHOD

WHAT
HOW

WHY +
WHO
WHEN WHERE
54
 PLAN 1 : PROBLEMS,
THEMES & GOALS
PROBLEM DEFINITION TECHNIC

WHAT ?
Difficulty in maintaining
the Insulin Cold Chain
from the Outpatient
Pharmacy of Raja
Perempuan Zainab II
Hospital (HRPZ II) to the
patient’s
home
Reference:
http://www.iddt.org/about/living-with-diabetes/storing-insulin
55
PLAN 1 : PROBLEMS,
THEMES & GOALS
DESCRIPTION OF WHAT?

1. PATIENT RECEIVES INSULIN WITH

SOME ICE CUBES FROM THE
PHARMACY COUNTER

56
 PLAN 1 : PROBLEMS,
THEMES & GOALS
DESCRIPTION OF WHAT?

2. USUALLY THE PATIENT KEEPS THE

INSULIN AND OTHER MEDICINES
IN THE VEHICLE

Glove Compartment Dashboard Area

57
 PLAN 1 : PROBLEMS,
THEMES & GOALS DESCRIPTION OF WHAT?

3. PATIENT RETURNS
HOME WITH THE
INSULIN

4. PATIENT NEEDS TO
Ice Cubes
ADD ICE CUBES TO
THE INSULIN
BEFORE REACHING
HOME
58
 PLAN 1 : PROBLEMS,
THEMES & GOALS DESCRIPTION OF WHAT?

5. PATIENT KEEPS THE INSULIN

IMMEDIATELY IN THE FRIDGE ONCE
REACHING HOME

59
 PLAN 1 : PROBLEMS,
THEMES & GOALS DESCRIPTION OF WHAT?

WITH HOPE
(THROUGH ADVICE AND COUNSELLING)

1 PATIENT HURRIES HOME AND STORES THE

INSULIN IN THE FRIDGE.

2 PATIENT WILL ADD ICE CUBES

IF DELAY IN REACHING HOME

THE INSULIN RECEIVED BY THE PATIENT IS

3 NOT SPOILT AND STILL HAS POTENCY TO
TREAT DIABETES
60
 PLAN 1 : PROBLEMS,
PROBLEM DEFINITION TECHNIQUE
THEMES & GOALS

WHY?

Containers or special
equipment not available
to store Insulin brought
by the patient

61
 PLAN 1 : PROBLEMS,
THEMES & GOALS
PROBLEM DEFINITION TECHNIQUE

WHEN?

Each time when the patient

receives Insulin at the
Outpatient Pharmacy counter
untill the patient stores in the
refridgerator
62
 PLAN 1 : PROBLEMS,
PROBLEM DEFINITION TECHNIQUE
THEMES & GOALS

WHERE?
Receive
1 At the Outpatient START Insulin from
Pharmacy
Pharmacy Counter Counter

HRPZII
Store Insulin
2 Inside the patient’s in the fridge
Keep the Insulin
in the vehicle
vehicle
3 At the patient’s Return
home
house
63
 PLAN 1 : PROBLEMS,
PROBLEM DEFINITION TECHNIQUE
THEMES & GOALS

WHO?
1
Staff at the Outpatient
Pharmacy Counter,
HRPZ II

2
Patient or relative
who receives the
Insulin
64
 PLAN 1 : PROBLEMS,
PROBLEM DEFINITION TECHNIQUE
THEMES & GOALS

HOW ?

No new work process for

maintaining temperature of
Insulin brought back by the Pharmacy
Counter
patient untill the house.

Patient’s House
65
 PLAN 1 : PROBLEMS,
THEMES & GOALS
DESCRIPTION OF WHAT?
FLOW CHART: RECEIVE INSULIN FROM PHARMACY COUNTER
UNTIL TO THE PATIENT’S HOUSE

Receive Insulin together with Ice Insulin’s

Cubes from Pharmacy Counter
Potency SAFE
Keep the Insulin in the vehicle
Insulin & Ice
Cubes
Drive home the vehicle

Insulin’s AddYA
ice
Ice Cubes
Cubes?
potency NO YES
in doubt
Patient proceeds on journey home

Patient immediately keeps Insulin in

the fridge on reaching home

FINISH
66
PLAN 1 : PROBLEMS, THEMES & GOALS

PROJECT’S THEME

67
 PLAN 1 : PROBLEMS,
THEMES & GOALS DESCRIPTION OF WHAT?

To Increasing The Percentage Of Patients Who Comply To The

Cold Chain from 30% to 100% at the Outpatient Pharmacy
HRPZ II within 6 months
MONTH Aug-16 Sept-16 Oct-16 Nov-16 Dec-16 Jan-17 TOTAL Average

Number of Diabetic Patients

Using Insulin at Outpatient 1014 871 800 618 683 767 4753 792
Pharmacy ACC HRPZ II

Survey 1-14 Feb 2017 CONCLUSION

Only 30% patients 70% OF PATIENTS FAILED
knew the potency of TO ADHERE TO THE COLD CHAIN
Insulin & other drugs
influenced by temperature DEFINATION :
Patients who FAILED TO ADHERE TO THE
Prepared by : Mr Ahmad Mustaqim,
COLD CHAIN = refer to Patients who FAILED TO
Mr Mohd Rozali and Mdm Siti Aisah
STORE the Insulin within 30 minutes OR FAILED
Source : TO ADD ICE CUBES on the way back home
OPD HRPZ II DATA (office hours only) for the period Aug 2016 – Jan 2017 (Survey Results) 68
 PLAN 1 : PROBLEMS, THEMES & GOALS DESCRIPTION OF WHAT?

Rujukan:
http://www.iddt.org/about/living-with-diabetes/storing-insulin

Litreature Review
prepared by :
Rujukan:
Pn Siti Aisah & En Razalle 69
PLAN 1 : PROBLEMS, THEMES & GOALS

MOST SUITABLE FOR INSULIN

INSULIN POTENCY :
CAN BE USED UNTILL THE EXPIRY DATE

70
PLAN 1 : PROBLEMS, THEMES & GOALS

LIMITED USAGE
INSULIN POTENCY :
CAN BE USED FOR A PERIOD OF 4 WEEKS ONLY

Reference: 71
 PLAN 1 : PROBLEMS, THEMES & GOALS

SPOILT AND CANNOT BE USED

INSULIN POTENCY :
SPOILT AND AT RISK IF USED

300,000 Kelantanese got Diabetes Workload of Diabetes

72
 PLAN 1 : PROBLEMS, THEMES & GOALS

IF INSULIN THAT DO NOT HAVE POTENCY

ARE USED
DIABETIC
COMPLICATIONS

RISK OF
MORE
CHRONIC
DIABETES

Care of Diabetes’s Patient 73

 PLAN 1 : PROBLEMS, THEMES & GOALS

IF INSULIN THAT DO NOT HAVE POTENCY

ARE USED

FAILURE IN THE
TREATMENT OF
DIABETES

Blindness due to
Diabetes 74
 PLAN 1 : PROBLEMS, THEMES & GOALS

Reduce
Congestion At
The Pharmacy
PROJECT’S Counter
MAIN
GOAL

Reduce Diabetes
Complications

75
2
PLAN 2: TROUBLESHOOTING &
CORRECTIVE PROCESS
CAUSE EFFECT DIAGRAM 1
Many other
METHOD commitments MANPOWER
Patient treatment Obtain Difficulty
process not effective Insufficient Insulin in bringing
supply back
No Cold Chain
Insulin supply Staff
Delivery(FREE)
with Insufficient Patient
ice cubes Insufficient
Difficult to maintain Temperature Attitude information regarding
potency of Insulin Cold Chain
Ice Cubes
Insulin requires Medicine Durability
Potency DIFFICULTY IN
specific storage
temperatures Non compliant MAINTAINING THE
Lack of in handling the INSULIN COLD
knowledge Cold Chain
CHAIN FROM THE
OUTPATIENT
PHARMACY HRPZ II
Refuse to pay TO THE PATIENT’S
Need to make HOME
Vehicle Expensive other payments

Purchase new
Wants it Limited Patient
equipment
No specific Difficult in cold free space Locality
vehicle Suitable Could not Difficult for
chain drug Difficulty in Far
potency delivery
delivery afford explaining about
Cold Chain
Expensive Hospital
Specific
equipment Cold Chain Delivery No policy
Locality
Equipment (WITH COST) regarding Cold
No specific and Chain delivery
cheap equipment

MACHINERY COST ENVIRONMENT 77

 PLAN 2: TROUBLESHOOTING &
CORRECTIVEPROCESS
CAUSE EFFECT DIAGRAM 1
FACTOR ROOT OF PROBLEM OBSERVATION
MANPOWER Lack of knowledge Non sensitive attitude and
and non compliant in many other commitments
handling the cold of patients exposes Insulin
chain to environmental
temperatures
METHOD Difficult to maintain Insulin Potency
potency of Insulin  Storage temperature 2-8
ºC maintained until expiry
date
 Storage temperature
below 25ºCelcius can be
used for a period of 4
weeks
METHOD Insulin supply with Durability of ice cubes is
insufficient ice cubes only 30 minutes to 60
minutes depending on
quantity of ice supplied
BASIC
CONSIDERATIONS
Patient needs to
immediately keep the
Insulin in the appropriate
storage place
(Refridegerator)
Failure to maintain the
cold chain causes the
potency of Insulin to be
spoilt
Patient need to get home
soon to maintain cold
chain and the Insulin is
more secure and safe
78
 PLAN 2: TROUBLESHOOTING &
CORRECTIVE PROCESS
CAUSE EFFECT DIAGRAM 1

FACTOR ROOT OF PROBLEM OBSERVATION BASIC CONSIDERATIONS

MACHINERY No specific Not all patient vehicles A safe and quality Insulin
transport to deliver have Cooler Box facilities. supply can be supplied
medicines requiring Negotiations with delivery right up to the patient’s
the cold chain companies that provide the house
service can be made.

COST Could not afford to Existing fast delivery
pay services impose high
charges
ENVIRONME Difficulty in Patients unable to get clear
NT explaining about explainations cause the
Cold Chain insulin potency to be
affected.
Patients receive non
quality medicine.
Patients, if proven cannot
afford to pay can be
referred to the Medical
Social Work Department
Difficult to do because of a
large number of patients
especially during peak
hours.
Patients must get a safe
supply of medicines.

79
PLAN 2: TROUBLESHOOTING &
CORRECTIVE PROCESS CAUSE EFFECT DIAGRAM 2
KAEDAH
METHOD MANUSIA
MANPOWER
Insulin supply with
No Cold Chain Insufficient ice cubes
Delivery(FREE)
Patient

Difficult to maintain
potency of Insulin Lack of
knowledge Non compliant DIFFICULTY
in handling the IN MAINTAINING
Cold Chain
THE INSULIN
COLD CHAIN
FROM THE
OUTPATIENT
Vehicle PHARMACY
HRPZ II TO THE
No specific
vehicle Limited PATIENT’S HOME
Could not space
afford
Difficult in cold chain Difficulty in
drug delivery explaining about
Expensive Cold Chain

Cold chain delivery

(WITH COST)

MACHINERY COST ENVIRONMENT 80

PLAN 2: TROUBLESHOOTING &
CORRECTIVE PROCESS
FACTOR MAIN CAUSES
MANPOWER Lack of knowledge and
non compliant in
handling the cold chain
METHOD i. Insulin supply with
insufficient ice cubes
ii. Difficult to maintain
potency of Insulin
MACHINERY No specific transport
COST Patients could not afford to
pay high cost of delivery
ENVIRONMENT Difficulty in explaining
about Cold Chain
CAUSE EFFECT DIAGRAM 2
OBSERVATIONS
 Patients supplied with Insulin do not understand the
importance of the Cold Chain.
 Need to overcome because Insulin requires precise
storage temperatures for maximum
potency/effective.
i. Patients on Insulin are supplied with ice cubes and
need to add on ice cubes while on the way home.
ii.Failure to add ice cubes by patients or a delay more
than 30 minutes in storing the insulin in the
refridgerator causes a reduction in potency of insulin
 For Insulin delivery.
 Patient’s vehicle not provided with equipments for
insulin storage.
 Patient cannot afford can be referred to other social
body.
 The waiting area at the Outpatient Pharmacy counter
is full of patients during peak hours.
81
 PLAN 2: TROUBLESHOOTING & CORRECTIVE PROCESS

PRE PROJECT CHECK LIST

Qp ICC TEAM
PRE PROJECT CHECK LIST FORM
(BASE ON QUESTIONS TO PHARMACY STAFF WHO
WORK AT THE COUNTER)

PRE Project Study DIFFICULTY IN MAINTAINING THE INSULIN COLD CHAIN FROM
using the methodology of THE OUTPATIENT PHARMACY HRPZ II TO THE PATIENT’S HOME
DURATION OF STUDY FROM 2/4/17 UNTILL 16/4/17
Checklist data collection ( PLEASE TICK √ IN THE BOX FOR THE RELATED WEEK ONLY )
beginning on 2/4/2017 -
NO. CAUSE WEEK 1 WEEK 2 TOTAL
16/4/2017
No specific transport to deliver
1.
medicines requiring the Cold Chain
15 Pharmacy staff were 2.
Difficulty in explaining about Cold
Chain
asked each day for 10
Insulin supply with insufficient ice
days. As many 150 Pre 3.
cubes

Project Checklist forms 4. Difficult to maintain potency of Insulin

were filled by ICC 5. Could not afford to pay

members . 6.
Lack of knowledge and non compliant
in handling the Cold Chain

TOTAL

All information given is intended to improve the Pharmacy

Department Service, HRPZ II for all our Clients’ Satisfaction
Thank you for your cooperation.
82
 PLAN 2: TROUBLESHOOTING & CORRECTIVE PROCESS

FREQUENCY OF ROOT OF PROBLEM AND PERCENTAGE OF FREQUENCY TABLE

PRE PROJECT STUDY 2/4/17 UNTILL 16/4/17
Cumulative
Cumulative Frequency
No Root of Problem Frequency Percentage of
Total Percentage
Frequency (%)
(%)
1 No specific transport to deliver
medicines requiring the Cold 150 31.4 150 31.4
Chain
2 Difficulty in explaining about
Cold Chain 136 28.5 286 60.0
3 Insulin supply with insufficient
ice cubes 97 20.3 383 80.3
4 Difficult to maintain potency of
Insulin
51 10.7 434 91.0
5 Could not afford to pay 32 6.7 466 97.7
6 Lack of knowledge and non
compliant in handling the Cold 11 2.3 477 100
Chain
TOTAL 477 100% 83
 PRE PROJECT PARETO CHART
477
500
475 100%
450

CUMULATIVE FREQUENCY PERCENTAGE

425
400
F 375
R 350
325
E 80%
300
Q 275
U 250
E 225
N 200
175
C 150 150
Y 136
125
100 95 97
75
50 51
32
25
Sukar memberi 11 Cause of
No specific transport to Difficulty in Insulin supply with Difficult to maintainpenerangan berkenaan
Could not afford to pay Lack of knowledge Problem
deliver medicines explaining about insufficient ice cubes potency of Insulin rangkaian sejuk and non compliant
requiring the Cold Chain Cold Chain
in handling the Cold
Chain 84
3
 CAUSE PROPOSED ACTION ALTERNATIVE ACTION CONSIDERATION RESULT
Contact with a few Much cheaper
No specific Identify a delivery company delivery companies delivery company ACCEPTED
transport to with minimal cost around the Kota Bharu available
district
ANALYSIS OF deliver
medicines Use department vehicle for
PROPOSED requiring the delivery
Request permission from
higher authority
Constraints on staff
and departmental REJECTED
SOLUTION Cold Chain vehicles

USING TREE Group information regarding

Cold Chain
DIAGRAM Amend the Work
Can be
TECHNIQUE Difficulty in
explaining about Specify time and date for
Process and position a
particular staff to
implemented via
ACCEPTED
Head of
Cold Chain Cold Chain information provide information
Department’s
and promote Cold
orders
OBJECTIVE Chain
Allocate a special room for
Cold Chain briefing

Patient need to add

Insulin supply Supply ice cubes
MAINTAINING with insufficient according to patient’s
quantity of ice cubes
THE INSULIN ice cubes Supply sufficient ice cubes need
while on the way ACCEPTED
home
COLD CHAIN
FROM
Can be implemented
THE Difficult to Use Polystyrene/Cooler
without involving ACCEPTED
Provide suitable
OUTPATIENT maintain receptacle for Insulin
Box existing ice packs
additional cost
PHARMACY potency of delivery
HRPZ II TO Insulin
Invent special Need creative ideas ACCEPTED
THE receptacles
PATIENT’S
Could not afford
HOME to pay
Identify patients who could Contact parties such
Request aid from as Hospital Social
not afford
Welfare Unit. Medical Welfare and ACCEPTED
Kelantan Islamic
Lack of Patients using Insulin Religious Council
knowledge and
need to be given
non compliant in Level of patients Unpredictable REJECTED
handling the Cold explainations from time to
education differs attitude of patients
Chain time
86
 PLAN 3 : SOLUTIONS (CATEGORY & AMOUNT)
PROPOSED ACTION SOLUTION

NO. PROPOSED ACTION PROPOSED SOLUTION

Identify a delivery company with Negotiate and co-operate with the selected
1
minimal cost delivery company

Group information regarding Cold

2
Chain
Specify time and date for Cold Group information (more than 3 person) given
3
Chain information to patients via video presentation or bunting
Allocate a special room for Cold
4
Chain briefing
Supply sufficient ice cubes Prepare or create a special container /suitable
5
for temperature control, durable and can
Provide suitable receptacle for protect from light so that the quality of Insulin is
6 maintained, safe and effective to the patient
Insulin delivery

Identify patients who could not Request/Channel aid from Social Medical
7
afford Welfare Department
87
 PLAN 3 : SOLUTIONS (CATEGORY & AMOUNT)
PROPOSED ACTION SOLUTION
PROCESS DECISION PROGRAMME CHART (PDPC )
DIFFICULTY IN MAINTAINING THE INSULIN COLD CHAIN
FROM THE OUTPATIENT PHARMACY HRPZ II TO THE PATIENT’S HOME
ACTION Provide
Allocate a Identify
Identify a Group Specify time Supply suitable
special room
delivery information and date for patients
for Cold sufficient receptacle
company with regarding Cold Chain who could
Chain briefing ice cubes for Insulin
minimal cost Cold Chain information not afford
regularly delivery

Difficult to
EXPECTED Difficult to find a Well-known fulfill Limited supply Most patients
DIFFICULTY delivery company companies, patient of equipments want free
that offers minimal offer high Difficulty in grouping patients at the
Pharmacy within the same time frame needs service
charges, suitable charges
to patient’s
affordability

RESOLUTION
Negotiate and High cost Explaination Video Channel to
Create a special container for
co-operate with presentation
/SOLUTION beyond given when more quality Insulin delivery, fast the Social
the selected patient’s than 3 people and bunting
and safe to the patient Medical
delivery affordability Welfare
company
Department

Patients understand better Create special container

FINISH Identify chosen company about Cold Chain / equipment

Towards Quality Insulin Supply, Safe and Effective 88

 PLAN 3 : SOLUTIONS (CATEGORY & AMOUNT)
PROPOSED ACTION SOLUTION

1 SELECT 2 GIVE 3 INVENT/CREATE

DELIVERY EXPLAINATION SPECIAL
COMPANY TO PATIENTS EQUIPMENT

PATIENT CONTAINER/
RECEPTACLE SUITABLE
DISCUSS WITH THE UNDERSTANDS
TO CONTROL INSULIN
DELIVERY COMPANY BETTER ABOUT TEMPERATURE AND
COLD CHAIN PORTABLE

Towards Quality Insulin Supply, Safe and Effective

Received by Patient
89
 PLAN 3 : SOLUTIONS PROPOSED ACTION
(CATEGORY & AMOUNT) SOLUTION
1 PROPOSED DELIVERY COMPANY SELECTION

PRO AND CONTRA METHOD

Proposed
No Pro Contra Result
Solution
1. No guidelines in delivering
1. Simple and fast Insulin via Post (need
Negotiate with
2. Safety of additional guidelines in a PRACTICAL
1. Insulin assured collective manner)
Post Malaysia 2. Requires consent from
3. Reasonable
charges higher authorities of
Pharmacy and Post Malaysia
1. Simple and fast NOT
Negotiate with 1. High charges.
2. Safety of PRACTICAL
2. available well-known More than RM100 for one
Insulin assured patient
delivery companies

1. Simple and fast 1. Need to identify the

Negotiate with the company willing to deliver
2. Safety of
3.
Co-operative Insulin assured
and comply with the terms PRACTICAL
specified by the Pharmacy
Company 3. Reasonable 2. Delivery limited to selected
charges location only
90
PRESENTATION TO THE STATE MANAGER
on 26th March 2017

State Manager
Post Malaysia Kelantan State
(En Mohamad Nazri bin Said) 91
4
 DEPARTMENT
DO 4 : DEGREE BACKGROUND
OF DIFFICULTY
PROPOSED CORRECTIVE ACTION SOLUTION
PROCESS DECISION PROGRAMME CHART (PDPC )
DIFFICULTY IN MAINTAINING THE INSULIN COLD CHAIN
FROM THE OUTPATIENT PHARMACY HRPZ II TO THE PATIENT’S HOME
Negotiate with available
ACTION Negotiate with Post Malaysia Negotiate with the
well known delivery Co-operative Society
companies

EXPECTED Need to add Need collective Delivery charges Difficult to find a

DIFFICULTY criteria in existing understanding from that are costly suitable company with
guidelines higher authorities of reasonable cost
Pharmacy and Post
Malaysia

RESOLUTION Negotiatiation and The Pos Malaysia Delivery service that is Offering delivery service
/SOLUTION cooperattion with party yet to give efficient , fast and safe to the that is fast and safe to the
Pos Malaysia a decision patient patient

FINISH The Pos Malaysia party DISAGREE because Identify selected company Identify selected company
it involves Cold Chain Medicine

Towards Quality Insulin Supply, Safe and Effective Received by Patient 93

 DIRECT NEGOTIATIONS
WITH A FEW COMPANIES
(cost for 1 patient from Kota Bharu)

1 WELL-KNOWN COMPANY
COST MORE THAN USD28.6 (RM100)

2 CO-OPERATIVE COMPANY
COST : USD14.3 (RM 50)
94
 SELECTED DELIVERY COMPANY
KB TECHNIC RESOURCES COMPANY
had been chosen based on successful Quotation

95
 DO 4 : DEGREE OF PROPOSED ACTION
DIFFICULTY SOLUTION
2 PROPOSED EXPLAINATION TO PATIENTS
OFFERING INSULIN DELIVERY SERVICE
COULD BE IMPLEMENTED THROUGH
COUNSELLING AND DISPENSING

AFTER AFTER
COUNSELLING DISPENSING
96
 DO 4 : DEGREE OF PROPOSED ACTION
DIFFICULTY SOLUTION

3 PROPOSED INVENTION/CREATION OF SPECIAL

RECEPTACLE AND PROTABLE

PROTOTYPE Available
1 Polystyrene Box

PROTOTYPE Modified
2 Cooler Box

Bag that can Control

PROTOTYPE Temperature
3 Changes
97
 DO 4 : DEGREE OF DIFFICULTY
SUPPORTIVE/APPROVAL LETTER TO PROCEED
WITH THE PROJECT FROM PHARMACY SERVICE
DIVISION, MINISTY OF HEALTH MALAYSIA

With Deputy Director of Pharmacy

Services MOH, Malaysia
(Pn Abida Haq) on 15/9/2016 98
 DO 4 : DEGREE OF DIFFICULTY
APPLICATION LETTER FOR MANAGEMENT PRESENTATION
AND APPROVAL FOR MANAGEMENT PRESENTATION

99
 DO 4 : DEGREE OF DIFFICULTY
LETTER OF APPROVAL FOR INSULIN
DELIVERY TO PATIENT’S HOME

26 Mac 2017

SHAIK NURUDIN SHAIK SHAHRUDIN

State Deputy Director Of Health
(Pharmacy) 100
 DO 4 : DEGREE OF DIFFICULTY
APPLICATION LETTER AND TRIAL RUN APPROVAL

Study On Effectiveness Of Delivering Insulin Of Quality,

Safe and Effective to patients’ home 112
101
126
 DO 4 : DEGREE OF DIFFICULTY
3 PROPOSED INVENTION OF SPECIAL
RECEPTACLE AND PROTABLE
PROTOTYPE 4 (Version 1)

Dx-Home Bag
STRAP
- for portability ZIP
- for safety of medicine

ICE PACK AREA

- for maintaining temperature of
Insulin 2-8°C
3 COMPARTMENTS
- for maintaining medicine temperature
- To identify patient’s medicines are in which compartment

Top View Front View 102

 DO 4 : DEGREE OF DIFFICULTY

PROTOTYPE 4 (Version 2)
INVENT CIPTA

103
 DO 4 : DEGREE OF DIFFICULTY
3 PROPOSED INVENTION OF SPECIAL
RECEPTACLE AND PROTABLE
PROTOTYPE 4 (Version 2)

104
 DO 4 : DEGREE OF DIFFICULTY

Function :
OBJECTIVE
PHARMACY SERVICE DIVISION
KELANTAN STATE

Maintains Insulin Temperature 2-8° To ensure all

farmaceutical and
Celcius During Delivery Process healthcare products
available in the market
(in accordance with Pharmacy Objective are of quality, safe,
: supply quality of medicine, safe and effective and controlled
according to the related
effective) regulations and used
rationally
Use : DEPARTMENT

To Transport Insulin to Patient’s Home OBJECTIVE

105
 DO 4 : DEGREE OF DIFFICULTY

Ice Pack area Normal

Medicine
Section

Zipped

Strapped
Cold
Medicine
Alluminium Layer Plastic Basket Section

106
 DO 4 : DEGREE OF DIFFICULTY

Size and Weight: 13 x 8 x 8 inch with a weight of 810g (2 bags + 1 plastic basket)
Material: 1. Outer Layer made of Alluminium Layer whereby having
high insulation effect and able to maintain temperature
at 2-8°Celcius for 6 hours
2. Inner Layer overlayed with PEP plastic(PolyEthylene Plastic)
to avoid wetting. Also as heat insulator
Accesories: 1. Ice Pack Unit of a size 6x4x1inci & weight 700g
(maximum 5-6 ice cubes)
2. MICROLITE® Thermometer capable of recording
temperatures within temperature range - 40 to 80°Celcius
3. Plastic basket of a size12 x 7 x 5 inci
Temperature 6 hours at a temperature of 2 to 8°Celcius
durability period in
the Bag 107
 DO 4 : DEGREE OF TRIAL RUN BY
DIFFICULTY PHARMACY STAFF

INSULIN DELIVERY SERVICE TO THE PATIENT’S HOME

ON 28th MARCH 2017

At Wakaf Bharu and Telipot while monitoring the temperature

108
 DO 4 : DEGREE OF TRIAL RUN BY
DIFFICULTY PHARMACY STAFF

INSULIN DELIVERY SERVICE TO THE PATIENT’S HOME

ON 4th APRIL 2017

At Pasir Pekan and Kampung Kutan

while monitoring the temperature 109
 DO 4 : DEGREE OF TRIAL RUN BY
DIFFICULTY PHARMACY STAFF

INSULIN DELIVERY SERVICE TO THE PATIENT’S HOME

ON 9th APRIL 2017

At Kg. Sungai Keladi and Kg Sireh, Kota Bharu

while monitoring the temperature 110
 DO 4 : DEGREE OF
DIFFICULTY
Discussion and Briefing to
KB Technic Resources Company

Briefing and Discussion with Explaination on method of delivery

KB Technic Resources Company and promotion to Company’s Delivery
Staff and Marketing Officer 111
 DO 4 : DEGREE OF
DIFFICULTY

Memorandum of Agreement Between State Deputy

Director of Health (Pharmacy) with KB Technic Resources
Company, Kota Bharu, Kelantan on 28th March 2017
112
 DO 4 : DEGREE OF DIFFICULTY

MAIN CONDITIONS
TO THE DELIVERY COMPANY
1. INSULIN TEMPERATURE SHOULD BE MAINTAINED BETWEEN
2 – 8 °CELCIUS.
THERMOMETER PLACED OUTSIDE Dx-Home BAG
(Temperature Monitoring Purpose).

2. DELIVERY TIME TO THE PATIENT’S HOME MUST BE ON THE

SAME DAY AFTER TAKING THE INSULIN FROM THE PHARMACY
COUNTER. (Temperature must be recorded)

3. PERMISSION TO PATIENTS WHO WILL BE USING THE SERVICE

WILL BE DECIDED BY THE PHARMACY.

4. BRIEFINGS , EXPLAINATIONS AND PROJECT MONITORING

WILL BE DONE BY THE PHARMACY FROM TIME TO TIME WHEN
NECESSARY.
113
 DO 4 : DEGREE OF
DIFFICULTY
Promotion and Insulin Delivery Campaign to the Patient’s
Home by the Company and Pharmacy HRPZ II

At Outpatient Pharmacy HRPZ II Day With Customers (Promotion and

HRPZ II Kiosk Continuous Know Your Medicine Exhibition)

At Kota Bharu Health Clinic World Pharmacy Day every year 114
5
 DO 5 : QUALITY OF POST PROJECT
IMPLEMENTATION PROCESS CHECKLIST

Qp ICC TEAM
POST PROJECT CHECKLIST FORM
(BASED ON QUESTIONS TO PHARMASI STAFF
WORKING AT THE COUNTER)

Post Project Study DIFFICULTY IN MAINTAINING THE INSULIN COLD CHAIN FROM
THE OUTPATIENT PHARMACY HRPZ II TO THE PATIENT’S HOME
using the methodology of DURATION OF STUDY FROM 14/5/17 UNTILL 28/5/17
Checklist data collection (PLEASE TICK √ IN THE BOX FOR THE RELATED WEEK ONLY )

beginning 14/5/2017 – NO. CAUSE WEEK 1 WEEK 2 TOTAL

28/5/2017 1.
No specific transport to deliver
medicines requiring the Cold Chain

15 Pharmacy Staff were

Difficulty in explaining about Cold
2.
Chain
asked each day for a period 3.
Insulin supply with insufficient ice
cubes
of 10 days . As many as 150
4. Difficult to maintain potency of Insulin
Pre Project Checklist Forms 5. Could not afford to pay
were filled by ICC members. Lack of knowledge and non compliant
6.
in handling the Cold Chain

TOTAL

All information given is intended to improve the Pharmacy

Department Service, HRPZ II for all our Clients’ Satisfaction
Thank you for your cooperation.

116
 DO 5 : QUALITY OF IMPLEMENTATION PROCESS

FREQUENCY OF ROOT OF PROBLEM AND PERCENTAGE OF FREQUENCY TABLE

POST PROJECT STUDY 14/5/17 UNTILL 28/5/17
Cumulative
Cumulative Frequency
No Root of Problem Frequency Percentage of
Total Percentage
Frequency (%)
(%)
1 No specific transport to deliver
medicines requiring the Cold 68 35.2 68 35.2
Chain
2 Difficulty in explaining about
Cold Chain
45 23.3 113 58.5
3 Insulin supply with insufficient
ice cubes
29 15.0 142 73.5
4 Difficult to maintain potency of
Insulin
28 14.5 170 88.0
5 Could not afford to pay 15 7.8 185 95.8
6 Lack of knowledge and non
compliant in handling the Cold 8 4.2 193 100
Chain
TOTAL 193 100 117
 POST PROJECT PARETO CHART
500
477 100%
475
450

CUMULATIVE FREQUENCY PERCENTAGE

425
400
F 375
R 350
325
E 80%
300
Q 275
U 250
E 225
200 193
N 175
C 150
Y 125
100
95 target
75 68
50 45
25
29 28 15 Root of
Sukar memberi 8 Problem
0Difficult in explaining No specific transport to Insulin supply with Could not afford
penerangan berkenaan
Difficult to maintain Lack of knowledge and
deliver medicines insufficient ice cubes to pay rangkaian
potency sejuk non compliant in
of Insulin
about Cold Chain
requiring the Cold Chain handling the Cold Chain 118
 COMPARISON PARETO CHART
PRE AND POST PROJECT
477
100 %
PRE POST DID NOT
F
Project Project
R SUCCEED
E
Q
U TARGETED ACHIEVEMENT
REDUCTION REDUCTION OF
E
80 % 59.5 %
N
C 193
Y TARGET NOT
40.5 %
ACHIEVED

95 20.5 %
20%

Root of No specific Difficult to give Medicine supply Difficult to Root of

Could not Lack of
Problem transport to deliver
medicines
explanations
regarding
with Insufficient maintain potency afford to pay knowledge and Difficult to give No specific Medicine supply Could not Difficult to Lack of Problem
ice cubes of Insulin non compliant in explanations transport to deliver with Insufficient afford to pay maintain potency knowledge and
requiring the cold chain of Insulin
handling the regarding medicines ice cubes non compliant in
cold chain
cold chain cold chain requiring the handling the
cold chain cold chain

119
 BAR CHART COMPARISON OF CUMULATIVE
FREQUENCY PERCENTAGE REDUCTION
MOST PROBABLE FACTOR POST PROJECT/TRIAL RUN
NO. OF FREQUENCY
600
F 100 % DID NOT
500
R 477 SUCCEED
E 400
Q
U 300
E 59.5 %
N 200
193
C 100 80 %
Y 95
0
PRE Project
Sebelum Projek Target
Sasaran POST Project
Pencapaian Awal

120
6
 CHECK 6 : ACCURACY &
COMPLETION OF EVALUATION

Insulin supply is delivered to patient’s home by the

Company and monitored by Qp Team Members
RESULT
Monitoring on the following factors based
on 5R Concept
PRACTICE
5R CONCEPT
1. Temperature

2. Delivery Time Right Dose

5R
3. Packaging Safety

4. Correct Medicine
(Right Patient, Medicine, Dose, Route and Time of Administration) 5B = Betul Pengguna, Ubat, Dos, Cara dan Masa Administrasi

122
 CHECK 6 : ACCURACY &
COMPLETION OF EVALUATION

INSULIN TEMPERATURE MONITORING

Delivery Date : 19/6/2017 and 3/7/2017

Temperature recorded is 2.5°C and 2.12°C°
123
 CHECK 6 : ACCURACY &
COMPLETION OF EVALUATION

INSULIN TEMPERATURE MONITORING

Delivery Date : 16/4/2018 dan 30/4/2018

Temperature still maintained within range
2 - 8°Celcius after 1 year service 124
 CHECK 6 : ACCURACY &
COMPLETION OF EVALUATION
Calibration Certificate
EQUIPMENT :
MICROLITE-II Thermometer
(ID No. CR03016)
2. Accuracy Test

CALIBRATION DONE BY :
Premier Calibration

CALIBRATION EXPIRY
DATE :

233Oktober
Oktober 2019
2018 1. Reference Standard Used

125
1. Organise Records/Dx-Home
Delivery Forms
BEFORE
a) Create delivery time
note by the Pharmacy and
time returned by the Company

b) Ensure the Dx-Home Bag AFTER

is returned to the Pharmacy
on the same day by the Company
126
2. Safety Assurance of the
MICROLITE-II Thermometer

a) A special container is BEFORE

available outside the Bag
to place the thermometer
to avoid damage due to a fall

b) Easy and clear for the staff

to read the temperature
AFTER 127
3. Safety Assurance of the Dx-Home Bag

a) Physical examination of the bag need to

be performed each time it is returned

b) Diversify size and

provide replacements
if needed

128
PHARMACY AND
COMPANY ACTION

4. Set the date to give

explainations :

i. in groups

ii. at other units/

departments

129
TEAM MEMBERS ACTION

5. Enhance promotions through:

i. increase circulation of
brochures to the public

ii. Cooperate with Kelantan

FM Radio Talk

130
PHARMACY ACTION

i) Contact the patient for re-delivery

appointment date

ii) Contact the Company for

replacement staff

IMMEDIATE ACTION Pharmacy staff

takes over delivery task 131
 CHECK 6 : ACCURACY & COMPLETION OF EVALUATION

PROJECT CHECKLIST

Qp ICC TEAM
POST IMPROVEMENT PROJECT CHECKLIST FORM
(BASED ON QUESTIONS TO PHARMASI STAFF WORKING AT THE COUNTER)

Post Improvement DIFFICULTY IN MAINTAINING THE INSULIN COLD CHAIN FROM

THE OUTPATIENT PHARMACY HRPZ II TO THE PATIENT’S HOME
Project Study using the DURATION OF STUDY FROM 4/6/17 UNTILL 8/6/17
(PLEASE TICK √ IN THE BOX FOR THE RELATED WEEK ONLY )
methodology of Checklist
data collection beginning NO. CAUSE WEEK 1 WEEK 2 TOTAL

4/6/2017 – 8/6/2017 1.
No specific transport to deliver
medicines requiring the Cold Chain

30 Pharmacy Staff were

Difficulty in explaining about Cold
2.
Chain
asked each day for a period 3.
Insulin supply with insufficient ice
cubes
of 5 days . So, total of 150
4. Difficult to maintain potency of Insulin
Pre Project Checklist Forms 5. Could not afford to pay
were filled by ICC members. Lack of knowledge and non compliant
6.
in handling the Cold Chain

TOTAL

All information given is intended to improve the Pharmacy

Department Service, HRPZ II for all our Clients’ Satisfaction
Thank you for your cooperation.
132
132
 CHECK 6 : ACCURACY & COMPLETION OF EVALUATION

FREQUENCY OF ROOT OF PROBLEM AND PERCENTAGE OF FREQUENCY TABLE

PROJECT STUDY 4/6/17 UNTILL 8/6/17
Cumulative
Cumulative Frequency
No Root of Problem Frequency Percentage of
Total Percentage
Frequency (%)
(%)

1 Difficulty in explaining about

Cold Chain
68 89 68 89
2 Lack of knowledge and non
compliant in handling the 8 11 76 100
Cold Chain
3 No specific transport to
deliver medicines requiring 0 0 76 100
the Cold Chain
4 Insulin supply with
insufficient ice cubes
0 0 76 100
5 Could not afford to pay 0 0 76 100
6 Difficult to maintain potency
of Insulin
0 0 76 100
TOTAL 76 100 133
 PROJECT PARETO CHART
500
477
475 100%
450

CUMULATIVE FREQUENCY PERCENTAGE

425
400
F 375
R 350
325
E 80%
300
Q 275
U 250
E 225
N 200
175
C 150
Y 125

76
100
75
50 68

25 8 0 0 0 memberi
Sukar 0
Root of
0
0 Difficulty in explaining Lack of knowledge No specific transport to Insulin supply with penerangan
Could not berkenaan
Difficult to Problem
Regarding Cold Chain and non compliant deliver medicines maintain potency
rangkaian
insufficient ice cubes afford to paysejuk
in handling the Cold
Chain
requiring the Cold Chain
of Insulin 134
 COMPARISON PARETO CHART
PRE, POST AND PROJECT

100%

PRE POST
Project Project

CUMULATIVE FREQUENCY PERCENTAGE

ACHIEVEMENT
TARGETED REDUCTION
ACHIEVEMENT
477
REDUCTION
OF REDUCTION OF
OF ROOT OF
PROBLEM 59.5% 84.1%
80 %

SUCCESSFUL
150 TARGET
NOT
ACHIEVED
96
20.5%
68
76

Root of
Root of Lack of Problem
No specific Difficult to give Medicine supply Difficult to Could not
Problem transport to explanations with Insufficient maintain afford to knowledge and Difficulttotogive
Difficult give No specific Medicine supply Could not Difficult to Lack of Root of Difficult to give Lackofof
Lack No specific Medicine supply Could not Difficult to
deliver ice cubes non compliant
Problem
regarding potency of pay explanations
explanations transport to deliver with Insufficient afford to maintain knowledge and

135
explanations knowledgeand
knowledge and transport to deliver with Insufficient afford to maintain
medicines cold chain Insulin in handling the regarding
regarding medicines ice cubes pay potency of non compliant regarding noncompliant
non compliant medicines ice cubes pay potency of
requiring the cold chain coldchain
cold chain requiring the Insulin in handling the cold chain ininhandling
handlingthe
the requiring the Insulin
cold chain cold chain cold chain coldchain
cold chain cold chain
 BAR CHART COMPARISON OF CUMULATIVE
FREQUENCY PERCENTAGE REDUCTION
MOST PROBABLE FACTOR PRE, POST AND
PROJECT

SUCCESSFUL
F
R 100%(477)
E
Q
U
E 193 (193)
N
C (95) Target
Y 76 84.1 % (76)
POST
IMPROVEMENT
Target Project

136
7
 CHECK 7 : IMPACT OF
RESULTS

Expenditure savings for 1 Patient in Kota Bharu District

with estimated average income of USD14.3(=RM50/day)
Savings for 1 patient for a year is :
1 patient x SAVINGS of USD10/month(=RM35) x 12
months = USD120 (=RM420)
SAVINGS FOR A YEAR is :
With an estimation that 50% of 792 HRPZ II
Diabetes patients using Insulin a month are
from Kota Bharu District
=50/100 x 792 x USD10/month
(=RM35) x 12month
=USD 47,520
(=RM166,320)
Note : 1USD=RM3.5 138
 CHECK 7 : IMPACT OF
RESULTS

SAVINGS PER A YEAR

USD 47,520
(=RM 166,320)
Note : 1USD=RM3.5 139
CHECK 7 : IMPACT OF
RESULTS

140
 CHECK 7 : IMPACT OF
RESULTS

IMPACT PRE PROJECT POST PROJECT SAVING

Number of
Pharmacy Staff
required for
preparing 3 person 2 person 1 person
medicine
(during peak
(preparing of medicine
hours)
is done off-peak hours)
in one day

141
 CHECK 7 : IMPACT OF
RESULTS

INCREASE IN NUMBER OF INSULIN

NUMBER OF INSULIN PATIENT PACKS

PACKS PREPARED IN 1 DAY=16 PATIENTS

THAT CAN BE COMPLETED DURING

1 DAY = 8 HOURS X 2 PATIENTS

1 Staff = 1 Patient = maximum 30 minutes

56 patients
PEAK HOURS

40 patients

PRE PROJECT POST PROJECT 142

 CHECK 7 : IMPACT OF
RESULTS
INCREASE IN INTERNAL CLIENT SATISFACTION LEVEL
( PHARMACY STAFF)
STAFF ARE ALWAYS CHEERFUL AND
INCREASE OF
COMFORTABLE WHILE

100 45% PERFORMING THEIR DUTIES

90
95%
80
70
PERCENTAGE

60
50
40 50%
30
20
10
0 AFTER
BEFORE

INTERNAL CLIENT SATISFACTION LEVEL

143
 CHECK 7 : IMPACT OF
RESULTS
INCREASE IN EXTERNAL CLIENT SATISFACTION LEVEL
(PATIENIT/PESAKIT’S RELATIVE)
PATIENT SATISFIED WITH
INCREASE OF
OUTPATIENT PHARMACY

100
30% SERVICE THAT IS GIVEN

90 95%
80
70
PERCENTAGE

60 65%
50
40
30
20
10
0
BEFORE AFTER
EXTERNAL CLIENT SATISFACTION LEVEL
144
 CHECK 7 : IMPACT OF RESULTS

ERRC VALUE IMPROVEMENT CURRENT TARGET TARGET %

Eliminate (E) Complaints (from 3 1 33.3%
Management Meeting 3
times a year)
Reduce (R) Patient Congestion 5 3 60%
(working days)
Reduce (R) Waiting Time 92.3% 95% 2.84%
(less than 30 minutes) (average Jan-
Jun 2018)
Raise (R) Patient Understanding 30% 100% 100%
Raise (R) Potency of Insulin 2-8°Celcius 2-8°Celcius 100%
Create (C) Create Dx-Home Bag to ensure Insulin temperature maintained
at 2-8°Celcius during delivery by company to the patient’s home.
145
 CHECK 7 : IMPACT OF
RESULTS
1 GIVES MORE CHOICES OF
VALUE ADDED SERVICES
(VAS) TO THE PATIENT
FIRST VAS IN MALAYSIA
for delivering Insulin /Cold
Chain medicine the patient’s
home
22
IMPROVE THE EXISTING
HOME MEDICATION REVIEW
SERVICE
By sending/delivering
including Insulin while on
patient’s home visit
146
 CHECK 7 : IMPACT OF
RESULTS
3 CREATED A KIOSK NEARBY THE
PHARMACY COUNTER

Managed by KB Technic Resources Company.

Monitored by Qp Team Members 147
 CHECK 7 : IMPACT OF
RESULTS
2
NO. KPI REPORT Other Dx-Home Other VAS +
YEAR 2017 VAS Dx-Home
1 JAN - MAR 12,754 - 12,754
(started
23/4/2017)
2 JAN - JUN 25,208 24 25,232
3 JAN - SEPT 37,977 37 38,014
4 JAN - DEC 52,062 73 52,135

Dx-Home
0.14% after 8 months
NOTE : KPI refers to Key Performance Indicator 148
 CHECK 7 : IMPACT OF
RESULTS
2
NO. KPI REPORT VAS Dx- VAS +
YEAR 2018 Home Dx-Home
1 JAN-MAR 14,688 70 14,758
2 JAN-JUN 30,021 99 30,120
3 JAN-SEPT 45,695 130 45,825

Dx-Home
0.28% after 9 months in
Year 2018 compared to 0.14%
after 8 months in Year 2017
NOTE : KPI refers to Key Performance Indicator 149
 CHECK 7 : IMPACT OF
RESULTS
INCREASE IN SALES PROSPECT/
2 COMPANY
REVENUE YEAR 2017 COMPARED TO YEAR 2018
QUARTER YEAR 2017 YEAR 2018
Dx-Home COMPANY Dx-Home COMPANY
REVENUE REVENUE
JAN-MAR - - 70 USD 350
(=RM 1,225)
JAN-JUN 24 USD 116 99 USD 493
(STARTED APRIL) (=RM 405) (=RM 1,725)
37 USD 173 130 USD 639
JAN-SEPT
(=RM 605) (=RM 2,235)
JAN-DEC 73 USD 344 - -
(=RM 1205)
Note : 1USD=RM3.5 150
 CHECK 7 : IMPACT OF
RESULTS
INCREASE IN SALES
2 PROSPECT/ COMPANY
SALES REVENUE YEAR 2018 COMPARED TO YEAR 2017
(USD)
1400

1200
1146
1000
639 Expected
800

600
493
27% 30%
350
400
23% 344
200 173
116
0
0 PERIOD
JANUARY-MARCH JANUARY-JUN JANUARY-SEPT JANUARY-DISEMBER
YEAR 2017 (USD) YEAR 2018 (USD) 151
CHECK 7 : IMPACT OF
RESULTS

CONCLUSION
Study on 1-14th of August 2017
100% - satisfied with Dx-Home service
100% - agreed to widen to Kuala Krai,
Jeli and Gua Musang districts
100% - know that medicine potency
influenced by temperature

152
 CHECK 7 : IMPACT OF RESULTS

1 JOB OPPORTUNITY OPENING

2
COMPANY DEVELOPMENT
Opening of job opportunities
to the jobless/graduants
Company able to diversify
whereby they can be trained
services that can be offered to
for delivery purposes
clients

153
 CHECK 7 : IMPACT OF RESULTS

2
3
POSITION
EXPANSION 4 COMFORT
The Assistant Pharmacist’s AND SATISFACTION 5
position can be expanded Patients do not SOCIALIZING
for a New Service that is need to apply
Quality time with
Insulin and other leave in order to
family and society
Medicine Delivery to get their medicines
can be fulfilled
patient’s home

154
 PATIENTS DO NOT NEED TO VISIT THE HOSPITAL
ANYMORE TO GET THEIR BALANCE MEDICINE SUPPLY

NOT TENSED UP WHILE

WAITING TO GET THE
BALANCE MEDICINE SUPPLY
1

NO NEED TO BE ON LEAVE/
ABANDONING DAILY WORK
2

NO RISK OF BEING SUMMONED

3
155
 PATIENTS DO NOT NEED TO VISIT THE HOSPITAL
ANYMORE TO GET THEIR BALANCE MEDICINE SUPPLY

NO RISK OF THEFT
WHILE LEAVING THE
HOUSE AND VEHICLE
THEFT
4

TIREDNESS AND
ACCIDENTS WHILE ON
THE JOURNEY CAN BE
OVERCOME
5
156
 CHECK 7 : IMPACT OF RESULTS

CASE STUDY 1
Diabetes patient, Tan Peck Hwa
shows a better result of Fasting
Plasma Glucose (FPG)
DATE OF PATIENT’S REFERENCE
SAMPLE FPG RESULT RANGE
(mmol/l)
16/5/2017 7.9 DM :
FPG >7.0
3/10/2017 5.6 DM :
FPG > 7.0
Reference : Laboratory Report HRPZ II
: 000001103827 dan 000001283728 157
 CHECK 7 : IMPACT OF RESULTS

2
CASE STUDY 2
Diabetes patient, Mohd Bakri Kassim
shows a better result of Fasting Plasma
Glucose (FPG)
DATE OF PATIENT’S REFERENCE
SAMPLE FPG RESULT RANGE
(mmol/l)
25/10/2017 12.4 DM :
FPG >7.0
21/2/2018 10.5 DM :
FPG > 7.0
Reference : Laboratory Report HRPZ II :
000001281926 dan 000001385881 158
8
 ACTION 8 : STANDARDIZATION

DESK FILE

PHARMACIST U44
FARMASI PESAKIT LUAR
OUTPATIENT PHARMACY WORK PROSEDURE
MANUAL
AHMAD MUSTAQIM
BIN ARIFFIN

PHARMACY DEPARTMENT

160
 ACTION 8 : STANDARDIZATION
Responsibility

Dx-Home Suggestion PF/PPF

Dx-Home
PATIENT
Refer patient to the
PF/PPF
Delivery Company

Patient
NO
Patient Goes REGISTRATION
Home
PROSEDURE
Agree ?

YES

Delivery Company fill up and signs the

Form with the Patient Company FLOW CHART
Patient hands over the original
prescription and Form to the Pharmacist Patient & PF

Pharmacy Photocopies 2 sets, stamps

and notes the date for the next follow- PF
up medicine delivery

1 photocopy of the prescription will be Patient Goes

handed to the Patient PF & Patient
Home

Attach original Prescription to the Note the medicine delivery date in Register patient’s particulars in
Form and sign the Planner the Dx-Home Delivery Form

PF PF PF
161
 ACTION 8 : STANDARDIZATION
Responsibility

Prepare Medicine Delivery Form PF

according to the set dates

Email Delivery Form to

the Company
PPF Dx-Home
MEDICINE
PREPARATION
Enter patient’s particulars
into the Computer PPF

Print Medicine Label PPF

PROSEDURE
FLOW CHART
Prepare Medicine PPF
INCORRECT
CORRECT

Counter check the PF

Label and Medicines

Countersign the prescription PF

Keep the Medicine PF/PPF

162
 ACTION 8 : STANDARDIZATION
Responsibility

Company Inform patient date of Dx-Home MEDICINE DELIVERY

medicine delivery
PROSEDURE FLOW CHART
PF/Company Collection of Medicine by Delivery
Company

Submit Medicine package and Delivery Company hands

Pharmacy/Company
Delivery Form to the Company over medicine package
to the patient

Pharmacy/Company Delivery Form signed by Pharmacy Submission FAILED Submission SUCCESSFUL

and Company

Patient Receives Medicine Package

Pharmacy keeps a copy Pharmacy receives medicine and makes Cash payment to the
Pharmacy/Company package and Delivery Form
of Delivery Record Delivery Company

Company Contact Patient

Pharmacy reschedules Patient acknowledges receipt of

Pharmacy/Patient
delivery date medicine package

Receive information from Delivery Company on

Pharmacy/Company confirmation of package received
163
ACTION 8 : STANDARDIZATION
ISO document had been updated
QP-007

164
ACTION : 8. STANDARDIZATION

165
 ACTION 8 : STANDARDIZATION

SHAIK NURUDIN SHAIK SHAHRUDIN

Deputy Director of Health(Pharmacy)
166
 ACTION 8 : STANDARDIZATION

Briefings to Hospital Chief Pharmacists

of Kelantan State on 28th June 2017 167
 ACTION 8 : STANDARDIZATION

KOTA BHARU TOWN HEALTH

CLINIC started on the 10th of
July 2017

Briefing to Senior Health

Pharmacist & other Officers at the
Kota Bharu Town Health Clinic on
the 4th of July 2017
168
 ACTION 8 : STANDARDIZATION

1. Regular training has been provided to Delivery Company

and Pharmacy staff.

April 2017- once a week

Mei onwards – once a month

169
 ACTION 8 : STANDARDIZATION

2. Expansion to the whole state through delivery companies

appointed in each state or centrally appointed

Eg. Pos Malaysia is one of the famous and big courrier service
in Malaysia
170
 ACTION 8 : STANDARDIZATION

3. Co-operate other hospital such as University Science Malaysia

Hospital (HUSM) (under other Ministries ) in same State for
expanding the project because HUSM also have Outpatient
Pharmacy Value Added Services (VAS)

Promoting VAS/Dx-home during

meeting on 8th of October 2018 171
 ACTION 8 :
STANDARDIZATION
TABLE OF ASSESSMENT AND RADAR CHART POST PROJECT
TEAM LEADERSHIP CO-OPERATION INNOVATIVE UNDE RS T ANDING CREATIVITY CONFIDENT COMMUNICATION TOGETHERNESS
MEMBERS POST POST POST POST POST POST POST POST
SITI AISAH 5 5 5 5 5 5 5 5
AHMAD MUSTAQIM 4 4 4 5 4 4 4 5
MOHD ROZALI 5 5 5 5 5 5 5 5
RAZALLE 4 5 5 5 5 5 5 5
ROSHILAWANI 4 5 4 4 4 5 4 5
TOTAL 22 24 23 24 23 24 23 25
AVERAGE 4.4 4.8 4.6 4.8 4.6 4.8 4.6 5.0
LEADERSHIP
188 x 100
Post Achievement 94% CO-
200 TOGETHERNESS OPERATION

Increased 94% (POST)- 73%(PRE) 21%

SCALE COMMUNICATION INNO-
VATIVE
1 TOO WEAK
2 WEAK
CONFIDENT UNDER-
3 MODERATE STANDING

4 GOOD CREATIVITY
PRE PROJECT
5 EXCELLENT POST PROJECT 172
 ACTION 8 :
STANDARDIZATION

Ex-DIRECTOR OF HEALTH
STATE OF KELANTAN
Y.Bhg. Dato’ Dr. Ahmad Razin
bin Dato’ Haji Ahmad Mahir
173
 ACTION 8 :
STANDARDIZATION

Datin Dr. Selasawati Bt. Hj. Ghazali

Hospital Director
Raja Perempuan Zainab II Hospital
(HRPZ II)
174
 All ICC Qp Team Members

WISH TO THANK :
1. DIRECTOR OF KELANTAN STATE HEALTH DEPARTMENT
2. DEPUTY DIRECTOR OF HEALTH (PHARMACY) KELANTAN STATE
3. DIRECTOR OF RAJA PEREMPUAN ZAINAB II HOSPITAL (HRPZ II),
KOTA BHARU, KELANTAN
4. COORDINATOR AND COMMITTEE MEMBERS OF INNOVATION
PLATFORM, HRPZ II
5. CHIEF PHARMACISTS OF HRPZ II, HTM dan HPM
6. STAFF OF PHARMACY DEPARTMENT, HRPZ II 175
 REFERENCES
1. Medical Development Division MOH’s Letter
(related self-prescribing and maximum duration of
prescription)

2. Good Practice Guidance 4: Expiry Dates for Medication

by NHS Berkshire East

3. Datasuite Software MICROLITE-II®/External Temperature

4. Insulatard ®, Mixtard ® and Novomix Brochures

(type of Insulins)

176
Dx-Home’s Client
WELLCOME TO KELANTAN, MALAYSIA