Medication Stockpiling (MS), in the Ministry of Health, Malaysia, resulted in the disposal of MYR 2 million worth of expired or spoilt medicines between 2014 and 2016. MS is an alarming issue that causes healthcare resources wastage and potentially harmful and toxic to patients. This study aimed to reduce MS in Hospital Selama, beginning with the medical wards within one year.
A situational analysis from the year 2013 to 2014 showed a 9.4% increase in MS. A four-month pre-intervention study from November 2014 to February 2015 revealed a 28% MS. The standard of the study was set based on the team members’ consensus. The aim was to reduce 50% of MS after four-month of intervention. The cause-effect analysis identified the main contributing factors of MS. The questionnaire was distributed to nurses in the wards and pharmacists to pinpoint the MS antecedent. The results indicated a lack of routine ward audit by the clinical pharmacists, over-indent by ward nurses and oversupply by the pharmacy unit. A flow-chart of the good care process comprises the steps of medications indent and supply was developed. It involved assigning the nightshift nurses for checking and indenting the wards’ medication stock, developing the ward stock indent (WSI) form, ensuring the pharmacy staff supply sufficient medication and enforcing a monthly ward audit by the clinical pharmacists and cross-audit by other pharmacists. Each indicator in the model of good care was then measured.
The post-intervention period successfully achieved a 3.5% MS; an 87.5% reduction (exceeded the target). Additionally, a cost reduction in the medication wastage from MYR 1,273.97 to MYR 654.44 was noted. The study successfully achieved less than 6% of MS from 2015 to 2018.
In conclusion, the study facilitated a successful collaboration among the hospital different units towards MS reduction.
OBJECTIVES: Despite the availability of a wide selection of anti-diabetic treatments, many type 2 DM (T2DM) patients still do not have controlled glucose levels. In addition to pharmacological intervention, patients' own implicit beliefs about their illness should be targeted for health intervention. Thus, we conducted a quantitative study to evaluate the associations between illness perception (IP) domains and metabolic control (HbA1c) of T2DM patients in Selama Hospital and to identify patients' perceptions of the causal T2DM factors.
METHOD: A cross-sectional study was conducted in the outpatient department of Selama Hospital from October to December 2015. A total of 200 T2DM patients were recruited using systematic random sampling. A self-administered validated questionnaire consisting of three sections was used, and the data were analysed using SPSS version 18. The associations between eight IP domains and HbA1c were evaluated via multiple linear regression. P values <0.05 were considered significant.
KEY FINDINGS: The analysis included data from 200 respondents with a mean age of 57.7 years (SE = 9.8). The majority were women (64.5%) and Malays (86%) with a primary school education (43.5%) and a family history of diabetes (53.5%). The median duration of illness was 5 years (IQR = 7), and the median HbA1c level was 8.15% (IQR = 3.1). The mean score for the eight IP domains was 33.7 (SE = 8.43) out of a total score of 80. Using multiple linear regression, HbA1c was found to be significantly associated with IP domains of identity symptoms at 0.221 (95% CI 0.083-0.358). Moreover, 79.4% of patients ranked diet and eating behaviour as the main factor for T2DM.
CONCLUSION: The IP domain of identity symptoms was significantly correlated with T2DM metabolic control. By understanding patients' IP, healthcare providers can focus on behavioural approaches to managing T2DM patients. Steps must be taken to educate patients about the importance of diet control in managing T2DM.
Study site: Outpatient clinic, Selama Hospital, Perak, Malaysia