1. i MEDIK

2. 1. Dr. Lee Oi Wah 2. En. Mohd. Azizan 3. Pn. Aishah Ismail 4. Pn. Norhayati Lee 5. Pn Minah Othman GROUP MEMBERS

4. PROBLEM VERIFICATION STUDIES… Aishah Ismail Food wastage rate: 6% 1 st to 7 th Dec. 06 Food wastage at the Ward of Hospital Batu Gajah. 3 En. Mohd. Azizan Delay in tracing within 30 min: 5% 1 st to 7 th Dec.06 Delay in tracing of patient’s file from record office of Hospital Batu Gajah. 2 Dr.Lee Infection rate: 8% 1 st to 7 th Dec.06 The high rate of clean wound infection post T&S at A&E unit Of HBG 1 Responsible person Study Result Period of study Problem NO

5. PROBLEM VERIFICATION STUDIES… Minah Othman 5 % 1 st Jan to 15 th Feb,06 Delay in emergency blood grouping and crossmatching for trauma cases in A&E unit of HBG. 5 Mohd. Azizan 5.5% 1 st Jan to 31 st Mac 06 Delay in“Response Time”for emergency ambulance call at Hospital Batu Gajah. 4 Responsible person Result of study Period of study Problem NO

6. PROBLEM PRIORITIZATION USING “SMART” CRITERIA Rating scale : 0 = low, 1 = medium, 2 = high DONE AS A GROUP 38 8 10 6 7 7 2. Delay in tracing patient’s file from record office of Hospital Batu Gajah. 33 8 6 6 6 7 3.Food wastage at the Ward of Hospital Batu Gajah. 49 10 10 9 10 10 1.T he high rate of clean wound infection post-T&S at A&E unit of HBG Total T R A M S Problem

7. Continuation …. Rating scale : 0 = low, 1 = medium, 2= high DONE AS A GROUP 39 9 6 7 8 9 4. Delay in“Response time” for emergency ambulance call at Hospital Batu Gajah. 38 8 7 7 8 8 5.Delay in emergency blood grouping and cross matching for trauma cases in A&E unit of HBG. Total T R A M S Problem

8. PROBLEM PRIORITIZATION USING SMART CRITERIA 38 8 7 7 8 8 5.Delay in emergency blood grouping and cross matching for trauma cases in A & E unit of Hospital Batu Gajah. 39 9 6 7 8 9 4. Delay in“Response time” for emergency ambulance call at Hospital Batu Gajah. 33 8 6 6 6 7 3.Food wastage at the ward of Hospital Batu Gajah. 38 8 10 6 7 7 2. Delay in tracing patient’s file from record office of Hospital Batu Gajah. 49 10 10 9 10 10 1.T he high rate of clean wound infection post-T&S at A&E unit of Hospital Batu Gajah. Total T R A M S Problem

10. REASON FOR PROBLEM SELECTION -Problem can be solved within specific time-frame(6 months). Time/ timeliness -Identified problem can be controlled, solved and continuosly monitored and is remediable. Remediable -Relevant to the needs and approach to the organisational process. -Cost effective and involved minimal expenditure. Appropriateness RATIONALE CRITERIA

14. OPPORTUNITY STATEMENT iv. The organization will be exposed to increased risk of litigation. v. The possible contributing factors are physical or environmental factors, equipment, skill and attitude of staffs and factor arising from patient themselves. vi. The aim of this study is to reduce the rate of clean wound infection from 8% to 4%.

15. Increase rate of clean wound infection Post-T&S at A&E unit of HBG Unsuitable treatment room Patient defaulted TCA CAUSE-EFFECT ANALYSIS Financial problem Improper T&S technique Lack of knowledge No patient education Staying in interior Irresponsible attitude of staffs Transportation problem Patient with co-morbid illness No designated treatment room Environmental temperature not suitable Did not practice aseptic technique Lack of experience of staff Lack of knowledge Indifferent attitude Low socio-economic status

16. Increase rate of clean wound infection Post-T&S at A&E unit of HBG CAUSE-EFFECT ANALYSIS Improper T&S technique Irresponsible attitude of staffs Did not practice aseptic technique Lack of experience of staff Lack of knowledge Indifferent attitude No patient education

22. MODEL OF GOOD CARE 100% Medical Officer All patient who required T&S Written consent from patient 3. 95% Medical Officer Wound without obvious contaminant (not grossly seen with the naked eyes) Selection of cases of clean wound 2. 100% Medical Assistant All patient with history of injury will be screened. Triage 1. Responsibility Std. Criteria Process No

23. MODEL OF GOOD CARE 100% Medical Officer/Medical Assistant Use the following checklist: a)To advise patient to keep wound dry. b)To seek immediate medical attention when wound becomes inflamed or discharging pus. c)To give appointment date for wound inspection and STO. Health education/Appointment for review 4. 100% Medical Officer/ medical Assistant Date, time and the procedure performed. Treatment given. Date, time and place for review ie; D3 for WI and D7 for STO Documentation 5. 100% Medical Assistant Perform procedure according to the SOP Perform T&S 3. Responsibility Std. Criteria Process No

24. CRITERIA Patients who defaulted review or who chose to get follow-up treatment at other health facilities. All cases of clean wound that fulfilled the definition of clean wound. EXCLUSION CRITERIA INCLUSION CRITERIA

27. Plan for Data Collection (What,When, Where, Whom, Why& How) -Monitoring with a checklist. -Observation. -Questionairre -SOP book Medical Assistant A&E During the T&S procedure Did not practice aseptic technique Skill of staff 1. -Questionairre Medical Assistant A&E During the T&S procedure Lack of knowledge and experience No. How Whom Where When What Factor

28. Plan for Data Collection (What,When, Where, Whom, Why& How) Attitude 2. -Checklist -Observation Medical Assistant A&E During the T&S procedure Did not follow the SOP -Checklist Medical Assistant A&E During the T&S procedure Did not give patient education and proper instruction for TCA No. How Whom Where When What Factor

29. Proposed Performed GANTT CHART Monitoring and re-evaluation Report writing Analysis Data Phase 2 Data collection Phase 2 Remedy measures implementation Analysis Data Phase 1 Data collection Phase 1 Briefing for staffs Proposal for research SEP 07 AUG 07 JULY 07 JUNE 07 MAY 07 APR 07 MAC 07 FEB 07 JAN 07 DIS 06 NOV 06 Activities

30. QUESTIONAIRE

32. OBSERVATION CHECKLIST FOR STAFF Did staff create sterile field during procedure? 5 Did you use the full T&S set during suturing a wound?? 4 Did staff wear sterile gloves during procedure? 3 Did staff wear mask during performing T&S? 2 Did staff practice handwashing before procedure? 1 NO YES STEPS NO

33. Master sheet table 3 HEALED HEALED GAPPING HEALED HEALED INFECTED GAPPING HEALED Outcome 27 FEB 07 YES MA HH 20 FEB 07 1234 35 NONE YES YES NONE YES YES YES Instruction for review 40 21 FEB 07 12 FEB 07 10 FEB 07 24 JAN 07 17 JAN 07 09 JAN 07 09 JAN 07 Date ofeview 11 40 Total MA GG 14 FEB 07 0431 MA FF 05 FEB 07 0336 MA EE 03 FEB 07 0330 MA DD 17 JAN 07 0230 MA CC 10 JAN 07 0210 MA BB 02 JAN 07 0130 MA AA 02 JAN 07 0117 MA responsible Date T&S done Patient

54. ABNA ABNA 5%

56. APPENDIXES APPENDIXES