Patient safety in Public Primary Care Clinics in Malaysia

The intention of developing the intervention package was to reduce or to prevent medical errors in primary care. This included diagnostic errors and management errors. The research team emphasised practicality and sustainability of the intervention package for the improvement of care in primary care setting. The intervention package consisted of the following: training, audit process, pharmacy safe netting and materials specially designed for use during the implementation of the intervention. The intervention package consisted of educational training, structured process change, additional review methods and patient education. The educational training was a 3-day workshop to the intervention group. Structured process changes included a clinic desktop flip chart (with rapid diagnostic and management guides), formatted paper records (new case sheet, continuation, asthma record sheet, hypertension record sheet, hypertension follow-up record), provision of peak flow meters, and carbon paper for copying prescriptions onto records. The Integrated Management of Childhood Illnesses ‘Mother’s card’, an educational pamphlet on child health to improve parents’ recognition of danger symptoms and signs in children, were given when applicable. Prescription safety net was done to identify errors and to provide immediate feedback to prescribers. Monthly clinical audit by primary care physicians with health care providers were used for review with immediate feedback to rectify errors and monitoring and to reinforce intervention. Personnel were interviewed to provide feedback on the intervention package. Fidelity checks on processes and the availability of materials were conducted monthly throughout the intervention. Three months after the intervention implementation, medical records were randomly sampled from 12 clinics and expert panel sessions were convened to review the medical records for errors. The total duration of the intervention was 3 months.