Hospital Rehabilitasi Cheras is committed to ongoing improvement of patient care in all areas. Our hospitals continue to focus on improvements to ensure that our services are as safe as possible and that we are minimising risks at all times.

In order to ensure the safety and quality of healthcare provided, Hospital Rehabilitasi Cheras adheres strictly to Malaysian Patient Safety Goals by Malaysian Patient Safety Council and Ministry of Health Malaysia. The goals include:

1. To implement good Clinical Governance

  • Clinical Governance is the systemic framework of accountability for the health care sector that integrates quality, safety and risk management
  • The framework include internal clinical audits, external organisation audit, Clinical Risk Management and Patient-centred Services
  • Internal Clinical Audit is done frequently and discussed during Morbidity and Mortality meetings
  • External Organisations Audit is conducted by external auditors/surveyors, including ISO and MSQH
  • Clinical Risk Management include implementation of Incident Reporting and Learning System (RCA and HFMEA), Hospital Infection Control and Occupational Safety and Health
  • Patient-centred Services include Patient Satisfaction Surveys and Complaints Management
  • Implementation of Clinical Governance is one of Key Performance Indicator of our hospital

 

2. To implement the WHO’s 1st Global Patient Safety Challenge: “Clean Care is A Safer Care”

  • Nosocomial (Healthcare-associated) infections are a major cause of morbidity and mortality in health-care facilities worldwide.
  • Cheras Rehabilitation Hospital is committed in implementing hand hygiene in its facilities.
  • Hand Hygiene Campaigns and Training Programmes are frequently conducted
  • Regular audits on Hand Hygiene Compliance Rate are carried out and become one of hospital’s Key Performance Indicator

 

3. To implement the WHO’s 3rd Global Patient Safety Challenges: “Tackling Antimicrobial Resistance”

  • Antimicrobial resistance poses a growing threat to the treatment and control of infection.
  • In Cheras Rehabilitation Hospital, The Malaysian National Antibiotic Guidelines, The National and State Campaign on Containment of Antimicrobial Resistance and Antibiotic Stewardship Programme are implemented to reduce antimicrobial resistance
  • Incidence rate of highly virulent microorganisms such as MRSA and ESBLs become one of our hospital Key Performance Indicator

 

4. To improve the accuracy of patient identification

  • Patient identification is essential step in ensuring that the correct treatment is being given to the correct patient
  • In our hospital, the use of at least two identifiers for a patient at point of care is implemented.
  • The Compliance Rate for “At least 2 identifiers Implemented” becomes one of hospital Key Performance Indicator

 

5. To ensure medication safety

  • Implementation of safety solutions for “Look alike Sound Alike” medications
  • Application of 6Rs and verbalization when administering medications- the healthcare providers check whether it is the RIGHT patient, medication, time, dose, rout and documentation
  • The number of Near misses and Actual Medication Errors is a Key Performance Indicator of hospital

 

6. To improve clinical communication by implementing critical value programme

  • Failure of timely communication and follow-up of critical laboratory results can lead to errors, increased morbidity and mortality
  • “Percentage of Critical Values Notified Within 30 minutes or Less” is one of hospital Key Performance Indicator

 

7. To reduce patient fall

  • Patient falls are potentially serious form of incident and are considered largely preventable
  • Fall prevention programme is implemented in our hospital to reduce the incidence of patients falls
  • “Percentage reduction in the Number of Falls for both adults and paediatrics” is one of hospital Key Performance Indicator

 

8. To reduce the incidence of Healthcare Associated Pressure ulcers

  • Pressure ulcers cause considerable harm to patients and can lead to morbidity and mortality. It also largely preventable.
  • “Incidence Rate of Pressure Ulcers” is one of hospital Key Performance Indicator

 

9. To implement an Incident Reporting and Learning System

  • At Cheras Rehabilitation Hospital, we cultivate the “non-blaming and learning culture” through the implementation of Incidence Reporting Systems
  • Incident investigation is done via Root Cause Analyssis (RCA) as a tool to support Incident Reporting System