Drug monitoring plan key to good health care
Progress towards reforms in financing and delivery of care that will enhance Hong Kong's health system remains slow and difficult. Meanwhile, doctors and patients in public hospitals are coping with lengthening queues for treatment, and public confidence has been shaken by a series of mistakes by medical staff. It is therefore important to strive to maintain the system's reputation for high standards of care. That is why we have welcomed the Hospital Authority's plan to implement a transparent, internationally recognised accreditation mechanism for its 44 hospitals that can eventually be widened to include the 12 private hospitals.
A key element of hospital accreditation is an effective drug safety programme. Mistakes happen in hospitals the world over. Human error cannot be eliminated. But patient medication is one area where steps can easily be taken to significantly reduce the potential for error. As we report today, the authority has concluded a pilot scheme at Queen Mary Hospital that has shown the way forward. Better monitoring and supervision of patients' use of medication helped prevent more than 200 potential drug incidents over four months, saving an estimated 250 doctors' working hours.
The World Health Organisation has identified 'medication reconciliation' as one of the most important issues in quality and safety of care. It means keeping an accurate record of drugs patients are taking when they enter and leave hospital or are transferred, to avoid duplication and ensure that they are continuing the correct medication. That sounds like basic practice. But problems with drugs featured prominently in a list of safety solutions issued by the WHO last year to cut the toll of health-care-related harm to millions of patients worldwide. The problems included look-alike, sound-alike medication names, lack of communication during patient handovers, and insufficient safeguards to ensure medication accuracy at transitions in care from one part of the system to another.
These are among the issues addressed by the authority's pilot scheme. Hong Kong's admission wards are busy. Queen Mary's chief pharmacist, William Chui Chun-ming, says doctors do not have time to do exhaustive reconciliations of patient medication. The authority placed a full-time pharmacist in the admission wards to check drug records thoroughly for omission or duplication upon admission, transfer or discharge. This included checking with private doctors, doctors at outpatient clinics and staff at homes for the elderly, and interviews with families. As a result unplanned readmissions were cut by 10 per cent, saving HK$200,000.
The authority has an internal assessment system for public hospitals and voluntary error-reporting mechanism for staff. To implement external benchmarking, it is considering joining a major hospital accreditation authority in Australia or the United States. In the US about 7,000 deaths a year are attributed to medication errors. The US accreditation body has included medication reconciliation requirements in national patient safety goals.
The Hospital Authority's co-ordinating committee on pharmacy proposes that the Queen Mary pilot scheme be introduced in all major hospitals in 2009-2010. Even if the scheme did not promise to save more money than it will cost, the authority should adopt the proposal without delay in the interests of both patients and doctors. It will help safeguard the standards of a health-care system affordable to all.