Patient dies in drug mix-up, woman given wrong blood in latest risk list

PUBLISHED : Saturday, 28 January, 2012, 12:00am
UPDATED : Saturday, 28 January, 2012, 12:00am


A chronically ill patient died after being given incompatible drugs, and another is recovering from a transfusion of the wrong blood type - the latest cases in a growing list of blunders at public hospitals.

The Hospital Authority would not elaborate on the two incidents, which were revealed yesterday in its latest 'Risk Alert'.

It also reported five cases of equipment being left inside patients' bodies. In one case, an 18cm feeding tube was found in the stomach of a patient who had undergone a tracheotomy. It was later removed without reported complications.

The fatal case involved a junior doctor who, misinterpreting a trainee doctor's note on the patient's record, prescribed incompatible drugs based on the medical record of another patient.

The patient who died had earlier been admitted to a medical ward for congestive heart failure, and had a history of diabetes and chronic renal failure, among others. A trainee doctor prescribed drugs to treat the condition and wrote 'resume usual med' on the patient's record.

A junior doctor misinterpreted the note to mean that, in addition to the newly prescribed drugs, the patient's usual medication should be administered. But the drugs, prescribed for a different person, were not compatible with the patient's renal-failure medication.

The error was only noticed in the morning. The patient died of kidney and heart failure two days later.

Meanwhile, another patient is recovering after a mistaken transfusion of red blood cells during elective spinal surgery put her in critical condition. Her blood type was confused with another patient's as their samples were tested at the same time.

The cases are the latest in a growing number of medical errors in the public hospital system. Lawmakers were told earlier this month that serious blunders in public hospitals had increased by one-third last year.

The Hospital Authority received reports of 44 incidents involving death, or serious physical or psychological injury from October 2010 to September last year.

A total of 42 blunders of various degrees of severity - 27 of them medication errors - were reported to the authority in the third quarter of 2011, up from 29 in the second quarter.

Authority chief executive Dr Leung Pak-yin said in December that a special task force would be set up to investigate the quality of service provided by public hospitals and their management.


Hong Kong's estimated public expenditure, in the local currency, on health - compared to HK$37.6 billion in private expenditure