LCQ15: Dispensing medicines at residential care homes for elderly

    Following is a question by the Hon Howard Young and a written reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (May 17):

Question :

     Regarding a recent incident in which wrong medicines were allegedly dispensed to elderly residents at a residential care home for the elderly ("RCHE"), will the Government inform this Council:

(a)  of the progress of the investigation into this incident, and the follow-up actions to be taken;

(b)  whether the authorities received complaints about the wrong dispensation of medicines at RCHEs in the past year; if so, of the details;  

(c)  whether prosecutions have been instituted in respect of the above complaints in the past year; if so, of the number and results of these prosecutions, and whether it will publish the names of the RCHEs prosecuted and the details of the wrong dispensation; and

(d)  of the measures to perfect the procedure for dispensing medicines at RCHEs and enhance their employees' awareness of medicine safety?

Reply :

Madam President,

     The Toxicology Reference Laboratory of the Hospital Authority (HA) collected data from public hospitals on the number of cases involving hospital admission due to hypoglycaemia from July 2005 to March 2006.  51 cases were identified.  23 individuals were suspected of taking hypoglycaemic medication by mistake.  Nine of them were residents of nine residential care homes for the elderly (RCHEs).  Upon being notified by HA of the aforementioned nine cases involving RCHEs in February/March this year, the Licensing Office of Residential Care Homes for the Elderly (LORCHE) of the Social Welfare Department (SWD) conducted investigations on the RCHEs.

     My replies to the specific questions raised by the Hon Li Kwok-ying are as below:

(a)  One of the nine cases involving RCHEs as mentioned above was known to SWD.  SWD had completed the investigation and follow-up actions on the case in 2005.  The incident occurred in August 2005, and involved an elderly resident of a RCHE being admitted to the Queen Elizabeth Hospital (QEH) in an unconscious state.  The Community Geriatric Assessment Team (CGAT) of QEH alerted SWD of the case and LORCHE started investigation.  LORCHE's investigation confirmed that a staff in the RCHE concerned had mistakenly given the hypoglycaemic medication of another elder to the elder.  LORCHE issued a warning letter to the RCHE in September 2005, instructing it to rectify and improve its procedures of handling drugs and the verification mechanism.  Also, LORCHE reminded the Health Worker (HW) concerned in writing to discharge her duties diligently and in accordance with the requirements set out in the Code of Practice for Residential Care Homes (Elderly Persons) (Code of Practice).  CGAT provided training to the RCHE to enhance the know-how of its staff on drug safety and management.  LORCHE conducted surprise inspections to the RCHE on a number of occasions after the incident.  The latest one was in April this year.  LORCHE observed that the RCHE had made improvements on various aspects of drug management.  

     For the other eight cases, LORCHE concluded after investigation that it was not possible to confirm that the RCHEs concerned had mishandled the drugs of the elderly residents.  That said, SWD has followed up with the Visiting Health Teams of the Department of Health (DH) to provide on-site training to the RCHE staff.

(b)  According to SWD, among the complaint cases for the period from April 1, 2005 to March 31, 2006 which were substantiated following investigation by LORCHE, five were related to improper dispensation of medicines to elderly residents in RCHEs.  One was the case mentioned in the answer to (a) above.  Two cases involved two RCHEs giving wrong medicine to two elderly residents.  Another case involved a RCHE making mistake on the timing of the medication to an elderly resident.  The remaining case involved a RCHE making mistake on the dosage of the medicine for an elderly resident.

(c)  SWD issued warning letters to the five RCHEs concerned, instructing them to rectify and improve their procedures of handling drugs and the verification mechanism.  Also, SWD issued warning letters/written advice to four health workers in three of these RCHEs.  HA's CGAT and DH's Visiting Health Teams provided training and seminars to the RCHEs concerned on drug safety and management.  Also, LORCHE stepped up surprise inspections to these RCHEs and observed that the RCHEs concerned had made improvements on various aspects of drug management.

     LORCHE will continue to closely monitor the drug management in the RCHEs mentioned above.  SWD may take further punitive actions against RCHEs which are found to have committed mistakes repeatedly, including prosecutions or refusal to renew the licence pursuant to the Residential Care Homes (Elderly Persons) Ordinance (the Ordinance), or deregistration of HWs who have committed mistakes repeatedly.  Also, LORCHE will continue to step up surprise inspections on RCHEs assessed to be of higher risks.

     SWD has introduced a new measure since December 15, 2005 to make public the names, addresses, nature of offence and date of conviction of RCHEs convicted under the Ordinance and/or the Residential Care Homes (Elderly Persons) Regulation (the Regulation) on or after that date in SWD's homepage.

(d)  We place great emphasis on the awareness of RCHEs on drug safety and their capability in handling drugs properly.  The Regulation requires that all medicine and drugs should be kept in a secure place.  The Code of Practice (October 2005 Revised Edition) further stipulates that medicine should be clearly labelled, kept in a safe and locked place, and dispensed to elderly residents by nurses or HWs following the prescriptions and advice of registered medical practitioners.    

     Nurses and HWs are required to receive training on drug management.  Apart from regular surprise inspections, LORCHE also conducts surprise inspections upon receipt of complaints.  The frequency of surprise inspections for RCHEs assessed to be of higher risks will be higher.  Also, DH's Visiting Health Teams have been educating RCHEs on the basic knowledge of safe handling of drugs.  To help RCHEs enhance their awareness of drug safety, and upgrade the capability of nurses and HWs in RCHEs in drug management, we have put in place the following measures:

(i)  SWD has revised the entry requirements and course contents of the curriculum for HWs.  Starting from April 1, 2006, the minimum educational requirement for enrollees of the HW training courses has been raised from F.3 to F.5.  The curriculum has also been beefed up, with the course contents and training hours on drug management enhanced (doubled from six hours in the past to 12 hours).  Also, drug management has been made a compulsory examination subject;

(ii) to enhance the knowledge of HWs on medical terms and drug nomenclature, the Skills Upgrading Scheme for the elderly care services has launched a course on "Applied knowledge of medical terms and drug nomenclature" for serving HWs; and

(iii) to help RCHEs enhance their drug safety awareness, SWD, DH and HA formed an inter-departmental task group in early April this year to compile the "Working Guidelines for RCHE Staff - Drug Safety Protocol".  The guidelines were distributed to RCHEs in late April.

     The Health, Welfare and Food Bureau, SWD and DH will liaise with HA, the various associations representing the local pharmacist profession and the RCHE sector to explore possible means to enhance the drug management capability and know-how of RCHEs.

Ends/Wednesday, May 17, 2006
Issued at HKT 12:57