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The Hospital Authority (HA) Board endorsed at its Administrative and Operational Meeting today (May 31) the implementation of a series of improvement measures for mortuary services in public hospitals after discussing the investigation report on the mortuary incident of Prince of Wales Hospital (PWH). With the endorsement of the Board, HA will submit the report to the Health, Welfare & Food Bureau.
The Director (Quality & Safety) of HA, Dr Leung Pak-yin, said the Authority has taken the opportunity to review the PWH incident with a view to identifying improvement areas across the board. Dr Leung outlined the enhancement programmes in the pipeline as follows:
* Development of the Mortuary Information System (MIS) to help minimise the risk of wrong identification of deceased bodies through a bar-coding system, track their movement across mortuaries, and monitor the utilisation rate. The project will be developed in two phases in the second quarter of 2007 and the second quarter of 2008 respectively.
* Enhancement of mortuary capacity across all clusters, which include an initial addition of 30 places in the new building of Pok Oi Hopsital, planning for about 220 additional mortuary places in 2007/08, and depending on availability of funds, another 330 places to be added in 2008/09.
* Streamlining the procedures on body collection and identification both on the nursing side during the collection of body from the ward and on the mortuary side with enhanced counterchecking and standardised documentation.
* Staff training will be conducted to reinforce a system in which staff vigilance and compliance with proper procedures can be continuously sustained.
* To encourage early collection of bodies, communication with patients' relatives will be enhanced. In the case of overcrowding, it will be conveyed to the family the need of sharing of compartment by two bodies of the same sex and possible need for transfer to other HA mortuaries.
At the meeting today, HA Board Members concurred with the conclusion of the PWH Investigation Panel that the unfortunate incident was mainly caused by non-compliance of the Mortuary Attendant concerned with stipulated operation guidelines.
According to the Cluster Chief Executive of New Territories East Cluster, Dr Fung Hong, the Investigation Panel also noted a number of other contributing factors for the incident, such as overcrowding of the mortuary leading to double occupancy of a compartment; guidelines were not stringently enforced nor consistently complied with on all occasions.
In pursuant to the above findings and the recommendations of the Investigation Panel, Dr Fung said PWH has already taken the following improvement measures:
* Piloting a bar-coding system to match the ID number on the wristband of the deceased body with that on relevant document
* Augmenting mortuary capacity of PWH from 56 to around 100 by end 2008
* Strengthening supervision of mortuary staff to ensure compliance with the existing guidelines on identification of bodies through random auditing
* Issuing clear and explicit instructions on the body identification process
* Enhancing the documentation and final counterchecking process
* Encouraging early collection of deceased bodies by relatives
Ends/Thursday, May 31, 2007
Issued at HKT 19:08
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