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The following is issued on behalf of the Hospital Authority:
The 13th issue of "HA Risk Alert" is published today (November 27) by the Hospital Authority (HA) as a risk management and communication initiative to further strengthen the reporting and monitoring of adverse incidents in public hospitals.
This latest issue also announces the enhancement in the mandatory reporting criteria and management process of serious adverse events which will take effect on January 1, 2010. In addition to the existing nine types of sentinel events, hospitals are also required to report any "Serious Untoward Event", an unexpected occurrence which could have led to death or serious physical or psychological injury of patients.
The latest issue of "HA Risk Alert" features a sentinel event of surgical procedure on the wrong site and four events of retained instrument, device and consumables in patients. Subsequent to in-depth root cause analyses during incident investigation, recommendations are made and shared in this publication to avoid similar events in future.
Some common pitfalls in local healthcare settings are also highlighted to enhance staff vigilance. In this issue, a case of baby identity mix-up is featured together with the lessons learned. Healthcare professionals are also reminded to note the potential risks associated with influenza antiviral drugs.
The publication has been distributed to all healthcare professionals in public hospitals for continuous quality improvement. It can also be accessed by the public at (www.ha.org.hk/riskalert).
"HA Risk Alert" is regularly published and posted on the HA website every last working Friday in the alternate (odd) month. The next issue will be published on January 29, 2010.
Ends/Friday, November 27, 2009
Issued at HKT 16:40
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