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The following is issued on behalf of the Hospital Authority:
The Hospital Authority (HA) today (January 21) published both the latest quarterly issue of HA Risk Alert and the Annual Report on Sentinel and Serious Untoward Events as a risk management and communication initiative to further strengthen incident reporting and sharing of lessons learnt for safety improvements in public hospitals.
According to the HA spokesman, the current issue of HA Risk Alert reported five cases of retained consumables and instruments, two cases of patient suicide and an incident of contaminated lung biopsy leading to unnecessary surgical operation. Furthermore, among the 14 reported serious untoward events, there were 12 medication errors and two cases of patient misidentification.
"Subsequent to incident review and analysis of root causes of these incidents, important lessons of patient safety are identified, while recommendations are made and shared in this publication to avoid similar events in future," the spokesman added.
In a similar development, the HA also released the Annual Report on Sentinel and Serious Untoward Events covering the 12 months from October 1, 2014 to September 30, 2015 after it was discussed and endorsed by the HA Board this afternoon. In this year's report 39 sentinel events are reported, as compared to 49 in the last reporting period.
The spokesman explained that serious untoward events are unexpected occurrences which did not cause death or permanent harm to patients, but which have the potential to do so in the absence of timely intervention. During the year, cases of serious untoward events showed a decline for the second year running to 68, among which 57 were related to medication errors and 11 involved patient misidentification.
The Annual Report on Sentinel and Serious Untoward Events can be accessed by healthcare workers and the public at www.ha.org.hk/report/sentinel_event, while HA Risk Alert has been distributed to the healthcare professionals in public hospitals for continuous quality improvement purposes and can be accessed by the public at www.ha.org.hk/riskalert. The next issue will be published on April 29.
Ends/Thursday, January 21, 2016
Issued at HKT 16:06
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