A Survey on Drug Management Practices in elderly homes IN HONG KONG

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1 Drug Management Practices in elderly homes: the result of the first territory-wide survey in Hong Kong Lisa YIP, Shelley CHAN, Susanna WONG, Fanny TSANG, Cadmon CHUI, David HO, Sammy NG, WM CHAN

2 BACKGROUND Medication errors occurring in elderly homes were reported by local media since early 2006 Enhancing drug management in elderly homes Enhanced training to homes with unsatisfactory performance Onsite training programmes Issuance of guideline Baseline survey

3 METHOD Cross-sectional design Conducted by VHT nurses along with the Infection Control Checklist in Aug to Oct assessment items in several areas: Staff Documentation Storage Procedure 755 homes surveyed (100% coverage) Private homes % Subvented homes % 3 Other 60 8%

4 RESULT Staff Documentation Storage Procedure

STAFF Dispenser Nurse Health Worker 1 Care Worker

Worker: completed training course approved by SWD

5 STAFF Dispenser Nurse Health Worker 1 Care Worker 2 Accompanying the resident to FU 2% 38% 74% Preparation 3% 31% 82% Distribute (daytime) 28% 77% 11% Distribute (night) 19% 49% 43% 1 Health Worker: completed training course approved by SWD 2 Care Worker: render basic & personal care to residents

6 KNOWLEDGE: 3 CHECKS 5 RIGHTS 100% 80% 82% 80% 71% 60% 5 rights all correct 3 checks all correct 3 checks 5 rights all correct

7 ATTITUDE: HOW TO MINIMIZE MEDICATION ERRORS Surveillance 3% others 16% Having good memory 1% Be concentrated 11% Be careful 15% Follow all the steps 41% Clear guidance 13% (n=755) 7

8 RESULT Staff Documentation Storage Procedure

9 TYPES OF MEDICATION RECORD AVAILABLE 100% 80% 90% 96% 60% 40% 20% 0% 20% drug summary drug chart drug incident record 9

10 USE OF IT IN DRUG MANAGEMENT General computer system, 18% Specialized computer system, 9% Not using any computer system for drug management, 72% 10

11 RESULT Staff Documentation Storage Procedure

12 SECURED DRUG STORE Individual drawers not well organized Organized according to the bed number of resident 12

13 STORAGE OF DRUGS REQUIRING REFRIGERATION Household fridge, stored with food, 16% Not applicable, 8% Pharmaceutical fridge Stored separately, 75% Household fridge

14 PROPER DISPOSAL OF UNUSED DRUGS 100% 80% 84% 79% 60% 47% 40% 35% 20% 0% Total (n=755) Private (n=569) Subvented & contract home(n=134) Other (n=52)

15 RESULT Staff Documentation Storage Procedure

16 PREPACKING DRUGS > 1 day 6% No prepacking 3% <1 day 1% 1 day 90% (n=755) 16

17 DRUG ADMINISTRATION AIDS Individual design Color coding

18 DRUG ADMINISTRATION AIDS Stacked design One stack: one cubicle One stack: one resident

19 DRUG ADMINISTRATION AIDS Webster-pak

20 CROSS-CHECKING No crosschecking 6% Crosschecking 94% (n=755) 20

21 WAYS OF CHECKING DURING DRUG DISTRIBUTION 80% 60% 55% 40% 30% 20% 21% 10% 12% (n=755) 0% No checking drug chart drug label pill count other 21

22 WAYS OF CHECKING DURING DRUG DISTRIBUTION Drug chart Organized according to time and location Instruction poster 22

23 IDENTIFYING RESIDENTS DURING DRUG DISTRIBUTION 100% 80% 77% 60% 40% 20% 0% 1% 17% 2% 2.50% No Verbal Verbal Checking By memory confirmation confirmation confirmation others only only only and (n=755) checking other 23

incident review system and other system for quality assurance

24 SUMMARY Health workers played an important role Prepacking drugs was a common practice Area for improvement identified Lack of drug incident review system and other system for quality assurance Improper disposal of unused drugs Insufficient knowledge of staff Attitude of staff

25 STRENGTH First territory-wide survey on drug management practice in elderly homes Coverage: 100% Face to face interview Direct observation of some practices: locking of drug cabinet

26 LIMITATION Direct observation not possible: drug administration, checking of drugs

Practice and guidelines issued by LORCHE Step-by-step

27 OPERATIONAL MANUAL ON DRUG MANAGEMENT IN RCHES Helps homes to meet the requirements stipulated in the legislation, Code of Practice and guidelines issued by LORCHE Step-by-step instructions for carers on drug handling Diagrams and flow charts User-friendly

28 BRIEFING SESSIONS

29 SHARING ON INFLUENZA VACCINATION PROGRAMME 2007

by contaminated hand Self-limiting Bronchitis and pneumonia are

30 INFLUENZA Influenza virus (A, B & C) Transmitted by droplets through sneezing/coughing/subsequent touching of eye/nose/mouth by contaminated hand Self-limiting Bronchitis and pneumonia are serious complications that commonly affect the weak and frail 30

INFLUENZA VACCINATION 31 healthy adults prevent

adults nursing home residents hospitalizations (all causes) by

(all causes) by 68% health-care workers (HCWs) influenza

31 INFLUENZA VACCINATION 31 healthy adults prevent laboratory-confirmed illness in approximately 70 90% of healthy adults nursing home residents hospitalizations (all causes) by about 50% the risk of pneumonia by about 60% the risk of death (all causes) by 68% health-care workers (HCWs) influenza infection absenteeism mortality in their patients financial savings to sponsoring health institutions

INFLUENZA VACCINATION PROGRAMME IN RCHES The programme aims to protect elderly from severe complications of influenza by immunizing them prior to the

32 INFLUENZA VACCINATION PROGRAMME IN RCHES The programme aims to protect elderly from severe complications of influenza by immunizing them prior to the peak influenza season Provide free influenza vaccination to the elderly living in elderly homes annually since 1998 Extended to elderly home staff since 2005

33 INFLUENZA VACCINATION PROGRAMME IN RCHES Coverage 90% 83% 85% 87% 87% 88% 93% 93% 94% 94% resident 93%* 60% 79% 74% 67%* staff 30% 33 0% *Provisional figures

34 OVERALL COVERAGE IVP 2006 & 2007 CAT I CAT II Resident 93.1% 94.5% 93.0% 93.1% Staff 60.9% 69.3% 76.6% 80.1%

35 常見疑問接受流感針注射是否百分百可以預防患上流感呢? 不是百分百不過 : 1. 可減少患流感的機會 2. 流感症狀較輕 3. 併發症亦會較輕微 35

36 常見疑問身體虛弱及經常生病的長者是否可以接受流感疫苗注射呢? 住院的長者較多患有慢性疾病染上流感後容易有併發症因此身體虛弱的長者, 不論年紀多大, 都需要打流感針 36

37 常見疑問如果身體健康, 便不需要接受流感疫苗注射呢? - 身體健康 = 不會患感染流感 - 院舍是集體生活的地方, 病毒較容易傳播 37

38 常見疑問流感疫苗會否引致流感? - 衞生署採用的疫苗是一種滅活疫苗, 所以不會引致流感 38

39 常見疑問流感疫苗有甚麼副作用? 39 - 除了注射處可能出現輕微腫痛外, 一般並無其他副作用 - 部分人士會在注射後 6 至 12 小時出現發燒肌肉關節疼痛疲倦等徵狀, 這些徵狀通常會在兩天內減退 - 嚴重的過敏反應如出現風疹塊口舌腫脹或呼吸困難等則非常罕見

40 常見疑問流感疫苗是否立即提供保護作用? - 不可以接種疫苗後需約兩星期時間讓身體產生抗體, 來預防流感病毒感染 40

41 常見疑問據說今年流感疫苗與現時流行的病毒不脗合, 會否影響保護作用? - 流感疫苗的病毒組合均由世界衞生組織每年作出預測, 間中會不完全準確今年疫苗組合現時流行的病毒保護作用甲型 / 新喀里多尼亞 /20/99(H1N1) 甲型 /H1N1/ 所羅門群島有良好的保護能力甲型 / 威斯康辛 /67/2005(H3N2) 甲型 /H3N2/ 布里斯本百分之四十至八十五的保護作用乙型 / 馬來西亞 /2506/2004 乙型 / 馬來西亞有良好的保護能力 41 乙型 / 山形近年曾在港出現, 相信本地市民對此病毒會有一定的免疫力

42 常見疑問注射流感疫苗可以預防患上禽流感?

43 THANK YOU

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浙江省肿瘤预防与控制工作介绍 Introduction to cancer control and prevention in Zhejiang Province 浙江省疾病预防控制中心 Zhejiang Provincial Center for Disease Control and Prevention 1 提纲 (Outline) 流行病