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
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
METHOD Cross-sectional design Conducted by VHT nurses along with the Infection Control Checklist in Aug to Oct 2006 25 assessment items in several areas: Staff Documentation Storage Procedure 755 homes surveyed (100% coverage) Private homes 569 75% Subvented homes 126 17% 3 Other 60 8%
RESULT Staff Documentation Storage Procedure
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
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
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
RESULT Staff Documentation Storage Procedure
TYPES OF MEDICATION RECORD AVAILABLE 100% 80% 90% 96% 60% 40% 20% 0% 20% drug summary drug chart drug incident record 9
USE OF IT IN DRUG MANAGEMENT General computer system, 18% Specialized computer system, 9% Not using any computer system for drug management, 72% 10
RESULT Staff Documentation Storage Procedure
SECURED DRUG STORE Individual drawers not well organized Organized according to the bed number of resident 12
STORAGE OF DRUGS REQUIRING REFRIGERATION Household fridge, stored with food, 16% Not applicable, 8% Pharmaceutical fridge Stored separately, 75% Household fridge
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)
RESULT Staff Documentation Storage Procedure
PREPACKING DRUGS > 1 day 6% No prepacking 3% <1 day 1% 1 day 90% (n=755) 16
DRUG ADMINISTRATION AIDS Individual design Color coding
DRUG ADMINISTRATION AIDS Stacked design One stack: one cubicle One stack: one resident
DRUG ADMINISTRATION AIDS Webster-pak
CROSS-CHECKING No crosschecking 6% Crosschecking 94% (n=755) 20
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
WAYS OF CHECKING DURING DRUG DISTRIBUTION Drug chart Organized according to time and location Instruction poster 22
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
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
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
LIMITATION Direct observation not possible: drug administration, checking of drugs
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
BRIEFING SESSIONS
SHARING ON INFLUENZA VACCINATION PROGRAMME 2007
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 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 peak influenza season Provide free influenza vaccination to the elderly living in elderly homes annually since 1998 Extended to elderly home staff since 2005
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% 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 *Provisional figures
OVERALL COVERAGE IVP 2006 & 2007 CAT I CAT II 2007 2006 2007 2006 Resident 93.1% 94.5% 93.0% 93.1% Staff 60.9% 69.3% 76.6% 80.1%
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
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
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
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
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
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
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
常見疑問 注射流感疫苗可以預防患上禽流感?
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