One-Stop Known Drug Allergy Alertness Cabinet Ensuring Medication Safety in Inpatient Setting of Hong Kong Buddhist Hospital

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Abstract Summary
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Authors (including presenting author) :
Chan SKA(2),Mui HSG(3),Cheng PH(2),Chuk SL(2),Chim YL(2),Chan YY(2),Pi SS(2),Chung KYE(3),Tam KFS(1),Yau YSC(1),Wong YLR(4)
Affiliation :
(1)Department of Medicine,Hong Kong Buddhist Hospital,(2) Department of Nursing, Hong Kong Buddhist Hospital,(3)Pharmacy Department,Hong Kong Buddhist Hospital,(4)Quality and Safety Department,Hong Kong Buddhist Hospital
Introduction :
Known Drug Allergy (KDA) was reported as the most common medication error in Hospital Authority Annual Report. Healthcare staff’s low alertness on patient KDA status and non-compliance with Guidelines of KDA checking were reported as the contributing factors. In-patient Medication Order Entry still could not perform cross checking if drug allergy history was entered by free text. In addition, there was no linkage between Clinical Management System alert and electronic Health Record Sharing System information under HA Corporate Alert System currently. Hence, a quality improvement program was conducted in Hong Kong Buddhist Hospital to ensure stringent KDA checking.
Objectives :
To ensure compliance on KDA checking in healthcare staff and to enhance alertness of healthcare staff to patient with KDA status
Methodology :
The program was commenced in July 2017. Plan-Do-Check-Act cycle was adopted throughout the process of methodology. The workflow of Queen Elizabeth Hospital Drug Allergy Check and Alert 2017 was adopted as the basic alert procedures and practices for staff to comply with. Baseline audit on staff performing the basic alert practices for allergy check was conducted in July 2017. The compliance rate was 58%. Frontline staffs were invited to analyse the root causes of the problem by Fishbone Diagram. They suggested putting all necessary items for performing all basic alert practice into a One-Stop KDA Alertness Cabinet. The One-stop cabinet was implemented in August 2017. Post audits were conducted two months and one year respectively after implementation of One-stop cabinet. All audits were conducted by the same pharmacist to ensure consistency. Staff preference survey on One-Stop cabinet and the first post audit were conducted in October 2017. The second post audit was conducted in September 2018 to evaluate the outcome whether sustained or not.
Result & Outcome :
The staff compliance rates of the first and second post audits were 90% and 100% respectively. Comparing the baseline audit with the first and second post audit, there were 55% and 72.4% increase in staff compliance rate respectively. The overall score of staff preference survey on One-Stop KDA Alertness Cabinet was 4.118 out of 5. There was no known drug allergy incident reported.In conclusion, this quality improvement program not only enhanced staff compliance on KDA check but also ensured medication safety and successfully established a hospital-wide safety culture of practice on KDA in Hong Kong Buddhist Hospital.

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