Medication safety program for patients with known allergy to antibiotics: use of an electronic medication prescription system in Emergency Department (ED) in Hong Kong

Ms. Angela WONG1, Dr. Larry LEE1, Dr. Kin-Ming POON1, Mr. Heyman TANG1, Ms. Wai-Ling CHAN1
1Department of Accident and Emergency, Tin Shui Wai Hospital, New Territories West Cluster, Hospital Authority, , Hong Kong SAR

Introduction: Prescription or administration of antibiotics to a patient with known allergy to antibiotics of the same class is a medication error which could lead to permanent harm or even death. In 2017, there were two related medication incidents reported in EDs of New Territories West Cluster (NTWC), Hong Kong. The leading reason is staffs’ unawareness of possible cross-sensitivity of antibiotics of the same class and the prescription order from ED doctors are sometimes in terms of written or verbal orders and hence drug allergy could not be checked electronically.

Objectives:

  • To reduce the incidence of known drug allergy related medication error in ED
  • To promote culture of medication safety

Methods: ED of Tin Shui Wai Hospital (TSWH) of NTWC – A newly established ED in NTWC of Hong Kong has implemented an electronic medication prescription system – ‘Admission Medication Order Entry (AMOE)’ since its commencement of service in March 2017. For hospitals under Hospital Authority in Hong Kong, patient’s medical history is recorded electronically in ‘Clinical Management System (CMS)’, including updated allergy history. AMOE system is linked with CMS and thus can provide mandatory system allergy checking upon drug prescription through CMS. AMOE system first applied on drug prescriptions of non-urgent, semi-urgent and urgent patients in ED, except resuscitation cases. Its use was extended to all antibiotics’ prescriptions of all patients, including resuscitation cases, from November 2017 onwards. The rate of related medication incidents of EDs of NTWC was reviewed periodically.

Result: There was nil related medication incident reported in ED of TSWH since the implementation of AMOE system. Culture of medication safety was promoted through daily coaching and internal training.

Conclusion: The use of AMOE system in ED can reduce the rate of medication incidents efficiently. Further enhancement on the system will be carried out to make it more fit in the future clinical management system.


Biography:
Ms. Angela Wong is an Emergency Specialty Nurse and works as an Advanced Practice Nurse in Accident and Emergency Department (AED) of Tin Shui Wai Hospital (TSWH) of New Territories West Cluster (NTWC) in Hong Kong. She graduated from the School of Nursing of the Hong Kong Polytechnic University in 2006. She also completed the Master of Science in Cardiology awarded by the Chinese University of Hong Kong in 2013. She worked in AED of Tuen Mun Hospital (TMH) of NTWC from 2006 – 2017. She participated in the commission of the opening of service of AED of TSWH – a newly established AED in NTWC of Hong Kong since 2017. She is the Training and Development (T&D) Coordinator in the department. She helps to deal with T&D related issues and implement relevant enhancement work e.g. coordinating department nurse training days, promoting Continuous Quality Improvement (CQI) programs, carrying out audits etc. She is also the vice-chairperson of Medication Safety Subcommittee in the department and helps to promote the culture of medication safety.