Replies to LegCo questions
LCQ2: Drugs distribution in residential care homes for elderly
Following is a question by the Dr Hon Joseph Lee and a reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (July 12):
Question :
Regarding the recent incidents in which wrong medicines were dispensed to
elderly residents at some residential care homes for the elderly (RCHEs), and
the fact that employing registered pharmacists to monitor the procedures for
dispensing medicines is not a mandatory requirement in the existing licensing
conditions for RCHEs, will the Government inform this Council whether it will:
(a) in order to prevent mistakes in dispensation of medicines by RCHE staff,
implement new measures such as developing new guidelines to ensure that all
RCHEs in Hong Kong will monitor the process of dispensing, storing, labelling
and distributing medicines with a well-developed, stringent and uniform drug
management system, adopting an effective system to record information on the
medicines taken by the elderly, and requiring RCHEs to employ resident
pharmacists or dispensers to take up high-risk and professional duties such as
handling, recording and distributing medicines; if so, of the details of such
measures and when the authorities expect such guidelines to be completed; if
not, whether existing measures which mainly target at the training of Health
Workers (HWs) is effective in preventing mistakes in dispensation of medicines,
and how the Government can ensure that RCHEs will achieve "zero error" in
handling medicine;
(b) review the existing mode of subsidy for RCHEs and raise the mean subsidy
amount in order to enable RCHEs to employ professional nurses to distribute
medicines and provide proper nursing care services; and
(c) set out in the conditions for the issue and renewal of licences for RCHEs
the respective manpower ratios of nurses and HWs to RCHE residents and the
requirement of the employment of resident pharmacists?
Reply :
Madam President,
We are concerned about the awareness of residential care homes for the elderly (RCHEs)
on drug safety and their capability in handling drugs properly. The Residential
Care Homes (Elderly Persons) Regulation (the Regulation) and the Code of
Practice for Residential Care Homes (Elderly Persons) require that RCHEs should
label the drugs clearly, keep them in a safe and locked place, and distribute
them to residents by nurses or Health Workers (HWs) in accordance with the
prescriptions and advice of registered medical practitioners.
The Licensing Office of Residential Care Homes for the Elderly (LORCHE) of the
Social Welfare Department (SWD) and the Visiting Health Teams of the Department
of Health (DH) instil RCHEs with knowledge on drug safety and management. RCHEs
are required to adopt a system of "three-checking and five-verification" for
minimizing errors in distributing drugs. SWD, DH and the Hospital Authority (HA)
had earlier on jointly completed a drug safety protocol, and disseminated it to
RCHEs this April.
To enhance consumers' access to information and RCHEs' vigilance on the
Residential Care Homes (Elderly Persons) Ordinance (the Ordinance) and the
Regulation, SWD implemented a new measure on December 15, 2005 to publish in its
website the information of RCHEs convicted under the above Ordinance or
Regulation on or after that date. SWD has recently published the information of
two convicted RCHEs.
My replies to the specific questions raised by the Hon Joseph Lee are as
follows:
(a) We agree that RCHEs should systematize their drug distribution process. DH's
Visiting Health Teams will work with SWD to design a drug management system
tailored for the local environment of RCHEs, including a detailed drug handling
manual and guidelines on drug storage and facilities, with a view to further
systematizing the process. Also, they will provide training to RCHE staff to
enhance their drug handling know-how and skills. SWD and DH will identify the
weaker links in the existing drug handling process in RCHEs and assist them to
strengthen those areas.
The experience and know-how of pharmacists on drug management is relevant to
RCHEs in enhancing their drug handling capability. However, I wish to point out
that while RCHEs have to distribute drugs to residents and serve them in taking
medication, they are not involved in the dispensation of drugs. The duties of
RCHEs in the handling of drugs are similar to those in hospital wards. While
requiring basic knowledge of drug management and prudence, the task of
distributing drugs is not exclusively the professional ambit of pharmacists or
dispensers. It is part of the regular duties of nurses or HWs. We consider it a
proper arrangement for SWD to require RCHEs to deploy nurses and HWs to
distribute drugs.
There are ongoing co-operation between individual pharmacist associations and
individual RCHEs on enhancing the latter's drug handling capability. We
encourage cooperation of this nature. In June this year, the Health, Welfare and
Food Bureau invited the three local pharmacist associations and various
associations representing local RCHEs to a discussion to exchange views on how
to further enhance the drug management capability of RCHEs. We are pleased to
continue with the discussion and co-operation.
(b) On the issue of subsidy, subvented care and attention (C&A) homes have the
necessary resources to employ nurses to meet their operational needs. Their
overall manpower provision is in general higher than the licensing requirement.
Since the implementation of the Lump Sum Grant mode by SWD, subvented RCHEs have
greater flexibility in deploying resources to recruit staff for meeting their
operational needs.
The most crucial manpower problem of RCHEs at present is the difficulties in
recruiting nurses. Nursing shortage in the recent years and the preference of
the Registered Nurses for working in hospitals are the contributing factors. To
address the nursing shortage in the welfare sector, SWD has commissioned the HA
to organise two rounds of Enrolled Nurses (ENs) training programme specifically
for the welfare sector in March and November this year. Graduates are required
to work in the welfare sector as ENs for at least two years after graduation. We
believe that the 220 ENs graduating from the two rounds of training programme
will help alleviate the nursing shortage in RCHEs.
(c) On the issue of staff ratio, the Regulation has set out the minimum
requirements on the ratio between care staff and residents. A C&A home should
have at least a manager, a nurse for every 60 residents, a HW for every 30
residents if there is no nurse, and a prescribed number of care workers.
Contract homes and private RCHEs participating in the Enhanced Bought Place
Scheme are required to comply with and maintain a care staff ratio higher than
the licensing requirements.
As I have explained, we do not see the need to require all the RCHEs to employ
pharmacists or dispensers. Therefore, we will not make this a statutory
requirement.
Ends/Wednesday, July 12, 2006
Issued at HKT 14:25
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