HA releases risk management publications

The following is issued on behalf of the Hospital Authority:

     The Hospital Authority (HA) today (January 26) published the latest quarterly issue of "HA Risk Alert" (HARA) as well as the Annual Report on Sentinel and Serious Untoward Events as a risk management and communication initiative to further strengthen incident reporting and the sharing of lessons learned for safety improvements in public hospitals.
 
     In the third quarter of 2023 (July to September), there were five sentinel events reported, comprising three cases of retained instrument/material after surgery/interventional procedure and two cases of inpatient suicide. Among the 18 reported serious untoward events, there were 16 related to medication errors and two patient misidentifications.
 
     "Subsequent to the incident review and analysis of the root causes of these incidents, important lessons for patient safety have been identified, while recommendations are made and shared in this publication to avoid similar events in the future," the HA spokesperson said.
 
     The HA also released the Annual Report on Sentinel and Serious Untoward Events covering the 12 months from October 1, 2022, to September 30, 2023. There were a total of 19 sentinel events and 78 serious untoward events reported during the period. Among the serious untoward events, there were 70 and eight events related to medication errors and patient misidentifications respectively. The Report has been endorsed by the HA Board.
 
     The Annual Report on Sentinel and Serious Untoward Events and HARA are distributed to healthcare workers and are accessible to the public through www.ha.org.hk/report/sentinel_event and www.ha.org.hk/riskalert. HARA is published on a quarterly basis and posted on the HA website on the last working Friday in the months of January, April, July and October. The next issue is scheduled for April 26 (Friday).