Pamela Youde Nethersole Eastern Hospital announces a sentinel event

The following is issued on behalf of the Hospital Authority:

     The spokesperson for Pamela Youde Nethersole Eastern Hospital (PYNEH) made the following announcement regarding a sentinel event today (October 17).
      
     An 83-year-old male patient with lymphoma was admitted to the Medical Ward at PYNEH on September 30 due to shortness of breath. He was transferred to the Intensive Care Unit (ICU) on October 5 for acute respiratory failure, and diagnosed with pneumonia. Presented with conditions including Hyperkalemia, medication was prescribed.
      
     Patient’s vital signs gradually turned stable on October 14 and was discharged to the Medical Ward for further treatment in the same afternoon, including the monitoring and treatment of Hyperkalemia. Staff of the Medical Ward performed blood tests for the patient at 9pm on October 14 and at 3am on October 15 respectively. Test results showed repeated high level of serum potassium. Prescribed medication and close monitoring of Hyperkalemia were required. 
      
     At 6:28pm on October 15, the patient was found unconscious by an ICU nurse during a regular follow-up ward round. Electrocardiogram wave was shown flattened. Cardiopulmonary resuscitation for the patient was performed immediately but in vain. The patient passed away at 7:40pm. An initial review has suggested room for improvements in the monitoring and treatment of Hyperkalemia for the patient. PYNEH is very concerned about the incident. It has been reported to the Hospital Authority Head Office (HAHO) via the Advance Incident Reporting System. A Root Cause Analysis Panel will be set up to investigate the incident and recommend enhancement measures.  The report will be submitted to the HAHO in eight weeks. The incident has also been reported to the coroner for further investigation.
      
     The hospital had expressed deep condolences and explained the treatment process to the patient’s family yesterday (October 16). The hospital will continue to closely communicate with the patient’s family to provide necessary assistance.