An Epidemiology Study Of Acute Drug Poisoning In Hong Kong Between 2007 And 2016

Background:Poisons are substances that cause distubances in organisms,usually by chemical reaction or other activity on the molecular scale,when an organism absorbs a sufficient quantity.A drug poisoning occurs when that substance is an illegal,prescription,or over-the-counter drug.In 2013,3.3 million cases of unintentional poisonings occurred and resulted in 98,000 deaths worldwide.Drug poisoning includes drug misuse,drug abuse,drug overdose and drug contamination.Since there was an increase in acute drug poisoning,the common contributing factors and improvment measures should be studied to prevent further reoccurrence of similar events.Part 1:Notification of poisoning cases in Hong Kong public hospital over 10 yearsObjective:To study the epidemiology,causes,and clinical course of the acute drug poisoning in Hong Kong public Hospital between 2007 and 2016.Methods:All poisoning cases reported by all accident and emergency department(AED)of Hospital Authority in the last ten years were retrieved from its database for analysis.The data of each poisoning case was inputted into the computer system according to information obtained from the consulting health care professional,medial record,electronic patient record(ePR)of HA and other relevant sources.Data collected included patient demographic data,poison data(poison type and dose,route,time,place and reason of exposure),clinical data(clinical features,investigations results)and outcome data(disposal for AED patient,final outcome and its relationship to the poison exposure)for the reporting cases.The outcome of the cases into 5 categories.Besides,the relationship between the poison exposure and clinical outcome were also graded according to the available information.Results:A total of 1,284 poisoned cases were analysed.There were 546 male patients(42.5%)and 738 female patients(57.5%).The majority of the cases(53.0%)were between 20 and 59 years old.Commonest place of exposure was in the patient's residential place(98.2%)and the commonest route of poisoning was oral exposure(95.0%),About 71.0%had exposed to a single poison while the remaining(29.0%)of the cases had exposed to multiple poisons.Common causes for poisoning were contamination/adulteration(66.4%),unintentional exposure(16.4%)and adverse drug reation(12.5%).The five commonest types of poison were Sibutramine,Glibenclamide,Diclofenac,Dexamethasone and Indomethacin.The five commonest types of Chinese Medicines were Aconitine alkaloids,Heavy Metal,Matrine,Gelsemine and Tropane alkaloids.The underlying reasons associated with poisoning are as follows:1)Improper self-medication;2)Consuming oral products as recommended and given by peers;3)Consuming Chinese Medicines without consulting CMPs;4)Contamination/Adulteration;5)Overdose;6)Erroneous substitution;7)Inappropriate preparation and 8)Prescribing error.Majority of the cases had uneventful recovery;0.93%resulted in death and 4.83%had major outcomes.Conclusions:This report provided updated epidemiological information on poisoning pattern and highlighted some important poisoning cases in Hong Kong.Part 2:Medication errors in Hong Kong public hospitalObjective:To report and analyse the medication errors from voluntary incident reporting in Hong Kong public Hospital between 2010 and 2016.Methods:All medication errors reported by staffs of Hospital Authority in the last seven years were retrieved from internel reports for analysis.Data collected included poison data(poison type and dose,route,time,place and reason of exposure),clinical data(clinical features,investigations results)and outcome data(disposal for AED patient,final outcome and its relationship to the poison exposure)for the reporting cases.The outcome of the cases into 6 categories.Results:A total of 570 medication incidients were analysed.The incident rate per 1,000,000 episodes of patient attendances/discharges and deaths had drop from 4.4 to 3.4 between Year 2010 and Year 2016.The five most common medication error were known drug allergen,dangerous drug,anticoagulant,insulin and oral hypoglycaemic agent.Of the 255 medication error related to known drug allergen,the three most commonly involved drugs were penicillin group,non-steroidal anti-flammatory drug(NSAID)and paracetamol.Majority of the cases had uneventful recovery;1.23%resulted in death and 19.30%had major outcomes.Subsequent to incident review and analysis of root causes of these incidents,important lessons of patient safety are identified,while recommendations are made and shared in this publication to avoid similar events in future.Conclusions:This report provided updated epidemiological information on the pattern of medication errors and highlighted some important incident cases in Hong Kong.