According to information from the Hospital Authority (HA), the elderly cancer patient who is a chronic hepatitis B carrier completed her chemotherapy in May 2016.
Three consultations were arranged for the patient between May 2016 and March 2017. However, a preliminary review by the clinical department found that an anti-hepatitis B drug was not prescribed in all three of the said consultations.
QMH was not aware of this incident until June 2017 when the patient was about to attend a follow-up session scheduled on 3 July. Prior to the session, a pre-consultation blood test result showed an elevated liver enzyme level. QMH then took immediate action to arrange hospital admission for the patient on 30 June. Currently, the patient is still in serious condition.
Clinical teams at QMH has openly disclosed the incident to the patient’s relatives on 11 July, reassuring that they will maintain close contact with the patient’s family.
HA said they had reminded front-line clinical units of the need for prophylactic antiviral prescription
QMH said it is ‘very concerned’ about the incident and it has reported the incident to the HAHO through the Advance Incident Reporting System on 8 July. Three days later, upon reviewing the clinical details, the hospital flagged the incident as SUE.
An Investigation Panel will be set up to investigate the incident, and submission of the report to the HAHO will be done in eight weeks.
Such incident comes after the medical blunder when two renal specialists at the United Christian Hospital (UCH) failed to arrange an anti-viral drug for a renal patient, also a hepatitis B carrier, in January and February this year.
In response to the incident, HA issued an internal reminder on 12 July to all relevant clinical departments on the need for prophylactic antiviral prescription after initiating immunosuppressive therapy to patients with hepatitis B infection.
The HA spokesperson said front-line clinical units were reminded to refer to the latest "Guideline on Pre-emptive Use of Nucleos(t)ide Analogues in Patients with Hepatitis B Infection Receiving Immunosuppressive Therapy" effective from 1 July this year. MIMS
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