Page 233 - Hospital Authority Convention 2017

Service Enhancement Presentations

F8.4 Young HA Investigators Presentations 14:30 Room 421

A Cluster-wide Patient Safety Programme in Reducing the Number of Models of Oxygen Regulators and
Enhancing Staff Competency on Their Use
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Lam MS , Wong CY , Cheng LLA , Kwok YTA , Tsang SKF , Chan WKW , Leung PMQ , Tang KS 2 HOSPITAL AUTHORITY CONVENTION 2017
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1 Nursing Services Division, Quality and Safety Division, Procurement and Materials Management Unit, New Territories West
Cluster, Hospital Authority, Hong Kong
Introduction
Since 2011, a number of incidents related to intra-hospital transfer of patients required oxygen therapy were reported. Among
these incidents, most of them were related to misuse of oxygen regulators. A knowledge gap in monitoring of flowmeter
was noted. On the other hand, a stock taking exercise in February 2014 showed that there were 44 models of oxygen
regulators being used in the New Territories West Cluster (NTWC). In view of this, a NTWC Workgroup on Standardisation
of Oxygen Regulators was formed by Nursing Services Division, Quality and Safety Division and Procurement Materials
and Management Unit in June 2014 to explore ways to reduce the potential risks and enhance patient safety and staff
competency.
Objectives
To enhance patient safety by reducing the number of models of oxygen regulators and enhancing staff competency in the use
of oxygen regulators.
Methodology
A stock taking exercise was conducted in February 2014 to understand the number of models of oxygen regulators in the
NTWC. Two models were identified as the standard models for purchase and use in the NTWC. In June 2014, all clinical
wards were invited to select their preferred models for replacement. Support from the hospital management was sought and
funding for replacement was approved in December 2014. A one-for-one replacement exercise was carried out between April
and July 2015. All NTWC staff who required handling portable oxygen cylinders, managing oxygen regulators and transferring
patients had to complete an online training course with quiz. A bilingual cue card was also produced to facilitate staff in using
the oxygen regulators. The Workgroup would continuously monitor the purchase of oxygen regulators and training status in
the NTWC.

Results
The one-for-one replacement exercise was completed in July 2015. The number of models of oxygen regulators was reduced
from 44 to two and more than 600 oxygen regulators were replaced. Further, an online training system was launched in March
2015. Up till 30 June 2016, more than 3,600 staff had completed and passed the quiz. There was also no incident related to
patient transfer with the use of oxygen regulators after the replacement exercise. Such good outcomes were presented orally
in the International Health Federation’s 40th World Hospital Congress in South Africa in November 2016. Wednesday, 17 May

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