LCQ3: Medication management relating to the elderly
9.6.2021

Following is a question by Dr the Hon Chiang Lai-wan and a reply by the Secretary for Labour and Welfare, Dr Law Chi-kwong, in the Legislative Council today (June 9): Question: It is learnt that due to a lack of knowledge of medications, quite a number of the elderly living at home organise and store medications improperly, and even unknowingly take at the same time multiple medications that cause an overdose or cancel out each other's effects, thus harming their health. Furthermore, medication incidents such as wrong dispensation of medication, and failure to keep accurate medication records have occurred from time to time at residential care homes for the elderly (RCHEs). For example, an incident occurred last year in which an elderly resident of an RCHE suffered from cerebrovascular disease and fell into a coma allegedly because she had taken the wrong medication given to her. In this connection, will the Government inform this Council: (1) whether it will subsidise non-profit-making organisations for providing pharmacist home visit services, and strengthen the pharmacist services provided by District Health Centres, such as providing the elderly with counselling on the use of medicines and services for organising and packaging of medications; if so, of the details; if not, the reasons for that; (2) given that the Government implemented the Pilot Scheme on Visiting Pharmacist Services for RCHEs during the period between 2010 and 2018 to enhance the medication management capabilities of RCHE staff, whether the Government will implement again and regularise the Scheme; whether the Government will provide subsidy to RCHEs for installing an electronic medication dispensing system and training their staff, so as to minimise cases of erroneous dispensation of medications; if so, of the details; if not, the reasons for that; and (3) given that the Office of The Ombudsman recommended, in its direct investigation report published in 2018, making wrong administration of medications by RCHE staff an offence, and the Working Group on the Review of Ordinances and Codes of Practice for Residential Care Homes also recommended enacting legislation to require RCHEs to properly handle medications, whether the Government will amend the relevant legislation; if so, of the timetable; if not, the reasons for that? Reply: President, Having consulted the Food and Health Bureau (FHB), my consolidated reply is as follows: (1) Operators subsidised by the Government to provide home care services for the frail elderly have to conduct assessment of each frail elderly person in order to formulate their individual care plans, including assessing whether he/she needs drug management service taking into account the conditions of the elderly person concerned and his/her family. Operators will provide drug management service for elderly persons in need, which includes advising them to check the expiry date of medication and sorting medication, providing them and their carers with information related to medication, assisting them to understand the importance of taking medication on time, etc. In a bid to shift the emphasis of the present healthcare system and mindset from treatment-oriented to prevention-focused, the Government, through the FHB, is setting up District Health Centres (DHCs) in all 18 districts across the territory. A multidisciplinary team comprising nurses, allied health professionals, pharmacists, social workers and supporting staff provides government-funded services, including health promotion, health assessment, chronic disease management and community rehabilitation at district level. As part of the DHC team, the on-site pharmacists are responsible for providing free medication consultation and drug compliance counselling service to members. Meanwhile, DHCs are positioned as district primary healthcare hubs to connect the primary healthcare services provided by the public sector, private sector and non-governmental organisations in the community, with a view to providing healthcare services and information on community resources to the public and enhancing information transparency. DHCs also strive to offer professional guidance to members of the public when needed and in a co-ordinated manner. The FHB will continue to review the demand for pharmacy services and their role in primary healthcare. (2) To raise awareness of drug safety and strengthen capability in drug management of residential care homes for the elderly (RCHEs), the Social Welfare Department (SWD) has implemented various measures covering different aspects such as system establishment, staff training, professional advisory service and technological support, including the following five measures: (a) The SWD collaborated with the Department of Health and the Hospital Authority to review the Operational Manual on Drug Management in RCHEs, and published the revised Guidelines on Drug Management in Residential Care Homes in end-August 2018. It sets out clear guidelines on the basic principles, procedures and quality assurance mechanism for drug management in residential care homes (RCHs). Among others, the guidelines cover such areas as establishing effective drug management systems in RCHs, conducting regular medication review for residents and performing drug safety audits in RCHs, and updating records of medication to ensure accuracy. These facilitate the elderly residents to use medication properly and safely, and ensure the RCH staff to implement effective and safe drug management; (b) The Code of Practice for Residential Care Homes (Elderly Persons) (Revised Edition) (the CoP), effective since January 2020, sets out detailed and clear guidelines on drug management. According to the requirements of the CoP, RCHs should arrange staff with relevant training (e.g. nurses or health workers) to be responsible for preparing drugs according to the prescriptions of medical practitioners, giving medication and assisting residents in taking medication safely. They should also properly maintain and timely update medication records of the residents; (c) To assist RCHs in drug management, the elderly service units receiving subsides from the SWD, if required, may apply for procurement or rental of drug management technology products, e.g. automatic tablet dispensing and packaging system, drug management system, etc., from the Innovation and Technology Fund for Application in Elderly and Rehabilitation Care launched by the SWD in December 2018. Besides, between 2010-11 and 2020-21, the Social Welfare Development Fund subsidised welfare organisations to implement 16 drug management projects for RCHEs; (d) Since October 2018, the SWD has arranged the Visiting Medical Practitioner Service for all the RCHEs in the territory. Furthermore, the SWD provides advice on how drug management should be improved depending on the actual circumstances during inspections, and organises relevant training workshops for RCHs regularly; and (e) Since March 2019, the SWD has provided health workers of RCHEs with full subsidies to attend Qualifications Framework-based courses including those relating to drug management. The Pilot Scheme on Visiting Pharmacist Services for Residential Care Homes for the Elderly (the Pilot Scheme) was launched in June 2010. Its main aim was to assess and optimise the drug management systems in the RCHs and enhance the knowledge and capability of their staff in drug management. The number of participating RCHEs dropped gradually, from 26 in the first year to six in 2018, right before the completion of the Pilot Scheme. In fact, with the implementation of the five measures mentioned in the above paragraphs, majority of RCHEs have established effective drug management systems, and their relevant staff have received training including drug management, and therefore the services provided by the Pilot Scheme were no longer required. The SWD will continue to implement the said measures to support RCHEs in drug management and safeguard the well-being of the elderly residents. (3) To further enhance the regulation of RCHs, the SWD set up the Working Group on the Review of Ordinances and Codes of Practice for Residential Care Homes (the Working Group) in June 2017. The Working Group completed the review in May 2019 and put forward various recommendations, among which was to include in the Residential Care Homes (Elderly Persons) Regulation (Cap. 459A) provisions relating to care service so that RCHs should properly manage drugs and strictly follow doctors' prescription in assisting residents to take medication. The Government is in the process of drafting the legislative amendments, and will submit them to the Legislative Council for scrutiny as soon as practicable upon completion. The SWD will continue to liaise closely with the sector and stakeholders to prepare for the implementation of the amended regulation in the future.