Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Wong RSM(1), Yung TH(1)(2), Cheung P(2), Lee BSC(2), Tse ML(1)
Affiliation :
(1) Hong Kong Poison Control Centre, Hospital Authority, (2) Chief Pharmacist's Office, Hospital Authority
Introduction :
Since the establishment of the Integrated Chinese-Western Medicine (ICWM) Programmes in the Hospital Authority in 2014, there have been concerns on the safety of Chinese Medicines (CMs) & the concomitant use of CMs with western drugs.
Objectives :
To develop guidelines on CM safety and herb-drug interaction to enhance safety and facilitate the implementation of ICWM programmes.
Methodology :
An Expert Panel (EP) on Chinese Medicine Safety for ICWM Programmes was established to assess all CMs listed in the ICWM protocols under the programmes. A trained professional team composing of pharmacist and CM pharmacists performed systemic reviewsEP performed systematic review of scientific literatures relating to their intrinsic toxicities related to cardiovascular (CV), liver and renal systems as well as herb-drug interactions. The EP reviewed the results of the systematic review with focused assessment to the quality and applicability of the evidence. Through consensus meetings, agreement among experts was made on the likelihoods of adverse effects and herb-drug interactions associated with the use of CMs at doses within the recommended ranges by official references. Based on these consensuses, the CMs were classified into four different risk ratings: (1) High Risk; (2) Moderate Risk; (3) Low Risk; and (4) No Reported Risk. Specific warning of the possible toxicities or potential herb-drug interactions together with recommendations of use suggested by the EP are formulated and tabulated.
Result & Outcome :
As of December 2023, a total of 322 CMs have been evaluated which was about 74% of all the CMs in granule form in HA. Seventy-five CMs (about 23% of those used in ICWM protocols) have safety concerns. Toxicities were identified in 65 CMs (about 20% of ICWM protocols, CV: 36 CMs, liver: 33 CMs, renal: 14 CMs). Twenty-six CMs (about 8% of ICWM protocols) have herb-drug interactions and specific recommendations were provided as appropriate. The guidelines have provided valuable information to frontline clinicians to ensure the quality and safety of ICWM treatment. With the expansion of ICWM programmes in HA and the wider integration of Chinese and western medicine treatment in Hong Kong, the establishment of the ICWM Treatment Safety Centre under the Hong Kong Poison Control Centre will help to further enhance the ICWM safety guideline as well as recommendations on herb-drug interaction to support the ICWM framework development.
