Queen Elizabeth Hospital has completed an investigation of a medication incident in which a nurse gave injections of expired reconstituted vaccines to five newborns.
On August 23, the nurse took a bottle of reconstituted Bacillus Calmette-Guerin vaccine from the ward's drug fridge to inject into four boys and one girl without checking the preparation date on the bottle. Later, the nurse saw that the vaccine had been reconstituted on August 21 and was supposed to have been used within four hours of reconstitution.
The incident was reported to the management immediately. All babies were assessed and are in satisfactory condition. Despite the slim chance of germs growing in the reconstituted vaccine bottle, a test was done on its remaining contents to rule out the risk these babies had been infected by other germs.
Four babies were discharged yesterday while one is still hospitalised with neonatal jaundice. The hospital will closely monitor their conditions. Its management expressed sincere apologies to the parents and met them on August 23 and again yesterday to thoroughly explain the incident and the follow-up actions.
Investigation showed it was an isolated incident caused solely by a human error following the staff member's failure to comply with the medication-checking guidelines. The nurse has been reminded to duly observe the related procedures and will be closely supervised at work for a period of time.
Hospital Authority Chief Executive Shane Solomon was deeply concerned about the incident and apologised again to the parents. He pledged the hospital will monitor the babies and provide any necessary help to their families.
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