LAHORE:The human error is being attributed in preparation of injectable drug solution, which caused the reaction and led to the death of two patients and affected 17 other patients here in the Chest Surgery Ward of Mayo Hospital, Lahore.
Punjab Minister for SHC&MED Khawaja Salman Rafique said that only two nurses were on duty in the said ward at the time of the incident. He confirmed that the mistake in preparing the solution was made by these nurses.
The hospital sources claimed that the nurses, on duty at the time of incident, mixed Ringer Lactate or normal saline water in the injectable drug supplied in powder form. "The calcium gluconate, present in normal saline, should not be mixed with Inj. Ceftriaxone to prepare a solution, for it may form a precipitate that can be fatal," the hospital pharmacy experts informed.
The said soluble drug should have been mixed with "water for injection", a special liquid to prepare injectable drug solutions. "Whether water-for-injection was provided along with the soluble drug in the ward or not is needs to be investigated," the pharmacy sources added.
The Medical Superintendent (MS) of the hospital confirmed that a 26-year-old patient, Daulat Khan, who was admitted for surgery, also lost his life last night due to the reaction. Earlier, a 31-year-old female patient had lost her life due to a suspected reaction. "Three of the 17 affected patients had been put on ventilators, while remaining affected patients are now out of danger," the hospital spokesman told the media.
Following the severe reaction, the authorities immediately halted the use of injection at the hospital. In response to the incident, the hospital administration formed an inquiry committee to investigate the matter.
A notification has been issued for the appointment of Prof Dr Israr-ul-Haq as the head of the inquiry committee. The 8-member committee also includes the chief pharmacist, deputy nursing officer, and AMS of the hospital.
Meanwhile, the hospital administration has directed that all remaining stock of the injection be immediately returned to the pharmacy. The hospital administration informed that the injection was not expired and had been duly-approved and supplied through the Punjab government in 2024. The Punjab Pharmacovigilance Centre, in 2024, had also received similar multiple adverse drug reaction reports from District Khanewal and Lady Wellington Hospital, Lahore, whereby IV Ceftriaxone was either being diluted with ringer lactate or was being administered via same IV site.
Following these reports, the Drug Control Authority, Primary and Secondary Healthcare, Punjab issued an advisory, which says that "Ceftriaxone and Ringer Lactate or any other IV Calcium Containing Product such as calcium acetate, calcium gluconate and parenteral nutrition etc. should not be mixed together due to IV admixture incompatibility."
It advised healthcare professionals: "The use of ceftriaxone and calcium products is contraindicated in neonates up to 28 days old. The Ceftriaxone shouldn't be given to neonates (infants 28 days old or younger) if they are receiving or are expected to receive IV products containing calcium. The infants older than 28 days may receive ceftriaxone and a calcium-containing IV solution in sequence if the IV line is flushed thoroughly between the two infusions with a fluid compatible with both. No patient of any age should receive simultaneous administration of ceftriaxone and any IV solution containing calcium via an IV tubing Y site. The Ceftriaxone shouldn't be reconstituted, diluted or mixed with any calcium-containing product including Lactated Ringer's, Ringer's, Hartmann's solution, or parenteral nutrition."
Meanwhile, Punjab Chief Minister Maryam Nawaz has sought a report from the Secretary Specialised Healthcare and Medical Education Department (SHC&MED) in this regard. She also ordered the provision of the best medical treatment to the affected patients and action against those responsible for negligence.
A few days ago, the chief minister had taken stern action for mismanagement in treatment of patients in Mayo Hospital Lahore. As a result, the CEO and MS of the hospital were removed from their positions.
As per report, Punjab Minister for SHC&MED Khawaja Salman Rafique said that despite the fact that the facility had ample stock of syringes, bernals and other disposables, patients were being told to bring medicines from outside the hospital. Moreover, the pathology lab had all kinds of test facilities, but patients were being told to get tested from outside. Mayo Hospital had its own budget of one and a half billion rupees and the Department of Specialised Healthcare and Medical Education purchased additional medicines worth Rs220 million from its top-up stock for Mayo Hospital.
A few days ago, the department again gave Rs340 million to Mayo Hospital for medicine purchase. The hospital had Rs150 million in UHI and Rs190 million in PLA account, despite which medicines were not purchased.
The minister, however, attributed the incident to human error. He explained that the injection was in powder form, and a mistake was made while preparing the solution. He said the affected patients had received a third dose, while the first two doses had not caused any adverse reactions.
The minister revealed that a stock of 6,000 injections had been supplied to the hospital and administered across different departments. However, the adverse reaction was reported only in the chest ward. The minister said that the report on the powder would be available soon, while the report on the solution would be released the following day. He further disclosed that the same injection had also been distributed to various hospitals in Lahore and Narowal.
The minister emphasised that nurses are trained to prepare antibiotics, but strict action will be taken against those responsible once the investigation report is finalised. He further revealed that around 400 new nurses had recently been recruited, while more hiring is currently underway as well at Mayo Hospital.
