Four separate, potentially dangerous patient-care incidents at the Alberta Children’s Hospital last year have resulted in a number of actions taken, according to health officials.

A failure to follow through on previous recommendations and poor communication may have led to the four unrelated errors in the same nursing unit at the Calgary hospital in February and March 2009, according to results released by the Health Quality Council of Alberta.

“It was a combination of factors, including systematic and communication issues between various health practitioners,” said John Cowell, CEO of the third-party investigative group behind the report.

“We are pleased our findings are being thoroughly reviewed by AHS and that several recommendations have already been implemented.”

Three of the incidents involved medication errors. Two children were given more than the required drug dosages, while another child intravenously received medication that was intended for a gastronomy tube. A fourth child received the incorrect breast milk from a woman other than the child’s mother.

Margaret Fullerton, the hospital’s interim vice-president, deflected criticism yesterday about the limited details released regarding the report.

“We can say there were very good recommendations. The people who work here are very caring and passionate about the patients,” Fullerton said.

The hospital pledged there will be accountability in following the recommendations, which include standardized procedures for labelling infusion lines, equipment adjustments, and making sure breast milk isn’t widely accessible.

Officials wouldn’t disclose the health of the children or any consequences of the errors, citing concerns about patient privacy, but did say the families have full disclosure.

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