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High-yield walkthrough of a medication-error scenario: immediate safety, escalation, candour, and governance. 🧠⚡️
Clinical vignette
You are an F2 in Acute Medicine on an evening shift. You realise a patient with a documented penicillin allergy received co-amoxiclav via e-prescribing two hours ago. The patient is currently stable with no signs of anaphylaxis. Nursing staff are busy with handovers and the on-call registrar is reviewing a deteriorating patient elsewhere. You must decide what to do next.
Question
Rank the following actions in order from most appropriate (1) to least appropriate (5).
Options
1) Offer the patient a timely, open apology and explain what happened and the plan under the duty of candour.
2) Record an accurate, time-stamped entry in the notes and submit an incident report (e.g., Datix) before the end of the shift.
3) Immediately review the patient, re-check observations, stop further doses, prescribe appropriate monitoring/treatment, and inform the nurse in charge.
4) Inform the on-call registrar and the on-call pharmacist as soon as possible to agree a management plan and reporting.
5) Amend the e-prescribing record to remove evidence of the error and plan to discuss it tomorrow to avoid causing alarm.
Answers shown at the end.
Explanation
Prioritise immediate clinical safety: see the patient now, confirm observations, stop further doses, and start appropriate monitoring with readiness to treat if symptoms evolve (e.g., antihistamines, steroids, adrenaline per protocol if indicated). Make allergy status clearly visible and involve the nurse in charge to coordinate observations and escalation.
Escalate early: the registrar provides senior oversight (observation period, thresholds for step-up care) and the pharmacist advises on allergy coding, safe alternatives, interaction checks, and to prevent repeat errors.
Apply duty of candour once you have a plan: apologise in plain language, explain what happened and the risks, outline monitoring/management, offer written information, and answer questions.
Complete governance: make a contemporaneous, factual, time-stamped record (who, what, when, actions taken) and file an incident report before the end of the shift to support continuity and learning.
Never conceal or alter records; it is unsafe, dishonest, and breaches probity.
Brief explanation
• Patient safety > admin: assess in person, stop the drug, monitor, treat.
• Early, structured escalation to senior and pharmacy ensures a safe, accurate plan.
• Candour requires honesty plus a concrete plan.
• Records and reporting enable continuity and system improvement.
• Concealment is always unacceptable.
Key takeaways
• SAFE: Stop harm & assess → Alert senior/pharmacy → be Frank with the patient → Enter notes & incident report.
• Prioritise: stabilise → escalate → disclose → document.
Links
https://www.passthemsra.com/courses/sjt-for-the-msra/
https://www.passthemsra.com/courses/sjt-msra-mock-papers-x-10/
— Correct Answers: —
Ranking (most → least appropriate): 3 → 4 → 1 → 2 → 5
3 — Immediate safety: Review the patient now, re-check observations, stop further doses on EPMA, initiate monitoring and have first-line treatments to hand; inform the nurse in charge so the ward response is coordinated.
4 — Escalation: Contact the on-call registrar and pharmacist promptly to agree the management plan (observation period, alternative therapy, allergy coding, EPMA safeguards) and reporting steps.
1 — Duty of candour: Offer a timely, open apology with an honest explanation and the agreed plan; provide written information and answer questions.
2 — Records & reporting: Make a clear, time-stamped entry and submit an incident report before end of shift to support continuity and learning.
5 — Concealment: Altering or deleting records is dishonest and unsafe; delaying disclosure to “avoid alarm” breaches probity and risks harm.
