Your own prescribing error

Step 1 · Read the instruction

WHAT TO DO

Check the format first. Choose-three questions are marked on the set, so you need to think about how the actions work together rather than which three look best on their own.

• 1Instructiontaken together, are the most appropriate response
  This is the key phrase. NHS England says the three most appropriate actions taken together should fully resolve the situation. Picking three individually good actions isn’t enough if they leave an important need uncovered. You must choose exactly three.

Step 2 · Work out your role and who is affected

WHAT TO DO

Ask what you’re responsible for and what you can safely do on your own.

• 2ScenarioYou realise that you prescribed an additional dose
  This is your error. That makes you responsible for acting on it and being open about it. It doesn’t mean you should manage everything alone.
• 3ScenarioThe registrar is available.
  Help is at hand. As an F2, you should involve a senior in managing a potentially harmful error, and the question tells you one is available now.

The people affected are the patient, who may be harmed and has a right to know, and you. The team and organisation are affected too, because they need to learn from the error.

Step 3 · Separate facts from assumptions, and find the risk

WHAT TO DO

Read the facts carefully. In choose-three questions the stem often lists the needs your set must cover.

• 4Scenarioit has been given
  The error has reached the patient. That makes it more than a near miss, which is an error caught before it could cause harm. When an error reaches a patient and may cause harm, the GMC says the patient must be told and the event reported.
• 5ScenarioIt could cause harm.
  Harm is possible, not certain. Anything you say to the patient must reflect that uncertainty, so neither “you’ll be fine” nor “this is serious” is accurate yet.
• 6Scenariocurrently stable but needs prompt clinical assessment
  “Stable” might tempt you to wait. The question rules that out: assessment is needed promptly.
• 7ScenarioNo one has yet explained the error to the patient or reported it.
  The stem is telling you what still needs to happen. Combined with the previous sentence, you now have a list of unmet needs.

Step 4 · Name the tension and write your task

WHAT TO DO

For choose three, list the separate needs. Each one usually requires its own action.

Making an error can make it tempting to minimise it or put off telling anyone. The tension is between that discomfort and your duties to keep the patient safe, be open and support learning. The stem gives you three separate needs:

1. clinical assessment and a management plan, with senior input;
2. an honest explanation and apology to the patient;
3. an accurate record and an incident report.

Your task: I need to make sure the patient is assessed and managed with the registrar’s help, tell them honestly what has happened, and record and report the error.

Step 5 · Strike out options with a clear flaw

WHAT TO DO

Look for the warning signs listed in Choosing three: deception, unjustified disclosure, unsafe delay, unsupported accusations or work beyond your competence. Remove these first, so you’re choosing from fewer options.

• 8Option DWait for the pharmacist to review the drug chart
  D is an unsafe delay. You already know what happened, and the question says assessment is needed promptly. Waiting until the afternoon helps no one.
• 9Option Fwait for the outcome of the investigation before discussing the error
  F’s first half, reporting, is correct. Its condition is the flaw. The GMC says communication and an apology shouldn’t wait for an investigation.
• 10Option Hunlikely to cause any problems
  H offers reassurance that the facts don’t support. The stem says the dose could cause harm, so this would mislead the patient.

That leaves A, B, C, E and G.

Step 6 · Work out what each remaining option contributes

WHAT TO DO

For each option still in play, ask which need it meets and how completely.

• 11Option Ainform the registrar now to agree monitoring and management
  A meets need 1 in full: your assessment plus senior input, now, leading to a plan.
• 12Option Bexplain to the patient promptly what has happened, apologise
  B meets need 2. It also says “with the registrar” and “be clear about what is not yet known”, which supports a difficult conversation and keeps it honest.
• 13Option CRecord the event accurately in the clinical notes and complete an incident report.
  C meets need 3: an accurate record and a route for the organisation to learn.
• 14Option Etell the registrar if anything changes
  E only partly meets need 1. More observations help, but the registrar would hear about it only if something goes wrong. No one agrees a plan now.
• 15Option GReflect on the error in your portfolio
  G is good practice for your own learning, but it meets none of today’s three needs.

Step 7 · Build a set of three and test it

WHAT TO DO

Try a provisional set. Then test it for coverage (does it meet every need?), compatibility (do the actions work together?) and necessity (would dropping one leave a duty unmet?). Swap out the weakest choice if another option does more.

Provisional set: A + B + C.

• Coverage: all three needs are met. The patient is assessed and managed, informed honestly and the error is recorded and reported.
• Compatibility: B’s “with the registrar” fits naturally with A, which has already involved them.
• Necessity: remove any one and a need goes unmet.

Test the swaps. Replace A with E, and no one agrees a management plan. Replace C with G, and nothing is recorded or reported: reflection improves your practice but doesn’t inform anyone else. Neither swap improves the set.

Notice C versus F. Both include an incident report. F’s condition, waiting before talking to the patient, would contradict B. The same action can be right or wrong depending on what is attached to it.

What could change the answer

WHAT TO DO

Ask which fact would make your preferred set wrong.

• If assessment, the conversation with the patient and the incident report had all been done, and the question were about what to do next, G would become central.
• If the patient were deteriorating now, getting urgent help would dominate. A would still come first, but more urgently.

The exam-speed version

1. Choose three, together; the set must resolve the situation.
2. My error reached the patient and could cause harm. The registrar is available.
3. The stem lists three needs: assessment and a plan, telling the patient, recording and reporting.
4. Strike out D (delay), F (delays candour) and H (false reassurance). One option per need: A, B and C.

Take this into your next question

Lesson: when a stem tells you what hasn’t happened yet (“no one has explained… or reported it”), treat each item as a need your set must cover.

When it applies: errors, incidents and any choose-three question where the stem lists gaps. See an error has occurred and look for what the set leaves unresolved.