Disclosing a medication error to a family — OSCE

Station brief (8–10 minutes)

A six-month-old infant became briefly apnoeic after an opioid infusion was programmed ten times too fast. The nurse stopped the pump, naloxone was given, and the baby has recovered. You are the registrar. The parent is at the bedside. Disclose what happened, explain the plan, and address the parent's concerns. Do not invent local statutory wording or compensation detail. [1] [13]

Tasks for the candidate

1. Confirm the child is now safe and monitored before the conversation begins. [1]
2. Disclose the error honestly in plain language: what happened, what it meant for the child, and what is being done. [13]
3. Avoid blame language; frame the event as a system failure and explain the analysis. [13]
4. Describe specific strong prevention actions — standard concentrations, a hard pump-library limit, and a genuine independent double-check. [14]
5. Offer follow-up, a named contact, and recognition of the parent's right to ask questions. [4]

Expected performance

Must hit. Confirms the child is safe before speaking; uses plain, honest language to say a medication error occurred and the baby was given too much opioid briefly; explains the child received the antidote and is recovering; names a clear plan to investigate and prevent recurrence; avoids blaming an individual and frames it as a system failure; offers follow-up and a named contact. [1] [13]

Merit. Names the tenfold-error mechanism and weight-based vulnerability without jargon; describes concrete strong actions — a hard pump-library limit and a genuine independent double-check — rather than vague reassurance; acknowledges the distress of staff as well as the family; invites questions and checks the parent's understanding. [4] [14]

Fail. Minimises or conceals the error; blames the nurse or the registrar by name; offers no specific prevention plan; leaves the family without a contact or follow-up; becomes defensive or evasive; fails to confirm the child is safe before talking. [1] [13]

Sample candidate structure

"I want to be honest with you about what happened. While [baby] was receiving a pain medicine through a drip, the pump was accidentally set to run about ten times faster than it should have. That made [baby] briefly slow their breathing. The nurse noticed straight away, stopped the drip, and we gave a medicine that reverses the effect, so [baby] is breathing normally again now. This should not have happened, and I am very sorry. We are keeping a close eye on [baby], and we will investigate exactly how the pump came to be set that way so we can stop it happening again — for example, by locking the pump to safe doses and having two nurses check these medicines independently. I will be your point of contact, and please ask me anything." [1] [13] [14]