Open disclosure after a medication error — OSCE

Station brief (8–10 minutes)

Conduct the initial open-disclosure conversation with the parents after the tenfold medication error. The child is stable. Acknowledge what happened, apologise, give the known facts, arrange appropriate follow-up, and ensure language access. Do not invent jurisdiction-specific statutory wording or local tribunal procedure. [1] [4]

Tasks for the candidate

1. Confirm the child is safe and stable; assemble the right people and a private setting. [1] [4]
2. Ensure a trained interpreter is present; do not use the child or a family member. [5]
3. Acknowledge what happened in plain language and give the known facts honestly. [1] [2]
4. Apologise with a sincere expression of regret for the harm, owning the event without blaming an individual. [1] [2]
5. Check understanding with teach-back, invite questions, name a single point of contact, and arrange the follow-up disclosure. [4] [14]

Expected performance

Must hit. Confirms the child is stable before disclosure; private setting with the right people; trained interpreter used (never the child); acknowledges what happened in plain language with the known facts; offers a sincere apology that owns the harm; avoids blaming an individual in front of the family; teach-back of understanding; names a point of contact and arranges follow-up; documents the conversation. [1] [4] [5]

Merit. Distinguishes the initial disclosure from the follow-up explicitly; addresses that the apology is owed and is not an admission of liability; names the second victim and arranges support for the clinician; offers a written summary; commits to sharing the improvement plan at follow-up. [2] [14]

Fail. Stays silent or trickle-discloses because the child 'seems fine'; uses the child as interpreter; uses defensive language ('sorry this happened to you'); blames the nurse or registrar in front of the family; offers no apology, no teach-back, no follow-up and no documentation. [1] [2]

Sample candidate structure

“Thank you both for sitting down with me. I have asked for an interpreter so we can be sure you understand everything — this is too important to get wrong. I need to tell you something serious. Overnight, [child] was given ten times the intended dose of a pain medicine, because of a decimal-point error on the chart. The nurse realised very quickly. We gave the medicine to reverse it, and [child] is now stable and comfortable. I am very sorry this happened, and sorry that your child was exposed to this. We are reviewing exactly how it occurred so it does not happen again, and I will meet with you again to tell you what we found and what we will change. What questions do you have right now? I will be your point of contact, and I will leave you a written summary of what we have discussed.” [1] [2] [4]