Open disclosure and duty of candour — formative SAQs

SAQ 1 (10 marks)

A 3-year-old on the ward is given ten times the intended dose of an opioid because of a decimal-point error. The nurse realises within minutes; the child is reviewed, given naloxone as required, and is now stable. Both parents are at the bedside and have limited English. [1]

1. Outline the staged process of open disclosure you would lead for this family. (5) [1] [4]
2. Describe how you would handle the apology, and address a concern that it might be taken as an admission of legal liability. (3) [1] [2]
3. Describe the follow-up you would arrange for the family and for the clinician involved. (2) [4] [14]

Model answer

Stabilise and treat the child first. Then lead the staged process: confirm the facts and the right people (treating clinician/consultant, nurse, interpreter, social worker); hold an initial disclosure in a private space — acknowledge what happened in plain language, give the known facts, say honestly what is not yet known, apologise, and describe the next steps, checking understanding and inviting questions; arrange a trained interpreter and never use the child; name a single point of contact; then hold a follow-up disclosure to share the investigation findings, system causes and improvement plan; document who was present, what was said, the apology and the agreed plan. [1] [4]

Offer a sincere expression of regret for the harm — saying sorry is owed as honesty and compassion. In ANZ and many jurisdictions, apology legislation protects a sincere expression of regret from being treated as an admission of legal liability, and the evidence associates disclosure with apology with reduced, not increased, litigation, so withholding sorry for fear of law misreads both the ethics and the data. [1] [2]

For the family: a written summary, a named contact, a scheduled follow-up meeting to share the review findings and the improvement plan, and counselling if needed. For the clinician (a second victim): arrange peer support, a debrief, and clinical cover so they can step back, protecting their return to safe practice. [4] [14]

SAQ 2 (10 marks)

A healthcare-associated infection outbreak is identified on a neonatal ward, affecting several infants. The unit is preparing to communicate with multiple families. [5]

1. Explain the difference between the professional duty of candour and the statutory/organisational duty of candour, and how each applies here. (4) [4] [5]
2. Describe how you would adapt open disclosure for a coordinated, multi-family incident on a neonatal ward. (3) [5] [10]
3. Identify two common pitfalls in disclosure after such an incident and how you would avoid them. (3) [1] [14]

Model answer

The professional (individual) duty of candour sits on each clinician and is set by codes of conduct (e.g. Medical Board/RACP, GMC); it obliges honesty with families regardless of organisational policy. The statutory (organisational) duty sits on the regulated provider — in England, CQC Regulation 20, triggered by a notifiable safety incident — obliging the organisation to inform, apologise and report. In an outbreak both apply: each clinician owes candour to the affected families, and the organisation owes a coordinated, consistent notification, apology and report. [4] [5]

For a multi-family incident, disclosure must be coordinated and consistent across families to avoid conflicting accounts: a single senior lead (with infection control and public-health input), a shared factual briefing developed once the facts are known, individual family conversations in private with interpreters as needed, a named contact per family, and a follow-up to share findings and the improvement plan. Consistency of message and individual privacy both matter. [5] [10]

Pitfalls: (1) concealment or partial/trickle disclosure — avoid by holding the initial conversation promptly and giving the known facts honestly; and (2) forgetting the second victim — the staff involved in the affected care need peer support and a debrief so they are not driven from safe practice. A third is defensive language that distances the team from the harm, avoided by owning the acknowledgement and apologising sincerely. [1] [14]