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Disclosure after a notifiable patient safety incident — MRCEM SBA MCQ

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HardProfessional practice and researchDisclosure after a notifiable patient safety incidentMRCEM SBA

A 38-year-old woman attends an NHS emergency department with a wrist laceration. Despite a clearly documented history of anaphylaxis to penicillin, she is given intravenous co-amoxiclav in error. She develops hypotension and wheeze, receives intramuscular adrenaline and intravenous fluids, and recovers without apparent lasting impairment. She requires an unplanned hospital admission for observation instead of the discharge originally planned. She now has capacity and asks that her husband, who is waiting outside, is not told about her care. The incident has been reported to the nurse in charge, but the investigation has not begun. What is the most appropriate plan for communicating about the incident?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Explain the known facts and apologise to the patient promptly, with documented written follow-up.

The immediate clinical priority—treating the anaphylaxis—has been addressed. This unintended treatment error caused significant, although apparently temporary, harm and an unplanned admission. It therefore meets the moderate-harm threshold for a notifiable safety incident in an NHS trust; permanent impairment is not required. The patient has capacity, so she is the person to notify. She should be told promptly and sensitively what is known, offered an apology and support, and told what further enquiries will take place. The discussion should be recorded and followed up in writing; the local patient-safety process should also continue. ([gov.uk](https://www.gov.uk/government/calls-for-evidence/duty-of-candour-review/duty-of-candour-review)) A might appeal because her husband is present, but she has expressly declined disclosure to him. B wrongly makes completion of the investigation a prerequisite: uncertainty about why the error occurred can be acknowledged during the initial conversation. D similarly delays an apology even though the incident and resulting harm are known. E mistakes the absence of lasting impairment for absence of a duty to notify; internal reporting does not replace communication with the patient. ([gov.uk](https://www.gov.uk/government/calls-for-evidence/duty-of-candour-review/duty-of-candour-review))

Reference: Duty of candour review — The duty (26 November 2024) — https://www.gov.uk/government/calls-for-evidence/duty-of-candour-review/duty-of-candour-review Being Open, Saying Sorry and Duty of Candour Policy — Regulation 20 appendix (2024) — https://www.dbth.nhs.uk/wp-content/uploads/2024/10/CORP-RISK-14-v-7-Being-Open-Saying-Sorry-and-Duty-of-Candour-Policy.pdf A guide to confidentiality in health and social care — Section 8: Carers, family members and friends (Date not stated on page) — https://digital.nhs.uk/data-and-information/looking-after-information/data-security-and-information-governance/codes-of-practice-for-handling-information-in-health-and-care/a-guide-to-confidentiality-in-health-and-social-care/hscic-guide-to-confidentiality-references/section-8