Explaining a medical error

Walkthrough Guide
Opening the consultation
 Introduce yourself with your full name and grade
 Check the patient details (name and date of birth)
 Set out the purpose of the discussion
 Gain consent to speak

Establish baseline understanding

 Ascertain the patient's understanding of their reason for admission
o "Do you know why you were admitted to hospital?"
 Ascertain the patient's understanding of the use of intravenous therapy
o "Do you understand why you were started on intravenous antibiotic
therapy?"
 Ask about the symptom of tinnitus
o "Can you tell me a bit more about the ringing in your ears?

Information giving
 Explain that a medication error has occurred
o "I'm sorry to tell you that there has been an error with one of your
antibiotics"
 Explain where the error occurred
o "You should have received the medication every 48 hours, however due to
an error in prescribing, you have been administered this medication every
24 hours"
o Avoid blaming a colleague or naming anyone as the cause
 Apologise for the medication error
o "I'm very sorry this has happened"
o Offer a sincere apology
 Explain that the medication level is safe and no further treatment is needed
o "We have checked the level of the medication and the level is safe. No
further treatment is needed"
 Explain that the tinnitus is a likely side effect of the gentamicin
 o "The tinnitus is likely a side effect of the gentamicin, which may have
been more likely to occur since you were given an erroneous dose"
 Explain to the patient that you don't know if the tinnitus will be permanent
o In fact, there is a possibility that the tinnitus is permanent but you are
not expected to know this at undergraduate level.
 Explain that a report will be made to investigate the error
o "This error has been logged here and we will fully investigate how it
happened"

Next steps
 Acknowledge patient's anger and empathises
o Acknowledge anger
o Empathise
 Offer the patient the opportunity to speak to consultant and/or the nurse in
charge
 Signpost patient to facility to make a formal complaint
o Most hospitals have a patient advice and liaison service (PALS)
 Reassure the patient that the drug has been stopped and that other options
can be considered
o In fact, they may even be switching to oral therapy after 4 days
 Inform the patient that you will refer them for a hearing assessment with
audiology follow up for review of their tinnitus
 Reassure the patient of their safety
 Check patient's understanding
 Invite questions

Concerns
 Ascertain the patient's main concerns

Expectations
 Ask the patient of their expectations of the consultation
 Manage patient's expectations
o I.e. advise speaking to the patient advice and liaison service and
following proper procedures