SJT: Free Q: 2R: Medication Error Discovered on Evening Shift

FREE MSRA PODCAST — SJT (Ranking) 🎧

High-yield walkthrough of a medication-error scenario: immediate safety, escalation, candour, and governance. 🧠⚡️

Clinical vignette

You are an F2 in Acute Medicine on an evening shift. You realise a patient with a documented penicillin allergy received co-amoxiclav via e-prescribing two hours ago. The patient is currently stable with no signs of anaphylaxis. Nursing staff are busy with handovers and the on-call registrar is reviewing a deteriorating patient elsewhere. You must decide what to do next.

Question

Rank the following actions in order from most appropriate (1) to least appropriate (5).

Options

1) Offer the patient a timely, open apology and explain what happened and the plan under the duty of candour.

2) Record an accurate, time-stamped entry in the notes and submit an incident report (e.g., Datix) before the end of the shift.

3) Immediately review the patient, re-check observations, stop further doses, prescribe appropriate monitoring/treatment, and inform the nurse in charge.

4) Inform the on-call registrar and the on-call pharmacist as soon as possible to agree a management plan and reporting.

5) Amend the e-prescribing record to remove evidence of the error and plan to discuss it tomorrow to avoid causing alarm.

Answers shown at the end.

Explanation

Prioritise immediate clinical safety: see the patient now, confirm observations, stop further doses, and start appropriate monitoring with readiness to treat if symptoms evolve (e.g., antihistamines, steroids, adrenaline per protocol if indicated). Make allergy status clearly visible and involve the nurse in charge to coordinate observations and escalation.

Escalate early: the registrar provides senior oversight (observation period, thresholds for step-up care) and the pharmacist advises on allergy coding, safe alternatives, interaction checks, and to prevent repeat errors.

Apply duty of candour once you have a plan: apologise in plain language, explain what happened and the risks, outline monitoring/management, offer written information, and answer questions.

Complete governance: make a contemporaneous, factual, time-stamped record (who, what, when, actions taken) and file an incident report before the end of the shift to support continuity and learning.

Never conceal or alter records; it is unsafe, dishonest, and breaches probity.

Brief explanation

• Patient safety > admin: assess in person, stop the drug, monitor, treat.

• Early, structured escalation to senior and pharmacy ensures a safe, accurate plan.

• Candour requires honesty plus a concrete plan.

• Records and reporting enable continuity and system improvement.

• Concealment is always unacceptable.

Key takeaways

• SAFE: Stop harm & assess → Alert senior/pharmacy → be Frank with the patient → Enter notes & incident report.

• Prioritise: stabilise → escalate → disclose → document.

Links

https://www.passthemsra.com/

https://www.passthemsra.com/courses/sjt-for-the-msra/

https://www.passthemsra.com/courses/sjt-msra-mock-papers-x-10/

— Correct Answers: —

Ranking (most → least appropriate): 3 → 4 → 1 → 2 → 5

3 — Immediate safety: Review the patient now, re-check observations, stop further doses on EPMA, initiate monitoring and have first-line treatments to hand; inform the nurse in charge so the ward response is coordinated.

4 — Escalation: Contact the on-call registrar and pharmacist promptly to agree the management plan (observation period, alternative therapy, allergy coding, EPMA safeguards) and reporting steps.

1 — Duty of candour: Offer a timely, open apology with an honest explanation and the agreed plan; provide written information and answer questions.

2 — Records & reporting: Make a clear, time-stamped entry and submit an incident report before end of shift to support continuity and learning.

5 — Concealment: Altering or deleting records is dishonest and unsafe; delaying disclosure to “avoid alarm” breaches probity and risks harm.

Episode Transcript

(00:00):
Welcome back to the Deep dive. Today we're really getting into
a core MSRA challenge. It's a scenario focused on a
serious medication error A. Classic, and this one's set up
as a ranting question, so you'llhave five options to put in.
Order exactly It tests that conflict, doesn't it, between
what you need to do clinically right now and your sort of

(00:21):
professional duties, the paperwork, the conversations.
It really does. It's all about hierarchy,
patient safety, duty of candour,professional integrity.
It's all in the mix. OK, so you'll need to rank 5
actions from most appropriate. That's number one down to least
appropriate, which is number 5. Definitely grab a pen and paper
if you can. Getting the sequence right is,

(00:43):
well, it's everything on this type of question.
Right, let's get into the scenario itself.
Picture this. You're an F2, you're working in
acute medicine and it's an evening shift.
You discovered that a patient who has a known penicillin
allergy was actually given Co amoxiclab about two hours ago.
It was an E prescribing error. Now the good news, thankfully,

(01:03):
is that the patient seems stableright now.
No obvious signs of anaphylaxis.OK, that's something.
But the nursing staff are reallybusy, the on call registrar is
dealing with critical patients elsewhere.
So it's on you. What do you do immediately?
Right, so here are your five possible actions.
Listen carefully because you know some sound immediately
urgent, others more like necessary admin.

(01:27):
Option one, offer the patient a timely open apology and explain
what happened and the plan underthe duty of candour.
Option 2 Record an accurate timestamped entry in the notes and
submit an incident report like adatix before the end of your
shift. Option 3.
Immediately review the patient, recheck their observations, make
sure further doses are stopped, prescribe appropriate monitoring

(01:49):
or treatment, and tell the nursein charge.
Option 4 Inform the on call registrar and also the on call
pharmacist as soon as you can tosort out a management plan and
agree on the reporting. And option 5, amend the E
prescribing record to basically remove evidence of the error and
plan to discuss it tomorrow. You know, to avoid causing
unnecessary alarm. OK.
That's quite a mix of clinical actions, communication,

(02:12):
documentation and potentially covering up.
Definitely. So the task again is to rank
these five options from one mostappropriate to five least
appropriate. Take maybe 15 seconds or so.
Think it through. What comes first?
What comes last? Commit to your ranking, OK?
Have a moment to think. Let's see how you did.
Right, the correct ranking according to the MSRA approaches

(02:32):
3, then 4, then one, then two, and finally 5. 34125 That's
interesting. Let's break that down, because
honestly, several of those soundlike things you should be doing
pretty sharpish. Why is option 3 the immediate
patient review? Why is that the absolute #1?
Well, it boils down to the fundamental principle.

(02:52):
Immediate clinical safety Trump's everything else.
Always right before you pick up a phone, before you write
anything down, you have to physically see the patient,
check their Obs, make absolutelysure the drug is stopped, start
any immediate safety measures, maybe antihistamines, steroids
if needed. You know, standard NHS safety
protocol. And telling the nurse in charge.
Exactly part of that immediate safety loop.

(03:14):
That's your core duty as the F2 on the ground.
Take prompt action. Protect the patient.
That has to be rank one. OK, that makes total sense.
Now rank 2 is option 4, escalation, getting the
registrar and the pharmacist involved.
Yeah, I can see some people thinking option one, the apology
should come next. If the patient is stable, why do

(03:36):
I need to chase down a busy registrar before I just talk to
the patient and fulfil my duty of candour?
That's a really crucial point, and it's exactly the kind of
nuance the SJT is testing. The duty of candour is
essential, yes, but it requires more than just saying sorry.
You have to explain what happened, the potential risks
and, crucially, the plan to manage those risks.

(03:57):
Like the? Plan and as an F2, especially
with a potentially serious allergy issue, you can't
realistically finalise that management plan alone.
You need senior input from the registrar and you definitely
need the pharmacist expertise for safe monitoring.
Maybe alternative prescribing coding the allergy correctly?
I see. So you need their input to
formulate the plan you're going to communicate.

(04:18):
Previously get the expert adviceagree the plan first.
That ensures what you tell the patient is accurate, safe and
properly thought through. That's why Escalation option 4
comes in at rank 2. OK, that logic is clear.
Now stabilise a patient directly, then get the senior
plan sorted. Then you can properly talk to
the patient. Exactly, which leads us

(04:39):
perfectly to rank three, option one, fulfilling the duty of
candour. Now you have the confirmed plan,
you can provide that full, honest explanation and apology.
Makes sense and following that rank 4 is option 2 documentation
and reporting. Writing the accurate time stamp
notes, submitting the data storeequivalent incident report

(04:59):
absolutely vital. It's crucial for continuity, for
learning from errors, for meeting GMC standards on record
keeping. But less time critical than the
first three steps we discussed. Correct.
Important, yes. But the immediate safety
planning and initial disclosure take precedence.
Which leaves us with option 5 atrank 5, the bottom of the pile.
And for very good reason. Option 5 amending the record to

(05:20):
hide the error. That is just completely wrong.
It's a definite no go area. Absolutely.
It's a serious breach of probity, of honesty, of
integrity. It actively endangers the
patient by obscuring what happened, and it goes directly
against everything the GMC stands for.
It is always without question the least appropriate action you
could take. So stepping back and looking at

(05:41):
the whole picture, the big take away here is really about that
hierarchy in a crisis situation.It is.
You've got to have that order clear in your head.
We can summarise it as clinical safety first, then escalation
and getting support, then open disclosure, your duty of candour
and finally formal documentationand reporting is.
There a way to remember that sequence easily?

(06:02):
Yeah, there's a useful mnemonic sometimes mentioned, SAFE, I
think S for stop harm and assessthe patient, A for alert your
seniors in the pharmacy, F for B, Frank with the patient that's
your candour and E for enter in the notes and file the incident
report safe. Safe stop Harm alert seniors B
Frank Enter notes. That's helpful.
It covers the core progression. So the advice is keep practising

(06:25):
these kinds of scenarios where you have competing priorities,
the immediate clinical need versus those crucial
professional and legal duties. Definitely nailing that
synthesis, understanding why things go in a particular order,
that's key for the MSRASJT. And that final point about
option five really hammers home the importance of integrity.

(06:47):
Absolutely never ever try to conceal an error.
It might seem tempting in the moment to avoid trouble, but
it's fundamentally unprofessional and unsafe.
The SJT really tests your professional character.
Great advice. We'll keep practising.
Keep collecting on these principles, you'll get.
There, good luck with the rest of your preparation.