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]}