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Paeds Vivasprofessional-practice-and-evidence

Paeds Vivas · professional-practice-and-evidence

Open disclosure and duty of candour — branching viva

Viva on staged open disclosure, duty of candour, apology and the second victim after a patient safety incident in paediatrics.

branching clinical structured oral2 min readVerification in progress

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Ward: a 3-year-old received a tenfold opioid dose from a decimal-point error overnight; the child was given naloxone and is now stable; the registrar who prescribed is visibly distressed; the parents, who have limited English, are at the bedside and have just been told nothing yet.

Opening (candidate)

I would treat this as an open-disclosure event driven by the duty of candour. The child is now stable, so I would move to disclosure: confirm the facts and assemble the right people — a consultant leading, the nurse, a trained interpreter (not the child), and social-work support — then hold an initial conversation acknowledging what happened, giving the known facts, apologising, and describing next steps, with a follow-up planned to share the review findings and improvements. I would also ensure the distressed registrar is supported as a second victim. [1] [4]

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References6ShowHide
  1. [1]Iedema RA The National Open Disclosure Pilot: evaluation of a policy implementation initiative. The Medical journal of Australia, 2008.PMID 18393742
  2. [2]Iedema R Patients' and family members' experiences of open disclosure following adverse events. International journal for quality in health care, 2008.PMID 18801752
  3. [4]Jacob H Openness and honesty when things go wrong: the professional duty of candour (GMC guideline). Archives of disease in childhood. Education and practice edition, 2016.PMID 27002114
  4. [5]Inkster T Duty of candour and communication during an infection control incident in a paediatric ward of a Scottish hospital. Journal of medical ethics, 2022.PMID 33593873
  5. [10]Iedema R Practising Open Disclosure: clinical incident communication and systems improvement. Sociology of health & illness, 2009.PMID 18983420
  6. [14]New L Second-Victim Phenomenon. Nursing clinics of North America, 2024.PMID 38272580
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