Amanda Coleman

(Practice Nurse)

Examiner

Station List
Doctor
Patient
Full Case

Marking Scheme

Data Gathering and Diagnosis 

  • Ask how the incident occurred (to understand the sequence of events and whether any safety steps were missed)
  • Ask how she became aware of the mistake (to assess her level of insight, whether the error was self-identified or reported, and to understand her awareness and accountability in clinical practice)
  • Ask if the patient had any reaction after receiving the wrong injection (to evaluate immediate clinical risk and safety concerns)
  • Ask if she has informed the patient yet (to assess understanding of duty of candour and professional responsibilities)
  • Ask if the patient has any known allergies (to identify any potential complications or risks from the wrong medication)
  • Ask what she thinks contributed to the error or what she believes caused it (to explore contributing factors such as fatigue, protocol breaches, or cognitive overload)
  • Ask what her main concerns are (to explore fears such as disciplinary action, patient harm, or job security)
  • Ask if, aside from seeking advice, there is anything else she was hoping to get from this conversation (to clarify her expectations and support needs)
  • Ask how she usually verifies medications before administration (to understand her usual safety practices and identify potential lapses)
  • Ask if any other medication errors occurred today (to ensure other patients she saw are safe and to rule out a wider pattern or systemic issue)
  • Ask how she is feeling about the incident; is she experiencing any emotional distress or guilt?  
  • Ask if she has completed an incident form 
  • Ask if she is currently going through any personal or professional stress (to identify external stressors contributing to the error)
  • Ask what her thoughts are on how such errors can be prevented in future (to promote reflection and quality improvement)
  • Ask if she feels she needs any support from colleagues or the wider team (to assess wellbeing and need for a supportive workplace response)

Example of explanation to Nurse​

Amanda, first of all, I want to thank you for coming forward and being honest about what happened. In healthcare, mistakes can occur—it’s a high-pressure environment, and none of us are immune to human error. What truly matters is recognising the mistake, learning from it, and taking the appropriate steps to ensure it doesn’t happen again.

I appreciate that you’ve already reflected on what might have contributed to this error, feeling stressed and not following the usual medication protocols. Acknowledging this takes courage and shows your professionalism and commitment to patient safety.

As part of our professional duty of candour, we need to be transparent with the patient. The best course of action would be to contact them as soon as possible, explain what happened, apologise sincerely, and reassure them. Fortunately, a single dose of vitamin B12 is unlikely to cause harm. However, it’s important that the patient is informed about the error and made aware of possible side effects from receiving an unnecessary injection, such as mild diarrhoea, headache, or rash/skin reaction, and asked to monitor for these. You can also provide the patient with the information leaflet for the B12 injection, so they know what to look out for and can seek medical advice if needed. They should also be informed that they haven’t yet received the pneumococcal vaccine they came in for, so we can arrange for this to be administered appropriately

We’ll also need to complete an incident report. This isn’t about blame, it’s a learning process to improve our systems and reduce the risk of future errors. It helps make our practice safer for patients and for all of us who work here.

You also mentioned feeling stressed. We need to support you with that. Options might include taking some time off work, trying relaxation techniques, using mindfulness apps like Headspace, or engaging in physical activities like yoga or regular exercise. If you’re experiencing ongoing symptoms of stress or feel overwhelmed, it would be worthwhile seeing your GP to explore further support.

I know you’re worried about potentially losing your job. Most people don’t lose their jobs over a single incident, especially when they’ve acted responsibly and come forward. However, if you’re anxious about this, I’d advise reaching out to your professional body or defence organisation—such as the Royal College of Nursing—if you’re a member, for further reassurance and advice.

You also mentioned some financial difficulties. Please know there are services available to help. The NHS offers free, impartial, and confidential money advice through the MoneyHelper organisation, which may be helpful in your situation, and our practice’s social prescriber may also be able to connect you with additional support.

You’re not alone in this, Amanda. I want to ensure you feel supported moving forward, not just in resolving this incident, but in maintaining your wellbeing overall.

Management

  • Reassure Amanda that errors can happen in healthcare; what matters most is recognising them, taking responsibility, and learning from them to improve future safety.
  • Acknowledge and commend her for recognising the error and thank her for having the courage to speak up.
  • Advise her to contact the patient as soon as possible to explain the error, discuss any potential impact, and offer a sincere apology — in line with the duty of candour.
  • Offer the patient appropriate follow-up care, including rebooking the pneumococcal vaccination with another nurse.
  • Reassure Amanda that vitamin B12 injections are generally safe but advise her to inform the patient of possible side effects from excess B12 (e.g., mild diarrhoea, headache, or flushing) and to monitor accordingly.
  • Ensure the incident is documented both in the patient’s medical record and in the practice’s clinical incident reporting system.
  • Emphasise that the purpose of reporting the incident is not to assign blame but to allow the practice to reflect, learn, and prevent future errors.
  • Reassure her that such incidents rarely lead to dismissal, especially when managed transparently; however, if she has concerns, she can contact her professional defence organisation (e.g., RCN-Royal College of Nursing, MDU- Medical Defence Union).
  • Advise that if she feels emotionally overwhelmed or stressed, she may consider taking time off work for her own wellbeing and for patient safety.
  • Recommend the Headspace app, which can support her with mindfulness and stress-reduction techniques.
  • Suggest she sees her GP if she is experiencing symptoms of anxiety, depression, or other mental health concerns.
  • Let her know that the MoneyHelper service, provided through the NHS, offers free, impartial, and confidential financial advice — including help with mortgage difficulties.

Learning point from this station: ​

This station highlights the critical importance of responding professionally and supportively to clinical errors within the healthcare setting. Mistakes can and do happen, even among competent professionals, especially in environments of stress, fatigue, or distraction. The response to these situations must be guided by honesty, compassion, and a commitment to patient safety.

According to the General Medical Council (GMC), every health and care professional has a duty of candour, which means they must be open and honest with patients and those in their care when something goes wrong with treatment or care that causes, or has the potential to cause, harm or distress. This includes:

  • Telling the person (or, where appropriate, their advocate, carer, or family) when something has gone wrong
  • Offering a clear and sincere apology
  • Providing an appropriate remedy or support to address the situation, where possible
  • Explaining fully the short- and long-term effects of what has happened

Additionally, professionals must be open and honest with colleagues, employers, and relevant organisations, participating in reviews and investigations when required. They must also be transparent with regulatory bodies and must support and encourage a culture where colleagues feel safe to raise concerns without fear of blame or retribution.

Promoting a culture of safety and learning is key. The goal of incident reporting is not to apportion blame but to identify learning opportunities and put systems in place to prevent recurrence. In an ever-evolving field like medicine, this reflective approach improves care for patients and builds a more resilient workforce.

It is also important to recognise the boundaries of your role during such consultations. This is not the time to begin taking a medical history from a colleague. While it’s appropriate to acknowledge signs of stress or distress, any medical concerns raised should be professionally and respectfully redirected by encouraging the colleague to seek help from their own GP or a suitable support service.

Further reading