Communication: Drug error

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Scenario: you are the register on the General Paediatric Ward. As you are reviewing patients, you realise that one of your patients, 9 month old Kayleigh, has been prescribed and given the wrong dose of paracetamol. She received one dose that was 5 x the recommended dose.

You need to speak to the family and let them know – how do you approach this?

Get the setting and intro right

It’s not easy telling a family that a mistake has happened. Be sensitive, open and honest.

Make sure the setting is right – it should be in a quiet room where they can hear you and be heard themselves.

Often when it’s a difficult conversation the best thing is just to vocalise that ‘There’s something I’d like to talk you about – it is a difficult thing to discuss but it’s important for me to be open and honest with you’.

Right at the beginning, you should state that Kayleigh is safe and well (assuming she is) – remember throughout the whole conversation, the parents main concern will be Kayleigh’s health and safety, and not whether you’ve made a mistake.

Explain exactly what happened and why

Many formal complaints are due to poor communication. Make sure you explain the error fully. This will include what drug it was; how much of an overdose was given; and how it happened.

Apologise. Don’t be scared to say sorry.

Talk about possible side effects for the child

Kayleigh has had a paracetamol overdose and the side effects and management of that need to be explained.

This is not likely to be a dose that causes any serious side effects. From the scenario given it looks like Kayleigh has received 75 mg/kg and for toxicity the required dose is likely to need to be 200mg/kg.

It’s best to check a paracetamol level at 4 hours, although you would expect this to be normal. Similarly check LFTs at the same time.

Outline the steps you will take to ensure this doesn't happen again

Inform the parents that:

  • The senior doctor in charge of the ward will be informed of the dosing error
  • The doctor who wrote the prescription will be made aware of the error
  • An incident form will be filled in which will go to departmental review

Finally let them know that if they wish to make a complaint you will get them the relevant info.

Check their understanding

Tie up the conversation by checking their understanding and giving a summary of what you’ve told them.

Reiterate that Kayleigh is safe and there is a low chance of her coming to any harm from this.

See if they have any further questions and offer to come back and discuss it again with them later.

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Tessa Davis is a paediatric emergency registrar from Glasgow and Sydney, but currently living in London. Tessa tries to spend time with her 3 kids in between shifts. @tessardavis | + Tessa Davis | Tessa's DFTB posts