Practice Scenarios: Patient Safety and Escalation (10 Full Worked Scenarios)

This final lesson brings together everything from the course into 10 full worked scenarios. Each scenario is followed by a detailed analysis using the SAFE framework, with ratings and reasoning for each option. Work through each scenario yourself before reading the analysis.

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How to Use These Practice Scenarios

1. Read the scenario carefully — note every detail
2. Apply the SAFE framework — Spot the risk, Act appropriately, Follow the right path, Ensure follow-up
3. Rate each option yourself before reading the analysis
4. Review the reasoning — understand WHY each option is rated the way it is
5. Identify patterns — the same principles recur across scenarios

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Scenario 1: The Unlabelled Syringe

You are a medical student observing in theatre. The anaesthetist steps out briefly and asks the operating department practitioner (ODP) to "push the white syringe." You notice there are three unlabelled white syringes on the anaesthetic tray.

Rate each action:

A) Ask the ODP to wait until the anaesthetist returns to confirm which syringe is correct.

B) Pick up the syringe nearest to the anaesthetic machine and hand it to the ODP, assuming it is the one intended.

C) Leave the theatre to find the anaesthetist and bring them back.

D) Say nothing because the ODP is experienced and will know which syringe to use.

Analysis

Applying SAFE:

• S: Unlabelled syringes in theatre = immediate patient safety risk. Giving the wrong drug could cause cardiac arrest, respiratory depression, or anaphylaxis.
• A: Prevent the wrong drug from being administered. You do not need to know which drug is correct — you need to prevent an unverified drug from being given.
• F: The ODP should wait; the anaesthetist needs to return and identify the correct syringe.
• E: Labelling practice should be reviewed. All syringes should be labelled according to national standards.

Action	Rating	Reasoning
A	Very Appropriate	Prevents potential harm; the ODP can wait a few moments for the anaesthetist
B	Very Inappropriate	You have no idea which syringe contains which drug; guessing could be fatal
C	Appropriate	Well-intentioned, but leaving the theatre delays the resolution; asking the ODP to wait is more immediate
D	Very Inappropriate	The ODP may not know which unlabelled syringe is which; assumption is dangerous

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Scenario 2: The Confused Discharge

You are on a care of the elderly ward. Mrs Begum, 82, is being discharged today. She appears confused about her new medications — she has been prescribed five new drugs and cannot remember which is which or when to take them. Her family is not present. The nurse hands her the discharge bag and says, "Your GP will explain everything."

Rate each action:

A) Speak to the nurse and suggest that Mrs Begum needs more support before she can be safely discharged.

B) Help Mrs Begum by writing down a simple medication schedule for her.

C) Accept that the GP will sort it out and wave goodbye to Mrs Begum.

D) Discharge Mrs Begum but phone her GP surgery to flag that she may need medication counselling.

Analysis

Applying SAFE:

• S: An 82-year-old confused patient going home with five new medications she does not understand = significant patient safety risk. Medication non-adherence or errors at home could cause serious harm.
• A: The discharge process needs to ensure Mrs Begum can manage her medications safely.
• F: The nurse, the discharging doctor, and potentially the pharmacy team need to be involved.
• E: Mrs Begum may need a medication review, a dosette box, or a community pharmacy follow-up.

Action	Rating	Reasoning
A	Very Appropriate	Addresses the core concern — the patient is not safe to be discharged without proper medication counselling
B	Appropriate	Helpful and proactive, but may not be sufficient if Mrs Begum's confusion is more than just forgetfulness
C	Very Inappropriate	Abdicates responsibility; the GP may not see Mrs Begum for days, during which she could mismanage her medications
D	Appropriate	Better than doing nothing, but does not address the immediate problem — Mrs Begum needs help NOW, not when the GP gets around to it

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Scenario 3: The Student Who Lied About Competence

A fellow medical student, Alex, tells you privately that they have been signing off clinical competencies in their logbook for procedures they have not actually performed. They say, "Everyone does it — nobody checks." You know this is not true.

Rate each action:

A) Tell Alex that you are concerned and advise them to speak to their clinical supervisor honestly.

B) Report Alex to the medical school's fitness to practise committee immediately.

C) Ignore it because it is Alex's problem, not yours.

D) Start signing off your own competencies in the same way, since Alex says everyone does it.

Analysis

Applying SAFE:

• S: Falsifying clinical competencies means Alex may be assessed as competent in procedures they have never done. In the future, this could lead to a patient being harmed by a doctor who was never properly trained. This is a patient safety issue (albeit future-facing).
• A: Approach Alex first, as this may be a misguided decision rather than malicious intent.
• F: If Alex does not act, escalate to the medical school.
• E: The integrity of clinical training depends on honest self-assessment.

Action	Rating	Reasoning
A	Very Appropriate	Proportionate first step — gives Alex the chance to correct their behaviour
B	Appropriate	Correct escalation, but would ideally come after giving Alex the chance to self-correct (unless you believe they will not)
C	Inappropriate	Falsified competencies affect patient safety; you have a duty to act
D	Very Inappropriate	Compounding the problem; putting future patients at risk

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Scenario 4: The Blood Transfusion Check

You are observing a blood transfusion on a surgical ward. The nurse checks the patient's wristband against the blood bag and says, "Close enough — the date of birth is off by one digit but the name matches." She prepares to start the transfusion.

Rate each action:

A) Ask the nurse to stop and recheck the identification, because even a one-digit discrepancy could mean this is the wrong blood for the wrong patient.

B) Agree that the name match is sufficient and allow the transfusion to proceed.

C) Suggest the nurse checks the hospital number as an additional identifier.

D) Leave the room because blood transfusions make you feel uncomfortable.

Analysis

Applying SAFE:

• S: A wrong blood transfusion is one of the most dangerous events in healthcare. ABO incompatibility can cause fatal haemolytic reactions. A one-digit discrepancy in the date of birth is a RED FLAG — this could be the wrong patient's blood.
• A: Stop the transfusion immediately. The identification check must be 100% correct.
• F: The nurse must repeat the full checking procedure. If there is any doubt, the blood should not be given.
• E: This should be reported as a near-miss.

Action	Rating	Reasoning
A	Very Appropriate	Prevents a potentially fatal transfusion error; one digit could mean wrong patient
B	Very Inappropriate	"Close enough" is never acceptable for blood transfusion identification
C	Appropriate	Good additional check, but the response should be stronger — the transfusion should be paused, not just supplemented with another check
D	Very Inappropriate	Leaving a patient safety risk unaddressed for personal comfort

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Scenario 5: The Colleague with a Needle-Stick Injury

You see a fellow medical student, Priya, prick her finger on a used needle while helping clear up after a procedure. She sucks her finger and says, "It's fine, I'll just put a plaster on it." She does not report it.

Rate each action:

A) Explain to Priya that needlestick injuries must be reported and encourage her to follow the hospital's needlestick injury protocol immediately.

B) Help Priya put a plaster on and agree it is probably nothing to worry about.

C) Report the injury yourself to the ward sister, without telling Priya.

D) Tell Priya you are concerned but respect her decision not to report.

Analysis