Scenario Type: Patient Safety Concerns

Patient safety scenarios are the highest-stakes questions in SJT. They test whether you will act decisively when a patient could be harmed — even when acting means confronting a colleague, challenging a senior, or stepping outside your comfort zone. This lesson provides a thorough analysis of the most common patient safety scenario types with fully worked examples.

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The Golden Rules for Patient Safety Scenarios

Before examining specific scenarios, internalise these rules:

Rule	Explanation
1. Never ignore a safety risk	Inaction when a patient is at risk is always rated "inappropriate" or "very inappropriate"
2. Act immediately when the risk is immediate	Do not wait for a convenient moment — act now
3. You are never "too junior" to speak up	Medical students have the same duty to raise safety concerns as consultants
4. Escalate if your initial concern is dismissed	If the first person you tell does not act, tell someone more senior
5. Document what you observed	Record the facts objectively — what, when, where, who

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Scenario A: The Impaired Colleague

The Setup

A colleague (doctor, nurse, or fellow student) appears to be impaired — they may smell of alcohol, seem excessively tired, appear confused, or behave erratically.

Why This Is High-Stakes

An impaired colleague can:

• Make prescribing errors
• Misjudge clinical situations
• Fail to respond to deteriorating patients
• Perform procedures unsafely
• Miss critical information during handover

The Correct Approach

Step	Action
1	Do not let them continue to see patients if you believe they pose a risk
2	Inform the most senior clinician available immediately
3	If no senior is available, contact the hospital site manager or clinical coordinator
4	Do not try to manage it alone — this is beyond the scope of a student or junior colleague
5	Document what you observed (factually, not speculatively)

Worked Scenario

Scenario: You arrive for a morning shift on a medical ward. Dr Khan, a junior doctor, smells of alcohol and seems unsteady on their feet. They are about to start reviewing patients.

Action	Rating	Why
Immediately inform the consultant or registrar on duty	Very appropriate	Patient safety is at immediate risk; this requires senior intervention
Take Dr Khan aside and ask if they are OK, suggesting they take a break	Appropriate, but not ideal	Shows compassion and may prevent immediate harm, but does not ensure senior awareness or that Dr Khan stops seeing patients
Say nothing because you are not sure — maybe they are just tired	Very inappropriate	The signs are concerning enough to warrant action; uncertainty does not justify inaction
Cover Dr Khan's patients yourself	Inappropriate, but not awful	Well-intentioned but you may not be qualified; does not address the root cause
Inform the ward sister or senior nurse on duty	Very appropriate	Appropriate escalation point if a doctor is not immediately available

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Scenario B: The Witnessed Error

The Setup

You witness a clinical error — a wrong medication being prepared, a wrong patient being identified, a procedure being performed on the wrong side, or a significant omission in care.

The Correct Approach

Step	Action
1	Intervene immediately if the error has not yet reached the patient
2	If the error has already occurred, ensure the patient is safe and alert the clinical team
3	Report through the incident reporting system (e.g., Datix)
4	Inform the patient (duty of candour) if they have been affected
5	Support the colleague who made the error — errors are usually system failures, not personal failures

Worked Scenario

Scenario: You observe a nurse preparing to administer IV antibiotics to a patient. You notice the name on the medication label does not match the patient's wristband.

Action	Rating	Why
Immediately alert the nurse to the discrepancy before they administer the medication	Very appropriate	Prevents the error from reaching the patient; direct and timely
Check the patient's notes yourself to verify the discrepancy before saying anything	Inappropriate, but not awful	Introduces delay; the nurse is about to administer the medication now
Say nothing because the nurse is more experienced than you	Very inappropriate	Hierarchy does not override patient safety; the error is clear and immediate
Report the near-miss through the incident reporting system after the situation is resolved	Very appropriate	Ensures system learning; important even when the error was caught in time

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Scenario C: The Deteriorating Patient

The Setup

A patient is showing signs of deterioration — they may be confused, their vital signs may be abnormal, they may be in pain, or their condition may be visibly worsening — and the clinical team has not yet responded.

The Correct Approach