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Home / Station 25: Disclosure of an insulin medication error

NAC OSCE preparation

Station 25: Disclosure of an insulin medication error

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Disclosure of an insulin medication error

11 minutes

Discipline: Communication, Ethics & Professionalism
Station type: Patient-safety disclosure
Setting: Medical ward

Your task

Speak with the patient after a medication error. Explain what happened and the next steps.

Information available at entry

Now stableEarlier glucose 2.1 mmol/L with sweating and confusionTreated promptly with IV dextroseCurrent glucose 6.4 mmol/L

Coach prompt: Disclose a harmful error honestly, address immediate care and explain prevention steps.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 25 of 30

Standardized-patient profile

NameMr. Daniel Brooks

Age63

Pronounshe/him

RolePatient

Demeanour: Tired and angry after recovering from hypoglycemia.

Opening statement: “The nurse said I was given the wrong insulin. What happened?”

History and standardized-patient responses

Known facts

Candidate explores	Standardized-patient response
Error	Rapid-acting insulin was administered instead of the prescribed long-acting insulin because two pens were stored together and the independent check was missed.
Harm	Symptomatic hypoglycemia; no seizure, fall or persistent neurologic deficit.
Current care	Frequent glucose checks and meal support are in place.
Investigation	A formal safety review has begun.

Patient concerns

Candidate explores	Standardized-patient response
Trust	Worries staff are hiding information.
Future harm	Asks whether it could happen again.
Family	Wants spouse informed.
Preference	Wants a plain explanation and written plan.

Physical findings

No physical examination required.
The candidate is the responsible physician for disclosure, not necessarily the person who administered the insulin.

Examiner prompts

Core disclosure elements?

Known facts, harm, apology/regret, immediate treatment, ongoing monitoring, investigation and prevention follow-up.

Should blame be assigned?

No speculation or blaming individuals; describe verified facts and system review.

Documentation?

Document clinical facts, discussion, questions, plans and follow-up according to policy.

Differential diagnosis

Medication error causing hypoglycemia

Investigations

Serial glucose monitoring
Electrolytes/ECG or further assessment if clinically indicated by severity
Safety-event review

Management

Treat and monitor hypoglycemia
Hold/adjust insulin safely
Notify appropriate clinical and safety leaders
Separate/look-alike insulin storage and restore independent checks
Provide follow-up disclosure

Communication behaviours

Be direct and nondefensive
Acknowledge anger and loss of trust
Do not make promises beyond known facts

Critical safety actions

Clinical stabilization comes before disclosure
Do not conceal the error
Ensure prevention and follow-up

Model closing summary

You were given rapid-acting insulin instead of the long-acting insulin that was ordered. That caused your blood sugar to fall dangerously low and led to the sweating and confusion you experienced. I am very sorry this happened. We treated the low sugar promptly and are monitoring you closely. We have started a formal review, including why the pens were stored together and why the independent check was missed. I will keep you informed about what we learn and the changes made to prevent this from happening again.

Common pitfalls

Passive wording such as a mistake was made
Speculating about who is at fault
Giving legal advice
Offering an apology without a care plan

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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