MSRA Safety and Compliance 2 — Questions and Answers
Question 1: A patient hands you a list of 10 medications and asks you to refill all of them. You notice one drug is from a different prescriber and may duplicate therapy. What is the most appropriate first action?
- Refuse to prescribe any medications until all records are obtained
- Contact the other prescriber to clarify the medication's indication before prescribing (Correct answer)
- Prescribe all medications to maintain the therapeutic relationship
- Instruct the patient to stop the duplicate medication immediately
Correct answer: Contact the other prescriber to clarify the medication's indication before prescribing
Contacting the other prescriber clarifies intent and prevents therapeutic duplication without unilaterally altering another clinician's treatment plan.
Question 2: During a ward round, you realize you administered the wrong dose of an anticoagulant to a patient two hours ago. The patient appears clinically stable. What should you do?
- Monitor the patient closely and document in the notes only if complications arise
- Inform the nurse in charge, document the incident, complete a clinical incident form, and inform the patient (Correct answer)
- Complete a clinical incident form and inform your consultant only
- Do nothing unless the patient's INR becomes supratherapeutic
Correct answer: Inform the nurse in charge, document the incident, complete a clinical incident form, and inform the patient
Medication errors require immediate disclosure to the clinical team, honest communication with the patient, and formal incident reporting under duty of candour.
Question 3: You suspect a consultant colleague is practicing while impaired by alcohol. You have observed slurred speech and unsteady gait on two separate occasions. What is the most appropriate action?
- Approach the consultant privately and suggest they seek help themselves
- Report your concerns to the medical director or responsible officer (Correct answer)
- Inform patients currently under that consultant's care
- Document your observations and take no further action
Correct answer: Report your concerns to the medical director or responsible officer
Concerns about a colleague's fitness to practice due to substance impairment must be escalated to the responsible officer or medical director to protect patient safety.
Question 4: A patient with capacity refuses a blood transfusion on religious grounds despite being told it is life-saving. How should you proceed?
- Obtain an emergency court order to administer the transfusion
- Respect the refusal, document it thoroughly, and explore alternative treatments (Correct answer)
- Administer the transfusion once the patient loses consciousness
- Seek a second opinion from another clinician to override the decision
Correct answer: Respect the refusal, document it thoroughly, and explore alternative treatments
A capacitous adult's informed refusal of treatment must be respected regardless of clinical consequences, and the decision should be documented.
Question 5: Which of the following best describes the concept of 'duty of candour' in clinical practice?
- The obligation to keep all clinical errors confidential to protect institutional reputation
- The professional and statutory obligation to be open and honest with patients when things go wrong (Correct answer)
- The requirement to disclose all financial conflicts of interest to patients
- A voluntary initiative encouraging clinicians to apologize for poor outcomes
Correct answer: The professional and statutory obligation to be open and honest with patients when things go wrong
Duty of candour is a statutory and professional requirement to be open with patients when a safety incident causes harm, including offering an apology.
Question 6: A junior doctor asks you to sign off a prescription they have already written and for which they have not reviewed the patient. What should you do?
- Sign the prescription if you trust the junior doctor's clinical judgment
- Refuse to sign and explain that prescribers must review the patient themselves (Correct answer)
- Co-sign the prescription and add a note that the junior doctor is responsible
- Check only the drug name and dose before countersigning
Correct answer: Refuse to sign and explain that prescribers must review the patient themselves
Prescribers are personally responsible for medications they sign; countersigning without patient review creates unsafe and legally indefensible prescribing.
Question 7: You notice a sharps bin on the ward is overfull and cannot be closed safely. What is the most appropriate immediate action?
- Continue using the bin carefully until the end of the shift
- Seal the bin at its fill line and request a replacement immediately (Correct answer)
- Remove some sharps and place them in a clinical waste bag
- Notify domestic staff to dispose of the overfull bin
Correct answer: Seal the bin at its fill line and request a replacement immediately
Overfull sharps bins must be sealed at the fill line and replaced immediately to prevent needlestick injury.
MSRA Safety and Compliance 2
A patient hands you a list of 10 medications and asks you to refill all of them.
You notice one drug is from a different prescriber and may duplicate therapy.
What is the most appropriate first action?