Synopsis

In this short video you’ll see a real‑world example of how a series of prescribing errors can jeopardise patient safety. The nursing staff repeatedly notice mistakes made by a Foundation Year 1 (FY1) doctor, try to address them directly, and—when those attempts fail—escalate the issue to a senior registrar. Yet the FY1 doctor ultimately downplays the problem, allowing the errors to continue.

As you watch, pay close attention to:

• Communication breakdowns – moments where the nurses raise concerns and the FY1’s response.
• Escalation steps – how the issue is taken to a senior registrar and whether that changes the outcome.
• Attitudes toward safety – any signs that the FY1 doctor is minimising the risk.

Importance of Escalating Concerns

Escalating concerns within healthcare is a critical process to safeguard patient safety, uphold professional standards, and maintain trust both within teams and across the health system. If a healthcare worker observes behaviour, practice, or circumstances that may endanger patients — whether due to a colleague’s actions, system failings, or inadequate resources — raising and escalating these concerns ensures issues are addressed before harm occurs. It also helps foster an ethical culture where transparency, accountability, and continuous improvement are valued.

Escalation Steps

Below are key steps one should take when escalating concerns about a healthcare colleague:

1. Identify and document the concern Be specific: what happened (or is likely to happen), when, where, who was involved, and why it raises clinical safety, ethical or professional concerns. Keep accurate records and, if possible, collect any relevant evidence (e.g. reports, observations).
2. Raise it locally first Speak to your line manager, supervisor or the colleague themselves if appropriate. Many trusts/organisations have policies for “raising concerns” or “speaking up” that allow you to follow internal routes.
3. Follow your employer’s formal process If local discussion doesn’t resolve the issue, then escalate according to your organisation’s policies — this may involve submitting a formal report, speaking to department heads, or invoking whistleblowing procedures. Use formal incident-reporting systems where available.
4. Involve designated persons or guardians Many organisations have roles like “Freedom to Speak Up Guardian” or designated safeguarding leads, or quality/governance teams whom you can contact if the regular chain of command is not effective.
5. Consider external escalation If the concern remains unaddressed, or if the risk is serious (e.g. potential harm to patients), then escalate to regulatory bodies. Depending on the profession and location this could be the General Medical Council (GMC), Nursing & Midwifery Council (NMC), Health and Care Professions Council (HCPC), or the Care Quality Commission (CQC).
6. Ensure protection and confidentiality The law (e.g. whistleblowing legislation such as the Public Interest Disclosure Act in the UK) protects staff who raise concerns in good faith. Maintain confidentiality wherever possible, and keep a record of all steps taken.
7. Follow up and feedback Seek feedback about what actions have been taken. If outcomes are unsatisfactory, continue escalation or seek advice from external bodies or professional associations.

Discussion Points

• What do we think about the means of escalation here?
• What would be the next step in escalating concerns? Discussion of formal and informal escalation.
• How can we ensure safety in prescribing? What sources should we consider in prescribing – BNF, medicines complete, local formulary, senior colleagues, pharmacists etc.
• Whose responsibility is it to check prescriptions doses? Emphasising conscientiousness in prescribing and medical practice in general.
• Whose responsibility is it to escalate safety and quality of care concerns?
• Discussion around PSA – safety in practice where FY’s have not yet passed.

External Resources

• Raising and Acting on Concerns about Patient Safety – GMC (UK) guidance
• Raising and Escalating Concerns Toolkit – Royal College of Nursing (RCN)