OSCE Toolbox | Accuracy Check 1 - Scenario

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Scenarios

Accuracy Check 1

By Jack Holmes • September 27, 2024 • Last reviewed: •

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Summary Intermediate

In this scenario, you must perform an accurate legal and clinical check on the following prescription and medication. You will need to communicate any discrepancies and resolve these with the prescriber.

Please ensure that this scenario and mark scheme align with the most up-to-date UK NICE guidelines and the BNF when using it for your OSCE assessment.

You will need a student pharmacist and an actor as the prescriber for this station. The assessor can play the part of the prescriber as well if needed.

Revision Topics

Be aware, this may reveal any answers!

Pain

Accuracy Checking

Student Instructions

You are a pharmacist at a community pharmacy working at the weekend. You are checking urgent medicines which will be put in the retrieval basket for pick up later in the day. You need ensure all legal and clinical checks have been made. Once you have completed your checks, the prescriber will be waiting for you to discuss any changes, if needed.

To do

You must perform an accurate legal and clinical check on this prescription using the latest up-to-date guidance.
You will need to clearly communicate any relevant issues to the prescriber and give suggestions to resolve the query.
If you find any issues that are not relevant to the prescriber, please mention these before or after speaking to the prescriber to the assessor.

You have 8 minutes.
You have access to the BNF.

The Prescription:

Actor Instructions

This may reveal scenario objectives!

You are the on-call prescriber working at an out of hours clinic. Your name is Dr Alan Sherlock.

The pharmacist will mention issues with the prescripton. You must sound incredibly annoyed and frustrated that they have contacted you out of hours to resolve the query.

When the pharmacist opens the conversation with you, let out a big sigh and say "Hello, can this wait till Monday morning?!"

The pharmacist will explain the issue(s) with the prescription. You must argue with what they are saying, even it is correct. You may wish to clarify any information during the station.

If the pharmacist explains that the date is incorrect:
"Is this even a big deal?"

Agree to change it and send a new prescription, after the pharmacist explains this is a legal requirement.

If the pharmacist asks an irrelevant question:
"I don't think that is important now but I will look into it shortly and get back to you."

If the pharmacist mentions any labelling/dispensing errors:

"Why are you asking me that? I don't know, maybe check with your team and discuss after we get off the phone"

If the pharmacist asks if you have any questions:

“No, I do not.”

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Issues that are not relevant to the prescriber but should be mentioned are written in the mark scheme. This can be received in a polite manner, before or after playing the role of the prescriber.

Mark Scheme

Introduction

0 / 4

Introduces self as the Pharmacist

Confirms who they are speaking with (the Prescriber)

States reason for call concisely (urgent prescription check)

Uses a calm, professional opening despite prescriber frustration

Legal Check

0 / 5

Identifies prescription is out of date and explains to prescriber this is a legal requirement to amend before supply

Requests new prescription from prescriber to meet legal requirements

Identifies missing coding for Co-Codamol 15/500mg Capsules (Controlled Drug)

Advises prescriber coding is needed for legal compliance

Checks all legally required prescription details are present (date, prescriber details, patient details, dosage instructions)

This mark can be given based on observation from the assessor

Clinical Check (If appropriate)

0 / 3

Reviews medicines for appropriateness and dose against BNF

This mark can be given based on observation from the assessor

Confirms no clinically significant interactions requiring prescriber input (none in this case)

This mark can be given based on observation from the assessor

States clinical check outcome to the assessor

Label Check - explains to the assessor (not during the phone call to the prescriber):

0 / 2

Amitriptyline – Take ONE daily on prescription should be: Take ONE at night for nerve pain

Amitriptyline – Wrong Name, should be Jack Holmes not James Holmes

Product Check - explains to the assessor (not during the phone call to the prescriber):

0 / 1

Co-Codamol 15/500mg Tablets Dispensed: This should be Co-Codamol 15/500mg Capsules

Excellent students should explain the risk of the patient receiving incorrect formulation, e.g. inability to swallow the medication, patient confusion and reduced trust

Communication

0 / 5

Maintains professionalism and composure despite prescriber annoyance

Uses clear, respectful, and non-judgemental language throughout

Uses appropriate language, volume, tone, pace, and emphasis.

The conversation is structured and flows well.

Conclude the conversation professionally, offering to assist with any further questions or concerns.

Patient Safety

0 / 1

The student did not say anything that could harm the patient

Any criteria in red must be met to pass this station.

Referral Criteria

Referral Criteria for Peripheral Neuropathy

A&E

Presenting signs of gangrene, purple or black skin, signs of tissue death and foul odour: May lead to damaged tissue removal, in severe cases amputation.

Urgent GP Appointment

The patient has ongoing numbness, tingling, or burning in their hands or feet: These symptoms could suggest peripheral neuropathy and need further investigation.
The patient experiences muscle weakness or difficulty with coordination: This may indicate nerve damage that requires prompt medical evaluation.
Associated symptoms of neuropathic pain, such as erectile dysfunction, dizziness, digestive issues, or bladder problems: These symptoms may point to a more severe form of neuropathy needing specialist care.
The patient has unhealed wounds or infections on their feet: Nerve damage can reduce pain sensation, leading to unnoticed injuries and infections that require immediate care to prevent serious complications.
The patient reports any persistent pain, especially at night: This type of pain can be a sign of nerve damage and should be evaluated to manage symptoms effectively.

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Referral Criteria for Peripheral Neuropathy

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Referral Criteria for Peripheral Neuropathy

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