OSCE Toolbox | Bite 1 - Scenario

By Amina Adnan • January 29, 2024 • Last reviewed: •

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Summary Intermediate

In this scenario, a patient visits your pharmacy with a bite. The pharmacist should take the relevant history, diagnose, and suggest an appropriate management plan. There are no images and you are not expected to examine the patient.

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

You will need a student pharmacist and an actor for this OSCE station.

Revision Topics

Be aware, this may reveal any answers!

Student Instructions

Actor Instructions

This may reveal scenario objectives!

Mark Scheme

Introduction

0 / 2

Introduce yourself with an appropriate greeting

+1

Confirm patient details: Name and age

+1

Medical History

0 / 3

Asks about medical history

+1

Confirms medication history including dose, frequency, indication, including any over-the-counter products and herbal remedies

+1

Check for allergies

+1

Identification and management

0 / 9

Identifies that the patient has an infected insect bite

+1

Explains to patient the diagnosis in lay terms

+1

Offers flucloxacillin

+1

500mg capsules FOUR times a day for FIVE days

+1

To be taken on an empty stomach (at least 1 hour before food and 2 hours after food)

+1

Alternatively: Student states recommendation of a suitable alternative treatment as per BNF (1)

Advises patients on self-care and pain relief e.g. paracetamol.

+1

Advises on preventative measures for the future, such as insect repellent or wearing long clothing during hikes

+1

Safety net the patient to return to the community pharmacy after 5 days if there is no improvement in symptoms.

+1

Signpost the patient to go to the GP or 111 if their symptoms rapidly progress or get significantly worse at any time.

+1

Communication

0 / 5

Uses volume, tone, pace, and emphasis appropriately, and gives time to ask questions.

+1

Knowledge and understanding of the topic are apparent.

+1

The conversation is structured and flows well.

+1

Concludes well, helping with further questions.

+1

The student did not say anything that could harm the patient

+1

This includes but is not limited to, providing incorrect information or medication, misdiagnosing conditions, neglecting to inquire about allergies, making incorrect referrals, or failing to act on red-flag symptoms.

Time Management

0 / 1

Completed the scenario in time and achieved 70% of marks

+1

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

Referral Criteria

Referral Criteria for Infected Insect Bite (Pharmacy First Criteria)

A&E

Systemic hypersensitivity:Signs of severe allergic reactions like swelling, difficulty breathing, or anaphylaxis.
Immunosuppressed patients:Symptoms of severe systemic infection in individuals with compromised immune systems need immediate medical attention.
Airway obstruction risk:Bites or stings in the mouth, throat, or near the eyes, where there is a risk of airway obstruction or orbital cellulitis.

Urgent GP Appointment

Animal bites or scratches:Need to evaluate for potential infections and complications.
Human bites:Elevated risk of infection; Requires timely assessment.
Tick bites with Lyme disease signs:Erythema migrans (bullseye rash) observed after a tick bite in the UK.
Travel-related bites:Concerns about insect-borne diseases if bitten abroad.
Unusual or exotic insect bites:Bites from rare or non-native insects requiring specialized assessment.
Systemically unwell:The patient shows signs of being significantly ill or unwell.
Complicating comorbidities:Existing conditions such as peripheral arterial disease, chronic venous insufficiency, lymphoedema, or morbid obesity may complicate or delay infection resolution.
Severe pain:Pain that is excessive relative to the wound, which may suggest a serious infection with toxin-producing bacteria.
Significant fluid or pus:Large amounts of fluid or pus at the infection site, potentially requiring incision and drainage.

References

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Referral Criteria for Infected Insect Bite (Pharmacy First Criteria)

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