osce toolbox
Search Files
In this scenario, a trainee GP visits a pharmacist to seek information about Apixaban. The pharmacist should collect essential patient information and ensure effective communication throughout the conversation.
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.
A student pharmacist and an actor playing the role of a trainee doctor are required.
Deep Vein Thrombosis
Anticoagulants
You are a community pharmacist. A local trainee GP has come to the pharmacy seeking information about Apixaban after a patient has been started on this medication. You are expected to take a brief history of the patient and respond to their questions appropriately.
To do
Gather essential patient details, including medical history, current medications, allergies, and lifestyle factors relevant to the scenario
Offer clear, evidence-based advice to the GP on potential next steps, including management options or further diagnostic testing.
You have 10 minutes.
You have access to the BNF.
You are Doctor Helen Cho (Hell-en, Cho).
Trainee GP:
Name: Dr. Helen Cho
Opening statement: "I have a patient who has been started on Apixaban about a week ago and wanted some more information on this medication.”
Patient details:
Only provide this information if prompted.
Reason for medication:
“She was just in hospital with deep vein thrombosis and got discharged a few days ago.”
Symptoms leading to hospital admission:
“It was a swollen, painful leg that was beginning to change colour.”
Management at the hospital:
“Managed with Apixaban and catheter-directed thrombolysis. She has been started on Apixaban upon discharge.”
Medical conditions:
“None.”
Medication:
“The combined oral contraceptive pill which has now been switched to the progestogen-only pill, and Apixaban since discharge.”
Allergies:
“None.”
Risk factors:
“She had recently returned home from Australia. So, a long plane journey.”
“She is a smoker - 10 cigarettes a day.”
“She drinks a glass of wine with dinner on special occasions.”
Questions:
You can ask these in any order that fits the flow of the conversation
“What is the correct dose and frequency of the medication?”
“Are there any side effects I need to make the patient aware of?”
“How do I monitor this medication?”
“Is this medication safe in pregnancy or breastfeeding?”
“Are there any contraindications to Apixaban?"
Any criteria marked in red must be met to pass this station.
Red Flags missed: 4
Referral Criteria for Anticoagulant Drugs
Refer to A&E if:
Severe Bleeding: Signs of severe bleeding, including uncontrolled bleeding from any site, or symptoms of major bleeding like significant blood loss, severe bruising, or black tarry stools.
Signs of Stroke: Sudden onset of symptoms such as numbness or weakness on one side of the body, difficulty speaking, or sudden loss of vision, which could indicate a stroke.
Severe Allergic Reaction: Severe allergic reaction symptoms like difficulty breathing, swelling of the face or throat, or severe rash.
Acute Renal or Hepatic Failure: Symptoms of acute renal or hepatic failure such as confusion, severe fatigue, or jaundice.
Refer for Urgent GP Appointment if:
Persistent or Recurrent Bleeding: Ongoing or recurrent bleeding that does not resolve with basic measures, including frequent nosebleeds, bleeding gums, or minor wounds that bleed excessively.
Signs of Thrombosis: Symptoms of deep vein thrombosis (DVT) or pulmonary embolism (PE) such as swelling, redness, pain in the legs, or sudden shortness of breath and chest pain.
Renal or Liver Impairment: Symptoms of worsening renal or liver function such as changes in urine output, swelling, or signs of liver dysfunction (e.g., abdominal pain, itching, dark urine).
NHS, 2024.Anticoagulants - Dosage. Available at:https://www.nhs.uk/conditions/anticoagulants/dosage/[Accessed 24 August 2024].
British National Formulary 2024.Apixaban.BNF (British National Formulary) [online]. Available at:https://bnf.nice.org.uk/drugs/apixaban/[Accessed 24 August 2024].
This website uses cookies to ensure you get the best experience
Learn more
