OSCE Toolbox | Hospital Discharge 2 - Scenario

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Scenarios

Hospital Discharge 2

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

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Summary Expert

In this scenario, you must optimise the medicines for this patient and reconcile the discharge summary. You are given all the information necessary to write in the patient's notes. You should clinically, legally, and accurately check the resources provided.

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 for this scenario.

Revision Topics

Be aware, this may reveal any answers!

ADHD

Head Injuries

Student Instructions

You are the Clinical Pharmacist working in the A&E ward. A 7-year-old patient's discharge information has been sent to the pharmacy department.

Patient name: Jimmy Pool

Age: 7

Medical History: ADHD (stable)

Medication history prior to admission:

Paracetamol 250mg/5ml oral suspension – Give 5ml every 4-6 hours when required

Medikinet 10mg XL tablet – Take 10mg daily

All lab tests were normal and within reference ranges

Diagnosis

Minor head injury

Progress Information:

Patient is maintaining average weight of a 7 year old (23kg) and is happy to discharged from hospital. Patient is ready to be treated at home as per Dr Sherlock's medical advice.

Task

Review all the patient's discharge forms
Legally, clinically and accuracy check the discharge form, compared to the medicines at admission
Outline any medicine optimisation issues and document your findings in the medical notes

You are allowed to use a BNF.
You have 10 minutes.

Write your answer on paper.

Patient Hospital Discharge Form:

Mark Scheme

Introduction

0 / 2

States time and date of entry in the medical notes

States profession (pharmacist) and ward name

Query

0 / 4

States ibuprofen dose should be 200mg THREE times a day (maximum 30 mg/kg per day)

States the discharge letter needs signed with the prescribers’ initials/signature with date

States ibuprofen is in the wrong section on discharge letter

It should be in the medications prescribed since admission section.

States Medikinet should be in 'admission drugs (unamended)' section

Management

0 / 7

Recommends monitoring or continuing to monitor pain, CRP, bleeding risk, follow up with GP - allow one mark for any suitable statement

States that liquid formulation should be used for ibuprofen ideally for the pain (paracetamol is prescribed in liquid form)

Checks doses against the BNF and documents ‘As per BNF’ or similar

States common side effects of medicine suggested

For ibuprofen, common side effects include nausea, vomiting, wind and indigestion.

States ‘as discussed with Doctor’.

Concludes appropriately with signature and name

States that an incident report should be filled (due to the incorrect transcribing of medications at admission and on discharge)

Patient Harm

0 / 1

The student did not say anything that could harm the patient

This includes but is not limited to, providing incorrect information or medication, using incorrect guidelines, neglecting to state to stop harmful medication, failing to spot incorrect dosing, or failing to act on red-flags.

Time Management

0 / 1

Completed the scenario in time and achieved 70% of marks

Referral Criteria

Referral Criteria for ADHD

Routine GP Appointment

Suspected ADHD symptoms are present: If a patient (adult or child) exhibits symptoms like inattentiveness, hyperactivity, or impulsiveness, a GP can discuss these concerns and, if necessary, arrange a referral for a specialist assessment.
Symptoms affect daily functioning: When ADHD symptoms interfere with everyday activities such as academic performance, work, or relationships, further evaluation by a specialist is advisable.

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Referral Criteria for ADHD

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