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Medication Counselling 2

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 Scenarios

Medication Counselling 2
By Isha Hussain   .   July 20, 2024 .   Last reviewed:   24/09/24 .    




Summary

 

In this scenario, the student is expected to counsel a patient who has recently been initiated on fentanyl patches. Their role is to answer the patient’s questions appropriately and provide them with any important information. 

 

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!

Pain  

Fentanyl  

Student Instructions

You are the hospital pharmacist. You have been asked to counsel a patient who has recently been initiated on fentanyl patches for chronic back pain. The patient is a 65-year-old male who has been diagnosed with chronic severe back pain and has been prescribed fentanyl patches. 

To do: 

  1. You are expected to provide counselling information to this patient and to answer any questions appropriately. You must provide relevant advice. 

 

You have 10 minutes.  

You have access to the BNF.  

 

You may use the following resources in this scenario: 

  1. You have access to the Patient Information Leaflet for Durogesic Patches (SPC) https://www.medicines.org.uk/emc/product/157/smpc#gref – Link 

 

Actor AI 🤖 (Beta)
Actor Instructions

You are Devin Richards (Dev-in Rich-urds) 

Opening statement: “This is my first time using fentanyl patches. I know I’ve been given them to manage my pain, but I’m unsure of how to use them and have a few questions I’d like to clarify." 

 

Patient information: 

To be given if the student asks. 

  • Name: Devin Richards 

  • Age: 65 

  • Prescription: 

    • Durogesic (Fentanyl) 12mcg/hr transdermal patches, to be applied every 72 hours 

 

Past Medical History: 

  • "I have chronic back pain." 

  • "I have high blood pressure." 

 

Medication History: 

  • "I take Amlodipine 5mg tablets once daily for high blood pressure." 

  • "I’ve tried all painkillers—paracetamol, codeine, morphine, and oxycodone—but none of them have managed my pain." 

 

Allergies: 

  • "I have no known allergies." 

 

Symptoms: 

  • "I have severe, continuous back pain that’s been ongoing for 3 years, but it has significantly worsened in the last few months." 

  • "I also have stiffness." 

  • "I have difficulty moving around." 

 

Lifestyle Factors: 

  • "I’m a non-smoker and a non-drinker." 

  • "I live with my spouse." 

  • "I’m retired." 

  • “I have been to the physiotherapist about this pain. They help me a bit, but I need these patches.” 

 

Questions: 

  1. “How do I apply the patches?”

    • If the student mentions applying to non-hairy skin, you should ask:

      “Should I shave the area before putting the patch on?” 

  1. “Do the patches start working straight away?” 

  1. “Are there any side effects I should look out for?” 

  1. “What shall I do if I don’t want to use them anymore, can I just throw them in the bin?” 

  1. “What happens if I forget to change the patch or if it falls off?” 

Mark Scheme

Introduction 
0 / 2
Introduce yourself as the pharmacist with an appropriate greeting
+1
Confirms patient details: Name and age
+1
Medical History
0 / 5
Confirms medical history
+1
Confirms medication history including dose, frequency, indication, including any over-the-counter products and herbal remedies 
+1
Explores the history of pain management e.g. previous painkillers
+1
Checks for allergies
+1
Confirms symptoms
+1
Advice
0 / 1
States common side effects such as dizziness, fatigue or constipation
+1
Question 1
0 / 8
How do I apply the patches?
Read the instructions carefully that come with your patch.
+1
Remove the patch from the packet. Do not cut fentanyl patches. Keep the empty packet to store used patches safely for pharmacy disposal.
+1
Peel off the plastic backing, avoiding contact with the sticky side.
+1
Apply to clean, dry, flat, undamaged skin. Avoid hairy areas or trim hairs beforehand. For young children, apply on their upper back out of reach.
+1
Press the patch firmly for at least 30 seconds, ensuring edges stick well.
+1
Use multiple patches as instructed. Do not let patches overlap.
+1
Do not cover the patch with anything. Consult your doctor or pharmacist if it doesn’t stick well. Wash your hands after handling.
+1
You should avoid direct heat
+1
For example, hot water bottles, electric blankets and heating pads.
Question 2
0 / 2
Do the patches start working straight away
Advises that patch can take around 24 hours to work or similar
+1
Patient can continue their regular painkillers in the meantime
+1
Question 3
0 / 3
Are there any side effects I should look out for?
Nausea, constipation, or drowsiness  
+1
Difficulty breathing
If the patient shows signs of addiction, they should be referred to their prescriber
Dependence signs include needing higher doses for the same therapeutic effect or inability to regulate fentanyl use.
Question 4
0 / 3
What shall I do if I do not want to use them anymore, can I just throw them in the bin?
Inform the patient to contact the GP if they want to stop using the patches because they can cause withdrawal effects when stopped abruptly (restlessness, irritability, and shivering/sweating).
+1
Unused patches should be returned to the pharmacy for disposal.
+1
After using a patch, firmly fold the patch in half so the sticky side sticks to itself and dispose in the bin. Wash hands after handling any patches.
+1
Question 5
0 / 3
What happens if I forget to change the patch or if it falls off?
May lose analgesic effect temporarily, depending on when the patch was removed 
+1
A new patch should be applied as soon as possible
+1
Advise to make a note of the day and time and to continue replacing every 72 hours thereafter
+1
Communication and knowledge 
0 / 6
Uses appropriate language for the person and situation
+1
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, by asking any 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.  




red flag Red Flags missed: 2

Total Score
0/34
Skills
professionalism 0/2
information gathering 0/6
patient safety 0/3
patient education 0/20
knowledge 0/21
problem solving 0/3
communication 0/4
patient-centred care 0/2
Time Management 0/1


Please login to save your score.
Referral Criteria

Referral Criteria for Fentanyl Patches 

 

Refer to A&E if: 

  • The medication makes the patient feel extremely sleepy, sick, or dizzy: This could be an overdose of medication and would need immediate intervention. 

  • If a patient loses consciousness on this medication: This could be an overdose of medication and would need immediate intervention.

 

Refer for an urgent GP appointment if: 

  • Incorrect administration: A fentanyl patch sticks to someone else who has not been prescribed the medication. Remove this immediately. 

  • Overdose of medication: The patient has taken an increased dose of fentanyl above what they are prescribed even with no symptoms. 

  • Pain is not controlled with current medication: The patient proceeds to buy over-the-counter medicines containing opioids (Pain is not being controlled effectively or suggestive signs of addiction). 

 

 

 

References

 

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