OSCE Toolbox

Medication Counselling 7

By Niharika Kalla . April 01, 2024 . Last reviewed: 24/09/24 .

Summary

In this scenario, the student is tasked with counselling a patient who has been prescribed sertraline and answering any questions they have.

Please ensure that this scenario and mark scheme align 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!

Depression

Student Instructions

You are a pharmacist. You have been asked to counsel a patient who has just been started on medication. The patient is a 35-year-old male who has recently been diagnosed. The patient has never taken this medicine before. You are expected to answer any questions and counsel this patient, so he is well-informed regarding his medication.

To do:

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

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

You may use the following resources if necessary:
EMC, 2024.Package Leaflet: Sertraline 50mg Tablet.Available at: https://www.medicines.org.uk/emc/files/pil.3501.pdf

Actor Instructions

Your name is Duncan Yates (Dun-kan, Yates).

Opening statement: “I have been prescribed a medication called ‘sertraline’ and I have never taken it, so I have a few questions I would like to ask.”

Patient information:

Provide this information when prompted.

Name: Duncan Yates

Age: 35

Medical History:

- “Recently diagnosed depression.”

Medication History:

- “None.”

Allergies:

- “No allergies.”

Symptoms:

- “I have been diagnosed with depression recently after struggling with a low mood for several months.”

Prescription:

- “I have been told to start taking 50mg of sertraline once a day, but I have not started it yet. I want to clarify my doubts about it.”
Lifestyle:
- "I am an editor for my local newspaper."
- "I cannot drive. I walk to work."
- "I do not operate any heavy machinary."

Questions:

“How does sertraline help my depression”

“What are some side effects of sertraline”

“How do I take sertraline”

“Do I need to avoid drinking or eating anything while on this medication”

Mark Scheme

Introduction

0 / 2

Introduce yourself with an appropriate greeting

Confirms patient details - name and age

Medical History

0 / 5

Confirms medical history

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

Confirms symptoms.

Check allergies

Confirms indication for new prescription

Explains Condition

0 / 1

Explain the condition or ask the patient to explain their condition to explain their understanding

e.g. Depression is a condition affecting your mood, which can make you feel sad/down for weeks or months. You might also feel a loss of interest in activities and lack of energy, as well as physical symptoms,

Question 1:

0 / 3

How does sertraline help my depression

Sertraline is an antidepressant. It changes the balance of some of the chemicals in your brain (neurotransmitters).

Sertraline affects a neurotransmitter called serotonin, which makes you happy

It makes sure serotonin lasts for a longer time in the brain

Question 2:

0 / 2

What are some side effects of sertraline (Maximum 2 marks awarded): Accept suitable alternatives.

Nausea

Vomiting

Diarrhoea

Weight Change

Being unable to sleep

It may be suitable to advise the patient to then take the medicine in the morning.

Discusses symptoms of anxiety, agitation or similar could become worse before they get better

Advises the patient to report any serious side effects to a healthcare professional

Mark 1

Mark 2

Question 3:

0 / 4

How do I take sertraline

Once a day tablet. You can take it with or without food.

You can take sertraline at any time of the day if you stick to the same time every day. If you take it in the morning this should help reduce the potential sleeping problems that it can cause.

You will see the effects in 4-8 weeks.

If you forget to take a dose, skip the missed dose, and take your next dose the next day at the usual time.

Question 4:

0 / 2

Do I need to avoid drinking or eating anything while on this medication

Do not drink grapefruit juice while taking this medication, as the juice can increase the amount of medication in your body thereby increasing the side effects.

Drinking alcohol while taking sertraline can make you drowsy, so it is best to avoid alcohol until you see how the medication makes you feel.

Contraindications

0 / 2

Checks for relevant contraindications

Suicide Risk

This is a suitable question as sertraline can make people feel worse before they feel better.

Mania e.g. "Do you ever have episodes of extremely high mood"

It is important to screen for possible bipolar disorder.

Lifestyle

0 / 1

Checks if patient drives or operates heavy machinary

It is a common side effect that sertraline causes drowsiness. This side effect may decrease with continued use. The patient should be made aware of this during their consultation.

Communication

0 / 6

Uses appropriate language for the person and situation

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

Knowledge and understanding of the topic are apparent

Conversation is structured and flows well

Concludes well, by asking if any further questions

The student did not say anything that could harm the patient

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

Any criteria in red must be written down accurately to pass this OSCE station.

Red Flags missed: 2

Total Score
0/

Skills

communication 0/8

professionalism 0/2

information gathering 0/5

patient safety 0/13

knowledge 0/10

patient education 0/16

Time Management 0/1

Please login to save your score.

Referral Criteria

Referral Criteria for Mental Health

Refer to Accident and Emergency (A&E) if:

Immediate risk of harm:The patient has suicidal thoughts with a plan, intent, or means, or there is a risk of violence toward others. Urgent intervention is needed to ensure safety.

Acute confusion or psychosis:Sudden changes in behaviour, hallucinations, delusions, or disorganized thinking may indicate a psychiatric emergency or an underlying medical condition needing immediate care.

Substance intoxication with overdose risk:Signs of overdose or dangerous intoxication, such as unconsciousness or respiratory distress, require urgent medical attention to prevent fatal complications.

Refer for an urgent GP appointment if:

Moderate to severe depression:Persistent low mood, lack of interest in activities, or changes in weight or sleep impacting daily functioning.

Severe anxiety symptoms:Frequent panic attacks or anxiety that interferes with daily life, or physical symptoms like chest pain or breathlessness needing evaluation.

Manic or hypomanic behaviour:Elevated mood, impulsive actions, or decreased need for sleep suggest bipolar disorder requiring psychiatric assessment.

PTSD symptoms:Flashbacks, nightmares, hypervigilance, or emotional numbness following trauma may need specialized treatment.

Eating disorders:Signs of anorexia, bulimia, or binge eating affecting physical health or daily life require comprehensive care.

New or worsening symptoms:Any new or worsening mental health symptoms, such as OCD or phobias, impacting daily life.

Lack of response to treatment:No improvement despite treatment, or adverse medication effects, requiring a review of the management plan.

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