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Medication Reconciliation 1

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Scenarios

Medication Reconciliation 1
By Leya Luhar   .   July 31, 2024 .   Last reviewed:   23/09/24 .    




Summary

 

In this scenario, the student should take a drug history from the patient and use their repeat prescription to document an accurate medication list for this patient before admission.

 

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!

Polypharmacy

Cardiovascular System

Student Instructions

You are a pharmacist working in the hospital. Please take an accurate medication history from Margerie Thomas, a 75-year-old female, who has just been admitted following a fall. You should gather relevant information from the patient and use their repeat prescription taken from their GP record to create an accurate up-to-date medication list.

To do:

  1. Take an accurate medication history from the patient using the sources provided. Ascertain who you are speaking with. You are not stopping, starting, or changing any medications.

You DO NOT need to give any advice or information to the patient.

 

You have 10 minutes.
You have access to a BNF. 

 

Resources:

 

Assume today’s date is 19/07/2024

A prescription form with text and images

Description automatically generated

Actor Instructions

You are Margerie Thomas (Mar-jeh-ree Tom-as)

Opening statement: "I have been told you want to ask me about my medications."

 Patient information: 

To be given if the student asks.

 

Medication History (State only when prompted):

If the Pharmacist Asks:

 

Mark Scheme

Introduction
0 / 3
Introduces with an appropriate greeting 
+1
Confirm patient details: Name and age/DOB  
+1
Establishes the reason for the conversation  
+1
History 
0 / 6
Confirm patient medication history, asking about name, dose, form, frequency, and adherence for each one:
Metformin modified release tablets 2g once daily  
+1
Dapagliflozin once a day  
+1
Recent antibiotic ear drops for ear infection  
+1
Ask the patient about sertraline, which is on the repeat prescription list  
+1
Ask the patient about atorvastatin, which is on the repeat prescription list  
+1
Asks about over-the-counter use, clarifying ibuprofen frequency, dose, indication
+1
Filling out form
0 / 3
Correctly fills out patient details, using information from the repeat prescription  
+1
Fills out allergy section correctly
+1
Ticks the correct sources of drug history  
+1
Correct Documentation of Medication
0 / 5
Metformin modified release tablets 2g once a day, no discrepancy
+1
Dapagliflozin 10mg tablets once in the morning, no discrepancies
+1
Ramipril 10mg tablets once in the morning, no discrepancies
+1
Amlodipine 10mg tablets once in the morning, no discrepancies
+1
Discusses vaccinations available for the patient
+1
Examples include flu, pneumococcal and shingles vaccinations.
Discrepancies
0 / 8
Correct documentation on atorvastatin:
Atorvastatin 20mg tablets once at night
+1
Notes discrepency
+1
Not taking these. GP should review.
Correct documentation on sertraline:
Sertraline tablets 100mg once daily.
+1
Notes discrepency 
+1
E.g. Not taking these. Antidepressants should not be stopped by the patient themselves. It is recommended for 6 months after the symptoms have resolved and the GP should review this.
Correct documentation on ibuprofen:
Ibuprofen tablets 200mg once or twice daily
+1
Notes discrepency
+1
E.g. This is not on the repeat medication list, which is concerning because the patient is taking them regularly. The patient should be further investigated for headaches and joint pain.
The patient should be taking a PPI with regular NSAID use.
+1
Student did not document antibiotic ear drops on the form
+1
In practice, short course of antibiotics within the last 3 months are usually documented in case the issue persists/ returns.
Patient Harm 
0 / 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 in red must be written down accurately to pass this OSCE station.

 

CORRECT ANSWERS: https://oscetoolbox.com/files/pdfs/medicine-reconciliation-1-answer-sheet.pdf




red flag Red Flags missed: 0

Total Score
0/27
Skills
communication 0/3
information gathering 0/9
patient safety 0/5
problem solving 0/4
documentation 0/14
Time Management 0/1


Please login to save your score.
References

  • Holmes, J., (2022).OSCE Scenarios with Mark Schemes: A Practical Guide for Pharmacy Students. Paperback edition. 25 Dec. 2022. 
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