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:
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.
The repeat prescription from the patient’s GP records can be found below
Assume today’s date is 19/07/2024
Actor AI 🤖 (Beta)
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.
Name: Margerie Thomas
Address: 50 Bread Crumb Drive
Age: 75
Allergies: None known
Past medical history:
Admitted an hour ago because of a nasty fall.
High blood pressure
Diabetes
Medication History (State only when prompted):
"I take Metformin, 2g tablets once a day every evening with tea."
"I take 'Dap up gliflozin' or whatever it’s called once a day, but I don’t know the dose."
"I take two blood pressure medications once a day with the rest of my medications, but I can’t remember the names."
"I used antibiotic ear drops from the GP 6 months ago for an ear infection, but that's all cleared up now, and I finished the ear drops in a few days at the time."
"I take one or two 200mg Ibuprofen tablets in the morning almost every day for headaches and general joint pain. I just got it from the supermarket."
If the Pharmacist Asks:
If asked about Sertraline/antidepressants: "Oh yes, I was feeling quite down for a while, and I took a tablet for about 3 months. I felt better, so I have not taken it for the last two weeks. I’ve kept the tablets in case I need them in the future."
If asked about a statin: "I tried it for a bit, but I don’t even remember what it was for, and it made my tummy feel off, so I stopped taking it."
If asked about vaccines: “I am not vaccinated. should I get any I got some when I was a baby I think.”
If the pharmacist asks for more details about your fall: “My memory is hazy, I don’t know.”
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.