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In this scenario, a patient comes into the pharmacy complaining of pain when urinating. The pharmacist should take a history, diagnose, and prescribe the appropriate medication.
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.
Pharmacy First 2023
Urinary Tract Infections
You are a community pharmacist. A female patient comes in with dysuria. You are expected to take a detailed history, respond to questions appropriately ensure patient safety and action on an appropriate management plan.
You are a prescriber
To do:
Conduct a thorough medical history assessment.
Based on the information gathered, formulate a treatment plan or, if necessary, recommend a referral to a healthcare provider or emergency services for further evaluation and management.
You have 10 minutes.
You are allowed access to the BNF.
You have access to the following resources if necessary:
Community Pharmacy England, 2024.Pharmacy First Clinical Pathways Resources. Available at:
You are Aisha Nassar (Ay-shah, Nah-sar).
Opening Statement: “I’ve been experiencing pain whenever I pass urine, and it is bothering me.”
Patient Information:
Provide this information when prompted.
Name: Aisha Nassar
Age: 22
Medical conditions:
“Eczema when I was younger, but no flare-ups since then.”
Medications:
“None.”
Allergies:
“Hayfever.”
Symptoms:
“It is a painful burning sensation when passing urine for the last 6 days.”
“I have tenderness and pain over my lower tummy too.”
If asked: “I am passing urine a lot more often than usual 8-10 times daily. This includes waking multiple times during the night to pass urine, which is disrupting my sleep.”
If asked: “My urine is dark and cloudy - I have not seen any blood in my urine, but I have not been looking for it.”
Lifestyle: You are a university student, and your exam season is approaching - you are concerned that your symptoms are going to affect your performance.
If the Pharmacist Asks:
“No pain of any kind.”
“No flu-like symptoms of any kind.”
“No nausea/vomiting.”
“No vaginal discharge.”
“No missed or lighter periods.”
“No pain during or after sex.”
If the Pharmacist Asks:
“I have never had these symptoms before.”
“I am 62kg.
If asked about
Menstrual history: “My last period ended 7 days ago, right on time.”
Sexual History: “No new partners in the last year. I use barrier contraception with a regular partner.”
Only if the student provides the correct diagnosis but does not offer the following information should you ask:
“Is there anything I can do to help the pain whilst the antibiotics are working?”
Any criteria marked in red must be met to pass this station.
Red Flags missed: 10
Referral Criteria for Urinary Tract Infections (Pharmacy First Criteria)
Refer to A&E if:
Confusion or drowsiness:Sudden onset of confusion, slurred speech, or unusual drowsiness may indicate sepsis, a serious systemic infection.
Skin and tongue discolouration:Blue, grey, pale, or blotchy skin, lips, or tongue (check the palms or soles for darker skin) could be signs of sepsis.
Non-fading rash:A rash that does not fade when rolled with a glass, similar to meningitis, suggests a severe infection.
Breathing issues:Difficulty breathing, breathlessness, or rapid breathing indicates a severe reaction requiring immediate medical attention.
Referral for an urgent GP appointment:
Temperature extremes: A very high or low temperature or feeling hot and shivery could be indicative of a severe infection. A temperature below 36°C may signify a serious condition or infection.
Severe Tummy or back pain: Significant pain in the lower tummy or back just under the ribs could suggest a severe infection or kidney involvement.
If the patient worsens rapidly at any time or does not improve within 48 hours of treatment: Further examination to determine the cause would be necessary.
Symptoms in children, men, or pregnant women: UTIs are less common or require further guidance for treatment due to a higher risk of complications. Alternatively, this may indicate other health issues.
The patient is immunocompromised:These individuals may be at higher risk for complications and require closer monitoring and management (Notify GP of supply and ask for an urgent review for the patient – Pharmacy First 2023).
Recurrent UTIs (2 episodes in the last 6 months. Alternatively, 3 episodes in the last 12 months): need further investigation to identify and address any underlying issues.
Sexual History does not rule out sexually transmitted Infections: Patient may need antibiotics if suspected sexually transmitted infection.
NHS, 2024.Urinary Tract Infections (UTIs). Available at:https://www.nhs.uk/conditions/urinary-tract-infections-utis/[Accessed 28 August 2024].
Clinical Knowledge Summaries (CKS), 2024.Urinary Tract Infection (UTI) Management. Available at https://cks.nice.org.uk/topics/urinary-tract-infection-lower-women/[Accessed 28 August 2024].
Community Pharmacy England, 2024.Pharmacy First Clinical Pathways Resources. Available at:https://cpe.org.uk/national-pharmacy-services/advanced-services/pharmacy-first-service/pharmacy-first-clinical-pathways-resources/[Accessed 28 August 2024].
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