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Prescription Check 7

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 Scenarios

Prescription Check 7
By Amina Adnan   .   July 25, 2024 .   Last reviewed:   24/09/24 .    




Summary

A patient has provided you with a prescription for their medication. The student is expected to check the prescription and contact the prescriber if any errors are found to rectify the mistakes. You do not need to counsel on the medication. 

 

Please ensure that this scenario and mark scheme align with the most up-to-date UK NICE guidelines and the BNF when using it for your OSCE assessment. 

 

 

 You will need a student pharmacist, a patient, and a prescriber for this OSCE Scenario. 

Revision Topics
Be aware, this may reveal any answers!

Novel/Direct Oral Anticoagulant Drugs (NOAC/DOACs) 

 

Student Instructions

You are a pharmacy student on placement at a community pharmacy. Your role is to counsel and support the patient who has come to pick up a prescription for Rivaroxaban. You need to check the prescription, action any errors if any are found and ensure proper communication with the prescriber. 

Please discuss your prescription checking aloud. Do not worry about using jargon. 

 

To do  

  1. You must perform a legal, accuracy and clinical check on this prescription using the latest up-to-date guidance. 

  2. Speak with the patients mother about any medical information you need for this prescription. (first actor)

  1. If necessary, state any changes you wish to make to the prescriber. (second actor)

 


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

 

The Prescription:

Actor AI 🤖 (Beta)
Actor Instructions

Actor 1

You are Camille Dallaire (Cah-meel, Dah-lair). 

Opening statement: “Hi, can I collect these tablets that I've been prescribed please?” 

 

Patient Information:
Provide this information when prompted.

  • Name: Camille Dallaire 
  • DOB: 06/03/1951

  • Address: 66 Bourneville Road, WW92 RPT

  • Medical History:  

    • “Osteoarthritis.” 

  • Medication History:  

    • “Topical ibuprofen gel as required.” 

  • Allergies:  

    • “None.” 

  • Indication for medication: 

    • “I recently had a fall at home. This resulted in a broken hip.” 

    • “I just had hip replacement surgery.” 

    • “The doctor has prescribed these medications to stop a clot from forming in my legs.” 

  • If the pharmacist mentions waiting for a new prescription:  

    • “I was brought in by care staff, as I am in a wheelchair. I am frustrated, how long will this take?” 

       

 

Actor 2

Prescriber Actor Information: 

You are Doctor Singh.  

 

Prescription Error:
The patient was prescribed rivaroxaban for VTE prophylaxis post hip replacement surgery. You should have prescribed 10mg once daily for 5 weeks, you have accidentally prescribed the treatment dose for a DVT. There is also an Interaction between Ibuprofen gel and Rivaroxaban.  

The student should explain the query and a solution. When prompted: 

  • “What would you like me to change and why” 

  • “I apologise for this mistake – I will rectify it now.” 

  • “I will send you a new prescription. Thank you.” 

Mark Scheme

Introduction 
0 / 2
Introduce yourself and greet the patient professionally
+1
Confirm the patient's identity: Name and age.
+1
Verification of prescription details 
0 / 4
Is the patient's name correct on the prescription
+1
Is the medication (rivaroxaban) accurate
+1
Does the prescription match the patient's condition
+1
Are the dosing instructions (frequency and duration) correct
+1
Ask about the patient's history. 
0 / 4
Confirm the patient's past medical history.
+1
Confirms medication history including dose, frequency, indication, including any over-the-counter products and herbal remedies 
+1
Ask about any allergies and confirm the reaction
+1
Identify any symptoms and concerns the patient may have.
+1
Identification of prescription error. 
0 / 3
Detects the error in the prescription
The medication should be 10 mg once daily for 5 weeks
+1
Prescription is out of date
+1
States that these errors would need to be amended on a new prescription
+1
Prescriber contact 
0 / 6
Identifies that they must contact the prescriber to rectify the mistake.
+1
Communicate the errors to the prescriber.
+1
Seek clarifications regarding the prescription.
+1
Relay all relevant patient history to the prescriber to explain the inaccuracy in the dose that they have prescribed
+1
Correctly identify the appropriate dose (10 mg once daily for 5 weeks).
+1
Identify the interaction between Ibuprofen and Rivaroxaban:
Increased bleeding risk - “While the risk of bleeding is low with a topical preparation, we would still advise caution or discuss alternatives.”
+1
Rivaroxaban and Ibuprofen both cause bleeding; using them together may raise this risk. Use with caution or avoid, as per manufacturer advice (BNF 2024). Additionally, NSAIDs may possibly enhance the effects of anticoagulants, although the chance of either of these occurring with a topically administered preparation is extremely remote (SPC 2024)
Communication with the patient 
0 / 6
States to patient that prescription is being amended by the prescriber
+1
Offer reassurance to the patient that the mistake has been rectified and they will get their medication as soon as possible  
+1
Guide the next steps, including when and how to obtain the corrected prescription. The GP will issue a new prescription for them.
+1
Offer the patient an Alert Card for DOACs to be carried with her at all times.
+1
States to seek medical advice if they experience (Maximum 2 marks):
Long or excessive bleeding
Exceptional weakness
Tiredness/paleness/dizziness
Headache
Unexplained swelling.
Communication 
0 / 5
Ensure that the patient comprehends the situation and the correction process.
+1
Maintain professionalism throughout the interaction.
+1
Demonstrate empathy and understanding of the patient's concerns.
+1
Conclude the conversation professionally, helping with any further questions or concerns.
+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: 5

Total Score
0/31
Skills
professionalism 0/4
communication 0/10
information gathering 0/5
patient safety 0/17
patient-centred care 0/6
diagnostic reasoning 0/1
knowledge 0/6
decision making 0/3
problem solving 0/2
patient education 0/1
Time Management 0/1


Please login to save your score.
Referral Criteria

Referral Criteria for Anticoagulant Drugs  

 
Refer to A&E if: 

  • Severe Bleeding: Signs of severe bleeding, including uncontrolled bleeding from any site, or symptoms of major bleeding like significant blood loss, severe bruising, or black tarry stools. 

  • Signs of Stroke: Sudden onset of symptoms such as numbness or weakness on one side of the body, difficulty speaking, or sudden loss of vision, which could indicate a stroke. 

  • Severe Allergic Reaction: Severe allergic reaction symptoms like difficulty breathing, swelling of the face or throat, or severe rash. 

  • Acute Renal or Hepatic Failure: Symptoms of acute renal or hepatic failure such as confusion, severe fatigue, or jaundice. 

 

Refer for Urgent GP Appointment if: 

  • Persistent or Recurrent Bleeding: Ongoing or recurrent bleeding that does not resolve with basic measures, including frequent nosebleeds, bleeding gums, or minor wounds that bleed excessively. 

  • Signs of Thrombosis: Symptoms of deep vein thrombosis (DVT) or pulmonary embolism (PE) such as swelling, redness, pain in the legs, or sudden shortness of breath and chest pain. 

  • Renal or Liver Impairment: Symptoms of worsening renal or liver function such as changes in urine output, swelling, or signs of liver dysfunction (e.g., abdominal pain, itching, dark urine). 

References

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