OSCE Toolbox | Prescription Check 8 - Scenario

By Amina Adnan • July 25, 2024 • Last reviewed: •

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Summary Expert

In this scenario, a patient has come into the pharmacy to pick up a prescription. The pharmacist should check the prescription and contact the prescriber if any errors are found to rectify the mistakes. You do not need to counsel on 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, a patient, and a prescriber for this OSCE Scenario

Revision Topics

Be aware, this may reveal any answers!

Student Instructions

Actor Instructions

This may reveal scenario objectives!

Actor 1
You are Sanjana Patel (Sun-jah-nah, Puh-tel).

Opening statement: “Hi, I've come to collect this prescription.”

Patient Information:

Provide this information when prompted.

Name: Sanjana Patel

DOB: 21/10/1944
Address: 24 Hobnob Avenue, AB23 XFF

Indication for prescription:

- “I had a recent diagnosis of atrial fibrillation.”

- “I was given apixaban for VTE prophylaxis – I’m not sure what VTE stands for.”

Medical History:

- “Type 2 Diabetes Mellitus, Hypertension, Chronic Kidney Disease – My kidneys have gotten so bad. My eGFR is 14ml/min. My doctor says this is not good, I used to be a nurse but I am not even sure what it means.”

Medication History:

- “Metformin, Ramipril, Alfacalcidol, Bisoprolol - I don’t remember the doses or anything, my daughter sorts it out for me. My doctor is having me reviewed due to this kidney problem for all of them.”

- “I don’t get over-the-counter medicine – my daughter told me my medicines might interact with many things.”

Allergies:

- “None.”

Symptoms:

- “I started noticing palpitations, dizziness and I was short of breath.”

If the pharmacist mentions waiting for a new prescription:
- "I will go down to the surgery and pick it up, thank you for your time."

Actor 2

Prescriber Information:

Name: Dr. Singh

Prescription Error:

The patient was prescribed apixaban for VTE prophylaxis for her atrial fibrillation. You should have been prescribed warfarin due to her CKD. If the student suggests warfarin as an alternative, this is adequate, they DO NOT need to suggest a dose, please reassure them of this. - “I can work out the dosing for warfarin don’t worry.”

If the pharmacist asks:

"There are some medicines being reviewed and have been stopped while his eGFR (renal function is so low). Don't worry about these for now we are going to get him reviewed again soon. Thank you for letting us know though."

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 / 3

Introduce yourself and greet the patient professionally.

+1

Confirm the patient's identity.

+1

Verification of prescription details

+1

Pescription Check

0 / 4

Is the patient's name correct on the prescription?

+1

Is the medication (apixaban) accurate?

+1

Does the prescription match the patient's condition?

+1

Are the dosing instructions (frequency and duration) correct?

+1

Verification of patient information

0 / 5

Confirm the patient's name, age, and medical history.

+1

Ask about the patient's history

+1

Ask about allergies

+1

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

+1

Identify any symptoms and concerns the patient may have.

+1

Identification of a prescription error

0 / 4

Detects the error in the prescription:

The patient cannot be given apixaban due to their CKD and eGFR

+1

States the error to the prescriber

+1

States to change prescription date to today

+1

States to amend these errors accordingly

+1

Prescriber contact

0 / 6

Identifies that they must contact the prescriber to rectify the mistake.

+1

Communicate the error to the prescriber (mention incorrect medication).

+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

Suggest warfarin as a suitable alternative

+1

States to check the patient's INR reading before issuing a new prescription - as this is how the dose is decided.

+1

The patient will need a blood test (INR) to check how long it takes for the blood to clot, and then the doctor will write a prescription based on the result.

Communication with the patient

0 / 3

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

Clear and Effective 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.