OSCE Stations

Question 1

Prescribing an antipsychotic

Answer 1

Check ECG, bloods are done

Give laxative PRN

Question 2

Prescribing a strong painkiller (codeine)

Answer 2

Give PRN laxative and anti emetic as well

Question 3

Prescribing a steroid

Answer 3

Give REGULAR bisphosphanate and PPI

Question 4

1 month supply

Answer 4

28 days

Question 5

Drugs that require brand names (not just generic names)

Answer 5

See IV fluids deck

Question 6

Prescription Review

Answer 6

1. Patient demographics eg. Age and gender
2. Check allergies and intolerances
3. Ask for medications, and in turn elucidate;
   - indication
   - dose
   - frequency
   - duration
   - route (vomiting on oral- give IV?)
4. Ask about compliance to medication
5. Co morbidities eg. Liver or kidney failure (ie. reduced dose)
6. Get BNF out
   - check drug interactions
   - check whether the drugs have been prescribed appropriately eg. Correct indication, dose, frequency, route etc.
   - does liver or kidney failure or age (ie. elderly) mean that a dose needs to be changed?
   - cautions/contraindications/pregnancy/breastfeeding
7. If you were given a physical prescription- has it been filled out correctly
   - patient name, DOB, hospital number
   - medicine name, formulation, route
   - prescribers signature and date
   -VTE assessment
   -allergies etc.
   -ABX in correct place etc.

Question 7

Medication history

Answer 7

1. Name and demographics/ where drug history has been obtained from
2. Allergies and intolerances (with reaction)
3. Regular medicines
   - name (brand where appropriate), indication
   - dose, frequency, route
   - time they take it, duration
4. PRN medicines
   - same as above, but ask do they need them prescribing in hospital
   - say “any inhalers, sprays, creams, patches, contraception, HRT?”
5. Acute medicines
6. Any recent changes to medicines
   - stopped or started
   - doses increased or decreased
   - any short courses of ABX or steroids
7. Any additional remedies
   - bought at the chemist/ over the internet
   - alternative remedies
   - vitamins and herbal remedies
   - illicit substances
8. Adherence to medicines
   - any issues
   - use of compliance aids
9. Plan for medicines on admission
   - take into account patients clinical condition, are there any medicines that need to be stopped
   - eg. Ramipril withheld if potassium is greater than 6.5

NB- any other source of information ie. prescription script, bag of meds under chair etc.

Question 8

Some things that could be wrong on a prescription review

Answer 8

Drug interactions/ indications (fill them all in)
Renal/hepatic injury or failure- some drugs may require stopping/dose reducing (diuretics, NSAID’s, ACE-i)
Hypotension and on antihypertensive or having falls and on antihypertensive (stop them for a few days)
Incorrect transcription ie. 25 mg bisoprolol not 2.5mg bisoprolol (need to check
They haven’t left enough time between doses ie. paracetamol/PRN (need correct spacing). Paracetamol needs 4 hours between doses, ibuprofen needs 6 hours
LMWH/MR morphine needs 12 hours between doses
Just give ABX spread out throughout the day (doesnt have to be exactly 8 hours apart)
If vomiting, do they need IV (can they still take oral (PO))- or do they need an antiemetic prescribing
Are they pregnant now- any changes/ what needs stopping