OSCE demo
Oral Structured Clinical Examination
• Patient interview.
ü Aim: Identify incorrect medications in medication
list
• Physician discussion.
ü Aim: Implement correct medication list
Tommy Eriksson
Ulrika Gillespie
• Teaching goals, the workshop coach will
– describe and demonstrate a method for training
pharmacists to identify and resolve admission Med Rec
problems
• Learning objectives. At the end of this session, participants
will be able to
– understand the importance of systematic training
sessions to improve patient care
– describe the demonstrated model
– implement a (the?) model in their own environment
– communicate with educational and professional bodies
to implement a national systematic training module
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
The OSCE sessions
1. Preparation for patient meeting (15 min)
Perform a fast medication review; id potential DRP needing
clarification, prepare the admission Med Rec form
2. Patient meeting (10 min)
Interview based on the adm Med Rec form i.e.
Id a correct medication list, handling-, knowledge- and
adherence problems. Other DRPs
3. Preparation for meeting the physician (30 min)
Id, summarize och prioritize DRP for suggested actions by the
physician. Prepare arguments and counter-arguments.
4. Meeting the physician (10 min)
Suggest changes in prescription based on prioritized DRPs.
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Training to perform Admission Med Rec
1. Read SOPs and forms
2. Observe an experienced clinical pharmacist
3. Perform an educational OSCE
4. Stepvise; observe, perform with help, perform
independently. Reflection, discussion and fill the form
5. Perform an OSCE examination
6. Licence to independently practice adm Med Rec
Training duration
• Patient Adm Med Rec 2-8 weeks
• Physician discussion 2-8 months
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
This afternoon
14:15-15 Demo and video recording of patient interview
and discussion with physician for
implementation of a correct medication list
based on patient case and instructions
15:30-16:30 Video viewing and assessment of pharmacist
performance using grading criteria forms
16:30-17:30 Group session practice of a a new case
17:30-18 Summary and discussion
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
In THIS demo session
• Preparation for meeting the patient (15 min)
– Perform a fast medication review; id potential DRP needing clarification, prepare the admission Med
Rec form
• Patient meeting (10 min)
– Id correct medication list, handling-, knowledge- and
adherence problems. Other DRPs
• Preparation for meeting the physician (30 min)
– Summarize och prioritize DRP for suggested actions by the physician. Prepare your arguments and counter
arguments .
• Meeting the physician (10 min)
– Suggest changes in prescription based on prioritized DRPs.
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Help and evaluations
• SOP and support (not provided)
– Patient adm Med Rec
– Med Rev and Physician discussion
• Systematic forms
– Adm Med Rec (LIMM Med. Interview Questionnaire)
– Med Rev (LIMM Med Rev Form)
• Training and examination of Adm MedRec and evaluation of
performance (patient and physician) (grading criteria, appendix 1)
– Information and instructions
– Patient meeting
– Physician meeting
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Support for OSCE evaluations
Attached for this session (Appendixes)
1. Training and examination of Adm MedRec and evaluation
of performance (patient and physician)
2. Patient case (David 75 years)
3. Instructions to patient
4. Instruction to physician
Also needed in real life training with several students
• Description and time flow-chart, 4 stations
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Patient case: David 75 years 1(2)
• Admitted to medical ward after arriving at the emergency room with
sweats, malaise and vomiting on Saturday.
• You meet him at 9 am on Monday morning and the nurse says that he is
already much better
• For the past 5 years he has been posted 7 times for sepsis, gallstone
attacks and major problems with pain from his ostomy. The ostomy is
now removed 6 weeks ago. He received a new heart valve 9 years ago
and is prescribed warfarin.
• Living in central apartment with his wife. Have no community help
• Lab including INR, OK
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
David 75 years 2(2)
Status
• Blood preassure (mmHg). Decreased from 185/110 to 145/90 (8pm)
• Puls (beats/min), decreased from 85 to 65
• Weight (kg) 76
• Calculated CLcrea (ml/min) 85
Medications at admission
• Tabl. Morfin Slow Released 10 mg 2+0+2+2
• Tabl. Paracetamol 500 mg 2+0+2+2
• Tabl. Warfarin according to list
• Cream Fenuril For the skin (moistureizer) when needed.
• Tabl. Zolpidem 5 mg 1 at night when needed
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Demonstration Patient Interview
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Information from the patient interview
Medication Dose Comments
Tabl Morphine Slow Release 2+0+2+2 Not correct 1+0+0+1 at home
Tabl. Paracetamol 500 mg 2+0+2+2 Not correct, stopped. Takes when
needed
Tabl. Warfarin according to
list
Cream Fenuril Skin moisturizer when
needed
Tabl. Zolpidem 5 mg 1 at nigh when needed Do not take these
Manage his drug himself. Take tablets directly from the jars. Regularly go to Warfarin
clinic. INR usually good
Knows what the various drugs are for and seem to have an eye on the time.
Has taken Morphine for 2 years because of ostomy pain. The ostomy was removed
6 weeks ago and now in a lot less pain.
After contact with the GP the morphine dose has been gradually decreased, 4 to 2
tablets last week. Believed that the increase in dose at the hospital was needed.
He has become very constipated last days. Have told the nurse last night but
nothing was done about it. Has not had bowel movements since admission
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Identified errors in medication list and DRP
• High dose Morphine
– Patient is reducing the dose, takes 1x2 at home
• ADE Constipation
– Depending on the erroneously high dose of morphine
• Unneseasary treatment
– Paracetamol has been discontinued
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Demonstration Physician meeting
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
What DRP and suggestions are suitable to put
forward to the physician?
Problem/ question Suggestion for action Resultat
High dose Morphine Decrease dose 1+0+1+1 and Dr says: gosh, how could this have
Patient is reducing the contact GP to again continue happened? The abstinence probably
dose, takes 1x2 at the dose decrease can explain his symptoms. We have
home given the dose hee had when he was
admitted last time.
Waiting for reply
I contact her GP to discuss the dose
and future plan
ADE Constipation Give the patient a single oral The Dr agree but suggest lactulose
Depending on the dose of a motility instead.
erroneously high dose stimulating medication.
of morphine (Natriumpicosulfat) and
follow up
Unneseasary treatment Remove paracetamol. If Dr agrees
Paracetamol has been needed discuss with GP
discontinued
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Video viewing and assessment of pharmacist
performance using grading criteria forms
Patient interview video viewing.
• During the video viewing complete the grading criteria form
• Discuss in group of three
Physician discussion
• During the video viewing complete the grading criteria form
• Discuss in group of three
• 60 minutes
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Group session practice
Practice in group on being the pharmacist/physician/patient
– Try to perform the sessions without interuption and
according to SOP
– Discuss what was good, bad, easy, hard
– Compare performance to the Evaluation checklist
– 60 minutes
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Summary and discussion
Next step for you?
• Do you have Adm Med Rec performed by pharmacist in
your setting, your country?
• Do you have a systematic approach
– For training?
– For practice?
• Could this be implemented in
– Practice?
– Pharmacy School?
• How can you support this?
• Prepare your own action plan
– Report back to EAHP?
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
Next step for you?
• Do you have Adm Med Rec performed by pharmacist in
your setting, your country?
• Do you have a systematic approach
– For training? For practice?
• Could this be implemented in
– Practice? Pharmacy School?
• How can you support this?
– Help from others, more experienced?
• Prepare your own action plan
– Report back to EAHP?
Lunds universitet, Medicinska fakulteten / Tommy Eriksson
