OSCE Legal & Clinical Check (copy)

Legal Check

Is the Rx legible & written or printed in indelible ink?

Is the Rx signed by the appropriate practitioner in indelible ink?

Is the address of the prescriber present?

Is there information to identify the professional designation of the prescriber?

Is there an appropriate date and is the date on the prescription valid?

Does the prescription contain the name of the patient?

Is the address (or equivalent) of the patient present?

If the patient is under 12 does the prescription contain the patients age or date of birth?

Clinical Check

PRESCRIPTION
Are all details present to allow you to clinically check the Rx (e.g. drug name, form, strength, dose, frequency, total quantity/duration...)?

ALLERGIES:
Does the patient have any allergies or intolerances to the medicine?

DRUG
Is the medicine licensed for the indication?

CONTRAINDICATIONS
Are there any contraindications for using this drug in this patient?

CAUTIONS
Are there any cautions for this drug that are relevant to this patient?

INTERACTIONS
Are there any interactions with existing therapy?

DOSE & FREQUENCY
Is the dose and frequency licensed and appropriate for this indication in this patient eg age & weight?

RENAL
Is the prescription appropriate for the patient's renal function?

LIVER
Is the prescription appropriate for the patient's liver function?

PREGNANT OR BREASTFEEDING?
Is the patient pregnant or breastfeeding and if yes is the prescription appropriate?

FORMULATION
Is the formulation appropriate (e.g can the patient swallow tablets...)?

DURATION
Should this medication have a specific duration - if yes is it appropriate?

QUANTITY
Dose the prescription specify an appropriate quantity to supply?

COUNSELLING
State important counselling points for the patient

Define RAMPILD

Renal

Allergies

Medical History

Pregnancy

Indication / Interaction

Liver

Drug History

Schedule 2 (CD POM) Legal Check

Does the Rx have an appropriate dose?

Does the Rx specify the form (if more than one exists)?

Does the Rx specify the strength (if more than one exists)?

Does the Rx specify the total quantity to be supplied in both words and figures?

What is an example of ISBAR?

Pharmacist querying the prescription to prescriber via phone:

Good evening, my name is Kiran Anusheelan and I am a pharmacist at Kings College London Pharmacy.

Am I talking to [state the prescriber’s name]?

I have received a prescription from [state the patient’s name] who is […. years old; born on the [D.O.B] and currently lives at [state address]].

The patient has [mention Past medical history], no allergies and has previously been given [mention the drug or n/a].

The patient has been prescribed with [state the drugs/formulations on the prescription for ( … )]. E.G. Amoxicillin for Community acquired Pneumonia and Paracetamol for pain and pyrexia with discomfort].

However; I realised on the prescription the patient has been given [e.g. 125mg Amoxicillin], which is an [underdose/overdose]. [Mention the risks: This can lead to the infection not being treated; sleepiness; constipation; …].

Can you please send a new prescription with instead [e.g. 250 mg Amoxicillin]?

Thank you.

What is an example of Responding To Symptoms Consultation Framework?

Hi, my name is Kiran and I am a pharmacist at KCL Pharmacy. How may I help you?

May I confirm your name and date of birth?

SOCRATES

• Site – Where do you feel these symptoms?

• Onset – How long have you been experiencing these symptoms?

• Character – What is the pain like? An ache? Stabbing?

• Radiation – Do these symptoms remain isolated in one area or spread across your body?

• Associated Symptoms – Are there any other signs or symptoms associated with the pain?

• Time – Does the pain follow any patterns or have regular occurrences?

• Exacerbating / Relieving Factors – Does anything you do change the pain? Does it make it worse or better?

• Severity – How would you describe the severity of this pain? Can you rate it on a scale of 1-10?

Before I continue gathering information, may I ask a few lifestyle questions?

• Do you drink or smoke?

• Have you consumed recreational drugs?

• How would you describe your diet?

• How would you describe your level of activity and fitness?

• Do you have any allergies?

• Are you pregnant or breastfeeding?

• Do you take any other medication? Any herbal or over-the-counter remedies?

—

• I believe you are suffering from [...] as you display symptoms of [...].

• Do you manage your own medication? Are you able to swallow tablets or do you require a different formulation of dosage?

• This medication is indicated for [...], take this medication [...] (frequency). If you have any doubts or queries feel free to ring the pharmacy and ask us but in the meantime, you can refer to the Patient Information Leaflet for more information.

• We will monitor your [...] (blood composition levels) for any abnormalities which may potentially occur in the near future? I will signpost you to [...] (Any avenue) for further support if you have any issues.

• Do you have any questions for me? Do you have any problems with what I have said?

What is an example of Patient Consultation (Patient Education) Tool?

Hi, my name is Kiran and I am a pharmacist at KCL Pharmacy.

May I confirm your name and date of birth?

What have you come in for today? / How may I help you?

BRAN

Follow PIL sections

• The medication you have been given is [...]. It is indicated for [...], take this medication [...] (frequency).

• If you ever come across symptoms such as [...] please do not worry as these are common side effects and bring no serious harm.

• This medication lasts for [...] (duration) AND MAY REQUIRE CHECK UPS TO SEE HOW YOU ARE DEALING WITH THE MEDICATION as standard procedure.

• If you believe the treatment isn’t working or if you have any side effects, call up your GP and refer to your Patient Information Leaflet in the meantime.

• If you have any queries, feel free to contact us too!

• Do you have any questions for me? Are there any issues with the medication you still need help with?

What is an example of taking a Drug History?

Hi, my name is Kiran and I am a pharmacist at KCL Pharmacy/Hospital.

May I confirm your name and date of birth?

Hello […], I am here today to discuss your medications to ensure we have an accurate record and address any concerns you might have. Does that sound okay?

Do you have any current question or concerns regarding your medication?

Before we continue, may I have your consent to access your GP Summary Care record to help me review your medication.

Do you know your hospital/NHS number?

Do you have any allergies? Can you tell me the reaction it causes please?

—

AIM: Compare SCR with patient info provided!

Any discrepancies should be approached with: In your SCR, it says you are taking […], are you still taking it? Do you know why it was stopped?

Pay attention to dates of prescriptions too!

Do you remember any of the medication you have been prescribed? What is the dose, formulation and strength of the medication? How often + long have you been taking it / Why do you take it?

Do you know why you were taken off this medication?

Do you take these medicines yourself or do you need support?

How have you been finding it? (Adherence} Is the dosing regimen okay or do you have any problems?

Any monitoring requirements?

—

May I ask a few lifestyle questions?

• Do you drink or smoke? What do you drink/smoke?

• Do you use recreational drugs? (Frequency?)

• How would you describe your diet & level of activity on a daily basis?

• How would you describe your level of activity and fitness?

• Are you pregnant or breastfeeding?

—

Any over the counter medication you buy?

Just to make sure we aren’t missing anything can I confirm you aren’t taking any Inhalers, Creams, Patches. Eyes/Ear/Nose drops, Vitamins or Herbal medication?

—

To summarize, you’ll be taking [medication] as discussed

If you have any further difficulties, feel free to contact the pharmacy.

Do you have any questions for me at all?

Thank you for your time.

SOAP Note (Bloods)

Dear Dr…

Many thanks for your referral to review [Patient]’s blood results in line with her current medication list.

Upon review of [Patient]’s blood results, these [INCREASED/DECREASED] values indicates [Confirmation of Disease]. State timeframe in which data has changed!

—

Link [Confirmation of Disease] to subsequent symptoms patient presents.

I would advise to [STOP meds] to prevent [RISK of continued med usage]. Offer alternative med plan, specifying medication and DOSAGE. Consider creatinine clearance.

Discuss a Follow up plan. How would you like the doctor to monitor progress of patient? What specific tests would you like to repeat?

Any self care tips?

—

Apply this logic to every medication problem in question.

Please do not hesitate to contact me should you require further advice.

Yours sincerely,

Kiran

Pharmacist