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Writing prescriptions OSCE STYLE

Learn tips for prescribing in OSCEs, avoid common mistakes, and practice with scenarios. Covers medication histories, drug explanations, and more.

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Writing prescriptions OSCE STYLE

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  1. Writing prescriptions OSCE STYLE

  2. DICLAIMER I am not a prescriber. The aim of this session is to give you insight into OSCE-style prescribing from my own experiences.

  3. You Will Need:

  4. Aims • Tips for prescribing in OSCEs • Avoiding common mistakes • Practice some scenarios

  5. Will not cover • FP 10 / Community prescriptions • How to become a perfect prescriber • Medication histories • Drug explanations

  6. THE CHART

  7. Patient Details

  8. Once Only Drugs

  9. Antibiotic Prescriptions

  10. Regular medications

  11. Prn Medications

  12. Basics • Use black ball-point pen (ideally not ink pens) • Write in block capitals • Read the question carefully • Use the BNF

  13. Internal Screams (WIKA) • Weight • Interactions • Kidney Function • Allergies

  14. Drug information • Approved name (with some exceptions) • Dose (be careful with abbreviations) • Form (tablets, oral solution, nasal spray etc.) • Route (IV, oral etc.) • Indication • Expected duration/ Review (particularly antibiotics)

  15. SCENARIOS

  16. Scenario 1 • Joseph Bloggs • DOB: 16/10/1950 • Hospital No: 1749362 • Weight 70kg • Ward: MAU • Consultant: Dr A Andee • Allergies: Penicillin (anaphylaxis) Mr Bloggs has a productive cough, fevers and chest pain. There is no evidence of any confusion. On examination, his RR 32, temp 38.2 degrees, o2 saturations 98% on room air, BP 135/80 and HR 90. There is dullness to percussion over the left lower lobe and coarse crackles. Urea=4. Dr Andee would like you to prescribe the appropriate medication according to trust guidance for community acquired pneumonia. The time is 13.00.

  17. Curb 65 CURB65score is calculated by giving 1 point for each of the following prognostic features: • Confusion (AMT < 8 or new disorientation in person, place or time) • Urea > 7 mmol/litre • Respiratory rate > 30 breaths/min • Blood Pressure < 90/60 mmHg • Age > 65 years

  18. Scenario 1 • Joseph Bloggs • DOB: 16/10/1950 • Hospital No: 1749362 • Weight 70kg • Ward: MAU • Consultant: Dr A Andee • Allergies: Penicillin (anaphylaxis) Mr Bloggs has a productive cough, fevers and chest pain. There is no evidence of any confusion. On examination, his RR 32, temp 38.2 degrees, o2 saturations 98% on room air, BP 135/80 and HR 90. There is dullness to percussion over the left lower lobe and coarse crackles. Urea=4. Dr Andee would like you to prescribe the appropriate medication according to trust guidance for community acquired pneumonia. The time is 13.00.

  19. Scenario 1 • Joseph Bloggs • DOB: 16/10/1950 • Hospital No: 1749362 • Weight 70kg • Ward: MAU • Consultant: Dr A Andee • Allergies: Penicillin (anaphylaxis) Mr Bloggs has a productive cough, fevers and chest pain. There is no evidence of any confusion. On examination, his RR 32, temp 38.2 degrees, o2 saturations 98% on room air, BP 135/80 and HR 90. There is dullness to percussion over the left lower lobe and coarse crackles. Urea=4. Dr Andee would like you to prescribe the appropriate medication according to trust guidance for community acquired pneumonia. The time is 13.00.

  20. Answer: Scenario 1 1/3/18 13.15 DOXYCYCLINE 200mg ORAL THE DOCTOR 1/3 2/3 3/3 4/3 5/3 6/3 7/3 DOXYCYCLINE 100mg ORAL 2/3/2018 3/3/2018 THE DOCTOR COMMUNITY ACQUIRED PNEUMONIA 7 DAYS

  21. Scenario 2 • Mary Winchester • D.O.B. 01/09/1960 • Hospital Number: 3743651 • Weight 60kg • Ward: 12 • Consultant: Dr Reyes • Allergies: NKDA Mary is due to have surgery later this afternoon and is expected to be in hospital for a couple of days. She normally takes 5mg Ramipril tablets every morning for hypertension. She is also complaining of a mild headache. Please prescribe a simple analgesic as required and prescribe her regular medication.

  22. Answer: Scenario 2 RAMIPRIL 5mg ORAL 1/3/18 3/3/18 THE DOCTOR HYPERTENSION PARACETAMOL 1g ORAL6 Hourly 4g 1/3/18 THE DOCTOR PAIN

  23. Scenario 3 • Derek Winters • D.O.B. 07.02.1970 • Hospital Number: 1442242 • Weight 65kg (BMI 22.5) • Ward: 11 • Consultant: Dr Khan • Allergies: NKDA Derek has been brought to hospital with a red, swollen leg and this has since been confirmed to be a distal deep vein thrombosis. This is the first time he has had a DVT and has no other risk factors. He will be given heparin for a few days and then be established on oral anti-coagulation. For now, the consultant has asked you to prescribe a stat dose of Fragmin. The time is 15.00.

  24. Answer: Scenario 3 1/3/18 15.15 DALTEPARIN 13,000 S/C THE DOCTOR SODIUM (FRAGMIN)UNITS BNF: 200units/kg every 24 hours by subcutaneous injection. Patient = 65kg Therefore: 200 units x 65 = 13000 units Note: BNF also gives 12500 units dose for people within this weight range to treat DVT. This question was designed more to get you to practice a drug calculation, however, depending on the question wording, this would also be a reasonable answer to give.

  25. Scenario 4 • Sofia Arias • D.O.B. 02.02.1948 • Hospital Number: 3388142 • Weight 57kg • Ward: 19 • Consultant: Dr Garcia • Allergies: Erythromycin Dr Garcia has asked you to prescribe her regular medications. Sofia takes Fostair 100/6, 2 puffs twice daily and salbutamol as required for her asthma. Please write the prescription accordingly.

  26. Answer: Scenario 4 FOSTAIR 100/6 (BECLOMETASONE WITH FORMOTEROL) 2 puffs INH 1/3/18 3/3/18 THE DOCTOR ASTHMA SALBUTAMOL100 MICROGRAMS 1-2 PUFFS INH 4-6 Hourly 8 PUFFS 1/3/18 THE DOCTOR ASTHMA

  27. Scenario 5 • Milo Tubbs • D.O.B. 25.08.1980 • Hospital Number: 986242 • Weight 65kg • Ward: 11 • Consultant: Mr Scott • Allergies: NKDA Milo has been recovering well after an elective operation, however, the surgical team would still like to observe him for a couple of days. He has eczema and Mr Scott has asked you to prescribe a regular emollient for Milo during his stay at hospital.

  28. Answer Scenario 5 DIPROBASE CREAM ONE APPLICATION TOPICAL 1/3/18 3/3/18 THE DOCTOR Eczema

  29. Take Home Messages • Read that question carefully • WIKA • If you mess up, it’s not the end of the world.

  30. What you need to do now • Familiarise yourself with the BNF • Practice filling out prescription charts • Eat, Sleep, Relax

  31. Any Questions?

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