He315icacuk Outline Prescribing in the OSCEs Anatomy of the Drug Chart Using the BNF Prescribing Medications Prescribing IV Fluids Outline Prescribing in the OSCEs Anatomy of the Drug Chart ID: 1012660
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1. Prescribing TutorialHussein ElghazalyHe315@ic.ac.uk
2. OutlinePrescribing in the OSCEsAnatomy of the Drug ChartUsing the BNFPrescribing MedicationsPrescribing IV Fluids
3. OutlinePrescribing in the OSCEsAnatomy of the Drug ChartUsing the BNFPrescribing MedicationsPrescribing IV Fluids
4. Prescribing in the OSCEsUnlikely to be a station on its own.Most likely scenario: after history/ examination.May be part of a clinical skills station e.g. IV fluids.
5. Prescribing in the OSCEsUnlikely to be a station on its own.Most likely scenario: after history/ examination.May be part of a Clinical Skills station e.g. IV fluids.Example: HistoryThis patient presented with SoB. Take a history and prescribe an appropriate medication.
6. Prescribing in the OSCEsUnlikely to be a station on its own.Most likely scenario: after history/ examination.May be part of a Clinical Skills station e.g. IV fluids.Example: ExaminationThis patient presented with SoB. Perform a respiratory examination and prescribe an appropriate medication.
7. Prescribing in the OSCEsUnlikely to be a station on its own.Most likely scenario: after history/ examination.May be part of a Clinical Skills station e.g. IV fluids.Example: Clinical SkillsThis patients needs IV fluids. Prescribe fluids in their drug chart and set-up an IV infusion.
8. Prescribing in the OSCEsThey could ask you to prescribe it on an iPad/ write it down on a piece of paper.Furosemide, 40 mg, oral, once a day ORThey can ask you to fill in a drug chart:
9. Prescribing in the OSCEsYou do not need to remember the doses *You may need to work out the medication by yourself, or the examiner will tell you which medication to prescribe.If you need to work it out yourself:It will be something really easyUse the BNF to find the appropriate medication* Some drugs are worth remembering for the OSCE and written. The main one to remember is Adrenaline.
10. OutlinePrescribing in the OSCEsAnatomy of the Drug ChartUsing the BNFPrescribing MedicationsPrescribing IV Fluids
11. Anatomy of the Drug ChartPatient DetailsRegular PrescriptionsOnce Only PrescriptionsFluid PrescriptionsOxygen Prescription
12. Patient Details* Tip: If you’re given a drug chart in the OSCE, check the ‘Previous Adverse Reactions’ part of the patient’s drug chart before you prescribe any medication.*
13. Regular PrescriptionsPatient DetailsDate and TimeNameDoseRouteFrequencyMedicationYour Name + Signature
14. Regular PrescriptionsDifferent drug charts have different structures.But they all have the same main components.
15. Regular PrescriptionsDifferent drug charts have different structures.But they all have the same main components. FrequencyAbbreviationstat once only once a dayO.D.twice a dayB.D.S.three times a dayT.D.S.four times a dayQ.D.S.five times a dayevery X hour(s)/minute(s)/day(s)/month(s)over X hour(s)/minute(s) As required, maximum FREQUENCYPRN, max X g/24h
16. Once Only Prescriptions
17. Fluid Prescriptions
18. Oxygen Prescriptions
19. OutlinePrescribing in the OSCEsAnatomy of the Drug ChartUsing the BNFPrescribing MedicationsPrescribing IV Fluids
20. Using the BNFYou’re not expected to know the doses for OSCEs.You will have access to the BNF (most likely electronic) in your stations, if required.Two Approaches:Search the condition (if you know the diagnosis)Search the drug itself (if you know it, or if told by the examiner)
21. Using the BNFMrs. Margaret Jenkins (DOB: 20/08/1930) is an 88 year-old lady who became acutely breathless and is coughing up pink frothy sputum. She has a past medical history of hypertension, diabetes and acute coronary syndrome and was diagnosed with left ventricular systolic dysfunction 2 weeks ago.On examination, she has bilateral basal crackles as well as sacral and peripheral oedema.Diagnosis?
22. Using the BNFMrs. Margaret Jenkins (DOB: 20/08/1930) is an 88 year-old lady who became acutely breathless and is coughing up pink frothy sputum. She has a past medical history of hypertension, diabetes and acute coronary syndrome and was diagnosed with left ventricular systolic dysfunction 2 weeks ago.On examination, she has bilateral basal crackles as well as sacral and peripheral oedema.Diagnosis?Acute Heart Failure/ Acute Pulmonary Oedema
23. Using the BNFSearching the condition
24. Using the BNFSearching the condition
25. Using the BNFSearching the condition
26. Using the BNFSearching the drug
27. Using the BNFSearching the drug
28. Using the BNFSearching the drug
29. Using the BNFSearching the drugDrug: FurosemideDose: 40 mg (20-50mg accepted)Frequency: Once DailyRoute: IV
30. Using the BNFSearching the drugDrug: FurosemideDose: 40 mg (20-50mg accepted)Frequency: Once DailyRoute: IV
31. Using the BNFPhysical CopyIf you are given a physical copy of the BNF, the process is identical.The only difference is that, instead of searching the condition/ drug, you will need to check them in the index.
32. OutlinePrescribing in the OSCEsAnatomy of the Drug ChartUsing the BNFPrescribing MedicationsPrescribing IV Fluids
33. Essentials of Every Prescription - ChecklistThe DatePatient ID (Name and Hospital No.)The DrugName and Formulation (if applicable)DoseFrequencyRoutePrescriber’s Name and Signature* If you’re given a drug chart in the OSCE, check the ‘Previous Adverse Reactions’ part of the patient’s drug chart before you prescribe any medication.
34. Things to keep in mindWrite in block capitalsUse the generic name not brand name of the drug. The only exceptions:InsulinAnti-epileptic drugs (e.g. phenytoin)Anti-psychoticsInhalersFor doses, accepted abbreviations are g (grams) and mg (milligrams).Micrograms must be written in full (Not µg or mcg)‘Units’ must be written in full
35. Prescribing Medications: Example 1You take a history from Mr Jason Anderson, a 29 year-old man who has come in with chest pain, preceded by fever, muscle ache and a sore throat. A diagnosis of acute pericarditis is made. Mr Anderson is admitted to the ward for observation and requires regular ibuprofen. Prescribe regular ibuprofen to the patient.
36. Prescribing Medications: Example 1Ibuprofen, 400mg, oral, three times a day.
37. Prescribing Medications: Example 1Ibuprofen, 400mg, oral, three times a day.IBUPROFEN400 mgYour name and signatureP.O31/3/19Jason Anderson1/1/1990
38. Prescribing Medications: Example 2When you get to the ward that morning, Mr Anderson is in a lot of pain. You are decide to prescribe co-codamol (30/500) once only. He also says that he couldn’t sleep overnight due to the pain and so you decide to prescribe paracetamol as required. Prescribe both medications to Mr Anderson.
39. Prescribing Medications: Example 2Co-codamol (30/500), 2 tablets, oral, once only.31/3/1911:30Co-codamol (30/500)2 tabletsORALName and Signature
40. Prescribing Medications: Example 22) Paracetamol, 1 g, as required, maximum 4 times per day.Paracetamol1gYour name and signatureP.O31/3/19Jason Anderson1/1/1990PRN for pain, max 4g/24 hr
41. OutlinePrescribing in the OSCEsAnatomy of the Drug ChartUsing the BNFPrescribing MedicationsPrescribing IV Fluids
42. Prescribing IV FluidsOne of the clinical skills stations can be setting-up an IV infusion.This may be accompanied by prescribing fluids.IV fluids have a specific section in the drug chart, so make sure you prescribe there.The prescription should include:Date of AdministrationRoute of AdministrationTotal volume to be administeredRate of infusionApproved generic name of the fluidApproved generic name of any drug added
43. Prescribing IV FluidsNormal Saline20 mM KCl in Normal Saline
44. Prescribing IV Fluids: Examples Prescribe 300 mL of IV normal saline to Mr Anderson over 6 hours.A routine ECG revealed that Mr Anderson has broad QRS complexes and tented T-waves. U&Es indicate hyperkalaemia. Prescribe an infusion of 10 Units of Insulin (Actrapid) in 250 mL of 10% Glucose over 30 minutes.
45. Prescribing IV Fluids: Examples31/3/1911:000.9% Sodium Chloride300 mL50 mL/hName and Signature Prescribe 300 mL of IV normal saline to Mr Anderson over 6 hours.
46. Prescribing IV Fluids: Examples31/3/1911:0010% GLUCOSE250 mLOver 30 minutesOR500 mL/hName and Signature2) A routine ECG revealed that Mr Anderson has broad QRS complexes and tented T-waves. U&Es indicate hyperkalaemia. Prescribe an infusion of 10 Units of Insulin (Actrapid) in 250 mL of 10% Glucose over 30 minutes.INSULIN (ACTRAPID)10 units
47. Prescribing: Question 1Prescribe gliclazide to a 45 year-old patient with uncontrolled T2DM on the ward.
48. Prescribing: Question 1Prescribe gliclazide to a 45 year-old patient with uncontrolled T2DM on the ward.
49. Prescribing: Question 2Prescribe an appropriate medication to a patient with Cushing’s syndrome.
50. Prescribing: Question 2Prescribe an appropriate medication to a patient with Cushing’s syndrome.
51. Prescribing: Question 2Prescribe an appropriate medication to a patient with Cushing’s syndrome.METYRAPONE250 mgYour name and signatureP.O31/3/19Jason Anderson1/1/1990
52. Prescribing: Question 3Prescribe an appropriate medication to a 25 year-old patient with hypothyroidism.
53. Prescribing: Question 3Prescribe an appropriate medication to a 25 year-old patient with hypothyroidism.LEVOTHYROXINE SODIUM100 microgramsYour name and signatureP.O31/3/19Jason Anderson1/1/199030 mins before breakfast
54. Prescribing: Question 4Prescribe insulin to a patient with T1DM.
55. Prescribing InsulinInsulinExampleOnset of ActionPeak EffectDurationShort-ActingAspart (NovoRapid)10-20 mins1-3 hrs3-5 hrsIntermediate-ActingIsophane (Humulin)1-2 hrs4-12 hrs14-24 hrsLong-ActingGlargine (Lantus)3-4 hrsNo clear peak22-24 hrs
56. Prescribing InsulinThere is no ne way of prescribing insulin.It needs to be prescribed in the Drugs that Require Monitoring section of the drug chart.Titrated according to the blood glucose levels.Knowing which insulin to give and what doses to administer is complex and is very unlikely to come up in the OSCE or written.
57. Extra Practice
58. Thank you for listeningAny Questions?
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