Home OSCE Practical Examination APIE – IMPLEMENTATION, NMC OSCE

APIE – IMPLEMENTATION, NMC OSCE

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IMPLEMENTATION STATION

Implementation Station is the third stage within the APIE framework, with a designated time limit of 15 minutes. This station involves interacting with either a real patient or a manikin.

During this phase, participants are tasked with the administration of oral medication, armed with a comprehensive drug chart detailing crucial information such as weight, height, allergies, stat medications, PRN medications, and regular medications. The patient or mannequin assigned here is the same as in the assessment and planning station. In this role-playing scenario, participants are expected to draw upon their skills and knowledge to administer oral medications accurately. Additionally, they must ascertain the patient’s potential allergic reactions to any prescribed medication.

Typically, a prescription chart will contain three or four medicines, among which there might be one the patient is allergic to or one with an incorrect prescription or dose. Participants are required to identify and omit these problematic drugs, administering only those that are due and clearly specified.

Key considerations during the Implementation Station include:

1. Articulating and explaining the prescription aloud while preparing the medicine.

2. Verifying the validity of the prescription and reporting any errors to the prescriber.

3. Confirming the timeliness of medication administration, taking into account the patient’s allergy status. If an allergy is identified, omit the medication with the appropriate code and report the prescription’s illegibility to the prescriber.

4. Checking the prescribed route of administration, and if it is not oral, stating the intention to administer the specific medicine after completing the oral medications.

5. Consulting the British National Formulary (BNF) before administering any drug to obtain essential drug details.

6. Investigating if there are precautions to be observed before administering a specific medicine, with a list of medicines and their required precautions available in the course room.

7. Confirming whether the medicine has been previously administered, particularly for PRN medicines, to avoid potential overdose. Additionally, verifying oxygen and IV therapy by cross-referencing the prescription, dose, and batch number.

Furthermore, participants must ensure adherence to the ten rights of medication administration:

1. Right Patient

2. Right Drug

3. Right Dose

4. Right Route

5. Right Time

6. Right Patient Education

7. Right Documentation

8. Right to Refuse

9. Right Evaluation

10. Right Assessment

PROCEDURE

Begin by entering the patient’s room and assess the scene for safety, ensuring it is safe to approach.

Maintain the patient’s privacy and dignity by closing curtains and the door.

Perform hand washing using the seven steps of WHO hand hygiene.

Introduce yourself, stating, “Hello, I’m [your name], your attending nurse today.”

Request the patient’s name and inquire about their preferred name.

Ask for the patient’s date of birth.

Verify the patient’s details by cross-checking with their ID tag, specifically checking their full name, date of birth, and hospital number.

Inform the patient of your purpose: “I am here to administer your medications due at [specified time].”

Inquire about any medication allergies, and if applicable, ask about the reaction to those medications.

Check if the patient is currently experiencing pain and, if so, inquire about the pain level on a scale of zero to ten.

Determine if the patient requires pain medication and explain that you will check the medication chart for any prescribed prn pain medication.

Ask about any swallowing difficulties and whether the patient has had something to eat.

Inquire if the patient needs to use the toilet and inform them that the procedure will take approximately 15 minutes.

Ensure the patient is in a comfortable position.

Inform the patient that you will check the drug trolley for their medications and invite them to call or use the call bell if needed.

Perform hand hygiene, don PPE and unlock the drug trolley, and inspect the medications.

Read aloud the medication chart, including patient details, admission information, and relevant medical data. Thus; Patient name, DOB, Hospital number, Admission date, Consultant name, prescriber’s bleep number, Height, Weight to help calculate drug dosage eg: weight below 50 kg Tab Paracetamol cannot be administered.

Pay special attention to any allergic medications mentioned in the chart.

If oxygen is prescribed and the patient is using nasal cannula, assess oxygen saturation, and adjust as necessary.

Check the prn medication section for previous administrations; if a pain medication has been given within the past 4 hours, withhold it.

Review regular medications, omitting any wrongly prescribed, illegible, or omitted medications, and document with appropriate codes.

Before administering the first drug, verify the patient’s identity using their ID band, checking their name, date of birth, and hospital number.

Explain the purpose of the medication to the patient and mention any major side effects using BNF.

While handling the tablet, check for expiry both outside and inside the container on the literature, transfer it directly to a cup without touching, and provide it to the patient with water or juice.

Confirm that the patient has swallowed the medication.

Administer medications one by one, signing after each administration.

In the event of an error, verbalize what actions to be taken in real-life scenarios.

When striking off an entry, use a single line, put your signature below, and verbalize the action taken.

Ensure that not administered medications are clearly listed at the back of the medication chart with appropriate reasons, avoiding the use of codes (e.g., patient already received pain medication, incorrect dose, or wrong timing).

After administering all medications, conduct a recheck if time permits, lock the medication trolley, express your intention to clean and prepare it for subsequent use.

Inform the patient that all prescribed medications have been administered.

Hand over the call bell to the patient, emphasizing its use in case of adverse reactions such as breathing difficulties or rashes, reassuring immediate assistance.

Restore the room to its original state by opening the curtains.

Discard PPE and used items. Do hand hygiene using the seven steps of WHO, and exit the room.

NOTE THE FOLLOWING

Prioritize patient identification again before drug administration.

Inquire about any swallowing difficulties and confirm the patient has swallowed the medication.

Remain vigilant for allergies, patient weight, and accuracy of prescriptions.

Adhere to a minimum four-hour gap between successive administrations of similar pain medications, such as Paracetamol.

Be mindful of stat medications already administered.

Seek clarification from the examiner regarding oxygen saturation during oxygen therapy. Verify blood sugar levels before dispensing anti-diabetic medications and assess blood pressure and pulse rate levels before administering anti-hypertensive medications.

If uncertain about any prescribed medication, refrain from administration, verbalize the reason for hesitation, and communicate your intention to consult with the doctor before proceeding.

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