Year 2 station 16h

Year 2 OSCE 2013
Station 16
Candidate Instructions

Clinical scenario
You are a junior doctor at a general practice.
Mr Tate, aged 56 has atrial fibril ation. He was started on warfarin 12
months ago and needs a sample of venous blood to be taken to check
his INR.

Task
In a total of five minutes:
• briefly explain the procedure to him [Mr Tate’s left arm wil be represented by a venepuncture trainer. You should obtain the specimen from this trainer but communicate with the simulated patient as if you were actual y taking blood from his arm.] [You should imagine that you are alone in the consulting room with Mr Tate. The examiner and any other individuals in the room are not part of the scenario and should be ignored once your ID has been checked.] Simulated Patient Information

Thank you for supporting this important School of Medicine final exam, your
contribution is greatly appreciated. Each candidate wil be with you for x minutes with
a 2 minute break in between. Your comfort is important to us. If you have any needs
during the exam please tel the examiner in your room and attention wil be sought.
There wil be scheduled breaks of y minutes during each run of the exam for brief
refreshment or bathroom stops.
The candidate has the following scenario and task
Clinical scenario
You are a junior doctor at a general practice.
Mr Tate, aged 56 has atrial fibril ation. He was started on warfarin 12 months
ago and needs a sample of venous blood to be taken to check his INR.

Task
In a total of five minutes:
• briefly explain the procedure to him [Mr Tate’s left arm wil be represented by a venepuncture trainer. You should obtain the specimen from this trainer but communicate with the simulated patient as if you were actual y taking blood from his arm.] Instructions for simulated patient
[You should imagine that you are alone in the consulting room with Mr Tate. The examiner and any other individuals in the room are not part of the scenario and You co ntrol ed and you are not overly concerned about your condition. You have come to your regular general practice for your INR check. This requires a sample of your blood be taken, which you do every 4 weeks. The candidate wil need to take some more blood from you to check on how the blood thinners are working. Your left arm wil be represented by a special trainer, from which the candidate wil actual y take the blood. Make it clear to the candidate that you are right handed. You have no al ergies or other medical conditions you are aware of. If asked about medications you may say, “whatever my doctor has me on, I take”. Provided the candidate explains what they are doing, cooperate with their requests. If they start to do the procedure without talking to you, angrily say ‘what are you doing?!’ You stil have a smal fear of needles and would appreciate some comfort on this point. When the candidate inserts the needle, wince a little, but say ‘it’s not too bad, you carry on doc’. Examiner Instructions
• Please verify that you are examining the correct student by checking the name on the student’s ID card against the name on the score sheet, as the student enters the room. The candidate has the following scenario and task
Clinical scenario
You are a junior doctor at a general practice.
Mr Tate, aged 56 has atrial fibril ation. He was started on warfarin 12 months
ago and needs a sample of venous blood to be taken to check his INR.

Task
In a total of five minutes:
• briefly explain the procedure to him [Mr Tate’s left arm wil be represented by a venepuncture trainer. You should obtain the specimen from this trainer but communicate with the simulated patient as if you were actual y taking blood from his arm.] • You are an observer examiner. Please do not speak to the candidate, except as described on this sheet. Please do not provide prompts on the station [You should imagine that you are alone in the consulting room with Mr Tate. • Stay out of the line of sight between the candidate and the patient. Do not The examiner and any other individuals in the room are not part of the scenario and provide any positive or negative feedback to the candidate. should be ignored once your ID has been checked.] • Please interrupt the candidate if they begin to label the venepuncture
specimen, instructing them the nurse wil do so after they leave. • Please record your observations on the scoresheet as you go, as discussed
• The candidate has only 5 minutes to complete the station. When the PA rings, they should be asked to finish and leave immediately. • You have two minutes between candidates to finalise your scoring and ‘reset’ • Simulated patient (male in 50s) lying in a hospital bed with a sheet and pillow simulated left venepuncture arm in place • Extra pil ow for under arm • Steel equipment trol ey with: o antibacterial hand gel o non-sterile gloves in the standard sizes o a kidney dish o tourniquet o alco-swabs o cotton bal s or gauze swabs o blue-top vacutainer tube, one per candidate plus spare o vacutainer needle, one per candidate plus spares o vacutainer barrels, one per candidate plus spares o sharps container • Laminated completed pathology form with the patient’s sticker, ‘INR’ in the tests section and ‘progress on warfarin’ in the clinical notes section • Large waste bin for simulated blood and equipment • Aprons • Goggles • Fake blood • IV pole • Tape • Pil ow slip to cover fake blood on IV
OSCE Score Sheet

Station Number:
Student: <Insert>

Examiner’s name: .……………………………………………………………….
Simulated patient (actor’s) name: .…………………………………………….
PLEASE MAKE ONE TICK IN
No. Assessment Item (details)
EVERY ROW
Introduction
Identifies patient
(name, address, date of birth, UR number, confirms test) Infection control
(washes hands with gel before, after, uses gloves) Preparation of patient
(determines patient’s preferred arm, locates venepuncture site, discusses options for increasing blood flow to area (tapping, hanging over edge of bed), cleans site) Procedure
(bevel up, connects tube, loosens tourniquet after flow established, adjusts needle to ensure blood flow, adequate specimen) Post sample collection
(detaches tube, inverts, applies swab, removes needle, applies pressure) Sharps disposal
Aftercare
(appropriately advises patient on aftercare (pressure application), attempts 10 CLARITY
11 WARMTH
(engagement, compassion, care for patient) Author
Learning outcomes assessed
1. Describe the anatomy of the common sites for venepuncture
2. Discuss the contra-indications, potential risks and complications associated with
venepuncture
3. Prepare a patient appropriately for venepuncture in relation to appropriate
explanation, confirmation of consent and patient positioning
4. Locate a suitable site for venepuncture
5. Prepare the environment and equipment to perform phlebotomy safely
6. Utilise the vacutainer device competently for the efficient col ection of venous
blood
7. Articulate the correct 'order of draw' when multiple samples are required
8. Demonstrate safe and effective patient after care (including monitoring site post
venepuncture)
9. Apply standard precautions through effective hand hygiene, use of appropriate
personal protective equipment, as wel as safe disposal of sharps and other clinical
waste
10. Utilise aseptic technique effectively to minimise septic complications from
venepuncture
11. Meet accompanying documentation requirements (including completion of
laboratory request forms and correct label ing of specimens)

References/information source

Source: http://gums.org.au/wp-content/uploads/Year-2-station-16H.pdf