Pharmacy Practice Scenarios 401


PP Assessment roster: link (updated with changes to group III times)
PP Assessment student information: link

Timetable of scenarios: link

Mental Health

1. Patient with insomnia who has developed tolerance to temazepam
2. Prescription: Olanzapine

Weight Management

3. Patient starting on Xenical
4. Prescription: Sibutramine

Contraception

5. Patient taking contraceptive pill, doxycycline - has diarrhoea with Xenical
6. Prescription: Levonorgestrel

Formulations

7. Patient developing nitrate tolerance
8. Prescription: Fentanyl patch

Narrow Therapeutic Index Drugs

9. Patient developing lithium toxicity after addition of enalapril
10. Webster-pak containing warfarin, digoxin, perhexiline, HCT and alendronate

Revision

Know which scenario to expect from the patient's initial presentation

CMI print list

A list of what to print out in preparation for the PP test

Assessment Scenarios

1. Breastfeeding mother on POP and antibiotics
2. Patient on warfarin requesting Optifast/Optislim
3. Breastfeeding mother runs out of POP, requests old COC pill

Additional tips for PP Assessment

• Introduce yourself but don’t force an introduction when there is no opportunity.
• If dispensing a prescription, confirm the patients’ identify.
• If customer is requesting a product, confirm who it is for.
• If you want to look at dispensing history, ask patient’s permission. The dispensing history/background information/prescription will be provided for you to look at 5 minutes before your session. You will need to return this back to the supervisor before you leave the holding room. The dispensing history and background information will also be available in the assessment room.
• Provide summary in an appropriate manner – this is done to ensure patient understanding not simply as an exercise.
• Use self-care cards in an appropriate manner. Do not just hand it to the customer without any supporting advice.
• Speak slowly and clearly.
• Listen to the patient’s response before asking another question. Respond to patient’s queries in an appropriate manner.
• Do not refer to GPs indiscriminately. Referral should not be made without sound reasons and where the pharmacist is able to use their knowledge and judgement to make interventions.
• If providing a product, please give directions on dose, frequency of use, duration etc.

Assessment feedback

- One of the areas where many students performed below par was in medication history taking. All tutors commented on the general lack of a systematic approach to history taking which led to students not being able to extract complete information from the patients and therefore led to, in many cases, the provision of inappropriate advice. This does not mean that patients are ‘bombarded ‘ with a list of closed questions; it does mean that you ask what is necessary to obtain the correct picture. ‘Don’t make assumptions’ comes into this too.

- History taking is an extremely important part of counselling as without this step, we, as health professionals, will not be able to assess the problem, or make appropriate recommendations or provide adequate advice. Dr March is an assessor for the Pharmacy Board oral exams, and noted that this was also a weakness in a number of interns, leading to the intern having to resit the assessment.
- - Active listening is another area where improvements can be made. In many cases, inappropriate advice was given because information provided by customer was not taken into account due to inactive listening or due to lack of attention. It is important that when you take a medication history and obtain information, you take on board the information provided, use the information and your knowledge to provide advice or to make recommendations.
- - Another area where performance could have been better was in the area of ensuring patient understanding. In many instances, a summary of important counselling points was not provided especially when a lot of information was conveyed to the patient. This led to lack of patient understanding or confusion about the information provided.
- - Another concern was that students often provided very superficial information. We are meant to be medicine specialists; if information provided is not extra to what could be picked up more generally, then we are failing our clients/ patients. It is of course necessary to pitch information to the perceived level of the consumer’s understanding. Back to the point relating to active listening. Careful listening will quickly bring you into accord with what the patients understand.

The average mark for the Pharmacy Practice assessment was 9.3. The lowest mark was 3.2 and the highest mark was 13.7

Previous material
PP1 Scenarios: antibiotics and contraceptive pill; counselling levonorgestrel
PP2 Scenarios: sertraline and alpralozam; counselling olanzapine
PP3 Scenarios: enalapril and lithium; webster-pak (warfarin, digoxin, perhexiline, thiazide)
PP4 Scenarios: isosorbide mononitrate, GTN, diltiazem; fentanyl patch (increased quantity)
PP5 Scenarios: metformin and metoprolol; counselling sibutramine
PP Assessment Preparation Guide