Is it safe? OSCE by James Chua

 
You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.

Scenario:

You are doing your morning EECU round and come across a 18 yo man who was admitted for observation after taking a polypharmacy overdose comprising of paracetamol, ibuprofen, alcohol and his sister’s antidepressants the previous evening. He has remained stable overnight with a normal conscious level and vital signs. He is now keen to go home. You have been asked to review him and decide if he is safe to be discharged. The mental health team are not in yet.

Instructions for the candidate

Please assess the patient and relay your impression to the mental health nurse when she arrives.

Domains being examined

  • Medical Expertise
  • Communication
  • Health Advocacy
  • Professionalism
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

Patient:
You are a 18 yo man who has recently moved from the country to study at University in town. You are currently living with your sister and her family. You are finding some difficulty adjusting to city life and you have not made any friends yet after leaving your mates back in the country. You are studying naturopathy at the university and find your classmates all a bit odd, with an over-representation of vegans. You have found the coursework more challenging than it should be. Your sister tries to be supportive but she is struggling with balancing her work with her family life and has mental health issues to deal with of her own.

You took the overdose because you felt that you have “had enough” last night. You are uncertain if you wanted to kill yourself but presented to hospital when you experienced some abdominal pain after taking the overdose (10 tabs of each medication). You feel better after having some antacids and a good night’s sleep.

You have no previous medical or psychiatric history, do not take any recreational drugs, but likes a drink or two on your own to combat your loneliness. You have no immediate plans to hurt yourself but are uncertain about how to get past your current situation. You feel you may well make a better attempt at ending your life should you attempt it again in the future.

Mental Health nurse:
Ask for a short summary of the doctor’s impression with particular emphasis on suicide risk assessment and urgency for review.

For the examiner

Candidate needs to have an appropriate approach to the patient and demonstrate a systematic approach to risk assessment. This is not a full psychiatric assessment and the purpose is to quickly assess risk and initiate appropriate plans after medical clearance. There needs to be appropriate and professional communication demonstrated towards the layperson and fellow medical professional.

Domains Assessment Objectives

Medical Expertise
need to demonstrate system for assessing suicide risk, familiarity with restrictive practices

Communication
uses appropriate language when communicating with patient and another health professional

Health Advocacy

Professionalism

Other Assessment Notes


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