He needs to drink... OSCE added anonymously 

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

Scenario:

Mr Lou is a 78yr old male BIBA overnight with deteriorating conscious state.
He is from a HLCNH following a diagnosis of advance Lung cancer with multiple metastasis. He is not for active treatment and had been in NH for 3 months now. He is bedbound, doubly incontinent and minimal verbal cues.
His daughter is listed as the NOK on the NH papers. Her first language is mandarin but she can speak sufficient English.
She had noticed that his cognition had worsened last 3 days and is no longer able to eat.
She demanded him to be send into the hospital for IV fluids as he is not drinking.
The overnight HMO had assessed him and feels patient should return to NH with palliative care service.
He is now in SSU to be sorted as a review then discharge back to NH.
You are the ED SSU consultant in the morning.
InReach service has been contacted and the have agreed to review patient in the NH with palliative care input.
You have arranged a meeting with the patient's daughter Kim to inform her of the plan and to address her concerns.

Instructions for the candidate

You are to meet with daughter Kim.
Informed her of management plan and address her concerns.

Domains being examined

  • Medical Expertise
  • Prioritisation And Decision Making
  • Communication
  • Teamwork and Collaboration
  • Leadership and Management
  • 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

You are Kim, Mr Lou's daughter.
You are the main contact but has no formal appointment as his MPOA.
You have always been the one making decisions. There is a mother but she is very frail and have not been informed about patient's deterioration, you do not want her to know for fear she will not cope with the stress.
You feel that it is inhumane not to provide your father with any fluids or food in one way or the other even if he can no longer eat. That you do not want him to be thirsty or hungry or in pain.
You understands that his disease is advance but feels he is suffering because the NH is not giving enough care.
You have not met with any palliative care team in the community and the GP is never around.
You have been told to sign an advance care plan for your father but did not expect that it means no fluids/feeding given.
Father was struggling in pain but staff had refused to give him any analgesia.
You are unhappy about the care given and wants your father to be hospitalised for IV fluids and pain relief.
You should be accepting of return to NH the candidate is able to provide clear and reassuring instructions and explanation but insist on wanting fluids be given to your father , ie s/c fluids, morphine etc.

For the examiner

Candidate should demonstrate:
ability to clarify concerns and issues
ability to demonstrate empathy/compassion
explain what it means for end of life care/ palliation
Provide alternative solutions to the issues.
Liaising with allied health and community services

Domains Assessment Objectives

Medical Expertise

Prioritisation And Decision Making

Communication

Teamwork and Collaboration

Leadership and Management

Health Advocacy

Professionalism

Other Assessment Notes


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