ORAL SKILLS COUNSELLING EXAMINATION (OSCE)

Anticoagulant Treatment (Warfarin)

Name of PRP : _________________________ Date : __________

Name of Examiners : _________________________
Peer-review score : _________________________
Peer-review done by PRP : _________________________

Counseling points Category Score

Introduction name & PRP status I
Why the need to counsel/discuss C
What is warfarin & indication C
How it works - Function of Vit K I
Dose titration
- Individualised dose titration, tailored according to own INR C
- Show the different tablet strengths & colours C
- Regular blood checks to know INR I
What is INR C
- Patient target & duration C
- What it means if INR or INR C
When to take - same time each day (6pm) C
- Missed dose Mx (take on same day, skip dose if next day) C
- If skip dose, record time & date into last section B
- NOT to double dose C
Explain that a number of things can change INR C
- Examples B
- Emphasize to come back for appointment to check INR C
- TCA to INR clinic & clinic system (when, where) B
Possible side effects to monitor
- List out the side effects from the book C
- What it means if occur (most probably INR too high) C
- What to do if occur (INR clinic/GP/A&E) C
Potential drug interaction will increase/decrease INR I
- Ask if patient takes any other medications/ supplements/topical C
application/herbs (ask for names)
- If pt on Rx/supplements/other products which can affect INR - I
what to do, write in the booklet
- Consult dr/pharmacist if want to start new supp/herbs C
- Inform GP/dentist/surgeons/retail pharmacists about warfarin tx C
before taking new Rx (esp. Abx, painkillers)
- If headache/pain take Panadol. If need stronger painkiller - C
consult Dr
Potential interaction with food B
- Keep diet consistent I
- Foods in Vit K/can affect INR moderate, consistent portion C
- Foods in Vit K can take without worries B
Interaction with alcohol ( INR in acute alcohol binge) C
- limited amount (eg 1 pint of beer /1 glass of wine daily) C
- monitor for signs of bleeding C
Avoid activities high risk activity which may cause injury, I
- Esp. be aware of intracranial bleeding
Child-bearing age female patient discuss with Dr if any plan to C
conceive (Ignore this C
if scenario is
not relevant)

General points Category Score

Ask for feedback B
Language, layman terms B
Flow of counselling B
Eye contact B
Preparation of tools (warfarin booklet, vege leaflet, TCA note) B

Marking scheme:
a. C = 3 pts, I = 2 pts, B = 1 pt
b. Fail if more than 3 Cs missed
c. Overall passing mark = 70%

No. of Cs missed : ___________

Total score achieved : ___________/ 93
Percentage achieved : ___________ % (Pass OR Fail)

1st review by Ryzah

nd
2 review by Yinkey/Ginni (Sept 2010)
rd
3 review by Yinkey & all clinicals (Feb 2013)