Assessment Station in APIE NMC OSCE Exam
Assessment is the initial station in the APIE stations which is Assessment, Planning, Implementation and Evaluation. Assessment can be a NEWS2 Assessment, Neurological Assessment or a Community Assessment. The scenarios you can get during the assessment stations are Anxiety and Depression, Asthma, Chronic Heart Failure, Community Assessment, Ectopic Pregnancy, Fall and Fracture, Hernia, Homelessness, Pneumonia and Subural hematoma. In this article, we will discuss in detail first about NEWS2 Assessment then we will discuss about additions needed in case of a Neurological and a Community Assessment. Time limit for all types of assessment is now 20 minutes. You will be given a NEWS2 Assessment Chart or Neurological Assessment Chart or a Community Assessment Chart depending on the scenario given. Important thing is to note be tensed (eventhough not easy), take some deep breaths and try to complete whichever chart is given to you. First after introductory phase, just ask an open ended question for eg. What brought you here to the hospital?. Take your observations, chart it and then ask further questions afterwards. It is very important to verbalize NEWS2 score in NEWS2 Assessment, GCS Score in Neurological Assessment and PHQ9 Score in Community Assessment (PHQ9 will be usually given with the scenario).
Assessment Station in APIE Stations of NMC OSCE Exam
Lets see what all you need to do in a NEWS2 assessment under the following headings. You will be getting five minutes to read the scenario before entering patient room.
The scenarios you can get during the assessment stations for NEWS2 Assessment are Anxiety and Depression, Asthma, Chronic Heart Failure, Ectopic Pregnancy, Fall and Fracture, Hernia, Homelessness and Pneumonia
- Entering to the patient room, checking for scene safety, ensuring that scene is safe to approach
- Protecting the privacy and dignity of patient by closing the curtains and doors
- Doing the hand rub using seven steps of hand hygiene (meanwhile observe for any hazards (cigarete packet, glass of water, pills, sample bottle, spectacles etc) kept, if found you need to remove it after asking patient consent and should explain the consequences.
- Hello, myself ‘name of candidate’ and am your attending nurse today
- Can you tell your name please
- What can i call you?
- Can you tell me your date of birth?
- Can i confirm the same with your id tag (Name, date of birth, hospital number)
- How are you now?
- Are you comfortable?
- What is your chief concern now? or Can you tell me what happened and why are you here?
- Do you have any allergies?
- Do you have any pain now? If yes, score using pain scale (Can you rate your pain on a pain scale of 0 to 10 where 0 is the least pain and 10 is the worst pain you have ever experienced). You need to take a note of the pain score verbalized by the patient.
- If patient is on oxygen mask or cannula, ask the patient whether he is comfortable to talk? Whether there is need to raise the bed end?
- Tell the patient that i am here to take your observations ie Blood pressure, Pulse rate, respiration, saturation and your temperature, is that okay with you?
- Tell the patient that you will also need to ask a few questions about your condition later so that i can plan your care accordingly, is that okay?
- Do you need to use the toilet now?
- Tell that procedure will take another 15 minutes, is that okay?
- Have you been resting for past 20 minutes?
- Verbalize that First you are going to take clients observations, please be calm, not talking and don’t cross your legs during this time, is that okay?
- Do a hand rub before touching observations machine
- I am confirming with the examiner that these equipments are cleaned, calibrated and ready to use? (Now a days its given in the scenario that equipments are cleaned and calibrated, so no need to re confirm it)
- I am going to check your BP, which arm would you prefer?
- Do you had any surgeries in this arm?
- I am confirming that this arm is free of any infection, inflammation or lesions
- Am confirming that the bladder length of cuff is more than 80 percent of patients arm circumference and bladder width is more than 30 percent of patients arm circumference.
- I have applied cuff after locating brachial artery and 2 inches above from antecubittal fossae
- Verbalize to patient that you will have a pressure sensation while measuring blood pressure
- Meanwhile i will also be checking your oxygen saturation on your other hand, is that okay with you?
- I am confirming that the finger is free of any infection and iflammation, finger is warm not cold and clammy and there is no false nails or nail varnish
- I am checking for capillary refill in the finger by pressing tip of finger for 5 seconds and releasing it
- Capillary refill is less than 2 seconds and it is safe to check oxygen saturation in this arm
- Putting on SPO2 probe in the finger, doing a hand rub
- I will be documenting patient details, while the machine records your blood pressure, is that okay?
- Verbalize to patient – So your BP is –/– and Oxygen saturation is –% which is quite normal, am recording it in NEW2 chart (provided during exam)
- Now i will be checking your body temperature using tympanic method. It is taken in your ear, is that okay with you?
- Do you have any hearing aids? (if yes ideally you should wait 20 minutes before taking the reading)
- I am inspecting the ear for any infection, inflammation or csf drainage, its clear
- Checking Temperature after putting the disposable cap, telling the temperature to patient, discard the cap in clinical waste
- Record the temperature on NEWS2 Chart
- Next, you should state that “Now am going to check your PULSE RATE for 2 minutes”
- Tell starting now, before counting pulse, check pulse rate for one minute, check respiration for next minute
- After checking verbalize the Pulse rate and RR to patient and tell that you have checked pulse rate for one minute and respiration for another minute and verbalize findings.
- Record everything in NEWS2 chart
While taking observations, you can go through the ABCDE method of assessment through the following steps
Airway: Clear; no visual obstructions.
Breathing: Respiratory rate; rhythm; depth; oxygen saturation level; respiratory noises (rattle wheeze, stridor, coughing); unequal air entry; visual signs of respiratory distress (use of accessory respiratory muscles, sweating, cyanosis, ‘see-saw’ breathing).
Circulation: Heart rate; rhythm; strength; blood pressure; capillary refill; pallor and perfusion.
Disability: conscious level using ACVPU (alert, confusion, voice, pain, unresponsive); presence of pain; urine output; blood glucose.
Exposure: Takes and records temperature; asks for the presence of bleeds, rashes, injuries and/or bruises; obtains a medical history.
NEWS2 Calculation Phase
- If patient is on Oxygen (usually nasal cannula or mask), mark in the appropriate column in News2 chart otherwise mark air
- Fill in the AVPU, calculate NEWS2 score, fill in the monitoring frequency and need for escalation, sign, date, time
- Do a hand rub, verbalize news score to patient and tell the escalation plan according to NEWS 2 score (given in chart provided)
Further Assessment using Questions
- Now am going to ask a few more questions to you for completing my assessment, start asking following questions
- Do you have any habits like smoking or drinking alcohol? (If smoking, mention smoking cessation program)
- Do you have any lifestyle diseses like diabetes, hypertension etc? (If time permits, educate about condition)
- How is your sleeping pattern?
- How many meals do you take a day? Do you take a mixed diet? (Refer to dietitian)
- Do you have any breathing problems or associated problems? (Refer to respiratory nurse)
- Have you opened your bowel today? Have you passed urine today or after coming to the hospital?
- Are able to do your daily activities or you need any assistance for that? (Mobility issues)
One Question that covers the others, if you are running out of time
- Most important is to ask the patient – Is there anything else you want to share with me? (its a trigger to spit out anything we have missed, if you don’t have time to ask any questions after observations, you ask this one before concluding)
- So, thank you for your cooperation, i will be escalating your care as and when needed, this is your call bell, if you need any thing just press the bell, i will be around and will be happy to assist you.
- Take the obs machine with you and verbalize that you will clean it and make it ready for next use
- Re open the curtains
- Do a hand rub using seven steps of hand hygiene before leaving the room
NEWS2 Assessment Chart
Common Scenairo for neurolgoical assessment is Subdural hematoma
- Follow the same steps for NEWS2 Assessment
- Include Orientation to Time, Place and Person in introduction
- After taking Observations, start neurological examination
- Ask for any surgery in eyes or use of contact lenses -> Check pupillary reaction (tell patient you are going to flash light)
- Ask for surgery on shoulder and back
- Check power of Arms & legs by pushing and checking resistance up and down
- Record every thing in Neurological Assessment Sheet provided
- Calculate GCS Score and explain plan of care
- Ask general assessment questions including swallowing problems, breathing problems, head ache, mobility, speaking issues, bowel and bladder incontinence, habits etc
- Give call bell and instruct usage
- Do a hand rub using seven steps before leaving the room
Neurological Assessment Chart
- Main Difference in Community Assessment compared to NEWS2 are
- There will be no id band or allergy band
- There will be details about admission, medication, lifestyle, chief concern, surgery done etc in the scenario itself
- You need to orient patient to Nursing home (toilet, kitchen, play area, tv room, dining room etc)
- There will be a PHQ9 (Patient Health Questionnaire) answered and scored in the scenario, you need to address that
- State that you will introduce to other inmates
- Instruct use of call bell
- There will not be SPO2 probe in community setting
- Observation chart will be different than NEWS 2 Chart
Community Assessment Chart
Assessment is the first part of APIE Stations. Usually if you make simple mistakes, its not an issue in this station. But if you forget to verbalize score of NEWS2 Chart, GCS Score or PHQ9 Score to the patient and plane for escalation, it may result in fail.
Assessment Steps in PDF – Assessment Final Article.
Please note that in above pdf time limit is given wrongly as 15 minutes, which is now 20 minutes.
The following are the common situations in which the candidate would be deemed as a fail in Assessment Station
If the candidate fails to acknowledge the actor and/or communicate effectively. For example: there is no or minimal eye contact, has their back to the patient, mumbles or has unclear verbal communications.
If the candidate is actively dismissive of the patient’s complaint,
If the candidate fails to accurately record physiological observations on the NEWS chart.
If the candidate fails to calculate the NEWS score accurately.
If the candidate fails to conduct an A-E assessment.
If the candidate fails to escalate concerning behaviour, or a deterioration in health (significant escalation in NEWS score).
If the candidate fails to acknowledge or record the main care needs of the patient.
If the candidate openly displays judgemental behaviour about a patient’s personal characteristics (e.g., sexuality), belief/cultural/lifestyle preferences.
If the candidate actively fails to utilise appropriate PPE causing risk to themselves and the patient.
If a candidate physically causes intentional harm to the patient through restraint and/ or unnecessary procedures.
If the candidate fails to check the ID with person
Disclaimer – Click Here
We have added a video including top tips for assessment section in APIE Stations of NMC OSCE which you can watch here. Time limit is now changed to 20 minutes instead of previous 15 minutes.
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