APIE introduction webinar slides 

Introduction to assessment by OSCE trainer

A TO E ASSESSMENT| NEW TOC| OSCE 2021| 

Marking Criteria

  • Time Limit: 20 mins
  • 5 mins to read the scenario before entering the patient room
  • Scenario
    • Hospital Settings
      • Pneumonia
      • Subdural Hematoma
      • Hernia (Dying patient?)
      • Asthma
      • Chronic cardiac failure (dying patient?)
      • Ectopic pregnancy
      • Fall and fracture
      • Homelessness
      • Anxiety and depression
      • Dementia? Confusion? Leg ulcer? Diabetes? 

    • Community Settings
      • Anxiety and depression
      • Community assessment
      • UTI? 
  • Assessment Tools
    • NEW2 Assessment (info)
    • Neurological Assessment （GCS)
    • Community Assessment (PHQ9)
      • I am going to speak to your GP about your condition
      • I am going to refer you to your community mental health team for further assessment.
      • I am gonna contact your relatives to visit you more if it is OK
      • I am going to contact a psychiatrist to prescribe an antidepressant
      • I am going to reassess your condition in next revisit in a week.

Points to Note

  • Count pulse and respiratory rate for a full one minute
  • Looking for cues for e.g. jug of water, candy kept for patient nil by mouth, inhalers, cigarettes, hearing aid, dentures, walking stick, mobile phones
  • Always ask patient if they have any needs or questions
  • A to E assessment
    • Airway
    • Breathing
    • Circulation
    • Disability
    • Exposure
  • Vital signs
    • temp
    • BP
    • pulse
    • SpO2
    • RR
  • PPE? Covid protocol

Marking Criteria

Introductory Phase

  • Assesses the safety of the scene and the privacy and dignity of the patient.
    • Ensure scene safety
      • I am checking for scene safety, I can see there is no slips or fall hazards, I am happy to proceed
    • Protect patient privacy (closing the curtain and doors)
      • I will make sure the curtains are closed, the door is closed in order to provide the privacy and dignity of my patient. 
  • Cleans hands with alcohol hand rub, or washes with soap and water and dries with paper towels, following World Health (WHO) guidelines
    • *No rubbing your wrist
    • look for traps (cigarette packet, glass of water, pills, sample bottle, spectacles etc), ask for patient consent to remove it and explain consequences.
  • Introduces self to person.
    • Hello, I am Vicky, I am your nurse today. I am here to do an A to E nursing assessment. Is that okay?
    • Before I proceed, can you tell me your full name please? What can I call you?
  • Checks identity (ID) with the person (the person’s name is essential, and either their date of birth or hospital number) verbally, against wristband (where appropriate) and documentation.（？）
    • Can you tell me your date of birth?
    • Can I confirm that with your id band? (Name, date of birth, hospital number)
    • That matches the record
  • Checks for allergies verbally and on wristband (where appropriate).
    • I can see that you have an allergy bracelet, are you allergic to any food, drug, or latex?
    • What reaction do you get from that?
    • I can see that you have a white wristband, do you have any allergies that you are aware of at all?
    • Perfect, so you have got the right wristband.
  • Gains consent and explains the reason for the assessment.
    • “[Preferred name], I will be taking a set of observations, which includes your blood pressure, respiratory and pulse rate, temperature and oxygen saturation. Then I will ask you a couple of questions regarding your activities of daily living so we could plan for your care. Is that alright?”
  • I can see that there are a pair of glasses, are they yours?
    • Do you need it during the assessment?
    • alright, I will just put it here so that you can reach it if you need it.
  • COMFORT/POSITION/PAIN
    • “Are you comfortable with your position? Are you in pain? (if yes, “When did you last
    • take your pain medication? From 1-10, with 1 as the lowest and 10 as the highest, how would you rate your pain? Do you want me to get pain medication for you?”)
    • “This assessment will take around 10-15 minutes, do you want to go to the toilet first?”
    • “If in the middle of the assessment, you will feel uncomfortable, don't hesitate to tell me, okay? Then we will continue with the assessment when you feel better”
  • Airway
    • I'm going to start with your airway
    • I can see you're clearly talking to me with no difficulty, so I can say that your airway is clear, with no form of visual obstructions.
  • Breathing
    • Next, I'm going to move on to your breathing, can you take a deep breath for me please.
    • For breathing, there are no audible respiratory noises.
    • 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).