Role Play A – Hospital consultation warfarin therapy

Pharmacy professionals brief

A 55 year old patient has been admitted to your hospital diagnosed with a DVT in the left calf. He/she has been initiated on warfarin and you have been asked to see them to talk through the warfarin counselling but have been warned that the patient is reluctant to take it.

The focus is not to give a detailed warfarin counselling session.

Please share these instructions with patient and observer: For this consultation assume the welcoming and introduction has been done. Focus on the central part of the consultation using appropriate questioning (information gathering) to find out what the patient knows about warfarin and their concerns/beliefs of treatment. Use explanation and planning whilst considering building the relationship throughout.

Starter for ten if helpful…….”So, you’ve been prescribed warfarin for a DVT, tell me what you know about warfarin”

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Role Play A – Hospital consultation warfarin therapy

Patient briefYou are a 55 year old patient who has been admitted to hospital with a DVT. You have been in hospital for several days now and the consultant has prescribed warfarin.

Here are some answers to the questions you may be asked:

You have never taken warfarin but know it a little bit about it as your sister took it. You know it ‘thins the blood’.

You don’t want to take warfarin because you have no fixed abode at the moment and from what you remember your sister had to have her blood monitored regularly. You feel worried because you have no idea where the clinic is, you don’t have any means of transport and you feel as though you may get the tablets mixed up (you seem to remember lots of different colours)

You can be open about not wanting to take the tablets from early on in the consultation.

The object of this scenario is for the pharmacy professional to be non-judgemental about your concerns about warfarin and empathetic to your situation. They should offer some options for you before agreeing a plan.

You take no other medication You have no pets You move around staying with friends as you have lost your home You drink about ten bottles of wine a week

Role play B – Hospital/community/primary care – Asthma

Pharmacy professionals brief

You are asked to see a patient (on the ward to take a medication history/ in the community pharmacy or GP practice for a medicines review/- please agree a location as a group) to discuss their regular asthma medicines. The patient was admitted to hospital with an asthma attack and has been prescribed a course of oral prednisolone tablets.

The focus is not to check inhaler technique

Please share these instructions with patient and observer: For this consultation assume the welcoming and introduction has been done. Focus on the central part of the consultation using appropriate questioning to find out how the patient was using their asthma medicines previously and what they understand about their medicines. Use explanation and planning whilst considering building the relationship throughout.

Starter for ten if helpful…….”So, tell me which medicines you were taking for your asthma before you went into hospital”

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Role play B – Hospital/community/primary care – Asthma

Patient brief

You are Jo(e), a 31 year old and have suffered with asthma since childhood. Lately you have suffered a lot of stress at work and feel very anxious all the time. (Try to look anxious: maybe clasp hands tightly; frown; speak quickly)

The pharmacy professional would like to know what medication you have been taking and how you use it. This is the first time you have been in hospital with your asthma for 10 years.

Here is some information to help you answer questions but only offer this information if asked:

You use a blue inhaler and take two puffs when you need to, to help you breathe. You are currently using this 2-3 times a day

You also use a Qvar 100 inhaler (you call this the brown puffer) - you should take one puff twice a day but stopped using it two months ago.

You stopped using your preventer as you don’t want to keep filling your body full of steroids. You are unaware that prednisolone is a steroid.

Asthma control – you wake up coughing very early on about 4 mornings each week.

Alcohol – you don’t drink alcohol You have never smoked You don’t have any pets You don’t take any other medicines

Role Play C – Community/ Primary Care – Type 2 diabetes

Pharmacy professionals brief

A patient has asked to speak with you about their medicines for Type 2 diabetes. The patient was diagnosed a month ago and their medicines record states they have been taking Metformin 500mg three times a day for three weeks.

Please share these instructions with patient and observer: Start at the beginning of the consultation (welcome and introduction) and move on to establish the agenda for the consultation. Use appropriate questioning to gather information from the patient. Use explanation and planning whilst considering building the relationship throughout.

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Role Play C – Community/ Primary Care – Type 2 diabetes

Patient brief

You are Sam, a 46 year old with type 2 diabetes. You have been referred to the pharmacy professional because you have had some problems with your medication.

Here is some information to help answer questions but only offer this information if asked:

You were diagnosed with ‘diabetes’ 1 month ago on receiving your results from a general ‘MOT’ from your GP (general blood pressure and blood test)

You are concerned about diabetes and don’t know much about it. You don’t understand why you have it as no one in your family has diabetes. You don’t understand what it means.

You take your Metformin 500mg tablets regularly three times a day (one with breakfast, one with lunch and one with evening meal as informed) and have had terrible diarrhoea since. You feel embarrassed and want to stop taking them.

Alcohol – you don’t drink alcohol Smoking – you have never smoked Exercise – you don’t do any regular exercise Blood pressure and cholesterol – The GP said both were a little bit high.

Role Play D – Community – OTC advice

Pharmacy professionals briefIt is a busy Thursday morning and you go out onto the medicines counter to help out. A young woman appears and is a little anxious. She has a packet of cigarettes in her hand. She requests a cough medicine for her child.

Please share these instructions with patient and observer: OTC consultations are generally quite short so start at the beginning of the consultation (welcome and introduction) before moving to appropriate questioning to gather information from the parent.

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Role Play D – Community – OTC advice

Patient briefYou have come to the pharmacy for a bottle of cough medicine for your child. You’ve had a stressful morning and not much sleep the night before so you appear a bit anxious. You’ve just had a cigarette outside and still have your cigarettes in your hand.

This information may help you answer specific questions at points in the consultation. Only provide this information if asked:

You would like a cough medicine for your son who is 3 years old The cough started about 2 and a half weeks ago when he caught a cold it sounds very

dry and tickly, he is not bringing up any phlegm The cough is much worse at night and last night neither of you got much sleep as he

coughed until he vomited He is not wheezing He is drinking normally but is not eating as much as usual He doesn’t have any fever He has had all his vaccinations You don’t have any pets

Smoking: you try to smoke outside as much as possible but you must admit that sometimes it’s too cold and when you are tired and stressed you just want a cigarette to calm you down. You never smoke in the children’s bedrooms but sometimes in the lounge.

Role Play E – Community – Smoking cessation advice

Pharmacy professionals briefA customer has come into the pharmacy to buy paracetamol 500mg tablets. You notice that they are also looking at the nicotine replacement therapy products and reading a leaflet. Tips:Consider how you will open up the conversation about smoking cessation advice

Please share these instructions with patient and observer: OTC consultations are generally quite short so start at the beginning of the consultation (welcome and introduction) before moving to appropriate questioning to gather information.

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Role Play E – Community – Smoking cessation advice

Patient briefYou are 32 years old and have come to the pharmacy to buy paracetamol 500mg tablets but while you are at the counter you see a leaflet about giving up smoking and a stand with nicotine replacement products on. You know you should give up but not sure you want to. You’ve given up briefly before but with little success as your heart wasn’t really in it. You enjoy smoking and as you don’t drink alcohol you see it as your one treat and stress reliever.

This information may help you answer specific questions in the consultation:

You smoke between 10 and 15 cigarettes each day, in the car on the way to work, in your breaks at work and then in the evening once you have put your 5 year old son to bed

You have a new partner who is very anti-smoking and he has been putting pressure on you to quit

You know that it is not particularly good for your health but you don’t smoke that many and never around your son

You do not take any medication other than the combined oral contraceptive and the odd painkiller for a headache

You do not drink alcohol You walk your son to school and swim with him once a week