SCA practice case · Telephone consultation
Older adults: SCA practice case
A district nurse’s request for medicines at home
Telephone consultation
Older adult patient
Someone else speaking
Hard
Older adultsLong-term conditions & cancerProfessional & ethical dilemmas
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Harold Bennett · 84-year-old man
Setting
Telephone consultation with a district nurse who is calling from the patient’s home on a Friday afternoon.
Past history
- Metastatic prostate cancer with bone metastases; oncology discharged to community palliative care 7 weeks ago
- Palliative care register; preferred place of care and death recorded as home
- ReSPECT form completed with him 6 weeks ago: not for CPR, not for hospital admission unless comfort cannot be achieved at home
- Hypertension
Medication
- Morphine sulfate modified-release 30 mg twice daily
- Morphine sulfate oral solution 10 mg/5 mL: 10 mg when required
- Paracetamol 1 g four times daily
- Macrogol one sachet twice daily
- Bisoprolol 2.5 mg once daily
- Simvastatin 20 mg at night
- Tamsulosin 400 micrograms once daily
Allergies
No known drug allergies
Recent notes
Last GP home visit 12 days ago: frail, eating little, comfortable, had capacity; anticipatory medicines ’to be arranged’ but none prescribed. eGFR 54 three weeks ago. No lasting power of attorney recorded. Lives with daughter Karen. District nursing visits daily this week. Message from reception at 3.20pm Friday: ’DN Sister Okafor at the house, asks GP to ring re just-in-case medicines and syringe driver, family upset.’
Reason for contact
Telephone call to the district nurse, Sister Angela Okafor, who is at the patient’s home.
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
Anticipatory prescribing is easy to do by rote and that is the trap. The nurse needs a prescription, but the station is about individualised prescribing for a man who can no longer swallow his opioid, a family split by an earlier bereavement, and a decision that belongs to neither child. Gather a structured account, look for a reversible cause of the restlessness, prescribe proportionately, commit to seeing him today, and support the colleague who is standing in the hallway.
The guidance behind it
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