The Pharmacy Examining Board of Canada

The Pharmacy Technician Qualifying Examination
Sample Stations - Part II (OSPE)

Format of Examination Stations - Part II (OSPE)

The Qualifying Examination - Part II consists of both interactive and non-interactive stations.

Each station will require that you complete one or more short tasks such as:
responding to questions from a “Standardized Patient” or “Standardized Client” or “Standardized Health Professional”
interacting with a “Standardized Patient” or “Standardized Client” or “Standardized Health Professional” to resolve a drug-related problem or ethical dilemma
responding to a message or request for information or advice
screening / evaluating new prescriptions
checking dispensed prescriptions for accuracy prior to their release

In any situation, you are expected to use your professional and/or ethical judgement, and act in the best interests of the patient, in order to provide safe and effective patient care.  In most instances, you are required to assist the client while the client is present in the station, NOT simply refer the client to another health professional nor indicate that you will call them back later with your response.

Two station examples, which are representative of the formats for three interactive stations and two non-interactive stations, are found below.

References - Part II (OSPE) Stations

(The most current edition of the following references or excerpts thereof may be provided in the stations):

Compendium of Pharmaceuticals and Specialties (CPS), Canadian Pharmacists Association (most current or second most current edition) OR relevant e-CPS monographs or excerpts.

Patient Self-Care (PSC), Canadian Pharmacists Association OR excerpts (photocopied pages).

Natural Medicines Comprehensive Database, text or web site: www.NaturalDatabase.com

Health Canada publications

Other professional references, where appropriate.

Reminder:

Part II (OSPE) examination is “open book”, but candidates may only use the references which are provided in the stations.

Candidates should become familiar with these (listed) references in order to use them efficiently, if provided.

Some of the written prescriptions in stations may have only the drug’s trade name or generic name. Note that trade and generic drug names are cross-referenced in the green page section near the front of the CPS.

Sample Stations - Part II (OSPE)

Qualifying Examination - Part II (OSPE)

SAMPLE STATION #1

Interactive Station (with a Standardized Patient) involving nonprescription medication

TITLE: Travellers’ Diarrhea

OBJECTIVES

To identify a potential drug allergy and refer patient to pharmacist to discuss the most appropriate therapy.

To answer a patient’s questions about a nonprescription medication and other options to treat travellers’ diarrhea.

COMPETENCIES TESTED

Competency 2  Professional Collaboration and Team Work

Unit 2.1 Collaborate to meet patient health care needs, goals and outcomes

Element 2.1.2
Participate in the circle of care to promote patient health and wellness.

Element 2.1.3
Cooperate with and show respect for all members of the inter-professional team.
i. make expertise available to others.
ii. share relevant information.
iii. contribute to achieving mutually determined goals and objectives.
iv. support other professionals and accept their support to optimize health outcomes.

Element 2.1.4            

Refer patients to other health care professionals when required.
i. determine if referral is necessary.
ii. collaborate with the pharmacist to identify the most appropriate health care provider for referral.
iii. recognize and refer situations requiring the knowledge, skills, and abilities of a pharmacist to the pharmacist.
iv. work with other health care providers to achieve the desired health outcomes.

Competency 7 Communication and Education

Unit 7.2  Provide information and education

Element 7.2.4
Assist patients to select and use drug administration devices, diagnostic and monitoring devices, home health aids, and other non-drug measures.

CANDIDATE’S INSTRUCTIONS

A patient is coming in to ask your advice regarding medication for travellers’ diarrhea. She is leaving tomorrow for a tropical vacation. Assist her as you would in practice.

Time Frame:  You have 6 minutes to complete this station.

SCENARIO DESCRIPTION

A young woman is busy with last minute preparations for a vacation at a coastal resort in Jamaica where she plans to enjoy the beach and take some tours. The day before leaving she goes to her regular pharmacy to ask about some non-prescription medication to treat travellers’ diarrhea, having been advised by her travelling companion, who has been in Jamaica before, that there is a high risk of getting it.

Client: Standardized Patient - Amy Kletchko, female, ambulatory, 22 years old

Behaviour, Affect and/or Mannerisms Required:

You are pleasant, excited, and have confidence in the pharmacy technician.

Client’s Opening Statement:

“Hi...I’m leaving tomorrow morning for a vacation in Jamaica. I’d like to take something along in case I get travellers’ diarrhea. My friend gave me a bottle of Pepto Bismol tablets. Would that be a good choice for me?”

Client Information (no patient record – patient gives this information on request):

Name:  Amy Kletchko
Age: 22 years old
Allergies:  acetylsalicylic acid (ASA, Aspirin) – hives and shortness of breath
Current Medications:  none
Social/lifestyle:
Non-smoker.
Moderate drinker – 3 or 4 drinks per week.

History:
Your skin burns quite easily when out in the sun.
You have purchased a good sunscreen and a sun hat.
When you took aspirin (ASA) you broke out in hives and experienced shortness of breath.
It happened when you were 9-10 years old.
You have never had allergy tests because you have not reacted to anything else or experienced these symptoms since then.
You have a MedicAlert bracelet (for your ASA allergy) – you don’t always wear it.
You try not to take medications unnecessarily – you use pressure points and drink water when you get a headache.
You have never travelled outside of Canada and the United States before.
You are going to a Jamaican beach resort for a week.
Your travel partner told you to get something to treat travellers’ diarrhea in case you get it, because it happens quite commonly in Jamaica.
Another friend gave you her unused Pepto Bismol, which she took along with her on a cruise, and suggested you might be able to use it.
You want to be sure it’s good for travellers’ diarrhea, so you are asking for some information when in the pharmacy to pick up some last minute supplies.

STANDARDIZED PATIENT (SP) INSTRUCTIONS

a) If the candidate says to avoid taking Pepto Bismol but does not explain why, the SP will ask:

“Why is Pepto Bismol not a good choice?”

b) If the candidate only refers the SP to the pharmacist, without identifying other options, the SP will ask: “What else do you have for travellers’ diarrhea?”

c) If the candidate does not discuss non-drug measures to treat travellers’ diarrhea, the SP will ask:

“Is there anything else I should do?”

d)  By the 4 1/2-minute mark, if candidate has not answered the opening question about Pepto Bismol and/or simply recommends something else, the SP will say:

“I was just wondering if Pepto Bismol would be okay (instead of buying something else).”

STATION MATERIALS

Reference:     CPS

Nonprescription Medications: 
Pepto Bismol tablets  
Imodium tablets or caplets
Kaopectate tablets  

ASSESSOR GUIDELINES FOR SCORING CANDIDATES’ PERFORMANCE

Problem Solved (full solution) if candidate:
«  Determines ASA allergy.
«  Cautions: do NOT take Pepto Bismol AND links the caution to ASA allergy.
«  Identifies other options: a product without ASA / salicylate (Imodium/Kaopectate) AND non-drug measures (fluids, electrolyte replacement).
«  Refers to the pharmacist: to determine the most appropriate therapy, including other options such as Dukoral, prescription options/antibiotics.

Solved/Marginal (partial solution) if candidate:
«  Determines ASA allergy.
«  Cautions: do NOT take Pepto Bismol, but does NOT link to ASA allergy.
«  Identifies other options: a product without ASA / salicylate (Imodium/Kaopectate) OR non-drug measures (fluids, electrolyte replacement), NOT both.
«  Refers to the pharmacist: to determine which product (Imodium or Kaopectate) is the best choice (does not mention other options).

Uncertain (unsolved/marginal) if candidate:
«  Determines ASA allergy  AND
«  Refers to pharmacist to discuss therapy, but does NOT answer patient’s questions about Pepto Bismol and other options. OR
«  Answers patient’s questions about Pepto Bismol and other options but does not refer to the pharmacist to discuss therapy.

Unsolved if any of the following apply
«  Does NOT determine ASA allergy.
«  Agrees that Pepto Bismol can be taken.
«  Simply refers patient to the pharmacist or a doctor (without determining ASA allergy or answering patient’s questions).

COMMUNICATION RATING:

Final (overall) Communication Rating is based on these four dimensions:
1. Responds to client's needs / feelings – professional / respectful.
2. Organized, logical, flexible approach – focuses the interaction.
3. Nonverbal communication – engages client / enhances dialogue.
4. Language / verbal expression clearly understood by client.

CHECKLIST 

Identify a potential drug allergy and refer patient to the pharmacist to discuss the most appropriate therapy

1. Asks about other medications, medical conditions.

2. Determines/confirms ASA allergy.

3. Cautions : Do NOT take Pepto Bismol.

4. Links Pepto Bismol caution to ASA allergy, explaining that Pepto Bismol:
  - contains a salicylate / ASA-like substance
  - may also cause an allergic reaction (as occurred previously
    with ASA)                

5. Refers to pharmacist to discuss therapy (after determining ASA
    allergy) :
  - to determine most appropriate therapy including other options
    such as Dukoral, prescription options/antibiotics
  - to determine which product (Imodium or Kaopectate) is best

Answer a patient’s questions about a non-prescription medication and other options to treat travellers’ diarrhea

6. Identifies other options :
  - a product without ASA/salicylate (Imodium, Kaopectate)
  - non-drug measures to treat travellers’ diarrhea (increased
    fluids, electrolyte beverages such as Gatorade, etc.).

7. Indicates appropriate dosing, as printed on package (for Imodium
    or Kaopectate).

8. Suggests non-drug measures to prevent diarrhea (e.g.,
    treated water/ice, peeled/washed fresh fruits and vegetables).

9. Recommends immediate medical attention for (persistent)
    diarrhea (with fever, blood in stool, abdominal pain,  persistent
    vomiting).

10. Discusses wearing a MedicAlert bracelet/ tag with (ASA)
    allergy information (at all times).

11. Simply refers to pharmacist or a doctor (without determining
      ASA allergy or answering patient‘s questions. (unsolved)

12. Agrees that Pepto Bismol can be taken. (unsolved)

RATINGS (to be based on the Assessor Information above and standard PEBC scoring guidelines)

Communications
O Acceptable
O Acceptable/Marginal
O Unacceptable/Marginal
O Unacceptable
Outcome
O Problem Solved
O Solved/Marginal
O Uncertain
O Unsolved

O Risk to Patient

Performance
O Acceptable
O Acceptable/Marginal
O Unacceptable/Marginal
O Unacceptable

O Misinformation

Qualifying Examination - Part II (OSPE)

SAMPLE STATION #2      

Non-interactive Station                                                                                   

TITLE  Checking Dispensed Prescriptions

OBJECTIVE To check dispensed medications and identify any corrections that must be made before the medications can be released.

COMPETENCIES TESTED

Competency 5  Drug Distribution

Unit: Ensure accuracy and quality of the final product.

Element: Verify the product against the prescription and /or formulation information.
i. using an independent double check.
ii. document actions taken.

CANDIDATE’S INSTRUCTIONS

1.  Before you enter the station:
Take one Candidate Answer Sheet from the folder marked “For Candidates Only”, on the door or wall outside the station. (Do NOT take anything from any other folder.)
Attach one bar code label to the Candidate Answer Sheet in the space indicated.

2.  When the start buzzer sounds:
Enter the station, find the station materials (listed below) on the desk / table and begin immediately.

3.   Do the exercise:
Read the instructions on your Candidate Answer Sheet.
Mark your answers clearly, by filling in the corresponding bubbles.

4.   When the final buzzer sounds:

Stop writing immediately.
Turn your completed Candidate Answer Sheet over (answer side down) on the desk / table, to be collected by examination staff.
Proceed to the next station, taking your calculator, pencil, notebook and barcodes with you.

Time Frame: You have 6 minutes to complete this station.           

WRITTEN PRESCRIPTIONS (only one example is provided; there will be four prescriptions in total)

Sample Rx1

Sample Label

The following dispensed products have been left for you to check before releasing them to the patient.
The written prescriptions and corresponding dispensed products are provided on the desk / table.

For each prescription, your tasks are to:
I. Check the dispensed products to identify problem(s), if any, to be resolved. Select all that apply from the choices given and fill in the corresponding bubble(s).
II. Check the prescription label to identify problem(s), if any, to be corrected. Select all that apply from the choices given.
III. If there is no problem, fill in the bubble for “No problem(s)”.

CANDIDATE ANSWER SHEET FORMAT

Q1. PRODUCT Rx1–problem(s):
Select all that apply.

O A. Medication
O B. Strength
O C. Dosage
O D. Packaging
O E. wrong quantity
O F. no problem(s) -
       product is correct

Q2. LABEL Rx1error(s):
Select all that apply.

O A. Patient name
O B. Physician name
O C. Drug name
O D. Drug strength
O E. Drug dosage form
O F.  Drug quantity
O G. Directions
O H. No problems(s) –
        label is correct

STATION REQUIREMENTS   
CPS
Printed prescriptions
Dispensed prescriptions and stock bottles