Comprehensive Analysis of the OSCE Assessment

This essay critically examines my performance during the Objective Structured Clinical Examination (OSCE) assessment, focusing on the utilization of the National Early Warning Scores (NEWS) escalation strategy as a track and trigger tool (NICE, 2007). The analysis will lead to recommendations supported by evidence, emphasizing the ABCDE approach employed in the OSCE.

Introduction

The ABCDE assessment is a crucial tool used to evaluate critically ill patients, covering Airway, Breathing, Circulation, Disability, and Elimination (RCUK, 2005). It provides a systematic approach to assessing the severity of a patient's condition, addressing life-threatening issues promptly (Grindrod, 2012).

During the OSCE assessment, I ensured to maintain a patient-centered approach, respecting Mrs. Jones's dignity and obtaining her consent (NMC, 2008).

Consent and Standard Precautions

Obtaining informed consent is essential to ensure patients fully understand proposed assessments (NMC, 2008). Although I obtained verbal consent during the examination, it would have been more appropriate to secure consent at the beginning of our interaction to ensure clarity and accountability. Additionally, I adhered to standard precautions, using alcohol-based hand rubs to prevent cross-contamination (NPSA, 2008; DOH, 2009).

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ABCDE Assessment

Airway: The assessment of Mrs. Jones's airway revealed a patent airway with no audible noises, indicating clear passage (RCUK, 2010). She could effectively clear secretions independently, contributing to adequate oxygenation (Jevon, 2011).

Breathing: I assessed for hypoxaemia by examining her oral mucosa for central cyanosis (O'Driscoll et al., 2008). Respiratory rate was accurately measured for 1 minute (Hunter, 2008), indicating a rate of 24 breaths per minute, outside the normal range of 14-18 breaths per minute (Mallett & Doherty, 2001). This raised respiratory rate generated a score of 2 on the NEWS chart (NICE, 2007).

Moreover, I should have observed accessory muscles to assess work of breathing (Esmond, 2003). Oxygen saturation levels were at 93%, slightly below the normal range of 94-98% (BTS, 2008). Administering 2L of oxygen via a nasal cannula helped raise saturations within the target range (BTS, 2008).

Circulation: Mrs. Jones presented with irregular radial pulse, prompting an ECG that confirmed atrial fibrillation (AF). Her capillary refill was slightly prolonged, and blood pressure was 115/85. I did not calculate pulse pressure or arterial pressure. Temperature was within the normal range (36.3°C). Low urine output, equivalent to <0.5mls/kg/hr, signaled cardiovascular compromise (Dutton, 2012).

Disability: Using the AVPU scale, Mrs. Jones displayed responsiveness (Palmer et al., 2006). The Glasgow Coma Scale could be used for a more comprehensive assessment (NICE, 2007). Her blood glucose levels were within the normal range.

Exposure: A thorough examination revealed no signs of phlebitis, rashes, erythema, or pressure sores. However, assessing for sacral edema is essential, especially considering the patient's heart failure risk (Porth, 2007).

Care Escalation

Documentation on the NEWS chart indicated a score of 7, signifying marked deterioration in the patient's condition. In such cases, it is imperative to initiate care escalation, including contacting the medical registrar and considering transfer to a higher-level care facility. I utilized the SBAR (Situation, Background, Assessment, Recommendation) briefing model to provide a concise handover to the registrar, although improvements in structuring the handover are needed.

Conclusion

The ABCDE assessment framework serves as a vital tool for healthcare professionals in promptly identifying and addressing life-threatening conditions. In this OSCE assessment, it helped guide interventions and referrals, preventing further deterioration. Continuous improvement in assessment techniques, consent, and structured handovers is essential for providing optimal patient care.