NMC ToC OSCE: Implementation (APIE) Station

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Introduction

The Test of Competence (ToC) is the assessment used by the Nursing and Midwifery Council (NMC) to determine whether internationally educated nurses (IENs) and returning-to-practice nurses possess the skills, knowledge, and values required to register and practise safely in the UK.

The implementation station forms the third part of the APIE structure. The APIE stations are four scenario-based stations that relate to the four stages of the nursing care process:¹

This station is a practical, active station where nurses must safely and correctly administer prescribed medication within 15 minutes. Candidates will encounter the same patient condition and actor from the assessment station.¹

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Medication administration

Medication administration is a routine but critical intervention performed by registered nurses. It is emphasised in Future Nurse: Standards of Proficiency for Registered Nurses by the NMC.²

At the point of registration, the nurse must be able to safely perform accurate checks, including transcription and titration, of any direction to supply or administer a medicinal product, while exercising professional accountability to ensure safe medication administration.² Nurses must also follow the legislative frameworks and government guidelines that govern medicines management in the UK.³

The consequences of incorrect medication administration can be severe or fatal; therefore, nurses must demonstrate safety and competence during the NMC exam.

The implementation station assesses a candidate’s ability to:

• Correctly read and interpret a medication prescription
• Demonstrate clinical reasoning and decision-making
• Administer medications safely and accurately
• Communicate effectively with patients
• Adhere to legal and professional guidelines
• Complete accurate documentation
• Follow infection control best practices

Medication administration records

In the NMC exam, candidates are provided with a medication administration record. There are two types:

• Hospital-based
• Community-based

Templates are available on the NMC Test of Competence website as part of the supporting documents.⁴ Candidates are advised to familiarise themselves with the layout before the exam.

The same principles apply to both scenarios; however, in community settings, prescriptions are written as individual patient-specific directions.

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Implementation station

The implementation station must be completed in 15 minutes and will typically involve a patient actor. Time management is essential, and candidates should adopt a clear, structured approach including:

• Key principles and patient safety
• Reading and confirming the prescription
• Dispensing the medication correctly
• Administering the medication
• Completing documentation

Candidates will receive a scenario briefing and a medication administration record and will be asked to administer medications at a specified time. They will have access to a medication trolley and electronic access to the British National Formulary (BNF).

Key principles

As with the assessment station, candidates must demonstrate the following at the start of the station:

• Maintain the patient’s privacy and dignity
• Perform hand hygiene using the WHO’s 7-step technique
• Introduce themselves (“Hello, my name is…”)
• Confirm patient identity and allergy status using the wristband and medication record
• Explain the intervention and gain informed consent

To support time management, assess the patient for pain or nausea early, as this may influence decision-making, especially regarding as-required medications.

Reading the prescription

A critical part of the implementation station is correctly reading and verifying the medication administration record.

Candidates should:

• Systematically review each page of the medication administration record
• Identify medications due at the scheduled time
• Identify medications not due or not to be given

From the first page of the record, verbalise the:

• Patient’s details
• Prescriber’s details
• Confirmation that the patient status is complete and signed
• Medication risk factors

For each due medication, verbalise the:

• Patient’s name, date of birth, hospital number
• Date
• Drug name
• Dose
• Time of administration
• Route
• Start and finish date
• Prescriber’s signature, bleep, and printed name

If all of the above are correct, the candidate must state that the prescription is “clear, valid, and legible“.

Dispensing the medication

Once the chart is verified and medications confirmed, the candidate should decontaminate their hands before dispensing, find the correct medication from the trolley and verbalise the:

• Drug name (confirm it matches the chart)
• Stock dose
• Number of tablets to achieve the prescribed dose
• Expiry date

Medications should be dispensed using:

• A non-touch technique
• Separate pots for each medication

Administering the medication

After dispensing, the candidate should return to the patient to administer the medication, ensuring they:

• Decontaminate hands before patient contact
• Complete a second identity check
• Explain each medication’s purpose
• Provide relevant information, including side effects
• Offer water
• Confirm that the patient has swallowed the tablets

Note: Failure to explain a medication’s purpose or giving incorrect information results in a critical fail.

Documentation

Documentation is a critically assessed part of the station, and candidates must ensure they have enough time to correctly sign for the medications they have given. Any errors or omissions in documentation will result in an automatic fail, as it is an unsafe practice.

Ensure that:

• You only sign after confirming the patient has taken the medication
• You sign the correct medication at the correct time
• You sign the front page administration log, which includes name, initials, signature and base
• Any omitted medication is recorded using the appropriate omission codes and documented correctly on the final page

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Omitting medications

Candidates must exercise clinical judgment when deciding whether a medication is safe and appropriate to administer. Some medications may be deliberately unsafe in the scenario, and candidates are expected to recognise this and omit the medication.

Candidates should consider:

• If the medication is indicated for the patient’s condition
• If the patient is allergic
• If there are any contraindications (e.g. anticoagulants in a subdural haematoma)
• If the patient had a previous dose, and if sufficient time has passed (important for as-required medications)
• The blood pressure and pulse for antihypertensives and cardiac drugs

Document any omitted medications correctly using the relevant code found on the second page of the medication administration record, and complete the omitted medication box on the final page.

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Using the BNF

Having a good knowledge of key medications is essential for the exam. However, candidates will have access to an electronic copy of the British National Formulary (BNF).⁵ The BNF is a comprehensive database that provides healthcare professionals with information on indications and uses, doses and frequency, dispensing, and administering medications.

As registered nurses, candidates should be familiar with the uses of the medication, normal dosage, side effects, and any contraindications.³ Nurses should not dispense or administer any medication without knowing this information.

Candidates are advised to check any medications they are unsure of using the BNF during the exam.

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Ending the station

Leave time to end the station professionally by:

• Checking that the patient is comfortable
• Asking if they have any questions
• Ensuring they have the call bell or GP and NHS 111 number in the community
• Performing final hand hygiene

If time allows, double-check all documentation, as documentation errors are a common cause of failure.

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Summary

The NMC OSCE implementation station assesses a nurse’s ability to demonstrate safe medication administration. Success relies on:

• Correctly reading and interpreting the medication administration record
• Making safe clinical decisions
• Having a good knowledge of key medications
• Following the six rights of medication administration
• Verbalising actions clearly and logically
• Completing accurate and legible documentation

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Editor

Dr Jamie Scriven

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References

1. NMC. Test of competence 2021. Nursing: Test specification for candidates. 2021. Available from: [LINK].
2. NMC. The Code. 2018. Available from: [LINK].
3. Lister S, Hofland J, Grafton H, et al. The Royal Marsden Manual of Clinical Nursing Procedures. 10^thEdition. 2021. Oxford: Wiley-Blackwell.
4. NMC. Test of Competence 2021: Supporting Documents. Available from: [LINK].
5. British National Formulary (BNF). Available from: [LINK].

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