Prescribing in Practice Essay

This assignment delves into the analysis of a prescribing episode within a clinical practice context, while emphasizing safe prescribing practices outlined in the Nurse Prescribing Formulary (NPF, 2013-2015 – Research Paper Writing Help Service). In order to critically examine and reflect on my role as a Community Practitioner Nurse Prescriber (CPNP), I will utilize Gibbs’ (1988) reflective model and a structured approach that incorporates a consultation model (see Appendix 1, Fig 1). The significance of prescribing in the nursing profession gained prominence following the Royal College of Nursing’s (RCN) initial discussion in 1980 and was later solidified as a cornerstone of healthcare delivery after being incorporated into the government agenda, notably following the Cumberlege report in 1996.

The report identified the imperative for nurses to become prescribers, particularly in community settings, to enhance patient care, ensuring safe and practical access to medications (Nuttal, 2008). Subsequently, the “Medicinal Product Prescribing Act” of 1992 marked a significant shift by authorizing nurses as prescribers, a move reinforced by the Crown Reports of 1999, which advocated for health visitors (HV) to be authorized to prescribe from a limited list, termed the Nurse Prescriber’s Formulary (NPF) (DH, 2004).

Scenario:

To maintain confidentiality, all names have been changed in accordance with the Nursing and Midwifery Council (NMC) guidelines (2008). The following scenario pertains to an experience during a morning baby clinic, where I worked alongside my mentor. A mother, Lisa, brought her 4-month-old infant, James, for a routine weight check. During our discussion about James’ weight progress, Lisa mentioned his persistent issue of dry, scaly skin on his scalp since birth. She further explained that the skin on James’ scalp occasionally developed crusty, patchy rashes, causing him discomfort and restlessness at times. Edwards (2010) underscores the importance of holistic assessments when engaging with clients, as the issue presented can significantly impact the quality of life for both the child and the family. As a student under my mentor’s supervision, we initiated a holistic assessment of James and concluded with a prescription decision. I initiated the assessment by asking open-ended questions about James’ general health and inquiring if Lisa had any concerns. She affirmed that James had been in good health since birth, and to ensure the accuracy of the information provided, I repeated it back to her. As a student practitioner prescriber, adhering to assessment frameworks and consultation models is crucial for enhancing and honing my skills (Nuttall, 2008).

The Consultation:

The consultation model in prescribing practice serves to guide nurses in diagnosing and subsequently prescribing the appropriate treatment. Various consultation models with normative or descriptive characteristics are employed in practice. For this case scenario, I will focus on Roger Neighbour’s 1987 consultation model. Neighbour (2005) delineates his model as a journey marked by checkpoints, with the initial connection being a pivotal point where the client establishes a rapport with the practitioner. This is crucial, followed by summarization, handing over, safety netting, and housekeeping. It is important to note that effective communication skills play a vital role in the consultation process, and nurse practitioners do not require fundamentally different communication skills compared to other professional prescribers (While, 2002).

However, While (2002) found that the need for an appropriate environment that guarantees privacy and confidentiality could pose a potential barrier during consultation, particularly for those working in clients’ homes. I chose Neighbour’s 1987 model for its consistency and ease of application in various circumstances. Moreover, it emphasizes building a relationship with the client through empathy and acknowledges the need for a balanced relationship between the practitioner-prescriber and the client (Tate, 2010). Another advantage of this model is the housekeeping stage, where practitioners can reflect on and address any unresolved issues before concluding the consultation (Neighbour, 2005). Despite opting for the Neighbour 1987 model, I will proceed to explain the process and prescribing decision using the principles of a good prescribing pyramid (see Appendix 1, Fig 2) (NPC, 1999).

Step 1 – Assessment: Consider the Patient:

According to Neighbour (1987), the initial step is establishing a connection with the client, but in a noisy clinic environment, this proved challenging. Despite this obstacle, I managed to find a more private seating area where I could engage in a discussion with Lisa to determine the need for a physical examination of James. As James was under 16 years of age, I obtained verbal consent from Lisa, who was his biological parent, in accordance with NMC guidelines (2013). To proceed further, I employed the mnemonic OLDCARD to assess James, with Lisa’s assistance, aiming to interact with her and elicit any physical or affective changes.

Bryans (2000) suggests that during the assessment, practitioners should leverage knowledge, experience, recognition, and prioritization. To conduct a holistic assessment and identify symptoms necessary for a diagnosis, I felt the need to ask Lisa additional questions after observing the identified symptoms and conducting a physical examination. This led to my conclusion that James was suffering from cradle cap, a form of seborrheic dermatitis primarily affecting the scalp with patches of thick scaling and, at times, yellow crusts (Sheffield et al., 2007). During assessments, it is crucial to rule out other conditions, as cradle cap can progress to atopic dermatitis or fungal infections such as tinea capitis or be easily misdiagnosed as crusted scabies (Yoshizumi and Harada, 2008). Continuing my assessment, I confirmed that none of these conditions were present in James’ case.

Family history was another vital aspect of the assessment. Lisa mentioned that her husband, James’ father, had suffered from atopic eczema since childhood. This information was significant because conditions like atopic eczema (dermatitis) are often hereditary (National Eczema Society, 2011). Atopic dermatitis or eczema is a chronic inflammatory skin disorder characterized by pruritic skin that typically appears on the face, neck, elbows, or knees, caused by a dysfunction in the skin barrier (NICE, 2013).

Step 2 – Which Strategy?:

After discussing the case with Lisa and under my mentor’s supervision as a CPNP V100, I made a prescribing decision based on the physical examination and the information provided. I diagnosed James with cradle cap (seborrheic dermatitis) (NICE, 2013). Furthermore, Lisa confirmed that James had no allergies and was not on any medication. To alleviate James’ discomfort and restlessness, I decided to prescribe an emollient and a bath additive. Pendleton et al. (1984) recommend that practitioners ascertain client expectations and consider alternative treatment options before prescribing. According to NICE (2013), greasy emollients and soap substitutes or bath additives effectively remove scales, and regular washing of the scalp with gentle brushing can help loosen the scales. However, after a careful examination of James’ scalp revealed no evidence of infection, there was no need to refer him to a General Practitioner (GP).

Consider the Choice of Product:

Practitioners should use the mnemonic ‘EASE’ (NPC, 1999) to choose appropriate, cost-effective products for clients.

• E: How effective is the product?
• A: Is it appropriate for the client?
• S: How safe is it?
• E: Is the prescription cost-effective?

Under my mentor’s guidance, I consulted the Nurse Prescribers Formulary (NPF) and decided to prescribe Oilatum Junior bath additive and cream as I believed this combination would be more effective for James’ treatment. Additionally, the packaging, which features a pump action, was appropriate and reduced the infection risks associated with emollients and various types of containers (NPF, 2013-2015 – Research Paper Writing Help Service). When determining the prescription products and quantities, I also considered Lisa’s requirements. According to NICE guidelines, emollients should be prescribed in large quantities, typically 250-500 grams per week, and are cost-effective (NICE, 2007). When prescribing emollients, it is essential to discuss possible side effects with clients, parents, or carers. While these products are generally considered safe, it is important to note that bath additives can leave the skin slippery after bathing the infant (BNFC, 2014). Therefore, educating the parent/carer on product usage and making them aware of potential risks and side effects is essential when prescribing products, particularly for infants.

Negotiate a Contract:

Courtenay and Griffiths (2005) advocate for viewing the prescribing process as a shared decision-making process between the client and the prescriber, with the prescribing decision representing a contract. Therefore, it was crucial to consider Lisa’s satisfaction with my decisions throughout the process. Effective communication skills and the ability to identify appropriate therapeutic treatments were paramount for achieving these goals. Throughout the process, I believe that Lisa felt empowered, as I entrusted her with the responsibility of applying the emollients to James’ skin (Baird, 2001). As I am not yet a medical prescriber, my mentor wrote the prescription for Lisa’s son, and we provided her with information leaflets regarding seborrheic dermatitis for further guidance.

Review:

Following Neighbour’s (1987) consultation model, this step encompasses safety netting and the follow-up of the consultation and potential outcomes. Together with my mentor, we scheduled a follow-up appointment in ten days to assess James’ progress and the effectiveness of the treatment. This review in ten days allows practitioners to identify any further concerns from the parents and potential side effects of the treatment (DH, 2010b).

Record Keeping:

In accordance with Nursing and Midwifery Council (NMC) guidelines (2006), it is the practitioner’s responsibility to maintain accurate records, including prescription details in the infant health record (NPC, 1999). I ensured that the prescription details and consultation information were entered into the general computer system within four hours after the consultation, and the GP was informed of the consultation and prescribed products. NMC guidelines (2006) stipulate that consultation and prescription details should be recorded in the computer system within forty-eight hours, with exceptions for special circumstances.

Reflection:

Employing Gibbs’ reflective cycle during the consultation process with Lisa’s infant allowed me to identify both positive and negative aspects of the scenario and reflect on my actions. The final stage of Neighbour’s consultation model, housekeeping, also provided an opportunity for me to reflect on my prescribing decision and the consultation process as a whole. Throughout the entire process, I believe that I made safe and effective decisions, even during moments of nervousness. My mentor’s positive feedback further validated my performance. One challenge I encountered was the environment; the baby clinic was bustling and noisy, making it difficult to find a private area for the consultation. Nevertheless, I can reflect on such issues to improve my future prescribing practice.

Conclusion:

This experience has been invaluable in my role as a V100 prescriber, allowing me to utilize specific tools like the consultation model and the steps of good prescribing. It also provided an opportunity to apply effective communication skills, medical knowledge, and legal considerations to ensure safe and effective prescribing practices. As a new CPNP, I can leverage various assessment tools based on consultation models and decision-making frameworks to support my practice, all while maintaining a partnership approach that addresses client needs and concerns. This experience has been pivotal in my educational journey as a V100 nurse prescriber.

References:

– Get top-rated homework assistance online by professional writers. Free of AI and Plagiarism.
– Get top-rated homework assistance online by professional writers. Free of AI and Plagiarism.
– Get top-rated homework assistance online by professional writers. Free of AI and Plagiarism.
– Get top-rated homework assistance online by professional writers. Free of AI and Plagiarism.
– Get top-rated homework assistance online by professional writers. Free of AI and Plagiarism.
– Get top-rated homework assistance online by professional writers. Free of AI and Plagiarism.
– Get top-rated homework assistance online by professional writers. Free of AI and Plagiarism.
– In need of help writing an essay online? Top Research Essay Writers or similar Custom Writing Services?

Order | Check Discount