Independent Prescribing Case Study

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Case Study for Independent Prescribing

There are many definitions of Independent prescribing, the Department of Health (2006 para 7 & 8)) working definition is: ‘Independent prescribing is prescribing by a practitioner (e.g. doctor, dentist, nurse, and pharmacist) responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing. In partnership with the patient, independent prescribing is one element of the clinical management of a patient. It requires an initial assessment, interpretation of that assessment, a decision on safe and appropriate therapy, and a process for ongoing management. The independent prescriber is responsible and accountable for at least this element of a patients care’ The aim of this case study is to focus on my future role as an independent prescriber. I have applied the seven principles of good prescribing (NMC 1999) and supported the decision making process with the use of Barbers model (Barber1995). As previously stated within the introduction I will reflect on the process using Gibbs model of reflective practice (Gibbs 1988), (appendix 1). In my role as a specialist nurse I am involved with caring for patients within a community setting and providing a holistic assessment of their needs. This can involve assessing patients as a result of a supported discharge from secondary care or referral from General Practitioners (GP’s) for issues related primarily to their cardiac condition, their general overall health and any other health related issues. These assessments can take place within the patient’s home or within a clinic setting. These assessments are quite commonly carried out with very little prior knowledge regarding the patient and this is currently an area under review. For the purpose of this case study I will look at a lady who attended a clinic session within a GP’s practice. This lady was referred to the clinic for an annual review of her coronary heart disease (CHD), when she attended it was obvious from the onset that this patient had been wrongly coded by the practice and did not have a diagnosis of CHD. For the purpose of this case study I will refer to the patient as Betty. Despite this error, I continued to discuss with the patient any other health related issues that she may have. At this point she disclosed that she felt that she was suffering from incontinence. On further verbal discussion it became obvious that the lady appeared to be describing symptoms of a urinary tract infection (UTI). Normally I would have referred this lady back to the GP but as an error had been made with her referral I decided it would be appropriate to assess the patient at this appointment initially. Previously in situations like this it would not have been unusual for a GP to generate a prescription, following an assessment by a member of the nursing staff. But as I am not yet an Independent Prescriber, nor am I working within the framework of a clinical management plan as a supplementary prescriber, this practice is illegal. I am accountable for my own practice and it is clearly outside the boundaries and legislative framework for me to ask another health care professional to prescribe for a patient that they have not seen or assessed. As stated in the NMC Standards for Prescribing (2006) I am accountable for all prescribing decisions, including actions and omissions and cannot delegate this responsibility to any other person This is an area of prescribing that has been discussed at length between myself and my mentor as this had implications for all staff who are prescribers and currently there seems to be discrepancies in the information given to nursing staff by some GP’s. As a specialist nurse it is currently outside the boundaries of my job description to prescribe any form of medication, therefore to provide safe and competent care the GP would also need to consult with...
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