Nurse Prescribing

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Within this assignment it is intended to present an example of a prescribing situation that arose in practice, to ensure prescribing issues are illustrated. The rationale for the decisions reached will also be discussed. A brief overview of the nurse prescribing initiative and how it developed will be addressed. The importance of ethical principles, accountability and legal issues that surround nurse prescribing will be demonstrated. As a patient will be addressed in the example, a pseudonym will be used.

According to Luker et al (1997), in 1985 the Royal College of Nursing (RCN) made a case for the prescribing rights for nurse. The Cumberledge Report (1986) acknowledged that the government recognised that nurses should be eligible to prescribe. Nurse prescribing has an important contribution to make in the service to patients and clients and the advantages were acknowledged in the Crown Report 1 (1989). Thomas (2000) informs us that in this review, it recommended that nurses with either a Health Visitor or a District Nurse qualification should be allowed to prescribe from a limited nurses prescribers’ formulary (NPF). In 1999 following a review of prescribing, it was suggested that prescribing right extend to include other groups of nurses and healthcare professionals (Crown Report 2 1999). The government endorses this in the National Health Service Plan (NHS) (2000).

With reference to clinical practice, a referral was received from the GP to assess a patient whom he had seen at home and had diagnosed a chest infection and prescribed antibiotics. Whilst assessing the patient Katherine, she complained that she had tenderness in the sacral area. On examination the GP found she was suffering with a sacral pressure sore, but she was unsure of how long she had the pressure sore for. Katherine is a seventy two year old lady who lives with her husband and prior to feeling unwell had been fairly fit. Unfortunately a constant cough meant that her sleep was disturbed, so she had taken to resting in bed for long periods of time. Due to increased production of phlegm Katherine’s appetite had been reduced eating only minimal amounts of food. Nutritional supplement drinks had been prescribed by her GP. European Pressure Ulcer Advisory Panel (EPUAP) (2005) advice nutritional intervention through supplements should be considered where it is not possible to enhance the patient’s own consumption of food and fluids. The importance of increased fluid intake and nutritional input were discussed, informing Katherine that due to having a exuding wound it was essential to replace the loss of fluid and proteins to ensure effective wound healing.

Following a holistic assessment of Katherine which took into account her physical, psychological and social needs, it was found that she suffered with osteoarthritis and due to staying in bed this condition was exacerbated. Osteoarthritis is a fairly common complaint that affects joints making them painful, in Katherine’s case her knees and hips were affected. (Medinfo 2004) As for most part the best treatment is keeping mobile, as Katherine had been in bed for a number of days she was now suffering with increased pain. Normally Katherine would only suffer with a mild ache, which did not interfere in her usual activities of daily living. Following liaison with her GP, he decided to prescribe paracetamol and capsican topical cream to apply to her affected joints, which would be appropriate at this time. She normally takes paracetamol one gram when required but her GP advised her to take the same amount four to six hourly. Katherine is not on any other medication.

It is acknowledged that the effects of a wound can impinge upon a patient’s psychological, social health and body image (Bentley 2001). A pressure sore is defined by EPUAP (2005) as “an area of localised damage to the skin and underlying tissue caused by pressure, shear, friction and or a combination of these.” It is essential that...
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